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1.
There is increasing recognition in the health promotion and population health fields that the primary determinants of health lay outside the health care and behavioural risk arenas. Many of these factors involve public policy decisions made by governments that influence the distribution of income, degree of social security, and quality and availability of education, food, and housing, among others. These non-medical and non-lifestyle factors have come to be known as the social determinants of health. In many nations--and this is especially the case in North America--recent policy decisions are undermining these social determinants of health. A political economy analysis of the forces supporting as well as threatening the welfare state is offered as a means of both understanding these policy decisions and advancing the health promotion and population health agendas. The building blocks of social democracies--the political systems that seem most amenable to securing the social determinants of health--are identified as key to promoting health. Health promoters and population health researchers need to "get political" and recognize the importance of political and social action in support of health. 相似文献
2.
Raine KD 《Canadian journal of public health. Revue canadienne de santé publique》2005,96(Z3):S8-14, S8-15
This article uses a population health perspective to examine the complex set of interactions among the determinants of healthy eating. An overview of current knowledge on determinants of healthy eating was organized as follows: 1) individual determinants of personal food choices and 2) collective determinants, including a) environmental determinants as the context for eating behaviours and b) public policies as creating supportive environments for healthy eating. A conceptual synthesis of the literature revealed that individual determinants of personal food choice (physiological state, food preferences, nutritional knowledge, perceptions of healthy eating and psychological factors) are necessary, but not sufficient, to explain eating behaviour, which is highly contextual. Collective determinants of eating behaviour include a wide range of contextual factors, such as the interpersonal environment created by family and peers, the physical environment, which determines food availability and accessibility, the economic environment, in which food is a commodity to be marketed for profit, and the social environment, in which social status (income, education and gender) and cultural milieu are determinants of healthy eating that may be working "invisibly" to structure food choice. Policy is a powerful means of mediating multiple environments. There are gaps in our understanding of the process of intervening in macro-level environments and the impact of such interventions on the promotion of healthy eating. Collective determinants of food choice and policy contexts for promoting healthy eating, therefore, require investment in research. Applying a population health promotion lens to understanding the multiple contexts influencing healthy eating provides insight into prioritizing research and action strategies for the promotion of healthy eating. 相似文献
3.
In this article, the authors draw on the disciplines of sociology and environmental and social epidemiology to further understanding of mechanisms through which social factors contribute to disparate environmental exposures and health inequalities. They propose a conceptual framework for environmental health promotion that considers dynamic social processes through which social and environmental inequalities--and associated health disparities--are produced, reproduced, and potentially transformed. Using empirical evidence from the published literature, as well as their own practical experiences in conducting community-based participatory research in Detroit and Harlem, the authors examine health promotion interventions at various levels (community-wide, regional, and national) that aim to improve population health by addressing various aspects of social processes and/or physical environments. Finally, they recommend moving beyond environmental remediation strategies toward environmental health promotion efforts that are sustainable and explicitly designed to reduce social, environmental, and health inequalities. 相似文献
4.
Ajay B. Pawar Palipudi Venkata Trinada Krishna Mohan Rajkumar K. Bansal 《Journal of urban health》2008,85(4):607-618
Improving the health of urban residents, particularly those living in slum areas, requires an integrated approach. Appropriate interventions must be based on a well-grounded understanding of health determinants. Social factors are as important as physical factors in determining health status and suggest alternative interventions. Employment, stress, social exclusion, social support, substance use, nutrition, transport, and conditions during childhood are among the most important social determinants of health status identified by the International Center for Health and Society. This paper uses social determinants of health approach to understand morbidity outcomes for people residing in the slums of Surat City, India. To quantify suboptimal health behavior and identify the determinants of health status for this population survey data on household characteristics, health-seeking behavior, socioeconomic status, food and personal habits, social life, and physical activity has been used. After controlling for socioeconomic and demographic factors, logistic regression analysis reveals that social exclusion, stress, and lack of social support are significantly associated with morbidity. Thus, understanding of social determinants of health by policy makers is important as the health sector has a crucial role in addressing disparities in social determinants. 相似文献
5.
