Fluent Essays

In Chapters 2-4 (attached), the authors’ goal is to help public health professionals understand how an array of disciplines in biological and social sciences contribute to public health policies, programs, and approaches to building health and well-being in communities and the population as a whole.Along with this, the success of a community action plan hinges not only on strong leadership but also on an interdisciplinary approach to community involvement.Watch the video below, http://www.smartgrowthamerica.org (Links to an external site.) Description: The California Endowments film crew put together this short piece about the Building Healthy Communities Initiative. The City Heights Community Congress features prominently.Identify at least four strategies that you might use to increase and maintain community involvement in solving a public health issue in your own community.State the public health issue and the four strategies you would use.Tips: In choosing your strategies, you’ll want to consider factors including the composition of your community, the amount of time that would need to be invested in order to implement strategies, and the resources and skills that might already be present in your community. Think about how you would go about recruiting people to support your action plan or how you would obtain needed resources to solve your issue.Minimum of 800 wordsInclude a minimum of 2 references chapter_3__determinants_of_health.pdf chapter_2__modern_public_health.pdf chapter_4__public_health_theories.pdf Unformatted Attachment Preview Key Concepts in Public Health Determinants of Health Contributors: Soumen Sengupta Edited by: Frances Wilson & Mzwandile Mabhala Book Title: Key Concepts in Public Health Chapter Title: Determinants of Health Pub. Date: 2009 Access Date: December 31, 2019 Publishing Company: SAGE Publications Ltd City: London Print ISBN: 9781412948807 Online ISBN: 9781446216736 DOI: http://dx.doi.org/10.4135/9781446216736.n4 Print pages: 16-20 © 2009 SAGE Publications Ltd All Rights Reserved. This PDF has been generated from SAGE Knowledge. Please note that the pagination of the online version will vary from the pagination of the print book. SAGE © Frances Wilson and Mzwandile Mabhala 2009 (editorial arrangement) SAGE Books Determinants of Health SoumenSengupta Definition Health is classically defined as ‘a state of complete physical, social and mental health, and not merely the absence of disease or infirmity’ (WHO, 1948). As such, health is as much a social construct as a biological characteristic. It is the product of a complex interaction of different factors: this is true at both individual and population levels. These determinants include not just an individuals particular characteristics and behaviours but also their economic, physical and social environments (Ashton and Seymour, 1992). Key Points • Health is created by a complicated interaction of different factors, only some of which can be directly influenced by individuals. • Social determinants tend to have a greater impact on population health status than healthcare services. • Different determinants have a differential influence on different groups of people: this can contribute to health inequalities. • An appreciation of the differential influence of determinants should be used to develop and deploy a wider array of public policy activities to promote good health. Discussion How different disciplines consider determinants of health is born of their traditions and values. There are four schools of thought (Beaglehole, 2004): • The biomedical view – emphasis on specific causes and discrete treatments for ill health amongst individuals. • The lifestyle view – emphasis on individual responsibility for lifestyle choices. • The broad socio-economic approach – emphasis on factors outside the healthcare sector, especially economic and social. • The population health view – emphasis on the impact on population health of wealth generation and distribution. Whilst the biomedical view has traditionally dominated health policy, recent years have seen increasing recognition of a more comprehensive suite of determinants (HM Treasury, 2004). Although healthcare services have some impact, more influential on population health are the economic, physical and social conditions that foster ill health – and that, if orientated correctly, should actively engender good health (Ashton and Seymour, 1992). Developing a Comprehensive Perspective Canadas Lalonde Report was the first official statement to describe a broader view of health (Lalonde, 1974). Its ‘health field’ concept described how health status was not just affected by biology and healthcare services, but was explicitly a product of lifestyle behaviours and the environment. This was then developed, most prominently in the Ottawa Charter for Health Promotion (WHO, 1984) which set out nine prerequisites for Page 2 of 5 SAGE Books - Determinants of Health SAGE © Frances Wilson and Mzwandile Mabhala 2009 (editorial arrangement) SAGE Books good health: • • • • • • • • • Peace Shelter Education Food Income A stable ecosystem Sustainable resources Social justice Equity Consequently, an ambitious proposition has been developed for prioritising resources ‘upstream’, from services targeted at the individual to policy action on