Features of the health socio-ecological model as it applies to families living in poverty in the UK.
Author: Yudai Kaneda (Johnny Yudai Schwarz)
5 January 2022
Introduction:
The socio-ecological model is based on the concept that individual behavior is based on interaction with society and is characterized by multiple levels of factors influencing human behavior. The socio-ecological model is a theoretical model that explains the interaction of individuals with the social environment at the micro level of "friends" and "family," the meso level of "organization" and "community," and the macro level of "country." Such models are useful for examining which level factors should be approached when planning programs and predicting what kind of impact they might have. Moreover, in recent years, they have been examined, especially in resilience and health behavior.
Healthy People by the US Commissioner of Public Health, published in 1979, reported that 50% of the leading causes of death (hypertension, cancer, stroke, suicide, accidents, influenza/pneumonia, diabetes, cirrhosis of the liver, atherosclerosis, and other killings) were attributed to unhealthy behaviors and lifestyles, and that improving five behaviors and lifestyles (diet, smoking, drinking, exercise, and compliance with antihypertensive medication) could reduce at least seven out of ten causes of death.(Department of Health and Human Services, 1989) Since then, scientific evidence on health has accumulated, and many countries have made efforts to focus on lifestyle improvement through behavior change. At the First World Conference on Health Promotion held in Ottawa, Canada, in 1986, it was recognized that health promotion requires a dual approach to individuals and society: building people's skills and abilities to maintain and improve their health and creating a supportive environment.(World Health Organization, 1998) And the Centers for Disease Control and Prevention of the US has identified four risk factors that determine our health: biological factors such as genetics, lifestyle factors, environmental factors, and health care system factors, with lifestyle factors considered to be the most important.(Smith et al., 2012)
This report describes the characteristics of the socio-ecological model of health applied to families in poverty in the UK, which was estimated to be 14.5 million people (22% of the population) in 2019/20,(UK Parliament, 2021) from three levels: individual, local/community and national. Persistent poverty increases the risk of developing non-communicable diseases such as declines in cognitive function, depressive symptoms, and diabetes.(Mendenhall et al., 2017) It has also been noted that poor people often behave in less healthy ways, further perpetuating poverty.(Mani et al., 2013) Therefore, it is important to understand the characteristics of the socio-ecological model to discuss the interventions that should be taken at each level.
Body of discussion:
(1) Individual level
Personal factors refer to age, gender, personality, and attitudes/knowledge/skills of one person that influence behavior. For example, vegetables are nutritious and healthy,(Mohammed and Qoronfleh, 2020) but it also refers to knowledge about the importance of eating vegetables and the skills to cook them well. However, many people living in poverty have been found to have minimal knowledge due to limited access to education.(Ezeh et al., 2017) The Theory of Planned Behavior (TPB),(Ajzen, 1991) states that when a person intends to act in some way, the "intention" to act is activated before the intended action is taken. The "intention" is influenced by the "attitude", "subjective norm", and "sense of behavioral control" of the person toward the behavior. He argues that when these three factors work positively, the "will" to act is increased and the desired behavior is more likely to occur. The Health Belief Model (HBM) is based on four fundamental concepts: awareness of the likelihood of disease, awareness of the severity of disease, awareness of benefits, and awareness of disability, but it is difficult for them to recognize health risks due to their limited knowledge. In addition, the Trans Theoretical Model (TTM) states that people's behavior is determined by the expectations of their confidence in their ability to act in a certain way that will bring about a specific result and their expectations of what results from they will get from their behavior.(Prochaska and Velicer, 1997) However, it has been shown that poor people in the UK often have mental problems,(Boardman et al., 2015) and it is difficult for them to change their behavior based on their own expectations.
(2) Local and Community level
Inter-personal factors are related to the community of small units that provide social support and social roles around a single person, such as the presence or absence of family and friends. For example, whether there is a family member who can prepare meals for them. The idea of social support applies here and includes emotional support such as empathy, love, trust, and care, as well as material support in the form of practical help and services for those who need help.(Hale et al., 2005) However, it has been found that people living in poverty in the UK have low socioeconomic status due to low income, which causes stress in the home and is not fulfilling both mentally and materially.(Fitzsimons et al., 2017)
Organizational factors refer to the rules and regulations of a particular organization, such as a school, workplace, or religious group, or the social norms and social networks of a community or a particular organization. At this level, community building is emphasized, but Freire emphasizes the importance of conversation in this process.(Gipson and King, 2012) Past studies have shown that economic inequality reduces the ability of people to rely on their communities,(Gipson and King, 2012) which means that poor people do not receive the proper support. They are forced to live an even more complex and isolated life.