The future role of nursing in health promotion 总被引:1,自引:0,他引:1
Chiverton PA Votava KM Tortoretti DM 《American journal of health promotion : AJHP》2003,18(2):192-194
Never before has health promotion been more important than it is today. Nurses in education, practice, and research settings can participate in the advancement of health promotion not only to the mainstream but to the forefront of nursing practice. Historically, nurse educators have taught patients how to manage illness; in the future, the focus must be on teaching people how to remain healthy. Nurses must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding to the public at large. As more people grow in their awareness of activities that lead to good health and become knowledgeable about their own health status and the health of their families, the overall health of the population will improve. 相似文献
6.
Rütten A Abu-Omar K Levin L Morgan A Groce N Stuart J 《Journal of epidemiology and community health》2008,62(6):560-565
Recent work carried out by WHO has recognised that an assets based approach to health promotion is crucial to support the promotion of population health and to reduce health inequalities. The assets approach was applied in a project aimed at promoting physical activity among women in difficult life situations. Within the participatory and collaborative work of the project, a specific set of assets for health that might initiate social participation and collaboration in health promotion action emerged. These assets are referred to as social catalysts for health promotion implementation. The article describes empowered individuals, informal social networks, mediating social institutions and organisational structures as potential social catalysts for health promotion implementation, and outlines some directions for further research on this topic. 相似文献
7.
Benedict S Campbell M Doolen A Rivera I Negussie T Turner-McGrievy G 《Journal of women's health (2002)》2007,16(8):1117-1124
Socioeconomic status (SES) and income disparity are strong predictors of health, and health promotion interventions that address them are more likely to be meaningful to participants and to sustain positive effects. Seeds of HOPE is an innovative project that is the result of a long-standing collaboration between the University of North Carolina (UNC) Center for Health Promotion and Disease Prevention, a Centers for Disease Control and Prevention (CDC) Prevention Research Center, and communities in rural North Carolina. Initial formative work, including key informant interviews, community surveys, and focus groups, strengthened our understanding of the link between hope and health and the importance of addressing social and economic issues as part of our health promotion interventions. A Seeds of HOPE strategic plan was developed using a community-based participatory process and led to the idea to start Threads of HOPE, an enterprise that will serve as a business laboratory where women will produce and market a unique product and also learn business skills. Threads of HOPE will be a health-enhancing business and will serve as a training program for a new cadre of women entrepreneurs in two rural communities. 相似文献
8.
The issues raised in this editorial indicate that public health research must embrace the advances made in the understanding of gender and other power dynamics, which influence the social distribution of health and illness among the population. Furthermore, it is crucial to recognize that social research (including that in health) is part of the social fabric--not separable from--the processes of power. Thus, a power perspective in public health can bring a more comprehensive and subtle understanding of the multiple and contradictory elements of gender and other relations of power that impact on the health status of populations. 相似文献
9.
The SF-12 as a population health measure: an exploratory examination of potential for application 总被引:5,自引:0,他引:5
OBJECTIVE: To describe the relationships among functional health status measures (SF-12 physical and mental components summary scores), traditional measures of community health status, and social determinants of health among respondents to community health status surveys conducted in nine different communities. DATA SOURCES/STUDY SETTING: Data collected as part of comprehensive community health status assessments conducted in each of nine communities (in seven states) between 1992 and 1997. The purpose of each assessment was to gather data to plan and evaluate population health improvement initiatives. STUDY DESIGN AND DATA COLLECTION: This is an opportunistic study drawing on the universe of community health survey data collected by the authors to support local health improvement initiatives. Both community-level as well as an aggregate of individual-level measures are used in the analysis. Within each locality, survey respondents were randomly selected using a telephone-facilitated, mailed survey methodology. PRINCIPAL FINDINGS: The key variables reported here are functional health status measures (SF-12) and social determinants of health variables. SF-12 physical and mental component scales correlated with two of four traditional measures of community health status. At the aggregate level of analysis, significant relationships were found for seven of nine social determinants of health measures when compared with SF-12 component summary scores. Relationships between social determinants measures and PCS-12 and MCS-12 scores suggest both application possibilities and the need for additional analysis in order to understand the nature of those relationships. CONCLUSIONS: Physical and mental health functioning summary scores as measured by the SF-12 are useful in describing overall community health status when compared with traditional measures such as total deaths, age-adjusted mortality, or physician to population ratio. The SF-12 can also be used to measure the relationship between physical and mental health functioning (as proxies for community health status) and the social determinants of health. This analysis can help to refine our understanding of how social determinants and health status interact in a community or population as a precursor to the development of models of community or population health. 相似文献
10.