the economic, physical and social determinants of population health. Unfortunately, most investment in health still reflects and reinforces the biomedical worldview (Hunter, 2003). Social Determinants of Health Systems theory states that a system is composed of interdependent and interrelated parts, with change in one part producing changes in others (von Bertalanffy, 1968). In order to explore the impacts of and the potential to influence different determinants it is thus necessary to appreciate their interrelationships. A number of conceptual models assist this. The most frequently cited is the Dahlgren and Whitehead ‘rainbow’ – Figure 3.1 (Dahlgren and Whitehead, 1991). The extent to which different determinants can be influenced varies; certainly no individual is likely to exert direct control over most of them. Furthermore, these determinants can have a differential impact at different stages of an individuals life; between different social groups; and between different countries (Solar and Irwin, 2007). Clearly context is crucial. Much of the discussion on determinants within the public health arena has focused on social factors. The rationale is that, however important individual genetic susceptibilities to disease may be, population health has been influenced much more by the rapidly changing social conditions in which people live (WHO, 2003). By focusing on social determinants, Graham and Kelly (2004) has suggested that different models implicitly follow a common structure that articulates a causal chain between the wider environmental elements and health status. Figure 3.1 Dahlgren and Whiteheads determinants of health model (1991) Page 3 of 5 SAGE Books - Determinants of Health SAGE © Frances Wilson and Mzwandile Mabhala 2009 (editorial arrangement) SAGE Books That said, it is important to recognise the value of healthcare interventions in reducing disease susceptibility (e.g. immunisation programmes). It is also important to remember that wider environmental factors should not be viewed as disconnected from the experiences of individuals. Simply put, these social systems are a product of individuals and their interactions. Moreover, the choices that individuals make should not be dismissed. However, they are a product of the choices available and the confidence different groups have in exercising them (i.e. the degree of self-efficacy possessed). Circumstances and conditions that provide people with greater control over different facets of their lives (and consequently nurture a greater sense of self-esteem) are associated with better health outcomes (Marmot, 2003). Health Inequalities Consideration of the differential influences of health determinants is almost inextricably linked to the question of why economically or socially disadvantaged groups consistently experience relatively poorer health status (Graham and Kelly, 2004). Such disadvantage can manifest in different forms, e.g. limited aspirations, low income and discrimination. Critically, such disadvantages tend to gravitate towards one another, creating vicious circles in which people get trapped. In the UK, the Black Report (Townsend et al., 1992) identified the primary reasons for worsening social gradients in mortality and other indicators of ill health as material deprivation and poverty; and its recommendations highlighted economic and social policy solutions. These conclusions were reinforced by subsequent publications, with the Acheson Report (Acheson, 1998) stating that: ‘the weight of scientific evidence supports a socio-economic explanation of health inequalities. This traces the roots of ill health to such determinants as income, education and employment as well as material environment and lifestyle.’ While there are clearly overlaps, the determinants of health are not exactly the same as the determinants of health inequality: the latter concerns the unequal (and by implication, unfair) distribution of health determinants (Graham and Kelly, 2004). Case Study Page 4 of 5 SAGE Books - Determinants of Health SAGE © Frances Wilson and Mzwandile Mabhala 2009 (editorial arrangement) SAGE Books Understanding determinants should help identify different policy levers (local, regional, national and transnational) that can promote health amongst different communities. This could include action to develop resilience amongst young people and vulnerable adults; strengthen social capital; improve infrastructure and access to services; and tighten environmental legislation. It should enable identification and mitigation of policy action that could have a detrimental impact – this is the essence of health impact assessment (Brown et al., 2005). It should also help develop a realistic sense of the limitations of any given intervention to improve population health. For example, although statins are a relatively effective pharmacological intervention for reducing the risk of heart disease (NICE, 2006), against the backdrop of an escalating obesity epidemic they can only have a limited impact in themselves (WHO, 2007). That does not mean they are not worth providing, but rather that they need to be part of a multi-dimensional package of activities. Cross-References Understanding health determinants has relevance to all aspects of public health. In using this textbook, it would be particularly