Approaches to public health issues

2. HEALTH DETERMINANTS & APPROACHES TO
PUBLIC HEALTH ISSUES
The determinants of health “do
not act independently of
each other. They are
interconnected.”
• Provides the foundations to
being understanding the
complexities of addressing
public health issues
• Public health models attempt
to “provide the framework for
understanding how to model
their interconnectedness.”
Health
Determinant
s
Physical
Environment
Social
Environment
Genetic
Inheritance
Health
Behavior
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 16) (2nd
ed.). New York City, NY: Springer Publishing Company.

3. APPROACHES TO PUBLIC HEALTH ISSUES
Each of these approaches attempts to integrate the determinants of health
into the public health practice.
Public
Health
Approaches
Ecology
Health
Promotion
Population
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 17-35)
(2nd ed.). New York City, NY: Springer Publishing Company.

4. ECOLOGY APPROACH
Ecology is “the study of the relationships between organisms & their
environments.”
There are 3 main models
• Social ecology model
• Epidemiology model
• Wheel of Causation model
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 16-21)
(2nd ed.). New York City, NY: Springer Publishing Company.

5. SOCIAL ECOLOGY MODEL
Social ecology model involves linking “the determinants of health in a
causal chain that ends” with a negative impact on an individual’s or the
public’s health.
• “May include all aspects of the environment that impact health.”
• “Include characteristics of individuals.”
• “Concepts from systems theory are used to understand the interplay
between environmental & individual characteristics & their mutual
influence on health.”
• “Emphasizes the interdependence of all factors contributing to health.”
• “Many disciplines are required to understand the interplay between them
& their effect on health & to bring about health improvement.”
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 17-19)
(2nd ed.). New York City, NY: Springer Publishing Company.
Health
determinant
Health
determinant
Public
health
concern

6. EPIDEMIOLOGY MODEL
“Developed & is used to understand
infectious disease transmission & to
provide a model for preventing
transmission, & thus, infectious
disease outbreaks.”
• Agent “is the microbial organism that
causes the infectious disease”
• Host “is the organism that harbors the
agent”
• Environment “are those factors that
facilitate transmission of the agent to
the host.”
Host
Agent Environ
ment
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 19) (2nd ed.).
New York City, NY: Springer Publishing Company.

7. WHEEL OF CAUSATION MODEL
This model is used “for explaining
infectious disease transmission.”
Illustrates “the multiple etiological
factors of human infectious
disease.”
• Host represents a human or
humans
• Physical environment
• Social environment
• Biological environment
Host
Social
Environment
Physical
Environment
Biological
Environmen
t
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 20-21) (2nd
ed.). New York City, NY: Springer Publishing Company.

8. HEALTH PROMOTION APPROACH
The health promotion approach targets public health interventions on
“individual’s behavior instead of the environment.”
• Takes into account individual behaviors “such as smoking, sedentary lifestyle,
& poor dietary habits” are “highly related to the onset & progression of chronic
diseases.”
Main Model
• PRECEDE-PROCEED Model
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices
(pp.22-27) (2nd ed.). New York City, NY: Springer Publishing Company.

9. PROCEDE-PROCEED MODEL
Part 1: PROCEDE is focused on “improving health by changing
individuals’ behavior through education, & not toward intervening at the
environmental level to change conditions or structures.”
Predisposing, Reinforcing, & Enabling Constructs in Educational Diagnosis
& Evaluation
• Proceeding factors are “person’s or population’s knowledge, attitudes, beliefs,
values, & perceptions that facilitate or hinder motivation for change.”
• Reinforcing factors are “the rewards received, & the feedback the leaner
receives from others following adoption of the behavior, may encourage or
discourage continuation of the behavior.”
• “Enabling factors are those skills, resources, or barriers that can help or
hinder the desired behavioral changes as well as environmental changes.”
• Education “about the risks of certain behaviors & the benefits of others
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp.23) (2nd ed.).
New York City, NY: Springer Publishing Company.

10. PROCEDE-PROCEED MODEL
Part 2: PROCEED is focused on the “attributes of the individual that
hinder behavior change including motivation to change, appraisal of
threat, self-efficacy, response efficacy, & so forth.”
PROCEED stands for the challenges to motivate individuals to bring about
changes in healthy behaviors.
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp.24) (2nd ed.).
New York City, NY: Springer Publishing Company.

11. PROCEDE-PROCEED MODEL
Health education
components of
health program
Predisposing
factors
Enabling factors
Behavioral
problems
Health problems Social problems
Reinforcing
factors
Basic outline of PROCEDE-PROCEED Model
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp.28) (2nd ed.).
New York City, NY: Springer Publishing Company.

12. POPULATION APPROACH
The population approach focuses on “the distal social environment– power,
wealth, & status– as the root cause of health problems.”
Study findings show that “an individual’s social status, wealth, & power
have a profound influence on his or her chances of being healthy.”
• The social context is “viewed as having a casual impact on health
behaviors.”
• Health behaviors are “viewed as patterned by the social environment,
not free standing.”
• Studied behaviors include smoking, alcohol consumption, diet, &
physical activity.
Main model
• Health impact pyramid
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp.29-30) (2nd
ed.). New York City, NY: Springer Publishing Company.

13. HEALTH IMPACT PYRAMID MODEL
The health impact pyramid model “best describes the impact of different
types of public health interventions & provides a framework to improve
health.”
Five elements
• Socioeconomic factors has “the most potential to improve health”
• Changing the context to make individuals’ default decisions healthy
“includes provisions of clean water & safe food, as well as passage of
laws that prevent injuries & exposure to disease-producing agents.”
• Long-lasting protective interventions “change the context to make
individuals’ default decisions healthy.”
• Clinical interventions “require limited contact but confer long-term
protection, & ongoing direct clinical care.”
• Counseling & education “focus on long-term individual behavior
change.”
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 35) (2nd
ed.). New York City, NY: Springer Publishing Company.

14. HEALTH IMPACT PYRAMID MODEL
Counseling
&
education
Clinical
interventions
Long-lasting protective
interventions
Changing the context to make
individuals’ default decisions
healthy
Socioeconomic factors
Increasing individual
effort neededIncreasing
population impact
Goldsteen, R.L., Goldsteen, K., & Dwelle, T.L. (2015). Introduction to public health: promises & practices (pp. 36) (2nd
ed.). New York City, NY: Springer Publishing Company.

15. THE END
Subjects covered:
• Health determinants & approaches to public health issues
• Ecology approach
• Social ecology model
• Epidemiology model
• Wheel of causation model
• Health promotion approach
• PROCEDE-PROCEED model
• Population approach
• Health impact pyramid model