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The Community Guide’s model for linking the social environment to health,☆☆

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Introduction

Individuals and families are embedded within social, political, and economic systems that shape behaviors and constrain access to resources necessary to maintain health… Greater emphasis is needed on public health interventions that involve communities, with the goal of collectively identifying resources, needs and solutions…”

Institute of Medicine, Health and Behavior 20011

I n the mid-1990s, the independent national Task Force on Community Preventive Services (the Task Force) was created under the auspices of the Department of Health and Human Services to summarize what is known about the effectiveness of community-based interventions to improve population health outcomes.2 The Task Force wanted to examine broad social determinants of health from an ecologic perspective—one that recognized the connection between health and sustainable human, cultural, economic, and social activities.3 Communities interact with resources in the social and physical environments over broad periods of time. Understanding patterns of health or disease requires a focus not only on personal behaviors and biologic traits but also on characteristics of the social and physical environments that shape human experience and offer or limit opportunities for health.

Section snippets

Social determinants of health

Social determinants of health are societal conditions that affect health and can potentially be altered by social and health policies and programs.4 Three broad categories of social determinants are social institutions—including cultural and religious institutions, economic systems, and political structures; surroundings—including neighborhoods, workplaces, towns, cities, and built environments; and social relationships—including position in social hierarchy, differential treatment of social

The Community Guide’s social environment and health model

The model shown in Figure 1 was developed by the Task Force and a multidisciplinary team consisting of the authors and consultants. We identified aspects of the social environment known to influence health, designed models to capture these relationships, synthesized and revised our models, and reached consensus on the model shown in Figure 1.

The fundamental premise of the Community Guide’s model is that access to societal resources determines community health outcomes.11 Standard of living,

Social conditions as risk and protective factors

The social conditions illustrated in the Community Guide’s social environment and health model are quantifiable and offer a means, using epidemiologic methods, to evaluate trends, correlate conditions with health outcomes, evaluate health and social programs, and inform policy decisions. High-risk or protective social conditions can be identified with available community-level data (e.g., on education, housing, employment, and crime). For example, data on the number of young children within

Summary

In this supplement we review relationships between the social environment and health, explore methods for gauging communities’ social resource needs, and propose health-promoting community interventions. Although some believe that studying the root determinants of health disparities in communities is futile because poverty and inequality are intractable, we present thinking that goes beyond this view. Internal and external resources are available to communities to improve health, and

Acknowledgements

We would like to thank our Consultation Team: Regina M. Benjamin, MD, MBA, Bayou La Batre Rural Health Clinic, Bayou La Batre, Alabama; David Chavis, PhD, Association for the Study and Development of Community, Gaithersburg, Maryland; Shelly Cooper-Ashford, Center for Multicultural Health, Seattle, Washington; Leonard J. Duhl, MD, School of Public Health, University of California, Berkeley, California; Ruth Enid-Zambrana, PhD, Department of Women’s Studies, University of Maryland, College Park,

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    The names and affiliation of the Task Force members are listed at the front of this supplement and at http://www.thecommunityguide.org.

    ☆☆

    Address reprint requests to: Community Guide Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-73, Atlanta GA 30341. Website: [email protected].

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