社会经济地位差异会带来老年人健康的不平等,社会经济地位的弱势对老年健康产生不利影响,但生活方式、公共服务和社会心理因素可在一定程度上弱化社会经济地位对老年健康的直接影响。基于2014年中国老年健康影响因素跟踪调查(CLHLS)数据,利用有序Logistic回归模型实证分析了社会经济地位对老年人健康状况的影响,并考察了生活方式、公共服务和社会心理维度变量的中介效应。研究发现:社会经济地位越高,老年人的自评健康、生理健康和精神健康状况越好;体育锻炼、食用水果和居住安排等生活方式变量有利于缓解社会经济地位弱势对老年健康的负面影响;医疗服务可及性在社会经济地位与老年健康的关系中具有显著的中介效应,但社区服务丰富性的中介效应不明显;生活满意度和社会参与度也能缓解社会经济地位弱势对健康造成的不利影响。改善老年人的健康状况不仅需要改变部分老年群体的社会经济地位弱势状态,也应该倡导健康的生活方式、提高公共服务水平和促进老年社会参与度。 相似文献
11.
Nick J Mulé Lori E Ross Barry Deeprose Beth E Jackson Andrea Daley Anna Travers Dick Moore 《International journal for equity in health》2009,8(1):18-11
In this paper we argue the importance of including gender and sexually diverse populations in policy development towards a
more inclusive form of health promotion. We emphasize the need to address the broad health and wellbeing issues and needs
of LGBT people, rather than exclusively using an illness-based focus such as HIV/AIDS. We critically examine the limitations
of population health, the social determinants of health (SDOH), and public health goals, in light of the lack of recognition
of gender and sexually diverse individuals and communities. By first acknowledging the unique health and social care needs
of LGBT people, then employing anti-oppressive, critical and intersectional analyses we offer recommendations for how to make
population health perspectives, public health goals, and the design of public health promotion policy more inclusive of gender
and sexual diversity. In health promotion research and practice, representation matters. It matters which populations are
being targeted for health promotion interventions and for what purposes, and it matters which populations are being overlooked.
In Canada, current health promotion policy is informed by population health and social determinants of health (SDOH) perspectives,
as demonstrated by Public Health Goals for Canada. With Canada's multicultural makeup comes the challenge of ensuring that
diverse populations are equitably and effectively recognized in public health and health promotion policy. 相似文献
12.
Frohlich KL Potvin L 《Canadian journal of public health. Revue canadienne de santé publique》1999,90(Z1):S11-S14
The last five years have witnessed intense debate among health researchers in Canada regarding the overlap of the health promotion and population health discourses. Meanwhile, strong currents within health promotion have attempted to move the field beyond a focus on individual behaviour towards the influence of social environments on health, although the tendency is often to fall back on individual behaviour modification as the primary lever for change. The Population Health research agenda bypasses behavioural determinants of health and explores instead social determinants. This body of knowledge provides useful insight for addressing some of the tensions in the health promotion discourse. This paper explores two of these tensions: whether individuals at risk or general populations should be targeted for change; and whether lifestyle is an individual or a collective attribute. We propose the notion of collective lifestyles as a heuristic for understanding the interaction between social conditions and behaviour in shaping health. 相似文献
13.
《Health & place》2017
Health interventions commonly have adverse effects. Addressing these could significantly improve health outcomes. This paper addresses an adverse effect common in the promotion of health behaviours: exacerbation of health inequalities between low- and high-socioeconomic groups. Health behaviours – particularly, physical activity - are positioned within the context of social inequality and the inequitable spatial distribution of resources. Area-based health policy that targets deprived areas is assessed for its capacity to promote health behaviours without exacerbating inequality. Data are derived from a 16-month ethnography in a deprived English neighbourhood that was the target of area-based intervention that prioritised the promotion of physical activity. Findings provide evidence of adverse intervention effects that further disadvantaged the low-socioeconomic population. Analysis demonstrates how this was ultimately the outcome of localised policy drifting away from initial commitments to equitable service access. These findings increase understanding of the processes through which adverse intervention effects arise and how they can be mitigated. 相似文献
14.
