3.4: Ecological Model and the Social Determinants

The idea of ecology, or of an eco-system, is that each part of the whole affects each other part. We saw this in Module 1. What happens in the society affects the neighborhood, and what happens in the family affects the individual, etc.

Most of the time, in the US, when people think the cause of an illness or an injury, they start with individual actions or characteristics.

• For example, when I get a cold, I might think, "I should have gotten more sleep this week!" A lack of sleep can affect the immune system, so I might focus on my individual actions.
• Or I might think about individual characteristics that are difficult to change, like "It's in our genes -- everyone in my family gets sick easily."

Ecological Model diagram - 4 levels as nested ovals

What the research into social determinants of health shows us, however, is that much of the risk for disease and injury originates at the level of society and community.

• In this simple case of a cold, the immune system plays a key part.
  • If a family lives in a community with a lot of noise or insecurity, that will affect their immune systems.
  • If a group of people experience economic instability or discrimination over time, their immune systems can be affected.
  • If a society as a whole suffers from food shortages or famine, that will depress the immune system of most people.
• In the video Unnatural Causes, we will see more explanation and examples of these social determinants of health.

The idea of the ecological model is that we are all interconnected. What happens around us, affects our families and our bodies.

It works the other way around too - what we do or don't do has an effect on our circle of family and friends, our neighborhoods, or even society as a whole.

• Individuals can take action to affect community and society - in fact, some research suggests there are health benefits on a personal level when a person stands up against injustice or speaks out - like lower blood pressure over time.
• Individuals can develop personal habits (like exercise or meditation) that help to offset the stresses caused by their environment.
• Small groups of people can link together to create political and social change. As Margaret Mead (anthropologist) said, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." (By "citizen" here, I take it to mean anyone who has a sense of civic engagement -- not necessarily someone with official papers as a citizen. Anyone can get involved in social change!)

(image: CDC)

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