Prevention, Health Promotion and the Social Determinants of Health

Prevention and Community Psychology

• Prevention is not only about stopping problems but also about creating conditions that help people and communities thrive

• Key lessons:

  • Even without knowing the cure for a problem, one can still prevent it

  • Prevention does not always require full understanding of the cause

  • Problems can often be prevented by changing human behaviour or social systems

What is Prevention

• Generally refers to measures taken to stop something from happening before it occurs, rather than treating it after the fact

Three Levels of Prevention

• Primary Prevention -- Aims to stop problems before they start

• Secondary Prevention -- Focuses on detecting and addressing problems early, before they become severe

• Tertiary Prevention -- Seeks to reduce the impact of an existing problem and improve qualit of live

Three Categories of Prevention

• Universal Prevention -- Targets an entire population

• Selective Prevention -- Targets groups at higher risk

• Indicated Prevention -- Targets individuals showing early signs of difficulty

Promotion

• Involves empowering individuals and communities to increase control over their health and well-being through education, skill-building, and supportive environments

• Promotions must consider the the broader ecological and social context in which people live

Choose to Move Example

• Program designed to support older adults in becoming more physically active, socially connected, and engaged in their community

• Program combined individual consultations, group meetings, and ongoing motivational support to help participants set achievable goals for physical activity and healthy living

• Trained coaches met participants where they encouraged small, sustainable lifestyle changes rather than prescribing a one-size-fits-all approach

• Evaluation showed:

  • Increased physical activity levels

  • Improved mental well-being and reduced feelings of isolation

  • Stronger social connections with peers in their communities

Risk Factors

• Traits, experiences, or circumstances that increase the likelihood that a person or group will experience poor health, mental distress, or other challenges

  • These factors may not directly cause illness but can combine with other stressors to increase vulnerability

• Having protective factors does not guarantee complete well-being

Protective Factors

• Traits, experiences, or conditions that decrease the likelihood of poor outcomes

  • Act as buffers that help individuals and communities cope with adversity or recover more quickly from challenges

• Having a risk factor does not guarantee that someone with become ill or experience social problems

Social Determinants of Health

• The economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole

Social Determinants as a Critique

• Public health has focused on individual risk factors such as physical inactivity, poor diet, or tobacco use -- These are certainly important, but they only tell part of the story

• Many prevention programs still assume that health outcomes are mainly a matter of personal choice or behaviour -- These individual behaviours are heavily influences by the conditions in which people live

Model of Determinants

• Individual Lifestyle Factors

• Social and Community Networks

• General Socioeconomic, Cultural, and Environmental Conditions

Alan Davidson’s Framework

• Social Detriments of Health:

  • Income, Inequality, and Health

  • Childhood and the Transition to Adulthood

  • Social Support, Social Capital, and Social Exclusion

  • Health of Aboriginal Peoples

  • Gender and Health

  • Employment, Working Conditions, and Health

  • Housing and Neighbourhood

  • Food, Food Insecurity, and Nutrition

  • Social Patterning of Behaviour

• List highlights how structural and social conditions intersect to influence health throughout the life-course

Mikkonen and Raphael’s Framework

• Social Determinants of Health:

  • Disability

  • Early Child Development

  • Education

  • Employment and Working Conditions

  • Food Insecurity

  • Gender

  • Geography

  • Globalization

  • Health Services

  • Housing

  • Immigration

  • Income and Income Distribution

  • Indigenous Ancestry

  • Race

  • Social Exclusion

  • Social Safety Net

  • Unemployment and Job Security

• Emphasizes how inequities in income, employment, and housing are closely connected to broader social systems such as globalization, colonialism, and racism

Social Determinants and Community Psychology

• The social determinants of health exist primarily at the higher levels of the ecological model of analysis -- The macrosystem

• Addressing health inequities through multi-level action, including advocacy, coalition building, participatory research. and the design of policies that promote fairness and inclusion