Lecture 3: Socioecological Model and Health Impact Pyramid

How is health defined?

Socioeconomic factors, physical environment, health behaviors, and healthcare

Social determinants of health

Socioeconomic factors and physical environment

Social determinants of health definition

The non-medical factors that incfluence health outcomes. They encompass the conditions in which people are born, grow, live, work, and age, as well as the broader systems shaping the conditions of daily life.

Social determinants of health

Economic stability, education access and quality, health care access and quality, neighborhood and built environment, social and community context

Economic stability

Access to stable employment and income.

Education access and quality

Opportunities for quality education and lifelong learning.

Heathcare access and quality

Availability of health services and ability to access them.

Neighborhood and built environment

Physical environments that support or hinder health.

Social and community context

Social relationships and societal structures.

What relationship do the social determinants of health have with theories or frameworks?

Theories and models provide a way to understand how these determinants shape health so we can design and test effective interventions,

Socio-ecological framework

Socio-ecological framework (SEF)

A model examining how individual, interpersonal, community, and societal factors shape health. Health is shaped by multiple layers of influence.

SEF policy

Federal, state, and local legislation

SEF community

Cities, neighborhoods, resources and norms

SEF institutional

Organizations, schools, and workplaces

Interpersonal

friends, family and social networks

Individual

Knowledge, attitudes, skills and behaviors

Why use the socio-ecological framework?

Encourages systems thinking for public health, combines individual and structural approaches for sustainable change, identifies interventions at multiple levels of influence.

Health Impact Pyramid

Health Impact Pyramid (HIP) definition

Framework to understand the population-level impact of public health interventions. Interventions lower in the pyramid affect broader populations and have greater impact, requiring less individual effort.

HIP History

Developed by Thomas R. Frieden, former director of the Centers for Disease Control and Prevention (CDC)

Levels of HIP

socio-economic factors, changing the context to make individuals’ default decisions healthy, long-lasting protective interventions, clinical interventions, and counseling education.

HIP socio-economic factors

Anti-poverty; education; access to health care; eliminating disparities

Changing the context to make individuals’ default decisions healthy

Smoke-free, laws, tobacco/soda taxes, 0g trans fat; healthy food options, urban design promoting healthy lifestyle; iodization, lead paint ban

Long-lasting protective interventions

Immunizations; brief interventions; smoking cessation; colonoscopy; early life interventions

Clinical interventions

Control of blood pressure, cholesterol, diabetes; aspirin

Counseling, education

Health education on nutrition and physical activity

Why use HIP?

Focus on social determinants of health, tiered structure portals that individual based interventions have less impact, guides policy decisions to focus on intervention with most impact.

Similarities of SEF and HIP

Both emphasize multi-level approaches and structural changes and both recognize the socioeconomic and political components to health.

Differences between SEF and HIP

SEF focuses on interactions among levels and determinants of

health. HIP focuses on intervention impact.