Integrating social theory into public health practice

The innovative practice that resulted from the Ottawa Charter challenges public health knowledge about programming and evaluation. Specifically, there is a need to formulate program theory that embraces social determinants of health and local actors' mobilization for social change. Likewise, it is imperative to develop a theory of evaluation that fosters reflexive understanding of public health programs engaged in social change.We believe advances in contemporary social theory that are founded on a critique of modernity and that articulate a coherent theory of practice should be considered when addressing these critical challenges.     

Integrating social epidemiology into immigrant health research: A cross-national framework

Scholarship on immigrant health has steadily increased over the past two decades. This line of inquiry is often approached as a “specialty” topic involving a discrete de-contextualized population, rather than a topic that is central for understanding patterns of population health within and between sending and receiving countries. Frequently immigrant health research employs theoretical frameworks (e.g., acculturation) that emphasize cultural explanations, while less commonly utilized is the “social determinants of health” framework, which emphasizes social and structural explanations. Drawing upon literature in the fields of economics, sociology of immigration, and social epidemiology, we present a conceptual framework for understanding immigrant health from a cross-national perspective. We discuss the theoretical foundations of this framework; the methodological challenges for undertaking research on immigration and health using this framework; examples of emerging research in this area; and directions for future research. Progress in immigrant health research and population health improvements can be achieved through an enhanced understanding of population health patterns in sending and receiving societies. Immigrant health research needs to be better integrated into social epidemiology. Concurrently, immigrant health research offers conceptual, empirical, and analytic opportunities to advance social epidemiological research. Together, scholarship in immigrant health and social epidemiology can make significant contributions toward one of their mutual and ultimate goals: to improve knowledge about population health.     

Integrating adult learning principles into training for public health practice

Providing training and planned learning experiences to practitioners and community partners is fundamental to effective public health. The extent to which principles of adult learning currently guide such training is unknown and likely varies widely. The purpose of this article is to introduce five principles of adult learning and discuss how each can be applied in assessing trainee needs, planning and delivering training, and evaluating training processes and outcomes. Training guided by these principles should facilitate adult learning, collaborative efforts, and mutual respect between agencies, practitioners, and community partners.     

Integrating research, surveillance, and practice in environmental public health tracking

The Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services is working with selected state and local health departments, academic centers, and others to develop an environmental public health tracking initiative to improve geographic and temporal surveillance of environmental hazards, exposures, and related health outcomes. The objective is to support policy strategies and interventions for disease prevention by communities and environmental health agencies at the federal, state, and local levels. The first 3 years of the initiative focused on supporting states and cities in developing capacity, information technology infrastructure, and pilot projects to demonstrate electronic linkage of environmental hazard or exposure data and disease data. The next phase requires implementation across states. This transition could provide opportunities to further integrate research, surveillance, and practice through attention to four areas. The first is to develop a shared and transparent knowledge base that draws on environmental health research and substantiates decisions about what to track and the interpretation of results. The second is to identify and address information needs of policy and stakeholder audiences in environmental health. The third is to adopt mechanisms for coordination, decision making, and governance that can incorporate and support the major entities involved. The fourth is to promote disease prevention by systematically identifying and addressing population-level environmental determinants of health and disease.     

Integrating preconception health into public health practice: a tale of three cities

In 2006, the national Select Panel on Preconception Care published a set of 10 recommendations on how to improve preconception health and healthcare in the United States. Since then, CDC has been engaged in efforts to ensure that those recommendations are implemented. To help translate the national recommendations into action at the local level, CDC funded CityMatCH, a national maternal and child health organization representing urban health departments, to coordinate a practice collaborative. Beginning in October 2006, multidisciplinary teams from Hartford, Connecticut, Nashville, Tennessee, and Los Angeles County, California, have engaged in the CityMatCH Urban Practice Collaborative on Preconception Health. The CityMatCH practice collaborative process includes team building and leadership development, community assessment, identification of strategies, and action planning around those strategies. The Hartford team's strategies are broad--conducting a scan of preconception health-related activity in Hartford and promoting public policy-and intended for building awareness of preconception health and healthcare among multiple audiences while strengthening the systems necessary to provide women's services. The Nashville team has focused on sickle cell trait as a point of entry into preconception care for women of reproductive age and has developed strategies involving extensive collaboration, a public awareness campaign, and data gathering. The Los Angeles County, California, team is strengthening and more explicitly connecting work related to preconception health that was already being performed in the public sector and the community. This paper describes the collaborative process designed by CityMatCH and highlights the three participating teams' experiences in implementing the national recommendations at the local urban level.     

