The social nature of chronic noncommunicable diseases and how to tackle them through communication technology, training, and outreach

As world leaders prepare for the United Nations High Level Meeting on Noncommunicable Diseases, to take place in September 2011, international organizations, nongovernmental organizations, and economic and business fora have created new alliances and initiatives to accelerate research, advocacy, and political commitment. This article argues that the time is propitious to reflect on the social nature of the most common behavioral noncommunicable disease determinants, including tobacco and alcohol use, physical inactivity, and unhealthy diet. Evidence is presented related to the fact that these diseases are profoundly rooted in social and community ties and points to the need for a modern communication strategy to serve as a linchpin of any successful action to address these public health threats. Several proposals, aimed at promoting health literacy, strengthening health workforce skills, capturing the power of new media and technologies, and targeting vulnerable groups, are discussed.     

Mental Health Consumer-Operated Services Organizations in the US: Citizenship as a Core Function and Strategy for Growth

Consumer-operated services organizations (COSOs) are independent, non-profit organizations that provide peer support and other non-clinical services to seriously mentally ill people. Mental health consumers provide many of these services and make up at least a majority of the organization’s leadership. Although the dominant conception of the COSO is as an adjunct to clinical care in the public mental health system, this paper reconceives the organization as a civic association and thereby a locus of citizenship. Drawing on empirical research on COSOs in one state and the citizenship and civic democracy literatures, COSOs are analyzed here as membership organizations with democratic norms and strong ties to local communities. The suggestion is made that by embracing and enhancing their status as civic associations, COSOs may advance the goals of the social movement that spawned them and avoid predictable obstacles to further growth and development.     

Establishing networks for health promoting schools in South Africa

South African schools were segregated by years of discriminatory practice. Apartheid policies adversely affected the health and social status of children in South Africa. The conceptual framework suggested by the health promoting schools movement was adopted in South Africa to address school health comprehensively. This approach provides a useful framework because it focuses not on the curriculum but on the school environment, community involvement, policy development, and appropriate health and social services. Currently, several initiatives in South Africa focus on developing networks of health promoting schools. Initiatives seen as a mechanism to address the historical inequities among children in South Africa are described.     

The fragility/strength of human life in rural communities of the Pantanal wetlands, Mato Grosso State, Brazil

From an ambiguous/complex standpoint, the fragility/strength of human life suggests an approach based on observations of the life-style dynamics of specific population groups. Conducted between 2003 and 2005, this study of a community living alongside the Pantanal Wetlands Private Natural Heritage Reserve established by the Social Enterprise Support Centre (RPPN/ SESC) in the Joselandia Rural District, Bar?o de Melga?o Municipality, Mato Grosso State, Brazil, explores its life-style, linking explanations of the health/disease process to historical, economic and social aspects of this community and the singularity of local healing practices, using historical documentary records, statements from local residents, a population poll, interviews and observations. Changes were noted in the links of solidarity among community members at work and for growing food. Healing practices based on folk-medicine are alternatives used to relieve symptoms and diseases. The fragility/strength of this specific community is established through strength based on solidarity and family ties, while its fragility is due to difficulties in accessing work, healthcare services and public facilities.     

Revitalizing Communities Together

Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.     

Tackling health inequalities and social exclusion through partnership and community engagement? A reality check for policy and practice aspirations from a Social Inclusion Partnership in Scotland

In the contemporary UK policy context, multisectoral partnership initiatives and community participation are increasingly viewed as appropriate mechanisms for tackling health and social disadvantage. Such initiatives are often put into practice in contexts of industrial and economic decline, fragmented neighbourhoods, hard-pressed public services, and sustained under-investment in voluntary and community sector organisations. This paper draws on ethnographic fieldwork in a Social Inclusion Partnership (SIP) in Scotland to suggest that policy-makers and public health practitioners need a better understanding of the difficulties involved in implementing partnership and participation initiatives in this kind of context. The East Kirkland SIP was set up to tackle social exclusion and health inequalities within the most deprived neighbourhoods of a Scottish town, yet community engagement remained elusive. Partnership proved to be risky territory for all involved, marked by rivalry and suspicion between SIP members, rather than co-operation, whilst health promotion and social inclusion priorities conflicted with those of community development and regeneration. In sum, this paper presents a reality check for some contemporary policy and practice aspirations.     

