During the past 20 years 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. This renewed interest in health promotion and disease prevention has not been without its critics. 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.

An Ecological Perspective on Health Promotion Programs

Photovoice is a process by which people can identify, represent, and enhance their community through a specific photographic technique. As a practice based in the production of knowledge, photovoice has three main goals: (1) to enable people to record and reflect their community's strengths and concerns, (2) to promote critical dialogue and knowledge about important issues through large and small group discussion of photographs, and (3) to reach policymakers. Applying photovoice to public health promotion, the authors describe the methodology and analyze its value for participatory needs assessment. They discuss the development of the photovoice concept, advantages and disadvantages, key elements, participatory analysis, materials and resources, and implications for practice.

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Photovoice: Concept, Methodology, and Use for Participatory Needs Assessment:

Meanwhile, the authors' antidote to the American sicknessa quest for democratic community that draws on our diverse civic and religious traditionshas contributed to a vigorous scholarly and popular debate. Attention has been focused on forms of social organization, be it civil society, democratic communitarianism, or associative democracy, that can humanize the market and the administrative state. In their new Introduction the authors relate the argument of their book both to the current realities of American society and to the growing debate about the country's future. With this new edition one of the most influential books of recent times takes on a new immediacy.\

Habits of the Heart: Individualism and Commitment in American Life

▪ Abstract The thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy resear...

https://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.27.021405.102100

An ecological approach to creating active living communities.

Health promotion programs often lack a clearly specified theoretical foundation or are based on narrowly conceived conceptual models. For example, lifestyle modification programs typically emphasize individually focused behavior change strategies, while neglecting the environmental underpinnings of health and illness. This article compares three distinct, yet complementary, theoretical perspectives on health promotion: behavioral change, environmental enhancement, and social ecological models. Key strengths and limitations of each perspective are examined, and core principles of social ecological theory are used to derive practical guidelines for designing and evaluating community health promotion programs. Directions for future health promotion research are discussed, including studies examining the role of intermediaries (e.g., corporate decision-makers, legislators) in promoting the well-being of others, and those evaluating the duration and scope of intervention outcomes.

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Translating social ecological theory into guidelines for community health promotion.

Objective: This study explored subgroups of performance profiles measured by organizations’ Well Workplace Checklist (WWC) benchmark scores and examined company characteristics associated with performance subgroups. Methods: The sample included 3728 US organizations that completed the WWC in 2008 to 2015. Latent profile analysis (LPA) was used to extract distinct subgroups of organizations based on benchmark performance. Multinomial logistic regression analysis was used to examine associations between the characteristics of organizations and their performance subgroup. Results: Three distinct subgroups of performance resulted from the LPA. Significant associations were found between subgroup assignment and characteristics such as size, industry, how WHP initiatives were paid for, and reasons for implementing WHP initiatives. Conclusion: The characteristics associated with subgroups of performance suggest utility for developing specific interventions tailored to different types of organizations to improve their overall quality of WHP initiatives.

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Association Between the Characteristics of Organizations and Their Profile of Performance Against Quality Benchmarks for Workplace Health Promotion

Purpose: To examine the extent to which neighborhood disadvantage accounts for variation in blood pressure. Methods: Demographic, biometric, and self-reported data from 19 261 health screenings were used. Addresses of participants were geocoded and located within census block groups (n = 14 510, 75.3%). Three hierarchical linear models were formulated to identify individual and census block group risk factors for hypertension. Neighborhood-level deprivation was determined using the Townsend Deprivation Index. Results: Of the 14 510 participants, 24% had a systolic blood pressure (SBP) of ≥ 140 mmHg, and 15% had a diastolic blood pressure (DBP) of ≥ 90 mmHg, indicating hypertension. At the neighborhood level, significant variation in average SBP and DBP across census block groups (P < .001) was found. Model 2 suggested that deprivation accounts for some of the variability in average SBP and DBP between block groups (P < .001). After controlling for individual-level risk factors in model 3, deprivation rema...

Neighborhood Disadvantage and Variations in Blood Pressure.

Collaboration among public health organizations is essential to ensuring the health of the public. Much of the day-to-day work of public health educators is done in groups or teams or in consultation with others. This study examined the extent of health educators' work in teams as a proxy for collaboration. Health educators participated in an average of four teams per individual; three of these were interorganizational teams. Moreover, 40% of the respondents participated in five or more teams. Health educators supervised by other health educators were more likely to work in interorganizational teams than were those supervised by other professionals. Certified Health Education Specialists were more likely to participate in intraorganizational teams. Curricula in academic programs should reflect the extensive teamwork in which health educators are involved. Employers need to provide health educators with grounding in organizational priorities and support to carry out their collaborative work.

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Public Health Educators' Participation in Teams: Implications for Preparation and Practice.

Employee wellness programs are popular among employers because they have the potential to lead to positive outcomes for the employees and the organization. Moving from a public policy to local implementation, or the process of "operationalizing," presents a challenge within most organizations. The case study presented here provides an illustration of one public university?s attempt to interpret and apply a state policy to implement a wellness program for its employees. It features a description of the policy, a description of the context in which the policy is implemented and provides observations of the challenges and successes implementing the policy, lessons learned, and future directions.

Daniel L. Bibeau

Papers

Association Between the Characteristics of Organizations and Their Profile of Performance Against Quality Benchmarks for Workplace Health Promotion

Neighborhood Disadvantage and Variations in Blood Pressure.

Public Health Educators' Participation in Teams: Implications for Preparation and Practice.

Health Promotion in the Public Sector: A Case Study from Policy to Practice

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