useful to cross-reference with inequalities in health (Chapter 5); assessing public health need (Chapter 21); planning public health initiatives (Chapter 22); health impact assessment (Chapter 24); and collaborative and partnership working (Chapter 34). Conclusion Health at both individual and population levels is the product of a complicated interaction of different factors. Health policy is still dominated by a biomedical paradigm, yet there is a substantial theoretical and evidence base to support a more comprehensive perspective. It is now widely understood that the primary determinants of health are the economic, physical and social environments within which individuals live. Few determinants can be directly influenced by the individual; and most social determinants have a greater impact on population health status than healthcare services. Critically, many determinants have a differential impact on different groups of people: this can contribute to inequalities in health. Developing an understanding of the complex nature of the health determinants is not a merely theoretical exercise; nor should the recognition of that complexity act as an excuse for inaction on discrete issues. Rather this understanding should be used to develop and deploy a wider array of public policy activities to promote good health. Further Reading Irwin, A. and Scali, E., (2005) Action on the Social Determinants of Health: Learning from Previous Experiences. Geneva: World Health Organization. http://dx.doi.org/10.1080/17441690601106304 Kelly, M., Bonnefoy, J., Morgan, A. and Florenzano, F., (2006) The Development of the Evidence Base about the Social Determinants of Health. Geneva: World Health Organization. • • • • • • • health inequalities health care services health care health impact assessment health ill health health status http://dx.doi.org/10.4135/9781446216736.n4 Page 5 of 5 SAGE Books - Determinants of Health Key Concepts in Public Health Modern Public Health Contributors: Fiona Adshead & Allison Thorpe Edited by: Frances Wilson & Mzwandile Mabhala Book Title: Key Concepts in Public Health Chapter Title: Modern Public Health Pub. Date: 2009 Access Date: December 31, 2019 Publishing Company: SAGE Publications Ltd City: London Print ISBN: 9781412948807 Online ISBN: 9781446216736 DOI: http://dx.doi.org/10.4135/9781446216736.n3 Print pages: 11-15 © 2009 SAGE Publications Ltd All Rights Reserved. This PDF has been generated from SAGE Knowledge. Please note that the pagination of the online version will vary from the pagination of the print book. SAGE © Frances Wilson and Mzwandile Mabhala 2009 (editorial arrangement) SAGE Books Modern Public Health FionaAdshead, and AllisonThorpe Definition Public policy has been defined as ‘the broad framework of ideas and values within which decisions are taken and action, or inaction, is pursued by governments in relation to some issue or problem’ (ONeill and Pederson, 1992). As such, policy generically can be described as a guiding principle of, not a guarantee for, action. Public health policy more specifically reflects an increasingly diverse agenda, developed against a context of global forces and changing social and political environments. An active social justice agenda and growing evidence of the impact of the social determinants of health on health inequalities and outcomes make more complex an already crowded picture. In this chapter we will look at the implications of current policy drivers in England for public health, with a particular focus on how at a national level policy directions are often influenced by, and influence, legislative frameworks and policies which are enacted at a European or global level. Key Points • Public health policy is not designed or delivered in isolation from the social and political context – it is linked to a wide range of social resources and infrastructures, social capital, social interaction and social support. • Policy boundaries are often blurred – European directives can both limit autonomy of action at a national level and ensure local activity has a resonance over a larger population level by setting clear parameters for action across nation states. • Modern public health policy and practice has to be able to respond to economic, demographic and epidemiological transitions, while still enabling everyday action on the ground. • With lifestyle-related diseases rising, peoples expectation of active engagement in promoting and protecting their own health means that the practice of public health is becoming increasingly personalised. This is reflected in the policy arena. Discussion Policy-makers working in the field of public health today face a very different environment to that which faced our forebears in the nineteenth century. Then, the primary focus of public health activity centred on sanitation, slum clearance and the prevention of infectious diseases (Gorsky, 2007). In our more modern complex society, we face new challenges. Rising rates of diabetes linked to obesity, escalating chronic diseases, and global tobacco control – to name but a small selection of our concerns – are juxtaposed with an increasingly articulate, educated consumer society and an increasingly engaged media and business presence. Unsurprisingly, against such a backdrop, it has long been remarked that for