quiz 2 Flashcards
socio-ecological model (SEM) of health,
developed in 1988 by McLeroy, Bibeau, Steckler and Glanz. It is largely based on the ecological framework for human development conceptualized by Urie Bronfenbrenner in the 1970’s. In Bronfenbrennere’s work, human development is driven by micro, meso, and macroenvironmental forces. The SEM is used extensively to understand how individual, interpersonal, community, institutions and policy interact to result in the adoption of particular behaviors. There are many variants of the SEM developed for a variety of health problems
Think of a common chronic disease that is of strong interest to you.
How might the SEM be used to better understand the etiology of the disease?
Describe what you think the strengths and weaknesses of the SEM might be when analyzing how to best implement prevention and control strategies for that disease.
practice
Health Belief Model (HBM) (Hochbaum 1958, Rosenstock 1960)
The HBM, with which you should also be familiar, holds that health behavior is a function of five main beliefs:
Perceived Susceptibility – Beliefs about the chances of getting a disease.
Perceived Severity – Beliefs about the seriousness of the condition.
Perceived Benefits – Beliefs about the efficacy of the advised action to reduce risk or seriousness.
Perceived Barriers – Beliefs about the costs of taking the advised action (tangible or psychological).
Self-efficacy – Confidence in one’s ability to take the advised action.
Cues to Action – Strategies used to activate one’s readiness to take action. Could be bodily events (signs of illness) or environmental events (media publicity).
Levels of Prevention
Primordial prevention seeks to address conditions that underlie the emergence of disease risk factors (typically social determinants of health). They can target selected populations or whole geographic areas. Addressing issues of poor general education in a neighborhood with the hopes that the children would adopt healthier lifestyles as a result would be an example of primordial prevention.
Primary prevention seeks to address factors that directly cause disease. These include the biological, environmental and behavioral factors that lead to disease. Primary prevention, like primordial, can be done over a geographic area or targeting specific populations. For example, reducing air pollution exposure to reduce rates of asthma attacks would by primary prevention. Health promotion often works at the level of primary prevention.
Secondary prevention targets individual patients that are in early stages of disease. However, secondary prevention can be done in population settings. One example of secondary prevention in a population setting would be conducting screenings to identify patients with depression, cancer, or diabetes. By introducing secondary prevention strategies, we are trying to prevent the onset of more severe forms of disease, and, if applicable, prevent its spread.
Tertiary prevention is specifically targeted at those who are known to have the disease, and includes treatment and rehabilitation. At this stage, we are attempting to minimize long-term harm or disability from the disease.
Quarternary prevention seeks to reduce overuse of the medical system, where such overuse might cause harm to the patient. For example, if a patient continues to receive tests that evidence does not suggest will be directly beneficial, then such tests
The role of the FAMILY
Family is the second level above individual in the SEM. Family influences the individual’s health behaviors by being the primary place where norms and culture are established and learned. It is also the social circle in which most health decisions are made for children, including exercise, nutrition, and access to health care. This early development can influence a trait known as executive functioning. Executive functioning is a person’s ability to take in information and make good decisions. It is a trait highly influenced by early trauma, nutrition, and education.
Good public health programs and policies should aim to incorporate measures of and encourage family health. According to the Family Impact Checklist designed by researchers at Purdue University, the below five policies should be considered in designing policies and programs. (Text taken directly from https://www.purdue.edu/hhs/hdfs/fii/wp-content/uploads/2015/06/fi_checklist_0712.pdf)
Principle 1. Family responsibility. Policies and programs should aim to support and empower the functions that families perform for society—family formation, partner relationships, economic support, childrearing, and caregiving. Substituting for the functioning of families should come only as a last resort.
Principle 2. Family stability. Whenever possible, policies and programs should encourage and reinforce couple, marital, parental, and family commitment and stability, especially when children are involved. Intervention in family membership and living arrangements is usually justified only to protect family members from serious harm or at the request of the family itself.
Principle 3. Family relationships. Policies and programs must recognize the strength and persistence of family ties, whether positive or negative, and seek to create and sustain strong couple, marital, and parental relationships.
