Galea (2015) wrote in an article regarding health across the lifespan that "a multilevel approach to population health is predicated on the understanding that exposures at many levels of organization work together to produce health outcomes". He then further describes how these exposures are both up and downstream of individual risk factors that tie into Social Determinants of Health. One framework that is often used in consideration of these other factors of health is the Social Ecological Model (SEM). The SEM of health is a framework used in public health to understand the complex relationships between factors that influence health on individual and population levels. It recognizes that health outcomes are shaped by multiple levels of influence, which could then be helpful towards developing policies and protocols to improve health (Stokols, 1992). The SEM typically consists of five interconnected levels: Individual level, interpersonal level, community level, institutional/organizational level, and societal/policy level (McLeroy et al., 1988). This interconnectedness emphasizes that changes or interventions at one level can have ripple effects throughout the entire system.
As a dietitian in oncology care, the focus in this blog post is how to address cancer using the SEM framework. The SEM can provide insight into how health care professionals and policy makers, and public health organizations can develop more effective strategies for cancer prevention, treatment, and survivorship.
Individual/ Intrapersonal Level:
- Health Behaviour: At the individual level, the SEM considers lifestyle factors that contribute to cancer risk, such as smoking, diet, physical activity, and alcohol consumption. It also includes factors like adherence to cancer screening guidelines and preventive behaviours. An individuals attitude and knowledge regarding a cancer diagnoses is also a factor to consider.
- Genetic Factors: Individual genetic predispositions to certain types of cancer can also be taken into account.
Interpersonal Level:
- Social Support: The availability of social support networks can influence an individual's ability to maintain cancer-preventive behaviours. In addition, support from family, friends, and caregivers can play a significant role in cancer patients' well-being and adherence to prescribed cancer interventions (medication routines, attending blood work appointments).
-Social Norms: Social norms within one's social network can affect cancer-related behaviours. For example, the acceptance of smoking within a peer group.
Institutional/Organizational Level:
- Healthcare Systems: The organization and availability of healthcare services, as well as the quality of care, can impact cancer outcomes. The Canadian Cancer Society is the largest national cancer charity, and they provide support those impacted by cancer. In British Columbia, BC Cancer is the primary institution for providing cancer treatment. There are other supportive cancer care centres such as Inspire Health.
Community Level:
- Environmental Factors: The community environment, including exposure to environmental carcinogens, air quality, and access to safe outdoor spaces for physical activity, can influence cancer risk.
Societal/Policy Level:
- Public Health Policies: Government policies can have a profound impact on cancer prevention and control, including regulations on tobacco, alcohol, and food labeling.
- Healthcare Policy: Health insurance policies, access to care, and funding for cancer research and treatment are essential factors at this level.
(Ecological Model, n.d.).
References:
BC Cancer. (n.d.). http://www.bccancer.bc.ca/
Canadian Cancer Society. (n.d.). https://cancer.ca/en/
Ecological Model. (n.d.). Healthy Campus. Americano College Health Association. https://www.acha.org/HealthyCampus/HealthyCampus/Ecological_Model.aspx
Galea, Sandro. (2015, May 31). The determination of Health Across the Life Course and Across Levels of Influence. Boston University School of Public Health. https://www.bu.edu/sph/news/articles/2015/the-determination-of-health-across-the-life-course-and-across-levels-of-influence-2/
Inspire Health. (n.d.). About. https://inspirehealth.ca/about/
McCloskey, D.J., et al. (2011). Principles of Community Engagement (2nd ed.). Agency for Toxic Substances and Disease Registry. https://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs.
Stokols, D. (1992). Establishing and Maintaining Healthy Environments: Toward a Social Ecology of Health Promotion. American Psychologist, 47(1), 6–22.
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