public health ‘boundaries are fiction’ (Terry, 1964). Determining how best to assure the health of our populations remains an enormous agenda – and one in which the whole of society has a shared interest, with roles for government, the healthcare system, the wider population, the community, and business itself. There has been a tangible policy move in recent years towards health improvement initiatives which take a wider partnership approach to delivering on health (DH, 2007d). Reports, such as the eponymous Wanless reports, have been successful in driving home the message that a sustainable healthcare system requires ‘full engagement’ of the people in its delivery (HM Treasury, 2002, 2004). With recent economic analysis suggesting that the total cost of preventable illness is 19 per cent of total GDP for England (NSMC, 2006), prevention is increasingly seen as the key factor in addressing growing Page 2 of 4 SAGE Books - Modern Public Health SAGE © Frances Wilson and Mzwandile Mabhala 2009 (editorial arrangement) SAGE Books concerns about the affordability of healthcare systems into the future (HM Treasury, 2002, 2004). Successive policy documents, such as Choosing Health (DH, 2004a) and Our Health, Our Care, Our Say (DH, 2006e) have reinforced this message, reflecting a recognition that no amount of legislation, regulation or structural adjustment can compete with the ability of people to choose how they live their lives. But such a person-centred approach for public health policy is a challenge in itself. Case Study The recent smoke-free legislation, which came into effect on 1 July 2007 in England, provides a tangible demonstration of the relationship between politics, policy development, the individual and the evidence. Despite evidence that second-hand smoke was a determinant of ill health, there was considerable resistance to the idea of taking a comprehensive legislative approach to the issue, largely centred around the human rights of smokers. The eventual policy decision to allow an open vote on how to progress the legislation was the culmination of a long campaign, which drew upon: • • • • policy-driven public consultations; high levels of popular and professional support; an extensive evidence base; examples of local-level action which was considerably ahead of the proposed national policy direction; • international and, in the case of Scotland and Ireland, more local examples of the success of enacting national legislation in other countries, with Scotland, for example, demonstrating a drop in symptoms in bar workers from 79 per cent to 53 per cent within one month of implementation (Menzies et al., 2006). The combination of these factors raised the level of debate, and ultimately influenced politicians to vote for the more radical and visionary legislation which was eventually enacted. This reinforces the need to recognise that public health policy cannot be designed or delivered in isolation from the social and political context: political decisions have to reflect a balance between the evidence and public opinion regarding what is right – and both affordable and sustainable – for society at the given point in time. The journey there, and the full engagement which characterised it, critically determines the success of the outcome. However, the success of the policy direction does not lie solely in the enactment of the legislation, but will be measured by its cumulative effect on the health of the population. In this case, enactment of the legislation is only one manifestation of the policy direction. Alongside this policy-makers are working to build on this historic milestone, through effective enforcement, policing and publicity, to encourage people to take advantage of health improvement initiatives, such as smoking cessation services, which will spare thousands more lives, and through consultations to raise the age of sale, to ensure that more people are spared the misery of watching their families and friends suffer with preventable smoke-related illnesses (DH, 2007a). This recognition of the need to take a more personalised approach to health underpinned the Choosing Health White Paper, reflecting a policy commitment to a broader social contract between the state and individuals, with choice and civic action being key elements of this contract. In effect, it recognised that public health policy needs both to provide a direction for and support action in relation to our key health priorities. In practice this means that policies must facilitate partnership across society, with joined up action at governmental, national, regional and local levels, and enable those who have an ability to contribute to do so. In practice, this means that policy direction must be supported by the appropriate levers to drive delivery: • realistic shared, cross-government targets which commit governments to improving health outcomes in their population; • co-ordination across government, and where necessary across national boundaries; Page 3 of 4 SAGE Books - Modern Public Health SAGE © Frances Wilson and Mzwandile Mabhala 2009 (editorial arrangement) SAGE Books • a commitment to wider action to improve the health of the most disadvantaged and tackle health inequalities, e.g. through action on housing, fuel poverty a ... Purchase answer to see full attachment