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Public health is a concept of “promoting health, preventing disease, and prolonging life through the organized efforts of society” (Karrar n.d., p. 3). It is the goal of most health promotions to improve public health since it affects the entire population over a prolonged period of time. In order for a public health promotion to have the maximum efficiency and outreach, it should follow a proper structure and socio-behavioral model.
These theories target an aspect of society that requires change and the organizations developing a health promotion campaign can determine the best approach. The social-ecological model is used in public health promotion programs to address cardiovascular disease which is prevalent in the UAE.
Public health supports the use of an ecological model for chronic disease prevention. Programs using this approach target specific levels of the model as a method to promote an active lifestyle which helps to prevent chronic disease. However, the ecological model has not been evaluated in regard to intervention at the community-based level. The article by Cargo et al. assesses the use of the ecological model in Aboriginal community level interventions to prevent cardiovascular disease (CVD) and type-2 diabetes (2011).
Chronic cardiovascular diseases present a major risk to society. Despite many challenges, the socio-ecological framework is most effective in public health interventions at the community and population level translating into policy.
The UAE has experienced a rapid increase of CVD and associated medical causes. The drivers contributing to the risk factors of chronic diseases include the prevalence of obesity (67% of adults, 43% children) as well as diabetes (18% of adults). These statistics greatly exceed the norms established by the World Health Organization and are the greatest contributors to early mortality and poor life quality in the UAE (Hajat, Harrison & Shather 2012).
The Weqaya program was developed as a high impact public health promotion campaign using primary care to target the population through education, screening, and levels of prevention. HAAD attempted to use health policy as a method of intervention to affect behavior and lifestyle changes in the population (Karrar n.d.). It used a multi-sectoral approach that seeks to empower the public.
The social-ecological model (also known as an ecological approach) is a framework used in social and health promotions with the primary focus on prevention. It is a multilayered approach that maximizes optimal synergy between the levels of society. The model begins with the individual level, identifying personal history and biological factors as well as attitudes and behaviors. Next, the interpersonal level focuses on relationships such as a family that may be a source of support. It includes a health care provider that a patient visits which can make recommendations and maintain reminders for monitoring improvement.
As a result, socio-cultural norms which are directly rooted in interpersonal communication should change. The organizational level interventions seek to influence behavior through change to the systems and policies of public institutions.
Clinics, schools, and employers can encourage certain behaviors and develop programs to support preventive care. Following, the community level helps health promotion conduct public awareness and education campaigns through the community systems such as health departments, neighborhood centers, and media resources. The last step is the policy level which focuses on implementing government directives and laws to support and fund health programs (Social Ecological Model 2015). Through cooperation amongst levels of government and relevant agencies, health promotion can begin preventive screenings and advocate a healthy lifestyle.
Chronic cardiovascular diseases must be managed with targeted and scalable interventions. The social-ecological model approaches CVD prevention from a broad perspective that individual behaviors are influenced by multiple environmental and social factors. The Healthy Lifestyles project was a public health intervention that used the socio-ecological model in Aboriginal communities. It involved community groups, organizations, and agencies.
It helped to implement prevention strategies such as CVD screening. Additionally, it promoted a healthy lifestyle and diet. The goal was to direct community resources towards chronic disease prevention through education and lifestyle initiatives. The interventions sought to strengthen inter-community and inter-organizational collaboration to plan, implement, and advance the public health intervention (Cargo et al. 2011).
Advantages and Disadvantages
The advantage of the social-ecological model is its complexity of considering multiple levels of human behavior and social environments. Their interaction can be deemed to determine the influence and origin of public health problems. Another advantage is the model’s ability to foster social change communication from various perspectives. It encourages collective education and action to resolve the problem (UNICEF n.d.).
The model helps problem analysis and drives the focus away from the individual-focused interventions which are very common in other behavioral theories and result in victim blaming. The article notes that public health improvement is maximized through community integration, established partnerships, and public policy. Various interested agencies and stakeholders share financial and material resources, as well as relevant knowledge and expertise. The model is effective since the “collaborative advantage” of multi-level resource cooperation allows to address health issues that would be impossible to solve on an individual basis (Cargo et al. 2011).
One of the model’s disadvantages is its limitation to produce the complete structural change needed to generate health-enhancing effects on the population. Since the social-ecological model begins with the individual and interpersonal levels, it is difficult to mobilize intervention that produces feasible results. It lacks the focus necessary for the tremendous time and resource commitment required to establish and implement the broad interventions in organizational, community, and policy structures (Golden et al. 2015). Another disadvantage is the difficulty in assessing the results and the overall environmental level of health promotion. This causes a difficult translation into socio-cultural norms. The broad aspect of the model presents the possibility of certain levels of intervention to have fallbacks such as lack of participation (Wilks 2016).
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The article notes that ecological based community programs suffer decreased participation and implementation over time. The limited financial resources make it difficult for competing organizations to collaborate. Pressure to demonstrate short-term results diverts investment from the long-term outcomes. The organizations seek to focus resources on treatment but fail to address socio-ecological factors such as housing and education that lead to the prevalence of CVD in the Aboriginal population (Cargo et al. 2011).
Success and Recommendations
The Healthy Lifestyles Project helped to shift community awareness about CVD and type-2 diabetes in order to prepare for further interventions. It has been determined that there are stages of development in an ecological approach and that timing is critical in the implementation of certain interventions. The complexity of ecological interventions resulted in the lack of leadership or an organizing body. The public health program fails to grow and become “more ecological.”
The desired outcomes of CVD and type-2 diabetes prevention take time and long-term investment. In the case of sensitive communities such as the Aborigines, strategies that are culturally competent should be developed and enabled through local leadership. (Cargo et al. 2011). Meanwhile, the Weqaya program in Abu Dhabi experienced tremendous success, screening 97% of nationals and hoping to achieve an 80% reduction in cardiovascular mortality by 2030 (Karrar n.d.). Recent research methods have increased cooperation between organizations, the scientific community, and government which ensures that future public health interventions meet the population needs and targets CVD on multiple levels simultaneously.
Cargo, M, Marks, E, Brimblecome, J, Scarlett, M, Maypilama, E, Dhurrkay, JG & Daniel, M 2011, ‘Integrating an ecological approach into an Aboriginal community-based chronic disease prevention program: a longitudinal process evaluation’, BMC Public Health, vol. 11, pp. 1-9. Web.
Golden, S, McLeroy, K, Green, L, Earp, JA & Lieberman, L 2015, ‘Upending the Social Ecological Model to guide health promotion efforts toward policy and environmental change’, SAGE Journals, vol. 42, no. 1, pp. 8S-14S. Web.
Hajat, C, Harrison, O & Shather, Z 2012, ‘A profile and approach to chronic disease in Abu Dhabi’, Globalization and Health, vol. 8, no. 18, pp. 1-12. Web.
Karrar, S n.d., CVD preventive health measures and public health the role of primary care. Web.
Social Ecological Model. 2015. Web.
UNICEF n.d., Module 1: understanding the social ecological model (SEM) and communication for development (C4D). Web.
Wilks, C 2016, Exploring the factors which effect participation and physical activity in adults with multiple sclerosis, Masters Thesis, University of Huddersfield. Web.