Article: A Conceptual Framework for Action on the Social Determinants of Health

PHE 500 Module Two 1 Public Health Core Functions Public health engages in many activities, but there are three core functions that define public health’s role: assessment, assurance, and policy development. Assessment includes tasks such as monitoring a community’s health status in order to identify public health issues and needs, investigating potential health hazards, and evaluating public health programs for their effectiveness. Examples of specific assessment tasks include conducting a community health needs assessment and performing workplace inspections (by an agency such as the Occupational Safety and Health Administration, or OSHA). Assurance includes tasks such as ensuring appropriate healthcare services provision, ensuring that a competent healthcare workforce is in place, and educating the community about health issues. Specific assurance tasks include ensuring emergency healthcare is available during a disaster and bringing together various community partners to hold a health fair. Policy development includes tas ks such as drafting plans and policies that support and engage community health efforts, enforcing laws that protect the public’s health and researching for new solutions to developing health problems. Specific policy development tasks include quarantining those who have come in contact with a highly infectious disease (such as tuberculosis or Ebola) and researching a proposed new transportation policy that will encourage additional physical activity (The University of California, Irvine, n.d.). These thre e core functions support public health’s overarching goals, which include the following:  Prevent the spread of disease and epidemic outbreaks  Protect against environmental hazards  Prevent injuries  Actively promote and encourage healthy behaviors  Ensure a timely and appropriate response to disasters and assist in recovery and rebuilding  Assure service quality and accessibility (CDC, 2014) 2 PHE 500 Module Two Theoretical Frameworks and Models in Public Health Public health operates from a variety of theoretical frameworks a nd perspectives. Together, they inform the way in which public health issues are viewed and how problems are approached. A few of the dominant frameworks and models include the following:  Life course framework : This framework views a person’s health as a result of a variety of factors, but emphasizes a temporal and social perspective (World Health Organization, 2000). This framework sees health as being affected by events and experiences that take place over the span of a person’s lifetime. It looks for in dicators for a person’s current health state by looking back at that person’s lifetime experiences, while at the same time recognizing that those experiences are shaped by the wider social, economic, and cultural context (WHO, 2000). The multiple determina nts of a person’s health are nested in biological, genetic, social, behavioral, and economic contexts that often change over time as a person develops (Halfon & Hochstein, 2002).  Social determinants of health : The social determinants of health are “the c onditions in which people are born, grow, work, live, and age,” (WHO, 2015, para. 1) and also take into account wider forces that shape a person’s life. These forces include development agendas, social norms, economic policies and systems, political system s, and social policies (WHO, 2015). The social determinants of health framework recognizes that all of these forces combine to determine one’s health. The SDH framework recognizes stress as being an important and contributing factor to lower life spans. Th e social determinants of health also recognize the presence of a social gradient in health. This means that in all societies, the health of individuals runs across a spectrum, from top to bottom. Those with the worst health are almost always in the lower s ocioeconomic classes, and those with the best health are almost always in the higher socioeconomic classes. For example, when looking at infant mortality rates, rates are highest among the poorest, and those in the second highest wealth quintile have highe r infant mortality rates than those in the highest wealth quintile. This means that mortality rates run across a spectrum, creating what is termed the social gradient. Those with the worst health outcomes (and subsequently those that also are in the lowest socioeconomic class) are at the bottom of the spectrum, and those with the best health outcomes (and subsequently those who are in the highest socioeconomic class) are at the top of the spectrum.  Ecological model : Also termed the “social ecological model ,” this model is based on the belief that health and disease patterns are strongly shaped by social and physical environments and responses to these environments (Fielding, Teutsch, & Breslow, PHE 500 Module Two 3 2010). The Institute of Medicine defines the ecological model a s one that “emphasizes the linkages and relationships among multiple factors (or determinants) affecting health” (2003, p. 5). These factors include individual behavior, social and community networks, working and living conditions, and broad social, cultur al, economic, health, and environmental conditions (IOM, 2003). There are other models and frameworks that are currently in use in public health, but these are the three that are most commonly used. It is important to note that the similarity among all t hree is that health is not influenced by one single factor. Instead, it is the result of a myriad of factors that combine to create the state of a person’s health. It is vitally important to understand the range of complex factors that determines a person’ s health when designing effective public health interventions, which will be discussed in a later module. 4 PHE 500 Module Two References Centers for Disease Control and Prevention. (2014). The 10 essential public health services . Retrieved from http://www.cdc.gov/nphpsp/do cuments/essential -phs.pdf. Fielding, J. E., Teutsch, S., and Breslow, L. (2010) A framework for public health in the United States. Public Health Reviews, 32 , 174 –189. Halfon, N., and Hochstein, M. (2002). Life course health development: An integrated fra mework for developing health, policy and research. Milbank Quarterly, 20 (3), 433 –479. Institute of Medicine. (2003). Who will keep the public healthy? Educating public health professionals for the 21 st century . Washington, D.C.: The National Academies Pres s. The University of California, Irvine. (n.d.). The three core public health functions and ten essential public health services . Retrieved from http://ocw.uci.edu/opencourses/09f/89300/core_functions.pdf World Health Organization. (2000). The implications for training of embracing a life course approach to health . Retrieved from http://www.who.int/ageing/publications/lifecourse/alc_lifecourse_training en.pdf World Health Organization. (2015). Social determinants of health . Retrieved from http://www.who.int /social_determinants/en/