Trends in maternal and child health care: implications for research and issues for social work practice

Trends are reviewed in four areas of maternal and child health care: (1) prenatal care; (2) infant mortality; (3) teenage pregnancy; and (4) HIV infected mothers and infants. The purpose of this review is to identify major trends in these programmatic areas, key indicators of physical-social health risk and survival, and central issues relevant to research and social work practice. Attention is directed to the status of research, and the usefulness of existing data sets available to researchers in the four programmatic areas of maternal and child health care under review. Emphasis is given to the importance of the integration of theory, research findings, and practice.     

社会流行病学在健康研究中的应用

社会流行病学是研究人群健康的社会分布和社会因素对人群健康的影响的一门交叉学科,是流行病学的一个分支学科,在国外已经有一定的研究进展,不仅在不同大学中开设课程,还在慢性病研究等领域中加以应用,但在国内仍处于初期和引入阶段。目前比较常见的基本理论框架有三个,每个理论框架都基于一个假设,如心理社会理论、社会流行病学应用因果DAGs理论和生态社会理论及多水平框架理论。为系统介绍社会流行病学这门学科,查阅中国知网数据库、万方医学期刊数据库和维普期刊数据库等文献,从定义、国内外应用现状和三个基本理论框架来介绍社会流行病学。基于社会流行病学侧重于社会因素,此文对其在老年健康研究、艾滋病防治研究以及心理研究领域(尤其是自杀研究)三个"社会病"领域的具体应用进行综述,梳理其在目前中国健康研究领域中的应用。     

精神卫生与社会发展整合的理论与实践

许多中低收入国家对精神卫生区别对待,将其作为一种专业性的卫生政策。尽管全球精神卫生工作取得重大进展,但与之有关的政策和实践与社会发展整合的程度有限,并且往往落后于全球更广义的卫生发展。这种差距的出现是由于忽略了社会发展对精神卫生服务的影响,而这种影响既可能是积极的,也可能是消极的。本文旨在分析当前精神卫生需要克服的一系列理论和实践挑战,探索富有成效的社会发展和精神卫生整合的政策。从理论角度出发,本文力求证明社会发展与精神卫生模式之间存在兼容性,能力方法可以为精神卫生和社会发展整合提供框架。然而,近期有关幸福能力导向的言论一直在讨论精神卫生所带来的潜在危害性后果。有关政策和实践部分,本文建议采用横向和纵向整合战略。横向战略需要精神卫生与初级卫生保健相结合,精神卫生服务的提供与服务包的扩展更加统一。纵向整合是指精神卫生与其它相关政策领域（尤其是社会、经济和政治领域）之间的结合。精神卫生的实证研究强调了社会发展理论的诸多方面可以在某种形式上对其实践产生影响：一是避免那些受心理疾病影响或存在患病风险的弱势人群遭到排斥;二是强调了执行过程是成功政策的重要组成部分;三是通过聚焦个人,尽力避免社会发展中的不均衡。     

Health promotion, social epidemiology, and social capital: associations and perspectives for public health

The idea of health promotion predates the use of the actual term. However, the incorporation of this idea and the practice of health promotion were influenced by the Canadian health reform movement, which echoed the voices of many others who were concerned with the influence of the physical and social environment on health. This provided the basis for the World Health Organization to launch a series of conferences beginning with the Alma Ata Conference in 1977 and followed by the Ottawa Conference, from which resulted the first international document on health promotion, known as the Ottawa Charter. Although health promotion has been the subject of a wide range of studies, the concept is still not well understood and its explicit practice is limited. Health conferences have been important for keeping the notion of equity in health alive, while the gap between the rhetoric of these conferences and practice remains to be bridged. However, the rise of social epidemiology and the development of the concept of social capital for health could bring new insights into traditional epidemiology in order to narrow this gap. The purpose of this paper is to elucidate these concepts and to describe the roles they play in public health in order to stimulate further debate.     

Concepts of social epidemiology in health services research

Background

Social epidemiologists aim to identify social characteristics that affect the pattern of disease and health distribution in a society and to understand its mechanisms. Some important concepts of social epidemiology are: social inequalities, social relationships, social capital, and work stress.