Bisexually Active Black Men in the United States and HIV: Acknowledging More Than the “Down Low”

HIV is disproportionately impacting Black men who have sex with men and heterosexual women in the United States. Current speculation posits a "bisexual bridge" of HIV transmission connecting these two subpopulations of the Black community. Specifically, bisexually active Black men who identify as heterosexual but do not disclose their same-sex behavior, or "down low" (DL) men, have received the most attention and blame as the primary group fueling this epidemic. This essay explores the current knowledge and limitations of public health research on bisexually active Black men. Implications for future research initiatives are discussed.     

Social networks and self-rated health in two French-speaking Canadian community dwelling populations over 65

The objective was to evaluate the associations between older persons' health status and their social integration and social networks (family, children, friends and community), in two French-speaking, Canadian community dwelling populations aged 65 years and over, using the conceptual framework proposed by Berkman and Thomas. Data were taken from two 1995 surveys conducted in the city of Moncton (n = 1518) and the Montreal neighbourhood of Hochelaga-Maisonneuve (n = 1500). Social engagement (a cumulative index of social activities), networks consisting of friends, family and children and social support were measured using validated scales. Multiple logistic regressions based on structured inclusion of potentially mediating variables were fitted to estimate the associations between health status and social networks. Self-rated health was better for those with a high level of social integration and a strong network of friends in both locations. In addition, in Hochelaga-Maisonneuve family and children networks were positively associated with good health, though the effect of friend networks was attenuated in the presence of disability, good social support from children was associated with good health. Age, sex and education were included as antecedent variables; smoking, alcohol consumption, exercise, locus of control and depressive symptoms were considered intermediary variables between social networks and health. In conclusion, social networks, integration and support demonstrated unique positive associations with health. The nature of these associations may vary between populations and cultures.     

Globalisation and global health governance: Implications for public health

Abstract Globalisation is a defining economic and social trend of the past several decades. Globalisation affects health directly and indirectly and creates economic and health disparities within and across countries. The political response to address these disparities, exemplified by the Millennium Development Goals, has put pressure on the global community to redress massive inequities in health and other determinants of human capability across countries. This, in turn, has accelerated a transformation in the architecture of global health governance. The entrance of new actors, such as private foundations and multi-stakeholder initiatives, contributed to a doubling of funds for global health between 2000 and 2010. Today the governance of public health is in flux, with diminished leadership from multilateral institutions, such as the WHO, and poor coherence in policy and programming that undermines the potential for sustainable health gains. These trends pose new challenges and opportunities for global public health, which is centrally concerned with identifying and addressing threats to the health of vulnerable populations worldwide.     

Are rural health professionals also social entrepreneurs?

Social entrepreneurs formally or informally generate community associations and networking that produces social outcomes. Social entrepreneurship is a relatively new and poorly understood concept. Policy promotes generating community activity, particularly in rural areas, for health and social benefits and ‘community resilience’. Rural health professionals might be well placed to generate community activity due to their status and networks. This exploratory study, conducted in rural Tasmania and the Highlands and Islands of Scotland considered whether rural health professionals act as social entrepreneurs. We investigated activities generated and processes of production. Thirty-eight interviews were conducted with general practitioners, community nurses, primary healthcare managers and allied health professionals living and working rurally. Interviewees were self-selecting responders to an invitation for rural health professionals who were ‘formally or informally generating community associations or networking that produced social outcomes’. We found that rural health professionals initiated many community activities with social outcomes, most related to health. Their identification of opportunities related to knowledge of health needs and examples of initiatives seen elsewhere. Health professionals described ready access to useful people and financial resources. In building activities, health professionals could simultaneously utilise skills and knowledge from professional, community member and personal dimensions. Outcomes included social and health benefits, personal ‘buzz’ and community capacity. Health professionals' actions could be described as social entrepreneurship: identifying opportunities, utilising resources and making ‘deals’. They also align with community development. Health professionals use contextual knowledge to envisage and grow activities, indicating that, as social entrepreneurs, they do not explicitly choose a social mission, rather they act within their known world-view. Policymakers could consider ways to engage rural health professionals as social entrepreneurs, in helping to produce resilient communities.     