Principle 4. Family diversity. Policies and programs can have varied effects on different types of families. Policies and programs must acknowledge and respect the diversity of family life and not discriminate against or penalize families solely based on their cultural, racial, or ethnic background; economic situation; family structure; geographic locale; presence of special needs; religious affiliation; or stage of life.
Principle 5. Family engagement. Policies and programs must encourage partnerships between professionals and families. Organizational culture, policy, and practice should include relational and participatory practices that preserve family dignity and respect family autonomy.
role of community
Community is in the SEM above institutions. When we talk of someone’s community, we are usually referring to the environment in which they spend most of their time living and working, and from where their family and peers are. There are both social and environmental aspects to the community. Analyzing someone’s neighborhood is a typical way of attempting to understand or quantify the role of community in health outcomes. Neighborhoods determine a lot about a person’s understanding of social norms. If someone grows up in a family that is unstable, and all of the rest of the families around them are unstable, then they are more likely to consider that a normal fact of life and have unstable families as well. If someone grows up in a family that is unstable, but most of the families in their neighborhood are stable, then they are more likely to see their own family as an outlier and learn how to develop stable families from observing those around them.
role of policy
The World Health Organization (WHO) defines health policy as “decisions, plans, and actions that are undertaken to achieve specific health care goals within a society.” Employers, educational systems, states, and countries all have health policies.
When you have determined that there is a need for change, then you can begin determining what policies might be best. Some basic steps to doing so include:
1. Defining the problem: how are people being negatively affected? 2. Assembling evidence: what will help convince policy makers? 3. Constructing alternatives: what options are there for your policy? 4. Selecting criterion: what would the best policy do? 5. Projecting outcomes: how would each of the alternatives meet the selected criterion? Implement and evaluate After you have projected the outcomes, you can choose which is best and go through the process of implementation. That process is going to vary depending on the type of organization you are in, and your position in that organization. For example, determining your company’s wellness program is very different from determining whether the US government should implement single-payer health insurance.
executive functioning
executive functioning. Executive functioning is a person’s ability to take in information and make good decisions. It is a trait highly influenced by early trauma, nutrition, and education.
built environment
Built environment is a term referring to the physical structures surrounding an individual. It includes their home, parks, streets, schools, stores, and any the overall construction of their community. If a built environment encourages active forms of transportation, such as biking, then people are more likely to engage in those activities. If a neighborhood is unsafe to bike, then residents are unlikely to do so.
health care access
Persons who have physical access to health care are much more likely to take advantage of it. However, there is more to health care access than just physical proximity. It also includes aspects of the health belief model. They need to be able to believe that accessing the health care system will be of benefit to them, and that they can do so effectively. Cost is a major barrier to health care access, as is community-level distrust of the health care system. For example, Johns Hopkins University in Baltimore, Maryland is one of the best health centers in the world. However, many poor residents in Baltimore who live in the same community as Johns Hopkins never receive care there, because they distrust the institution.
neighborhood violence
Neighborhood violence is a key defining health factor for many in the US and abroad. Exposure to violence can lead to obvious mental health problems, but stress levels associated with exposure to violence can also have measurable biological consequences.
food deserts
Food deserts are another key way in which communities influence health outcomes. A food desert is a place where people do not have regular access to healthy food. Similar to measures of health care access, they are identified by both physical proximity and measures of affordability. There are many people who live in wealthy areas that do not have a neighborhood grocery store, but we would not consider those neighborhoods as food deserts.
health policy
health policy as “decisions, plans, and actions that are undertaken to achieve specific health care goals within a society.” Employers, educational systems, states, and countries all have health policies.
advocates
Oftentimes needs are known because there are advocates, or persons who recognize a problem and bring it to the attention of those who have the ability to impact change. An advocate might be a researcher, community member, or lawmaker.
health impact pyramid
Health Impact Pyramid. It displays how different types of interventions have different levels of population impact and require different levels of individual effort. This is not to say that all interventions at the top of the pyramid are ineffective or wrong, but that they take more effort and have less population impact.
