About CoH – What's Different About CoH?
Medical interventions and lifestyle behaviors are heavily influenced by the social and environmental contexts in which they occur. Here are three distinctions of an integrated approach that simultaneously addresses both individual and social dimensions of health, well-being and security.
1. Place Matters: The Choices We Make Are Shaped by the Choices We Have
EXAMPLE: Las Vegas was recently named by Men’s Fitness magazine as the “fattest city in America” – not because it has the highest proportion of overweight or obese citizens, but because of prevailing social and environmental conditions such as crushing commutes, lack of open space, excessive TV viewing and extreme temperature. These “upstream” influences have been linked to lack of physical activity, poor diet and other “downstream” risk factors.
“It’s very difficult for people to change their behaviors if they don’t have an environment in which to make that change.” – Ana Diez-Roux, MD, PhD, MPH, University of Michigan School of Public Health
IMPLICATIONS: In addition to promoting healthy behavior change, an integrated approach considers the availability, condition and underlying causes of physical space, economic vitality and local services that can support or compromise individual health.
2. Context Matters: Our External Environment Gets Under Our Skin
EXAMPLE: Tobacco use could kill one billion people worldwide this century, a ten-fold increase from the previous hundred years, according to the World Health Organization. Yet, the rate of death per smoker varies widely by country and socioeconomic class, since the context in which people smoke can make them more susceptible to its harmful effects. While the Japanese smoke twice as much as Americans, they live four years longer on average. And low-income smokers in the U.S. are more likely to become ill and die sooner than those at the top of the income ladder who smoke the same amount.
“We can now show the biological consequences of social experience. You have gene propensity, but it’s the environment that changes the way genes get expressed and makes people vulnerable to a range of diseases. The environment is where the action is.” – S. Leonard Syme, PhD, Health Research for Action Center, University of California Berkeley
IMPLICATIONS: Addressing social and environmental contexts must reach beyond health literacy and resource access to uncover deep sources of psychosocial stressors that weaken resiliency.
3. Participation Matters: Coming Together Improves Health
EXAMPLE: The link between social cohesion and health is well documented. In the U.S., regional differences in mortality and morbidity are directly tied to levels of “social capital,” the networks, norms and trust that enable groups to cooperate toward shared objectives. This dynamic is particularly important in community health interventions, which are significantly more successful when designed by the community itself.
“Our society won’t work well if we don’t have these social connections. Schools don’t work as well; crime rates are higher where people don’t know their neighbors; people are unhappier and unhealthier.” – Robert Putnam, Harvard social scientist and author of Bowling Alone: The Collapse and Revival of American Community
IMPLICATIONS: Community transformation must be a participative process that allows people to come together in ways that are mutually supportive and empowering – because research shows that social support and empowerment are fundamental determinants of health.