Question

Describe the Social Ecological Model and how it can be used in developing a public health intervention to address maternal and infant mortality.

Answer 1

Socio-ecological models were developed to further the understanding of the dynamic interrelations among various personal and environmental factors. Socioecological models were introduced to urban studies by sociologists associated with the Chicago School after the First World War as a reaction to the narrow scope of most research conducted by developmental psychologists. These models bridge the gap between behavioral theories that focus on small settings and anthropological theories.

The SOCIAL ECOLOGICAL MODEL
The social ecological model is primarily a multi-level, systems theory framework for analyzing and understanding social systems and interactions between individuals and environments. It is “a framework for understanding how individuals and their social environments mutually affect each other across the lifespan...[and] the factors that produce and maintain health and health-related issues, allowing identification of promising points of intervention and understanding how social problems are produced and sustained within and across the various subsystems” (Wendel et al.). It was applied to epidemiology in 1996 by Mervyn Susser and Ezra Susser and in 2005, Urie Bronfenbrenner fit the model to its current design as and within a systems theory (Wendel et al.). The model follows a systems theory format, in which the individual is the core and concentric circles representing interpersonal factors, organizational factors, community factors, and policy factors as levels of influence. These five levels refer to the public health and social institutions that function at these levels to maximize the synergy of intervention to create the greatest impact.

Introduced as a conceptual model in the 1970s, formalized as a theory in the 1980s, and continually revised by Bronfenbrenner until his death in 2005, Urie Bronfenbrenner's Ecological Framework for Human Development applies socioecological models to human development. In his initial theory, Bronfenbrenner postulated that in order to understand human development, the entire ecological system in which growth occurs needs to be taken into account. In subsequent revisions, Bronfenbrenner acknowledged the relevance of biological and genetic aspects of the person in human development.

• In community health promotion: identifying high impact leverage points and intermediaries within organizations that can facilitate the successful implementation of health promoting interventions, combining person focused and environmentally based components within comprehensive health promotion programs, and measuring the scope and sustainability of intervention outcomes over prolonged periods. Basis of intervention programs to address issues such as bullying, obesity, overeating and physical activity.
• In public health: drawing upon this model to address the health of a nation's population is viewed as critically important to the strategic alignment of policy and services across the continuum of population health needs, including the design of effective health promotion and disease prevention and control strategies.^[29] Thus also, in the development of universal health caresystems, it is appropriate to recognize "Health in All Policies" as the overarching policy framework, with public health, primary health care and community services as the cross-cutting framework for all health and health-related services operating across the spectrum from primary prevention to long term care and end-stage conditions. Although this perspective is both logical and well grounded, the reality is different in most settings, and there is room for improvement everywhere.^[
• Infant mortality is defined as the death of a liveborn infant before his or her first birthday. The infant mortality rate is defined as the number of deaths occurring under one year, calculated out of 1,000 live births. In this metric, the United States currently ranks 31s t out of the 34 OECD countries
• Disability-adjusted life expectancy (DALE) measures the number of life years expected to be lived in full health. Globally, there is a strong linear relationship between infant mortality rate and disability-adjusted life expectancy: as the infant mortality rate rises, DALEs fall. “The strong linear relationship between [infant mortality rate] and DALE means that IMR accounts for more than 80% of the variance of the DALE” (Reidpath and Allotey, 345); this suggests that one measure could serve as a proxy for the other. “The fact that [these measures] are so highly correlated merely goes to reinforce the intuition that the causes of infant mortality are strongly related to those structural factors like economic development, general living conditions, social well-being, and the quality of the environment, that affect the health of entire populations” (Reidpath and Allotey, 345).