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Public Health Approach

Understanding Public Health


The basic approach used in public health seeks to define, monitor and provide surveillance on the problem (using peer-reviewed research to inform practice); identify risk and protective factors; pilot and evaluate effective prevention programs; and ensure broad-based dissemination. Because of the health equity principles inherent in public health, many argue it’s also a social justice approach, while some see public health as more of a “medical model.” Key concepts used in public health often involve the promotion of systemic change as well as an individual focus and developing programs based on data/research. Public health recognises the impact of the broader environment on the behaviour, health and choices of individuals who live within it. Public health approaches point out the effects of the environment on individuals behaviour, and the way the environment shapes or perpetuate social norms which again affect behaviour. John Briere, PhD clinician and adolescent trauma specialist points out that:

“Toxic decisions seem rational in toxic environments.”

Social issues from the public health perspective involve problems that affect individuals or groups beyond their capacity to correct. Social issues are detectable when responsibility is shifted from individuals being able to adequately make changes themselves, toward holding external social causes or influences accountable. It is clear that many aspects of pornography meet this definition of social issues and warrant public health advocacy efforts.

Why a Public Health Response? was originally published in the Porn Harms Kids Report, 2017 and authored by Cordelia Anderson, M.A. Human Development, with a focus on sexuality and prevention of sexual violence. Cordelia is Founder of Sensibilities Prevention Services and has 40+ years’ experience working to promote sexual health and prevent sexual harm.


While the public health framing was designed originally for disease prevention, eChildhood has modified this framework for preventing the harms of children and young people's exposure to online pornography. Drawing on the work of the Australian Institute of Family Studies to address violence against women, key underlying determinants and contributing factors prompting the need for a Public Health Approach include:

Widespread availability and accessibility of online pornography

The internet is often unfiltered and unmonitored. Ever-expanding new platforms and complex online environments enables pornography to be accessed by children and young people every single day.

Inconsistent approach

Lack of knowledge and wide-spread awareness of the risk of exposure and potential consequential harms. At present, there are insufficient national safeguarding/policy/online prevention measures to ensure children and young people are not exposed or can readily access harmful online content.

Inadequate relationships and sexuality education

Currently, there's a lack of consistency and a dismissive or minimised understanding of the scope of pornography harms on children and young people. Often overlooked, pornography is a contributor to concerning changes in attitudes and behaviours (online and offline). As such, any education provided may be misaligned with young people's needs, particularly relating to continuity of education embedding protective behaviours (***defining term) and personal safety. Also, sexuality education rarely achieves a holistic, inclusive and comprehensive standard.

Lack of access to resources and support systems

Significant gaps to therapeutically respond to the harms of pornography on children and young people exist, along with uncertainty surrounding best-practice therapeutic responses. A pornography impact lens is lacking for frontline problems. Currently, no data collection or reporting processes exist to monitor the harms of pornography on children and young people. For example, data isn't collected by hospitals and health clinics from instances of young women presenting with anal fissures and other bodily injuries. As such, responses may be misunderstood, and necessary research overlooked. Consequently, correctly targeted support for therapeutic, restorative, psycho-educational and allied health professional follow-up may fail to meet the lived reality of porn impacts on children and young people's lives.

The types of harm to children and young people caused by them accessing online pornography have been extensively researched and documented.

Research is detailed in the 2019 eChildhood Report, KIDS AND PORNOGRAPHY IN AUSTRALIA: Mobilising a Public Health Response (pages 11-13) and in the eChildhood Statement of Research.


The public health framework locates strategies at three points:

  • Primary (or universal) interventions are strategies that target whole populations/communities to build public resources and attend to the factors that contribute to the occurrence of pornography harms.
  • Secondary (or selective) interventions target children and young people who are “at-risk” for pornography harms.
  • Tertiary (or indicated) interventions target children, young people and families in which pornography harms have already occurred.

Primary prevention of harms includes any program, campaign, policy or other measure that sets out to address these underlying factors and reduce the likelihood that exposure to online pornography will occur, and when it does occur, harms are minimised. Consultative changes should be developed and implemented through the knowledge of a Public Health Approach and informed by Critical Porn Analysis—an educational response to the researched harms of pornography as a public health crisis. Proposed actions for primary, secondary and tertiary interventions are detailed in the eChildhood Public Health Approach.


A Public Health Approach aims to provide the maximum benefit for the largest number of people. A Public Health Approach includes the care of individuals and focuses on preventing health problems in a way that extends better care and safety to entire populations (World Health Organisation 2002).

Public health has widespread acceptance across many disciplines, including health, education, and welfare. The aim of conceptualising a particular social problem or health issue within a public health framework is fundamentally one of prevention. This has been termed an "upstream" approach to prevention.

