Lecture 3 - Social Ecological Model: A Framework for Health Promotion

Question 1

What is the social-ecological model and what is its main point?

Answer 1

• The social ecological model is a theoretical framework for understanding the factors that influence health at varying levels surrounding individuals
• Posits that there are interacting spheres (layers) of influence that impact a person’s health behaviors and health

Question 2

What are the different layers of the social ecological model?

Answer 2

1) Individual - knowledge, skills, and attitudes of a person. Sits at the core
2) Relationships - family
3) Community - schools, workplaces, fast food restaurants, grocery stores
4) Societal - health policies, social policies, etc.
- Each layer interacts and influences the individual who is at the centre.
- Interventions can occur at each layer, important to recognize influences

Question 3

How can the social ecological model be applied to dietary practice?

Answer 3

• Eating behavior is not just an individual choice that is disconnected from the environments (e.g. relationships, community, and society) in which an individual lives
• Interrelationships between an individual’s personal dimensions (e.g. food preferences, cooking skills) with the multiple components of an individual’s life context (e.g. relationships, community, and society) influence ability to make dietary choices that support their health

Question 4

How can SEM be used to understand dietary practices in Arctic Canada?

Answer 4

• In Arctic Canada foods are expensive and may be of lower quality
• Education about healthful choices (i.e. eat more fruit) when foods are unfamiliar (e.g. fruit doesn’t grow in the Arctic) and food environments are not supportive (expensive and quality is poor) may not produce desired effects on behavior (e.g. no increase in fruit consumption)
• Not beneficial to work at an individual level, policies such as subsidizing cost of healthy foods would be helpful

Question 5

How can you use SEM to understand sugar-sweetened beverages?

Answer 5

• Whether you purchase sugar-sweetened beverages in your local store (community) depends on whether your family commonly consumes SSB (interpersonal/relationship) and if the price of SSB has been raised through the use of an excise tax (societal/policy environment)

Question 6

What are excise taxes?

Answer 6

• Government implements tax on goods that have a high social cost, such as alcohol, tobacco, and sugar-sweetened beverages to discourage their purchase
• Considered ‘sin’ taxes
• Companies that produce these products pay an additional tax and they pass on that tax to the consumer by raising cost of goods
• Hidden taxes, consumer doesn’t know you are paying the cost of them

Question 7

Explain how a multi-level intervention could be used to reduce obesity in elementary school children

Answer 7

• Individual: conduct education programs with children to teach them about healthy food choices
• Interpersonal relationships: provide parents of children with healthy recipes, menus and cooking methods
• Community: work with local schools to create healthier food and beverage choices (e.g. school cafeterias, vending machines)
• Societal: advocate for the passage of regulations to eliminate soft drinks from all schools in Alberta

Question 8

What are 3 strategies for health promotion?

Answer 8

1. Mediate
2. Advocate
3. Enable

Question 9

Explain the mediate strategy

Answer 9

• Mediate between different interests in society for the pursuit of health
• Coordinated actions that promote and protect health by all concerned, e.g. governments, health sectors, non-government and voluntary organisations, industry and media

Question 10

Explain the advocate strategy

Answer 10

• Advocate for favourable conditions for health
• Individual and social actions to obtain political commitment, policy support, and social systems that support a health goal

Question 11

Explain the enable strategy

Answer 11

• Enable all people to reach their full health potential
• Health promotion focuses on achieving equity in health
• Health promotion activities to improve health are taken in partnerships with individuals so that they are empowered to take action to protect and promote their health

Question 12

What are the 5 action areas of the Ottawa Charter for Health?

Answer 12

1. Strengthen Community Actions in priority setting and in strategies - community fun runs, kitchens, supports/organizations
2. Develop Personal Skills through education for health and life skills - online education, teaching material
3. Create Supportive Environments to improve living and working conditions - healthy workspaces, restricting junk food ads, links to environment
4. Reorient Health Services towards health promotion - health, educator roles, improving access, stop smoking programs
5. Build Healthy Public Policy at all sectors and levels of government - seatbelts, helmets, smoking restrictions, OHS

Question 13

Why has health for all not been achieved?

Answer 13

• Many programs only focus on a single action area, focus on individual behavior
• WHO Health for All Model tries to promote health and sustainable development through multiple policies and actions

Question 14

What is policy?

Answer 14

A statement by an authoritative body (e.g. Health Canada) of an intent to act in order to maintain or alter a condition in society

Question 15

What is the vision of food policy for canada?

