Strengths And Weaknesses Of The Socio-Ecological Framework

The need to have a deep understanding of the dynamic inter-relations among various personal and environmental factors gave rise to the development of socio-ecological framework. There are five nested, hierarchical levels of the social ecological framework: Individual, interpersonal, community, organizational, and policy/enabling environment. The individual level consists of characteristics of an individual that influence behavior change, including knowledge, attitudes, behavior, self-efficacy, developmental history, gender, age, religious identity, racial/ethnic/caste identity, sexual orientation, socio-economic status, financial resources, values, goals, expectations, literacy, stigma, and others. While interpersonal level consists of formal (and informal) social networks and social support systems that can influence individual behaviors, including family, friends, peers, co-workers, religious networks, customs or traditions. The third level of the framework, the community level, consists of relationships among organizations, institutions, and informational networks within defined boundaries, including the built environment (e. g. , parks), village associations, community leaders, businesses, and transportation. The organizational level consists of organizations or social institutions with rules and regulations for operations that affect how, or how well services are provided to an individual or group. The final level, the policy/enabling environment level, consists of local, state, national and global laws and policies, including policies regarding the allocation of resources for maternal, newborn, and child health and access to healthcare services, restrictive policies (e. g. , high fees or taxes for health services), or lack of policies that require childhood immunizations. The social ecological framework comprises of person-focused and environment-focused interventions designed to promote health.

The social ecological framework can be used as an ideal tool for addressing a broad range of public health issues and implementing new health promotion programs due to its wide scope of integrating behavioral and environmental changes. Variations of the social ecological approach are presented in the public health literature but the main perspective of this framework centers on certain core themes. These themes are individual/intrapersonal, interpersonal, institutional/organizational, community factors, public policy, social structures and globalization. An important advantage of the social ecological model in health promotion is that it can provide a better understanding of how social conditions shape our behaviors. These social determinants of health are critical when designing health promotion interventions and measuring potential impact. In the article by Frieden, he provides a 5-tier pyramid to show the impact of various types of public health interventions (2010). According to his article, the base of the pyramid contains interventions with the greatest potential for population health impact, which is represented by socioeconomic factors. He uses the term socioeconomic factors interchangeably with social determinants of health, which he claims interventions that focus at this level are “more effective because they reach broader segments of society and require less individual effort. ” Another variation of the social ecological framework was presented in the article by Schulz et al. , which also addressed the social determinants of health but also focused on environmental health promotion efforts in decreasing health disparities (Schulz & Northridge, 2004). Their model examines the complex relationships between social and economic inequalities (fundamental factors), the built environment and social context (intermediate factors), and stressors, health behaviors, and social relationships (proximate factors).

These factors ultimately give rise to individual and population health and well-being. The authors proposed using their conceptual model to help design health promotion interventions aimed at reducing environmental health disparities. Specifically, they propose using intermediate-level interventions that focus on the development of a healthy and sustainable built environment. Another key feature of the social ecological model is that it incorporates two or more core themes or perspectives (e. g. , intrapersonal, organizational, community, public policy). This enables researchers to examine impacts of both individual and community-level interventions on health promotion and communication. In the article by Dutta-Bergman, he mentions the importance of having programs “focused on the social ecological approach” that will influence both social policy and community environments will affect individual behavior (Dutta-Bergman, 2005). These integrative environmental strategies of behavior change is a major strength of the social ecological approach within a broad systems-theoretical framework. In class we learned about several different but effective intervention programs, also mentioned by Schultz et al. , that helped reduce environmental health and social disparities through the use of the social ecological perspective. These intervention programs included: Dump Dirty Diesel Campaign, Children Can’t Fly educational campaign, and the Harlem Hospital Injury Prevention Program. Success of these programs was primarily due to the use of intermediate and fundamental-level interventions that were applied to address inequalities present in each community. The programs were also successful because they implemented a wide array of strategies, such as community mobilization and development, urban planning, policy, enforcement and advocacy. There are some challenges, as well, in implementing health promotion programs that use the social ecological framework.

One main challenge is that programs are expensive and complex to implement in certain community settings. Also, there needs to be close coordination and collaboration between individuals and groups. In the article by Wagemakers et al. , the authors developed a framework that links the domains of social environment and health, with key health predicting mediators, and operational variables of participation and collaboration (2010). They based this framework on experience in case studies, audits of community health programs in the Netherlands, and ideas found in the literature. The authors offer four key guidelines on how to apply the framework that can help increase community participation and collaboration. These guidelines are: use the variables as a menu, set specific aims for social change processes, use an action research approach and triangulate data. This framework can be used to evaluate the effectiveness of community health promotion designs and address the challenges faced in implementing new programs. In conclusion, the social ecological framework is truly interdisciplinary and covers a broad scope when addressing health behaviors and designing health promotions programs. It encompasses the behavioral and environmental role used by individuals and groups in modifying their own health behavior. Lastly, challenges can be addressed with adequate evaluative studies.