The four steps of a Public Health Approach Public health aims to provide the maximum benefit for the largest number of people. It adopts a particular process for achieving this using the following four steps:

  1. Defining the problem
  2. Identifying risk and protective factors
  3. Developing and testing prevention strategies and programs
  4. Ensuring widespread adoption by disseminating the information

1. Defining the problem

This is achieved through the systematic collection of information about the magnitude, scope, characteristics, and consequences of children’s exposure to online pornography. This step aims to understand the "who", "what", "when", "where" and "how". Regarding children’s exposure to online pornography, this step involves understanding the initial and ongoing impacts and harms to children and young people, where and how the exposure is occurring, and when and how children continue to be exposed to such harmful content. It also answers such questions as understanding the times of day accessed, and whether they are alone or with peers; the locations or opportunities that children and young people have to access explicit content; and the ease at which technology and social media platforms facilitate access. Some of these questions are answered in the literature cited in this Report and other eChildhood publications. We welcome more research to improve understanding.

2. Identifying risk and protective factors

This involves understanding why harm occurs in terms of the causes and correlates of exposure to online pornography, factors that increase or decrease risk of exposure and harm, and factors that might be modified through interventions. This step reviews research to identify what factors put children and young people at risk of being harmed from pornography (either individually or extended), and what protective factors may stop or reduce individual or extended harms.

Individual harms include the attitudes, behaviours and beliefs developed, unhealthy patterns such as compulsive sexual behaviours, mental health concerns, relational impacts, and so forth.

Extended harms include problematic or harmful sexual behaviours scripted by pornography that are then reenacted on others. This may consist of child-on-child or peer-on-peer sexual abuse; online sexual harassment; sexting (coerced and/or self-produced child sexual exploitation material); grooming with pornography to sexually offend against, and so forth.

These individual and extended harms were detailed in the eChildhood Statement of Research; the “Defining Terms” (pp 7-9) and overall strategy outlined in The Porn Harms Kids Report and in various eChildhood submissions.

More work is required to understand protective factors relating to stopping or reducing individual or extended harms and will be achieved through the work of the eChildhood Protection Coalition and subsequent research.

3. Developing and testing prevention strategies and programs

With the information gathered in the previous step, programs and intervention strategies can be designed to target risk and protective factors. These interventions can then be evaluated for process, learning, and effectiveness. These intervention strategies can be found 2019 eChildhood Report and online, detailing the Public Health Approach of eChildhood. The Solutions Diagram, initially published in The Porn Harms Kids Report has pivoted since 2017 and is informed by increased knowledge as we more clearly articulate solutions.

4. Ensuring widespread adoption by disseminating the information

Information about "what works" in addressing the factors influencing children’s exposure and harms to online pornography requires the evaluation of strategies and interventions, with targeted analysis about what aspects of the interventions worked or didn't work. This builds the body of evidence around prevention and enables the information to be disseminated broadly so that successful interventions can be replicated or spread widely. The aim is to "scale up" by implementing effective and promising interventions in a wide range of settings. The effects of these interventions on risk factors and targeted outcomes should be monitored, and their impact and cost-effectiveness should be evaluated. Evaluation will be best achieved through university partnerships and the work of the eChildhood Protection Coalition.

This section draws on the work of the Australian Institute of Family Studies to address violence against women through the lens of public health.


eChildhood believes that every child in Australia deserves a porn free childhood. The reality is, we are failing our kids because they currently have 24/7 access to hardcore porn. Without intervention, education and support, pornography’s impact on children and young people can include poor mental health, sexism and objectification, sexual aggression and violence, child-on-child sexual abuse, and shaping sexual behaviours.

In our 2019 Report, eChildhood has framed a Public Health Approach and is mobilising a Public Health Response in Australia. Like-minded organisations are invited to join the eChildhood Protection Coalition to implement this Public Health Response.

In the Convention on the Rights of the Child, the State is called to take all appropriate measures to protect the child from all forms of violence, injury or abuse, including sexual abuse, including through forms of prevention. The connection between the State's obligations under the International principles of due diligence, and the State’s responsibility to not only protect children from harm but also prevent harm from occurring to children is clear and evident.

The consensus which has emerged amongst child safety advocates and health professionals is sufficient to prompt the application of the precautionary principle and do all that we can to reduce children’s access to this harmful content.


Detailed in the 2019 eChildhood Report, KIDS AND PORNOGRAPHY IN AUSTRALIA: Mobilising a Public Health Response, the eChildhood Public Health Approach presents a positive framework to be enacted in consultation with key stakeholders and supporters. References for this section can also be found in this report.

***Defining Term:

Protective Behaviours

Protective Behaviours education encourages self-empowerment, empathy, connection and responsibility to the rights of others, and responsibility for an individual's right to feel safe all the time. Protective Behaviours develops awareness and connection to others, teaches skills and strategies to avoid victimisation, and promotes healthy relationships that do not victimise. Protective Behaviours personal safety education includes recognising when someone is feeling unsafe (early warning signs), body boundaries, consent and the creation of safety networks. Learn more at the Association of Professional Protective Behaviours Practitioners.

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  • A world where kids can grow up without being harmed by accessing graphic, violent online pornography
  • Prevention of children’s access to pornography through digital child protection buffers
  • Updated legislation and education to address pornography as a public health crisis that increases children and young people's vulnerabilities to sexual harms

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