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GEH1049 / GEC1015 Public Health in Action

Application of Public Health Frameworks: Case Studies

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological perspective on health promotion programs. Health Education Quarterly 15 (4), 351-377. DOI:10.1177/109019818801500401
There has been a dramatic increase in societal interest in preventing disability and death in the United States - by changing individual behaviors linked to the risk of contracting chronic diseases. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease.  "This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes."


Below are examples of scholarly articles applying the "Social-Ecological Model" to various public health issues:
  1. Golden, S. D., McLeroy, K. R., Green, L. W., Earp, J. A. L., & Lieberman, L. D. (2015). Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Education & Behavior, 42(1_suppl), 8S-14S. DOI:10.1177/1090198115575098.
    "We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere."
  2. Chelsea A. Kolff, Vanessa P. Scott & Melissa S. Stockwell (2018). The Use of technology to promote vaccination: A social ecological model based framework, Human Vaccines & Immunotherapeutics, 14:7, 1636-1646. DOI: 10.1080/21645515.2018.1477458 
    "Vaccinations are an important and effective cornerstone of preventive medical care. Growing technologic capabilities and use by both patients and providers present critical opportunities to leverage these tools to improve vaccination rates and public health. We propose the Social Ecological Model as a useful theoretical framework to identify areas in which technology has been or may be leveraged to target undervaccination across the individual, interpersonal, organizational, community, and society levels and the ways in which these levels interact."
  3. Wang, H., Dai, X., Wu, J., Wu, X., & Nie, X. (2019). Influence of urban green open space on residents' physical activity in ChinaBMC Public Health, 19(1), 1093-12. DOI:10.1186/s12889-019-7416-7
    "Urban green open space is a valuable resource for physical activities of urban inhabitants and has the potential to reduce chronic illness and improve health. Research on the relationships between green open space and physical activity is incomplete and limited in China. Thus, the study examines how the urban green open space contributes to physical activity" based on the social ecology theory.

  4. Quinn, L. A., Thompson, S. J., & Ott, M. K. (2005). Application of the social ecological model in folic acid public health initiatives. JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(6), 672-681. DOI:10.1177/0884217505281877
    "All women of childbearing age who are capable of becoming pregnant should consume 0.4 mg/400 μcg of folic acid daily. Folic acid decreases the incidence of neural tube defects in newborns. Despite continued public health initiatives, many women still do not consume the recommended daily requirement. This article analyzes the use of the social ecological model in folic acid public health initiatives and emphasizes assessing the outcomes of such initiatives."

  5. Vichayanrat, T., Steckler, A., Tanasugarn, C., & Lexomboon, D. (2012). The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool childrenThe Southeast Asian Journal of Tropical Medicine and Public Health, 43(2), 526. 
    This study reports the effects of a pilot multi-level oral health intervention on caregivers’ oral health practices and their determinants in Chon Buri Province, Thailand. Quasi-experimental, pretest-posttest evaluations using a comparison group design were employed to evaluate the effectiveness of a proposed intervention for promoting caregiver oral health behavior. The intervention consisted of three components: home visits by lay health workers (LHWs), enhancing oral health education and services at health centers, and community mobilization.

  6. ​Caperon L, Arjyal A, K. C. P, Kuikel J, Newell J, et al. (2019). Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation. PLOS ONE 14(3): e0214142. DOI:10.1371/journal.pone.0214142.
    "Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels... We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour."
  7. Cooper, J. (2018). Examining factors that influence a woman’s search for information about menopause using the socio-ecological model of health promotion. Maturitas, 116, 73-78. DOI:10.1016/j.maturitas.2018.07.013
    "Recognizing that increased knowledge of the perimenopause transition, in advance of experiencing symptoms, can make a positive impact on a woman’s menopause experience, this study investigated whether women engage in self-directed learning to inform themselves about menopause, and if they do initiate self-directed learning, what socio-ecological issues may help or hinder their search."
  8. ​Tanhan, A, Francisco, VT. (2019). Muslims and mental health concerns: A social ecological model perspectiveJournal of Community Psychology, 47: 964– 978.DOI:10.1002/jcop.22166.
    "Muslims in the United States experience many psychosocial issues and under utilize mental health services. This study sought to systematically identify the common issues and strengths of the Muslims affiliated with a college in the Southeast region of the United States and address them accordingly. A survey comprising 33 items and 2 open‐ended questions regarding common issues and strengths was constructed. A total of 116 participants completed the survey. The overall rating for items quite high, whereas the satisfaction rating was very low. The most important item was,“You have prayer places/rugs,ablution stations, and water in restrooms,” with an importance rating of 94.52% and a satisfaction rating of 20.50%. Four items regarding mental health were rated as the least important, and participants reported lack of knowledge regarding mental health services. This is the first study that includes a list of common concerns and strengths of the Muslim communities affiliated with colleges in the United States."


