If we want more evidence-based practice, we need more practice-based evidence.*
Table of Contents
Building on the historical framework from Chapter 1, this chapter extends the concepts of educational, social and environmental interventions. Each type of intervention has been emphasized in a different phase of history. Ecology, one of the five science foundations of community health, is introduced in this chapter, along with the Health Field Concept and its classification of the determinants of health. In addition to the four primary objectives stated at the beginning of Chapter 2, our intent is to help you develop a deeper understanding of the dynamics of communities and populations and to distinguish them from individual patients, clients, students, clinics, worksites, and classrooms as units of analysis and organization.
Ecological concepts and components are introduced first. The elements of the Health Field Concept Ė human biology, environment, behavior, and healthcare organization -- are discussed and then placed in a model of community and population health that shows the dynamics and the relationship to the natural history of health and the social history of health, Figure 2-3. The social history of health is discussed first in terms of community norms, values and organization, then in terms of economic and equity concepts. Community action, innovation and diffusion are described in terms that would distinguish them from individual actions to influence health.
Quality of Life Rating of US Cities.(AOL, June 15, 1999). A recent study from Penn State University places Portland fourth out of the top five places to live around the country. The main factors in determining the "livability" of a city are: climate, educational opportunities, low crime rate and the arts. The top five places to live are: San Jose, California; San Francisco; Oakland; Portland; Seattle.
Rich Nations to Fight Third World Poverty (Associated Press, May 8, 1996) The more affluent countries of the world have agreed to a 20-year plan to ease suffering and boost living standards in developing countries.
As Nation Tightens Borders, Immigrants Lose Health Benefits (The Nation's Health November 1996) Increased efforts to keep illegal aliens (mostly Mexican) out of the US has limited the social and health services previously afforded to legal and illegal immigrants.
Canada Tops in the World for Quality of Life (Vancouver Sun July 16, 1996) Canada's combined score on this survey just nosed out the US. What factors should be considered in defining quality of life.
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Blanks Hindman, E. (1998). Community, democracy, and neighborhood news. JOURNAL OF COMMUNICATION 48(2): 27-39.
Braden, S., & Mayo, M. (1999). Culture, community development and representation. COMMUNITY DEVELOPMENT JOURNAL 34(3): 191-204, July.
Catalano, R. A., Lind, S. L., Rosenblatt, A. B., & Attkisson, C. C. (1999). Unemployment and foster home placements: Estimating the net effect of provocation and inhibition. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 851-855.
Fullilove, M.T., Green, L., & Fullilove, R.E. III. (1999). Building momentum: An ethnographic study of inner-city redevelopment. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 840-844.
Geronimus, A. T., & Bound, J. (1998). Use of Census-based Aggregate Variables to Proxy for Socioeconomic Group: Evidence from National Samples. AMERICAN JOURNAL OF EPIDEMIOLOGY 148 (5): 475-486.
Khan, N. A. (1999). Community cooperation in a voluntary environmental project: some lessons from Swansea, Wales. COMMUNITY DEVELOPMENT JOURNAL 34(3): 205-218, July.
King, L.A., & Hood, V.L. (1999). Ecosystem health and sustainable communities: North and south. ECOSYSTEM HEALTH 5 (1): 49-57.
Linnan, L. A., Fava, J. L., Thompson, B., Emmons, K., Basen-Engquist, K., Probart, C., Hunt, M. K., Heimendinger, J. (1999). Measuring participatory strategies: Instrument development for worksite populations. HEALTH EDUCATION RESEARCH 14 (3): 371-386.
McKee, M., Sanderson, C., Chenet, L., Vassin, S., & Shkolnikov, V. (1998). Seasonal variation in mortality in Moscow. JOURNAL OF PUBLIC HEALTH MEDICINE 20(3): 268-274. For the abstract, and other titles/abstracts in this issue, go to:http://www.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/
Motteux, N., Nel, E., Rowntree, K., & Binns, T. (1999). Exploring community environmental knowledge through participatory methods in the Kat River valley, South Africa. COMMUNITY DEVELOPMENT JOURNAL 34(3): 227-231, July.
Onyx, J., & Dovey, K. (1999). Cohabitation in the time of cholera: praxis in the community sector in the era of corporate capitalism. COMMUNITY DEVELOPMENT JOURNAL 34(3): 179-190, July.
Richard, L., Potvin, L., & Mansi, O. (1998). The ecological approach in health promotion programmes: The view of health promotion workers in Canada. HEALTH EDUCATION JOURNAL 57 (2): 160.
Schuftan, C. (1999). Sustainable development beyond ethical pronouncements: the role of civil society and networking. COMMUNITY DEVELOPMENT JOURNAL 34(3): 232-239, July.
Szwarcwald, C. L., Bastos, F.I., Viacava, F., & de Andrade, C. L. T. (1999). Income inequality and homicide rates in Rio de Janeiro, Brazil. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 845-850.
ABSTRACT: Objectives. This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate.
Books and Reviews
Berkman, L. and Kawachi, I. (Eds.). Social Epidemiology. New York: Oxford University Press, due Feb. 2000.
Young, T. K. (1998). Population health: concepts and methods. New York: Oxford University Press.
1. Health without organization. The first boxed issue asks you to draw on the sense of history from the previous chapter to imagine what survival was like before there were organizations, and to consider how human organization has altered the natural history of health. Consider the question asked in that boxed issue. Use Figure 2-2 to explore your answer
2. Tampering with nature. This boxed issue on page 49 raises one of the thorniest issues facing recent scientific and technological advances as these might affect the environment and health. If possible, you may wish to review recent issues of Science Magazine, a periodical that tends to report on the latest developments and regulations from the National Institutes of Health on genetic research. The successful cloning of animals in 1997 has introduced some serious ethical discussions around the world. Discuss some of the risks and benefits of human cloning.
3. Caveats on coalitions. Consider ways to organize and manage agency partnerships and coalitions to gain advantages they might offer in coordinating programs while avoiding the traps and shortcomings described in the caveats.
4. Diffusion curve. It is important to understand the diffusion curve, because it is has been broadly applied to analyze the spread of all kinds of new innovations from computers to hybrid farm seeds. To see its explanatory ability related to health and disease, graph statistics on the consumption of cigarettes in any country from the beginning of the 20th century to see how well they fit the diffusion curve, figure 2-11, (up to the 1960s when consumption began to decline). Also, estimate where your community falls today on the diffusion curve in its adoption of any positive or negative health practice, such as nutrition.
5. Health promotion vs. health protection vs. health services. In Chapter 1, we defined community health promotion as any combination of educational, social and environmental actions conducive to the health of a population of a geographically defined area. In this chapter, we see that those actions directed exclusively at environmental determinants of health have been referred to in recent national policy as health protection; those directed through health care organization as health services, leaving those directed particularly at behavioral determinants or lifestyle to be called health promotion. In the past, when communicable diseases were rampant, environmental reforms and health services promoted health because they required action to improve the health of the community. Today, most environmental controls are directed at protecting the existing health status of the community, and most health services are designed to restore health or to prevent the progress of specific diseases. Health promotion, then, has come to refer today more specifically to the one remaining front on which further improvements in health can be most fruitful, namely health behavior or lifestyle and discuss social conditions. Discuss these shifts in the definition and use of these terms.