Psychosocial Interventions + Policy

Question 1

Social Policies

Answer 1

–Policies provide key avenues for translation of evidence about the social determinants of health into population health improvements

–Can address causal questions about the health consequences of social factors shaped by policies

–Influence all facets of our lives (when & where we attend school, risk of poverty, whom we marry, etc.)

Question 2

Policy Mechanisms Influencing Social Determinants of Health and Socially Patterned Risk Factors

Answer 2

Policies regulating fundamental social causes lead to:

• education, quality of content,
• financial resources (minimum wage, taxation, welfare)

Social causes lead to changes in behaviors, health care access, housing, stress, social norms

Leads to changes in morbidity and mortality

Question 3

Social policies relevant to education?

Answer 3

–Policies regulating funding for pre-, primary, secondary, and tertiary education

–Subsidies for education outcomes of the public school system
–Curriculum standards
Court decisions re: desegregation & affirmative action
Adult education initiatives

Question 4

Policies relevant to income?

Answer 4

Taxation
Unemployment insurance
Financial subsidies to poor families
Disability insurance
Pension systems

Question 5

Urban Planning & Community Development

Answer 5

Access to groceries (e.g., Healthy Food Financing Initiative)

Housing (e.g., Moving to Opportunity Housing Demonstration Program)

Density of alcohol outlets, fast food, convenience stores

Question 6

What is a psychosocial intervention?

Answer 6

–A systematic attempt to modify a psychosocial process”

Psychosocial process = “social and/or psychological factors that are known to impact health directly (e.g. social isolation, job strain, social capital, inequality, discrimination) or indirectly, through their influence on health-related behaviors (e.g., self efficacy, peer pressure, risk or health promoting behaviors)

They are Intermediated steps in causal chains linking macro level factors to behaviors/health outcomes

Question 7

Types of Psychosocial Interventions

Answer 7

Behavioral change interventions
Social support interventions
Disease management interventions
Distress mitigation interventions
Control/efficacy enhancement interventions
Collective efficacy in communities
Organizational change interventions aimed at organizations and workplaces

Question 8

Social Support Interventions

Answer 8

1. These interventions have been primarily conducted at the individual level
2. Often with populations previously afflicted with a major illness (e.g. heart disease, stroke, cancer, HIV)

-Professional led support groups
-Mutual support groups
-Multifamily support groups
-Support mobilization interventions
-Support substitutional interventions
Findings in this area of research are mixed, partially due to methodological flaws

Question 9

Collective Efficacy Interventions

Answer 9

1. Target the larger community context rather than individuals or families”
2. Occur at the neighborhood/community level to mobilize existing resources
3. Emphasis on community empowerment, conceptualized as a key mediator linking adverse material conditions to poor health

Question 10

What are some of the barriers to eliminating disparities?

Answer 10

• Lack of public awareness
• Inverse case law
• Difficulty proving effectiveness of interventions because of lags
• Vested interests

Question 11

Lack of Public Awareness

Answer 11

1. Awareness of disparities may actually make people feel worse if no practical solutions are evident
2. Knowledge can be overrated; often has little correlation with actual behavior change

Question 12

Inverse Care Law

Answer 12

–Individually targeted behavior change interventions improve the health of the already well off (& widen the gap)

–Community-targeted programs and partnerships end up attracting the most organized communities – not the most needy

–Community-based programs selectively benefit the most well-off members within the community

Question 13

Lags

Answer 13

• -Payoff of interventions are often reaped after the political cycle
• -Evaluating policies might require short-term outcome measures
• -Need to begin interventions early in the life course

Question 14

Vested Interests

Answer 14

–Many harmful behaviors have powerful advocates

–Smoking, drinking, junk food, physical inactivity, firearms…

Question 15

How can we help individual people change their behaviors?

Answer 15

Hierarchy of strategies

• -Information
• -Incentives
• -Regulation

Question 16

Changing Individual Behavior: 1. Information

Answer 16

Examples:
–Warning labels on cigarette packs; point of purchase information on health food choices

–Unintended consequences: information requires individual to make healthy choice. Those who can do, those who can’t don’t (widens gaps).

Question 17

Changing Individual Behavior: 2. Incentives

Answer 17

–Examples: price increases via excise tax (tobacco); price decrease in vending machines (healthy snacks)

–Incentives are generally more effective than information

–Incentives often lower health gaps because low income individuals are more price sensitive

Question 18

Changing Individual Behavior: 3. Regulations

Answer 18

Examples: indoor smoking restrictions; banning soda machines in school cafeterias

Bypasses individual choice

Regulations are also a powerful means of changing norms