Rabiner DJ 《Home health care services quarterly》2005,24(4):47-63
Over the next three decades, the proportion of Americans over age 65 will grow to exceed 25 percent of the population. Although research has shown that health promotion and disease prevention interventions for older adults can lead to positive health outcomes, our understanding of the effects of health promotion on the health and well-being of older people could be improved through the development and use of a conceptual framework. This article presents a conceptual model for understanding the determinants and consequences of engaging in health promotion activities for older adults, describes how to use the model to estimate the impact of health promotion programs on a variety of individual- and community-level outcomes, and then applies the model to two different health promotion programs for older persons: REACH II and the Senior Wellness Program. 相似文献
15.
Maurice J. Elias Ph.D. 《The journal of primary prevention》1995,16(1):5-24
Primary prevention continues to be shackled by an implicit “magic bullet” perspective and an inoculationist mentality. The
proliferation of short-term, uncoordinated programs co-exists with data showing that large segments of our teenage-and-younger
population are exposed to conditions that are likely to harm their psychosocial growth. The status of primary prevention in
the schools is shown pictorially as a jumbled confusion. An argument is made that coordination of interventions, centered
around the goal of promotion of health and social competence, is necessary to achieve more successful primary prevention.
Skills comprising social competence as life skills for adaptation to diverse environments are outlined. A representation of
schools with programming organized by a shared prevention/promotion skills/set of strategies is provided. Primary prevention
is discussed as emergent from the promotion of health and social competence; the latter are ends in themselves, reflecting
children's inalienable, developmental “rights”. Persons concerned with primary prevention—and therefore with the education
and the socialization of children—are called upon to examine their efforts and determine the extent to which they are addressing
focal skills and doing so in a coherent, developmental, and cross-culturally sensitive manner, accompanied by the commitment
of resources, time, and focused professional development activity guided by the tenets of knowledge in the primary prevention
field. 相似文献
16.
OBJECTIVES: The negative health effects of cigarette smoking are nowadays well known. An important prerequisite for the implementation of rewarding health promotion campaigns aiming at reducing the tobacco dependency in the general population is the knowledge about smoking prevalences in different social population groups, and specific information about social factors and determinants influencing smoking behaviour. METHODS: In this regard, the Microcensus is a very valuable data source for Germany. Included in the present analysis are persons aged 18 years and older, which are present in the "Microcensus Public Use File 1995" and had answered the questions about their smoking behaviour (N = 186,424). The dependent study variable is current cigarette smoking. Independent study variables are sociodemographic factors (age, sex, family status), occupational status, unemployment, socio-economic situation and regional-specific variables (size of community, East vs West Germany). RESULTS: All together, 30.5% of the males and 18.0% of the females were current smokers. Significantly higher smoking rates were observed for persons living in metropolitan areas, persons with low educational achievement and low occupational status, for people being divorced, unemployed, and living on social welfare. In a second step, we analysed the cumulative effect of these social factors for current smoking status. In summary, it was found that the cumulation of social determinants explained a great part of the variance in smoking prevalence. Current smoking was four to six times more prevalent in population groups characterised by several unfavourable social conditions compared to more privilege population groups. CONCLUSIONS: Thus, smoking related prevention activities should be evaluated, among others, regarding their potential to reduce the social polarisation of the smoking epidemic. 相似文献
17.