The health educator's role in advocacy and policy: principles, processes, programs, and partnerships

Advocacy skills are essential for the public health practitioner. Recognizing this need, two statewide public health organizations partnered for a series of advocacy trainings. Outcomes included an increased competence for such advocacy as providing expert testimony, writing position papers, forging stronger relationships with policy makers, and committing to ongoing advocacy. An increase in statewide initiatives also included a legislative scorecard, development of a model advocacy network by voting districts, advocacy policy for associations, fact sheets for legislators on pending public health issues, a new university advocacy course, and advocacy action by two associations' members to reach common goals. The trainings and subsequent initiatives provide a template for organizations and individuals to build advocacy skills and increase the role of public health professionals in setting state public health policy.     

Promoting youth health by social empowerment: a media campaign targeting social capital

This article reports on a public health campaign that aims to promote social ties and social trust as a means to improve the health of youths. Analyses on data from telephone survey interviews at baseline, Year 1, and Year 2 consider the trends and predictor patterns of 2 traditional social capital measures-civic perceptions and civic participation. Civic perceptions increased over the course of the focal media campaign, whereas civic participation remained constant. Civic participation was positively associated with TV and newspaper campaign recall at Year 1, whereas both civic participation and civic perceptions were positively associated with TV and newspaper campaign recall at Year 2. In addition, newspaper and TV news use play positive roles in predicting the 2 social capital measures at Year 1 and Year 2. The findings are discussed in terms of literature in the areas of public health and mass communication.     

"Sense of community belonging" in health surveys: what social capital is it measuring?

Canadian national health surveys regularly ask respondents to rate their sense of belonging to their local community. Health studies commonly use this question as a social capital indicator, but what social capital domains community belonging is measuring remains unclear. Analyzing Canadian General Social Survey data, we evaluate the validity of this measure with respect to network-based social capital and health. Results indicate that sense of community belonging is associated positively with several network-based social capital measures. Neighborhood network-based social capital most substantially reduced associations between sense of community belonging and health measures, but results differed by urban and rural settings. These findings indicate the need for public health surveys to include specific measures of respondents' networks.     

Investigating the Support Networks for Mothers of a High-density Public Housing Community and the Effects of Housing Closures on These Support Systems

Over the past few decades, public housing initiatives have focused on the decentralization of poverty by replacing high-density public housing (HDPH) models with lower-density, mixed-income models. This action has resulted in the displacement of families who had lived in these developments for generations. In past studies, public housing residents have been shown to have stronger social ties than those living in other types of assisted housing. Research on the dismemberment of US public housing has demonstrated a “root shock” or disruption in the support infrastructure in these resource-limited communities. The purpose of this study was to use intergenerational analysis to analyze support systems of mothers in a low-income community and to investigate how the dismemberment of a Chicago HDPH community, Cabrini Green, affected parenting experiences and support infrastructure. Two generations of the former HDPH community were interviewed: (Gen1) mothers who raised their children in Cabrini Green and (Gen2) their daughter(s) who were raised in Cabrini Green but who now raise their children elsewhere. Interviews were analyzed for common themes in relation to mental health, social support networks, and parenting experiences. Four main components of parenting support were identified: familial support, father of child support, community support, and institutional support. Interviews suggest that the closing of Cabrini-Green high-rise buildings impacted relative contributions from specific components of mothers’ support infrastructure, particularly community and institutional support. Mothers with support void in one component of support had better outcomes if they had the reserve to compensate by increasing one or more other areas of support. Programs that foster other sources of parenting support during and after public housing closures may help to improve outcomes for mothers and their families. By analyzing the experiences of mothers of both generations, we also gain insight into how experiences of motherhood and support systems compared before and after Cabrini Green’s dissolution as well as insight into the participants’ views on the impact of the housing closing on the parenting experience.     

Healthy cities: overview of a WHO international program

Health is the outcome of all the factors and activities impinging upon the lives of individuals and communities. The last decade has seen an emerging understanding within development circles that living conditions are greatly affected by local action, by the work of local government, and by community groups and organizations. In addressing health and environmental issues and making interventions, an integrated approach, based on 'settings', exemplified in the Healthy Cities approach, has proved most effective. A Healthy City project can involve people and organizations in the programs and activities that are needed for better health, and enables a city or neighborhood to mobilize the human and financial resources required to address many health and quality of life issues. The WHO program involves implementating city projects and networks in all regions of the world and serves as a vehicle for many health programs, including major disease control initiatives. Healthy City projects allow Ministries of Health to develop stronger partnerships with local government organizations (such as the Union of Local Authorities and its members, "Local Agenda 21" initiatives, and others). One focus for the program is the development of 'multi-'multi-city action plans' for major global priority issues, including AIDS, sanitation, women's health, and violence, to ensure that major public health programs are strengthened by wider community participation. It is recognized that city networking--at national, regional, and international levels--now must be better exploited by individual cities and municipalities to solve local health problems.     