(3) National level
This includes factors caused by local and national policies and laws, for example, consumption tax on vegetables. In the UK, income security for low-income families, support for parental employment, and child rearing are all present in the system.(The UK Government, 2021) However, in other low- and middle-income countries, it has been found that people living in poverty have limited access to information,(Folayan et al., 2020) and this has also been applied in the UK, which may explain the current high poverty rate in the UK. The ecological model considers human behavior to be determined by factors at multiple levels, such as individuals, inter-individuals, organizations, communities, environments, and policies, and that maximum behavioral change can be expected if systematic and comprehensive interventions are targeted at the mechanisms of behavior change at each level.(Sogari et al., 2018) These factors do not exist in independent and exclusive ways. Factors in a region or community may affect an individual's beliefs or knowledge level, or an individual's abilities may change the social norms of the entire community. Each factor is not independent but influences each other, and this relationship is called "mutual causality”.(U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2005) Therefore, the ecological model is a model that has attracted international attention in recent years.
(4) Discussion
From the above perspective, families living in poverty in the UK face various problems such as educational, income, and mental health issues. These factors have various adverse effects on their social life, such as not being able to access appropriate support and not being able to earn enough to support their families. Thus, it would be a mistake to view poverty as a problem that is the individual's responsibility and be aware that society has created poverty and is creating a vicious cycle. Therefore, it is necessary to understand what problems of poverty are prevalent at the community/local level and provide the appropriate support. Studies have shown that the risk of needing nursing care and the probability of developing dementia are reduced in people who participate in nearby gyms and hobby activities.(Kanamori et al., 2014, Saito et al., 2018) Whether or not they participate in the community has a significant impact on their health. In addition, cities with high rates of community level sports group participation have fewer depressed people, including non-participants, than cities with low participation rates.(Tsuji et al., 2018) An individual's health habits, such as overeating, drinking, and smoking, are, of course, determinants of the individual's health. However, the underlying community and social environment also dictate the individual's behavioral choices. Therefore, it is essential to accumulate evidence through repeated research on successful and practical support in the community.
Conclusion:
In conclusion, it is necessary to consider that the risk factors of poverty and health-related problems exist at all levels and affect each other. Therefore, we should not consider them as problems caused by individual responsibility but create by the local environment. It is essential to view society as an integrated whole, with appropriate interventions adapted to each level. In particular, many recent studies have shown that environmental factors influence individual health status. It is important to consider health disparities from such a community level.
References
AJZEN, I. 1991. The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211.
BATESON, P., BARKER, D., CLUTTON-BROCK, T., DEB, D., D'UDINE, B., FOLEY, R. A., GLUCKMAN, P., GODFREY, K., KIRKWOOD, T., LAHR, M. M., MCNAMARA, J., METCALFE, N. B., MONAGHAN, P., SPENCER, H. G. & SULTAN, S. E. 2004. Developmental plasticity and human health. Nature, 430, 419-21.
BOARDMAN, J., DOGRA, N. & HINDLEY, P. 2015. Mental health and poverty in the UK - time for change? BJPsych Int, 12, 27-28.
DEPARTMENT OF HEALTH AND HUMAN SERVICES. 1989. Health Objectives for the Nation [Online]. Available: https://www.cdc.gov/mmwR/preview/mmwrhtml/00001462.htm [Accessed December 1 2021].
EZEH, A., OYEBODE, O., SATTERTHWAITE, D., CHEN, Y. F., NDUGWA, R., SARTORI, J., MBERU, B., MELENDEZ-TORRES, G. J., HAREGU, T., WATSON, S. I., CAIAFFA, W., CAPON, A. & LILFORD, R. J. 2017. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet, 389, 547-558.
FITZSIMONS, E., GOODMAN, A., KELLY, E. & SMITH, J. P. 2017. Poverty dynamics and parental mental health: Determinants of childhood mental health in the UK. Soc Sci Med, 175, 43-51.
FOLAYAN, M. O., EL TANTAWI, M., ALY, N. M., AL-BATAYNEH, O. B., SCHROTH, R. J., CASTILLO, J. L., VIRTANEN, J. I., GAFFAR, B. O., AMALIA, R., KEMOLI, A., VULKOVIC, A., FELDENS, C. A. & ECCAG 2020. Association between early childhood caries and poverty in low and middle income countries. BMC Oral Health, 20, 8.
GIPSON, P. & KING, C. 2012. Health Behavior Theories and Research: Implications for Suicidal Individuals' Treatment Linkage and Adherence. Cogn Behav Pract, 19, 209-217.
HALE, C. J., HANNUM, J. W. & ESPELAGE, D. L. 2005. Social support and physical health: the importance of belonging. J Am Coll Health, 53, 276-84.
About the Author
Yudai Kaneda (Johnny Yudai Schwarz)
Born in Frauenfeld, Switzerland.
Half German and half Japanese, and currently a fourth-year medical student at Hokkaido University in Japan.
Since this September, has been studying at the University of Edinburgh in the UK, specializing in health policy and global health.