Discussion

Concepts used in social epidemiology can make a useful contribution to health services research because the underlying social factors do not only influence health but are also related to health care. Social inequality indicators like education or income have an impact on access to health care as well as on utilization and quality of health care. Social relationships influence adherence to medical treatment, help-seeking behavior, utilization of health services, and outcomes. Social capital in health care organizations is an important factor for the delivery of high-quality coordinated care. Job stress is highly prevalent among health care providers and can not only affect their health but also their performance.

Summary

The theoretical considerations behind factors like social inequalities, social relationships, social capital and work stress can enrich health services research because theory helps to specify the research question, to clarify methodological issues, to understand how social factors are related to health care, and to develop and implement interventions.

     

Integrating a framework for conducting public health systems research into statewide operations-based exercises to improve emergency preparedness

ABSTRACT: BACKGROUND: Due to the uncommon nature of large-scale disasters and emergencies, public health practitioners often turn to simulated emergencies, known as "exercises", for preparedness assessment and improvement. Under the right conditions, exercises can also be used to conduct original public health systems research. This paper describes the integration of a research framework into a statewide operations-based exercise program in California as a systems-based approach for studying public health emergency preparedness and response. METHODS: We developed a research framework based on the premise that operations-based exercises conducted by medical and public health agencies can be described using epidemiologic concepts. Using this framework, we conducted a survey of key local and regional medical and health agencies throughout California following the 2010 Statewide Medical and Health Exercise. The survey evaluated: (1) the emergency preparedness capabilities activated and functions performed in response to the emergency scenario, and (2) the major challenges to inter-organizational communications and information management. RESULTS: Thirty-five local health departments (LHDs), 24 local emergency medical services (EMS) agencies, 121 hospitals, and 5 Regional Disaster Medical and Health Coordinators/Specialists (RDMHC) responded to our survey, representing 57%, 77%, 26% and 83%, respectively, of target agencies in California. We found two sets of response capabilities were activated during the 2010 Statewide Exercise: a set of core capabilities that were common across all agencies, and a set of agency-specific capabilities that were more common among certain agency types. With respect to one response capability in particular, inter-organizational information sharing, we found that the majority of respondents' comments were related to the complete or partial failure of communications equipment or systems. CONCLUSIONS: Using the 2010 Statewide Exercise in California as an opportunity to develop our research framework, we characterized several aspects of the public health and medical system's response to a standardized emergency scenario. From a research perspective, this study provides a potential new framework for conducting exercise-based research. From a practitioner's perspective, our results provide a starting point for preparedness professionals' dialogue about expected and actual organizational roles, responsibilities, and resource capacities within the public health system. Additionally, the identification of specific challenges to inter-organizational communications and information management offer specific areas for intervention.     

Integrating occupational health, safety and worksite health promotion: opportunities for research and practice

BACKGROUND: There is emerging evidence that coordinating and integrating worksite health promotion and occupational health and safety enhances the effectiveness of efforts to promote and protect worker health, and growing attention internationally to the importance of integrating worksite health promotion and occupational health and safety. OBJECTIVES: (1) To present the rationale and scientific evidence for coordinating and integrating worksite health promotion and occupational health and safety as a means of enhancing the effectiveness of efforts to promote and protect worker health; and (2) to discuss recommendations for research priorities and future directions. METHODS: Review of the literature, drawing mainly on studies from the United States and Europe. RESULTS: The strongest evidence available supports the efficacy of this intervention model in promoting smoking cessation, particularly among blue-collar workers; some evidence additionally indicates significant effects for other health behaviors. Little evidence is available to date documenting the impact of these programs on occupational health and safety outcomes. Conclusions: Priority research directions include: social epidemiological research to identify key work-related factors associated with hazardous occupational exposures and risk-related behaviors, and to identify the underlying causes of social disparities in worker health; methods development research aimed at developing both appropriate measurement tools and new intervention approaches; efficacy and effectiveness studies to examine the effects of integrated interventions on both occupational health and safety outcomes as well as health behavior changes; assessments of the process of intervention implementation, including intervention implementation evaluation, cost assessments, and process-to-outcome assessments; and dissemination and durability studies, to identify strategies to promote the sustainability and dissemination of evidence-based programs.