Bringing researchers and community developers together to revitalize a public housing project and improve health

Tens of billions of dollars-both public and private-flow to low-income communities each year, mostly for affordable housing. However, it is rare for the health effects of these investments to be assessed. In San Francisco, California, a collaborative effort is under way that aims to fill this research gap while helping residents of Sunnydale, the city's largest public housing project, where poverty, violence, and truancy are entrenched. The collaboration is in its earliest stages-with construction not scheduled to start for at least four years-but some early lessons have emerged. For example, researchers and community developers have found that their data collection needs and timeline expectations often don't match. Nevertheless, the collaborators intend to use the long period before groundbreaking to establish baseline measurements of residents' social and physical well-being, plan initiatives in collaboration with community members and stakeholders, and seek funding for the initiatives and a longitudinal evaluation of the community.     

The Right to Health and the Climate Crisis: The Vital Role of Civic Space

Under the United Nations Framework Convention on Climate Change and its protocols, states have legal obligations to address the climate crisis. The principle of participation is increasingly acknowledged as central to the protection and promotion of human rights, including the right to health. This paper explores states’ obligations to address the climate crisis—and concomitant health crises—from a right to health perspective. The right to health lens provides a valuable opportunity for engaging diverse civil society constituencies in the response to the climate crisis. However, civic space must be protected if these actors are to participate meaningfully. The climate crisis discourse has lacked an explicit recognition of the interconnected nature of the right to health, environmental degradation and climate change, and civic space. There is also concern that restrictions on civic space will continue after the COVID-19 pandemic. While the public health community is an important constituency in the design and implementation of laws, policies, and programs to address climate change, the human rights literacy of this community remains to be strengthened. This paper addresses these lacunae within the context of the right to health as enshrined in United Nations human rights treaties and related international law.     

Selbsthilfe im GesundheitswesenStand der Forschung und Forschungsbedarf

Health related self-help groups and organisations make an important contribution to the health of the public in Germany. In particular self-help groups increase mutual aid and social support, knowledge about the disease and its consequences and possibilities for changing attitudes of the group members and their social environment. They disburden the primary social networks and families of the afflicted persons and reinforce the ‘intelligent’ use of professional services within the health care system. To date, virtually no systematic investigations concerning the activities of self-help organisations, apart from counselling services, have been carried out. Financial contributions from the social security system to self-help groups and organisations are increasing and they are becoming more and more an integral part of the health care system. However, the co-operation between self-help initiatives and the professional health care system is characterised by an imbalance between medical laymen and experts. Research in this area is fragmented; further investigations should address the questions of how larger proportions of the population can be involved in self-help activities and how the relevance of self-help differs in various patient groups. Research promotion and co-ordination in this area appear to be necessary.     

The health politics of asthma: environmental justice and collective illness experience in the United States

While public health, medical, government, and community actors agree that there is a serious asthma epidemic, there is significant disagreement over the role of outdoor environmental factors in causing or triggering asthma. The outcome of these disputes is important because it substantially influences the focus of public health prevention and government regulation. Minority communities in the United States have higher morbidity rates than white communities and, as a result, are more readily affected by debates over environmental factors and subsequent public health and government efforts. Therefore, asthma has figured prominently in community activists' agendas concerning health inequalities. We compare and contrast the efforts of two community environmental justice organizations that include asthma as part of their overall community organizing efforts. We explore obstacles and strategies common to both groups as well as key differences in their orientation vis-à-vis science. To do so, we first discuss the discovery, current research, community action, and resultant changes in the understanding of the disease, specifically within poor and minority communities. Then, to offer a context to examine our two examples of asthma activism, we explore the social discovery of asthma and its environmental correlates, along with the political and economic conflicts surrounding asthma research and regulation. Using examples from the two activist groups, we discuss common approaches to address asthma in poor and minority communities such as challenging "transit racism", employing an environmental justice perspective, and using education to empower community members. Finally, we explore how the issues raised in terms of asthma and the environment lead to a collective form of illness experience, in which people with asthma make direct links to the social determinants of their health.     

Understanding similarities in the local implementation of a healthy environment programme: insights from policy studies

This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme–context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004–2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent–child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment» and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of intersectoral health action to address social determinants of health.