Answer 15

• Health Canada is developing a guide to food-related decisions and actions
• The vision of the food policy for canada: all people in Canada are able to access a sufficient amount of safe, nutritious, and culturally diverse food. Canada’s food system is resilient and innovative, sustains our environment and supports our economy
• Will act across multiple sectors (e.g. agricultural and schools)

Question 16

What should school nutrition policies aim to do?

Answer 16

• Improve the quality of food and beverage intake
• Help students make healthier nutritional choices
• Build skills that enhance healthy dietary behaviors
• Reduce risk for overweight and eating disorders

Question 17

Why is it important to create supportive environments?

Answer 17

• Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable
• Supportive physical and social environments increase the ability of people to make healthy choices in places where they live, work, learn, and play

Question 18

What are two types of environments health promotion can focus on?

Answer 18

• Physical environments: E.g. healthy workplaces and communities. Can support being healthier
• Social environments: social participation and integration in social environments (e.g. school, work, neighborhood) are important to health). For example, working on social integration vs social alienation. Do people feel like they belong?

Question 19

What is strengthening community action and why should it be done?

Answer 19

• The empowerment of communities - expanding the resources and capacity of communities to make decisions and take action to increase their control over the determinants of their health (that is, to take ownership and control of their own destinies)
• E.g. food policy councils and other community capacity building activities that provide the skills, knowledge and competencies that people require in order to take action

Question 20

What do the learnings from a Food Security Action Group in Alexander First Nation show?

Answer 20

• Look at how everyone can have safe, culturally appropriate food
• Developing policy for healthy food in the community

Question 21

What is the intention of developing personal skills?

Answer 21

• Enable people to increase control over, and to improve, their health through information, education and life skills
• E.g. distribute educational material on healthy eating, increase food skills through cooking classes, increase nutrition literacy through offering workshops on how to read food labels

Question 22

What is the intention of reorienting health services?

Answer 22

• Develop the capacity of health systems to achieve improved population health and greater health equity, rather than just treating disease
• Need to feel culturally safe and recognize determinants
• E.g. AHS cares for patients who experience poorer health and barriers to health services due to a number of social determinants including the following groups: Indigenous, immigrants, refugees, specific visible minorities, french speaking Albertans ,and people experiencing homelessness

Question 23

List the 4 tenents of comprehensive school health and give examples

Answer 23

1. Physical environment: schools have a kitchen to prepare healthy meals
2. Teaching and learning: students learn food preparation skills
3. Healhty school policy: set nutrition standards for food that can be served and sold at school
4. Partnerships: connect with local hunters to provide traditional food (e.g. moose) for the school’s lunch program

Question 24

What is the integrated model of population health and health promotion?

Answer 24

• it combines actions for health promotion outlined in the Ottawa Charter, the determinants of healh, and various levels of potential intervention (social ecological model)
• The foundations of the model are evidence-based decision making that includes research, experimental learning, and evaluation
• Values and assumptions are at the core of the model
• Combines the level of action to be taken (Social ecological model) with health determinants to influence and the actions areas of the Ottawa Charter

Question 25

When taking a population health approach, what three questions are critical to build actions to improve health?

Answer 25

1. “on WHAT should we take action?”
2. “HOW should we take action?”
3. “WITH WHOM should we act?”

Question 26

Why is evidence-based decision making required?

Answer 26

• Required to ensure that policies and programs focus on the right issues, take effective action and produce sound results
  → Research studies on the health issue
  → Experiential learning gained through practice
  → Evalulation of policies and programs

E.g. Research has found that:
- A supportive partner, family member, or friend plays a key role in the success of breastfeeding. When a mother feels supported she is more likely to feel confident and empowered with her choice to breastfeed
- School nutrition policies can result in improvements in the quality of foods and beverages available to students

Question 27

What are the main overall concepts involve with the population health promotion model and how should it be used in practice?

Answer 27

• Comprehensive action needs to be taken on the determinants of health
• The health of individuals and groups is a combined result of their own health practices and the impact of the physical and social environments in which they live, work, and play.
• In order to enjoy optimal health, people need opportunities to meet their physical, mental, social, and spiritual needs in environments, based on the principles of social justice and equity
• Meaningful participation of people in the development and operationalization of policies and programs is essential for them to influence the decisions that affect their health

Question 28

How can you use the PHPM to focus on specific health concerns such as breastfeeding and school lunch programs?

Answer 28