We explored the social and contextual etiology of coronary heart disease (CHD) prevention and management in women. Social and contextual influences on CHD risk include such factors as socioeconomic status, access to healthcare, cultural mores, working conditions including work overload, multiple role responsibilities, and social isolation. Women, particularly economically disadvantaged women, occupy lower levels on the social status hierarchy and, therefore, experience more stressful life experiences, less favorable living conditions, and less opportunity to affect positive health behavior and outcomes. Women are often discriminated against economically, politically, and socially, and this discrimination may adversely affect their efforts at CHD health promotion and treatment. Multiple role responsibilities within the family and psychosocial factors, including chronic life stress, are critical to an understanding of the health status of women, particularly poor and minority women. Although community-based interventions appear to be ideal for addressing the contextual risks related to CHD in women, a number of issues need to be considered, for example, the limited acknowledgment of secular trends in economic development that influence lifestyle decisions and health promotion efforts. Directions for research and interventions include recognition of the full spectrum of CHD risk in women, recognition of culturally competent interventions, and recognition of the need for empowerment of women. 相似文献
18.
国民营养事关国民健康素质的提高和社会经济的发展,营养与健康状况监测信息,是公共卫生及疾病预防控制工作不可缺少的基础信息,为全民营养健康状况改善、食物生产及慢性病防控策略的制定提供技术支持。近年来,我国营养供给能力显著增强,国民营养健康状况明显改善。本期“营养健康监测”栏目发表的论文来自中国居民营养与健康监测及省(市)级自主开展的营养监测报告,这些数据为制定全国或地方性营养与健康策略提供了科学的参考。当前,我国营养工作面临多重挑战,党中央、国务院始终把人民群众的营养与健康摆在十分重要的位置,为促进全民健康,我国政府已实施多项营养促进政策或策略,营养监测又将进一步评估这些措施实施的效果。 相似文献
19.
BACKGROUND: The benefit of folic acid is a simple health promotion message of proven effectiveness that is particularly pertinent to a young population with a high birth rate. OBJECTIVE: The aim of the present study was to compare the uptake of a folic acid health message in two different ethnic groups. METHODS: Community antenatal teams in Tower Hamlets were asked to recruit women attending for a booking between October 1997 and July 1998 to the study. Tower Hamlets, in east London, is one of the poorest areas in England and Wales, with an ethnically diverse population. A questionnaire enquiring about age, employment, level of education, use of folic acid in their current pregnancy, understanding of the benefits of folic acid and self-described ethnic group was administered verbally immediately before the booking appointment to those women who agreed to participate. RESULTS: Completed questionnaires were received on 249 women. Univariate analysis showed that white women were 5.7 [95% confidence interval (CI) 2.5, 13.2] times more likely to have taken folic acid supplements before conception than Bangladeshi women. Having controlled for the variables, age, school leaving age, social class, parity, planned pregnancy and 'heard of folic acid', ethnic status remained a significant predictor of taking folic acid, with the odds ratio dropping to 5.2 with a 95% CI (1.1, 25.2). CONCLUSION: The Bangladeshi community in the UK have been shown to have poor access to health information sources, which is consistent with the results of this survey, which shows that a simple and important message has not been acted upon equally by white and Bangladeshi women in east London. This survey lends support to the view that resources and innovative forms of health promotion are needed to ensure that ethnic minority groups have adequate access to health promotion messages. 相似文献
20.
Studies examining the effects of neighbourhood characteristics have reported what has been called a 'group density' effect on health, such that members of low status minority communities living in an area with a higher proportion of their own racial or ethnic group tend to have better health than those who live in areas with a lower proportion. In this paper we survey published research on ethnic group density and health with the aim of stimulating further research. We situate the research question in the context of contemporary social epidemiology and provide a narrative review of studies of ethnic density and health. We go on to discuss processes which may underlie ethnic density effects, and highlight gaps in the literature and opportunities for further research. Although first recognised in studies of mental illness, 'group density' effects on physical health have been shown more recently. Generally, given individual material circumstances, living in a poorer area is associated with worse health. Members of ethnic minorities who live in areas where there are few like themselves are likely to be materially better off, and living in better neighbourhoods, than those who live in areas with a higher concentration. However, through the eyes of the majority community, they may be made more aware of belonging to a low status minority group, and the psychosocial effects of stigma may offset any advantage. If the psychological effects of stigma are sometimes powerful enough to override material advantage, this may have implications for our understanding of how low social status affects health more generally. As well as highlighting the importance of low social status, cultural isolation and social support to health and quality of life, this paper shows how an understanding of group density effects also has something to offer to our understanding of issues of prejudice, segregation, assimilation and integration in diverse societies. 相似文献