The document discusses social ecological models for understanding health. It presents an ecological framework that considers individual and environmental factors that influence health and behavior across multiple levels: individual, interpersonal, organizational, community, and population. The model helps analyze health problems, design interventions targeting various levels, and evaluate programs. It promotes moving beyond blaming individuals to address upstream social and environmental determinants of health.

1. Social Ecological Models

2. Fall 2006
How can we begin to
understand all of the
factors that influence
health?

Ecological
Model

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Community
Population/Policy
Institutions
Interpersonal
Individual

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What is an Ecological
Perspective?
A framework that enables us to consider the
influence of
individual and environmental
factors on health & health-related behaviors

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Why the ecological framework?
 Health & health problems are complex
 Health problems are influenced by multiple
variables
 These variables interact with each other
 Multiple levels are relevant for understanding
& changing:
– Human behavior
– Complex environments

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By focusing on factors beyond the
individual, we are…
 Less likely to ‘blame the victim’
 More likely to address the underlying
determinants of health & health behavior

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By focusing on factors beyond the
individual, we are…
 Better able to see where action is needed
Upstream action
vs.
Downstream approaches
What do we mean by up/down stream
approaches?

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Ecological Framework helps us with…
 Problem analysis
 Intervention design
 Intervention evaluation

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Problem analysis
Public Health Problem Determinants

Population
Community
Organizational
Interpersonal
Individual

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Community
Population/Policy
Institutions
Interpersonal
Individual

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Youth Smoking Determinants

Population/Policy
Lack of law enforcement for selling to minors
Community
Positive attitudes toward smoking
Organizational
Easy availability of cigarettes at stores
Interpersonal
Popular kids smoke/parents smoke
Individual
Lack skills/self-efficacy to ‘just say no’

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Intervention Design
 Prevent or ameliorate existing problems
 Interventions, at their best are…
– Intended to Identify & shape solutions
 Specifying goals, objectives, activities
– Theory-based
– Designed by multi-disciplinary teams
– Targeted at multiple levels
– Able to maintain a broad (ecological) scope

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Individual Level Interventions
 Target of change  Individual Person
 Focus on characteristics of the individual
– E.g., knowledge, attitudes, skills, beliefs…

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Individual Level Interventions
What types of strategies
might we use at this
level?
What type of
individual level
intervention
would be useful in
youth tobacco
prevention?

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Interpersonal Level Interventions
 Target of change  Social influences
– E.g., family, work group, friendship networks…
 Focus on nature of social relationships
– E.g., social norms, access to diverse & supportive
networks/influences

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Interpersonal Level Interventions
What types of strategies
might we use at this
level?
What type of
interpersonal level
intervention would
be useful in youth
tobacco
prevention?

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Organizational Level Interventions
 Target of change  Organization/Institution
– E.g., worksites, schools, agencies, churches…
 Focus on organizational culture
– E.g., norms, rules & regulations, incentives &
benefits, structures

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Organizational Level Interventions
What types of strategies
might we use at this
level?
What type of
organizational
level intervention
would be useful
in youth tobacco
prevention?

19. Fall 2006
Community Level Interventions
 Target of change  Social environment
 Focus on community norms, values,
attitudes, & power structures

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Community Level Interventions
What types of strategies
might we use at this
level?
What type of
community
level
intervention
would be useful
in youth
tobacco
prevention?

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Population Level Interventions
 Target of change  Local, state, & national
laws & policies
 Focus on government regulations & other
regulatory processes, procedures, or laws to
protect health

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Population Level Interventions
What types of strategies
might we use at this
level?
What type of
population level
intervention would
be useful in youth
tobacco
prevention?

23. Fall 2006
What types of health issues or health
behaviors lend themselves to using
the social-ecological model?
Are there any issues that don’t?

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Challenges to ecological interventions
 A lot of work – involving several sectors of society
 Difficult to evaluate change at environmental level
 Challenge to translate interest in change into social norms
and public policy
– Powerful norms are hard to change
– Budget cuts – so difficult to undertake wide-range interventions
– Difficult to get certain health issues on public policy agenda
 Still, it’s being done!
E.g., nutrition guidelines, tobacco, fitness, elder transportation

25. Fall 2006
So…
 The ecological framework emphasizes:
– Relationships among behaviors, socio-political
structures & health
– Applying this framework allows us to:
 Determine & describe public health problems
 Move beyond solely focusing on (& blaming) the
‘individual’
 Assess multi-level determinants of health & how to
address them
 Design, implement, & evaluate interventions