Below are examples of academic titles applying the Public Health Approach to various public health issues:
  1. Center for Disease Control and Prevention. National Center for Injury Prevention and Control, Division of Violence Prevention. (2019). The public health approach to violence prevention. Retrieved from
    Public health emphasizes input from diverse sectors including health, education, social services, justice, policy and the private sector. Collective action on the part of these stakeholders can help in addressing problems like violence. The public health approach is a four-step process that is rooted in the scientific method. It can be applied to violence and other health problems that affect populations.

  2. Seet, B., Wong, T. Y., Tan, D. T., Saw, S. M., Balakrishnan, V., Lee, L. K., & Lim, A. S. (2001). Myopia in Singapore: taking a public health approachBritish Journal of Ophthalmology85(5), 521-526.
    In this paper, the authors systematically examined the impact of myopia in Singapore, proposed a model to explain its high prevalence in the population, and outlined a strategy for myopia control.
  3. Ramirez, S. P. B., Stephen, I., Hsu, H., & McClellan, W. (2003). Taking a public health approach to the prevention of end-stage renal disease: The NKF Singapore ProgramKidney International63, S61-S65.
    "At present, studies that definitively demonstrate the effectiveness of population-based screening for renal disease are not available. Randomized clinical trials would be the ideal methodology to evaluate the effectiveness of this comprehensive, population-based approach to disease prevention. However, such trials are not generally feasible because of the requirement of large sample sizes of communities and the long period of observation. As an alternative, statistical simulations of screening programs may provide indirect evidence of the cost-effectiveness of such programs."
  4. Chan, R. S., & Woo, J. (2010). Prevention of overweight and obesity: how effective is the current public health approach. International Journal of Environmental Research and Public Health7(3), 765-783.
    "Obesity is a public health problem that has become epidemic worldwide. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. Therefore, a public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance. However, public health intervention programs have had limited success in tackling the rising prevalence of obesity. This paper reviews the definition of overweight and obesity and the variations with age and ethnicity; health consequences and factors contributing to the development of obesity; and critically reviews the effectiveness of current public health strategies for risk factor reduction and obesity prevention."
  5. O'Connor, M., O'Brien, A.P., Griffiths, D., Poon, E., Chin, J., Payne, S. and Nordin, R. (2010), What is the meaning of palliative care in the Asia‐Pacific region?Asia‐Pacific Journal of Clinical Oncology, 6: 197-202. doi:10.1111/j.1743-7563.2010.01315.x.
    The public health approach to palliative care suggests four key components for developing palliative care. "This paper describes the preliminary work required to understand cultural differences in palliative care in the United Kingdom and three countries in the Asia‐Pacific region, in preparation for a cross‐country study. The study is intended to address cultural understandings of palliative care, the role of the family in end of life care, what constitutes good care and the ethical issues in each country. Suggestions are then made to shape the scope of the study and to be considered as outcomes to improve care of the dying in these countries."
  6. Roberts, S. C. M., Fuentes, L., Berglas, N. F., & Dennis, A. J. (2017). A 21st-century public health approach to abortion. American Journal of Public Health, 107(12), 1878-1882. doi:10.2105/AJPH.2017.304068.
    "We propose a 21st-century public health approach to abortion based in an accepted public health framework. Specifically,we apply the Centers for Disease Control and Prevention’s 10 Essential Public Health Services framework to abortion to describe how health departments should engage with abortion. With this public health framework as our guide, we argue that health departments should be facilitating women’s ability to obtain an abortion in the state and county where they reside, researching barriers to abortion care in their states and counties, and promoting the use of a scientific evidence base in abortion-related laws, policies, regulations, and implementation of essential services."
  7. ​​Mendelson, T., Mmari, K., Blum, R. W., Catalano, R. F., & Brindis, C. D. (2018). Opportunity youth: Insights and opportunities for a public health approach to reengage disconnected teenagers and young adultsPublic Health Reports, 133(1_suppl), 54S-64S. Doi:10.1177/0033354918799344.
    "In this article, we view youth disconnection from a public health perspective, dividing our discussion into 3 sections. First, we describe the distribution and consequences of youth disconnection in the United States. Second, we provide a conceptual model of youth connection and disconnection, which is grounded in ecological theory, life course development concepts, and epidemiological principles. Third, we offer recommendations for multisector strategies aimed at reducing and preventing youth disconnection."

islam and health policies

8. Barmania, S. & Reiss, M.J. (2018). Islam and health policies related to HIV prevention in Malaysia. Cham : Springer, 2018. 
"This salient text presents a culturally aware public health approach to the HIV epidemic in Malaysia, a country emblematic of the Muslim world's response to the crisis. It explores complex interactions of religion with health as a source of coping as well as stigma and denial, particularly as Islam plays a central role in Malaysian culture, politics, and policy. At the heart of the book, a groundbreaking study analyzes attitudes and behaviors toward prevention among diverse people living with HIV, faith leaders, and government health officials. From these findings, readers gain insight into how health professionals, policymakers, and organizations can create appropriate prevention programs in Malaysia, with implications for other Muslim countries."