Alterations in Governmental Policies, Technological Systems, and Ecological Conditions
In 2007, an article titled "UCCE Helps Community Coalitions Reduce Childhood Overweight" was published in California Agriculture, highlighting the potential impact of community coalitions in addressing public health issues. This approach has since gained traction, with various coalitions across the United States implementing integrated strategies to improve community health.
One such framework guiding these efforts is the Social-Ecological Model, a tool used to identify factors influencing behavior at individual, interpersonal, organizational, community, and public policy levels. The Health Impact Pyramid, another influential model, describes the relative impacts of public health interventions, with interventions addressing socioeconomic determinants and the context of health-related decisions having the greatest potential impact.
The Health Impact Pyramid consists of five tiers: interventions addressing socioeconomic determinants, context of health-related decisions, one-time protective interventions with long-term benefits, clinical interventions, and counseling and education. Effective community change occurs when the most relevant influences at each level are identified and addressed.
Practical examples of Policy, System, and Environmental (PSE) changes implemented by coalitions to improve community health include policy changes such as banning smoking in public places or imposing taxes on sugary beverages to reduce obesity and chronic disease risk. Systems changes might involve modifying organizational procedures and institutional structures to enable healthier behaviors, such as improving health care system workflows to integrate preventive services. Environmental changes could involve shaping the physical environment to promote health, like reducing toxins, increasing access to green spaces, or redesigning neighborhoods to encourage physical activity.
These interventions operate across multiple layers of the Social-Ecological Model, from individual behavior to broader societal factors, and correspond to tiers of the Health Impact Pyramid by making healthy choices more accessible, changing the context to support healthy default behaviors, and addressing social determinants of health through systemic reforms.
The process of identifying community health influences and working toward PSE change can lead to improved collaboration, coordination, growth, and development of programs, and leveraging of resources to have a greater impact in the community. Moreover, PSE can keep coalition members engaged in the work of the group and pave the way for further collaboration.
Various resources are available to aid coalitions in their efforts. For instance, Coalitions Work offers tools and resources for a variety of coalition processes and coalition evaluation. Iowa State University, North Central Regional Center for Rural Development published a publication titled "Vision to Action: Take Charge Too" about community assessment, vision development, action planning, and evaluation. The University of Wisconsin-Extension offers Logic Model templates and examples for program development and evaluation. The Asset-Based Community Development Institute provides downloadable resources on community assessment and community mobilization. The Health Policy Institute of Ohio, Ohio Wellness and Prevention Network published a factsheet on 'Policy, System and Environmental Change' in 2012. The University of Kansas provides toolkits on a variety of topics related to partnership building and community change.
In conclusion, community coalitions employ integrated PSE strategies combining legislative, organizational, and environmental reforms to create sustainable improvements in community health consistent with the frameworks of social ecology and population health impact. These strategies have proven effective in reducing the risk of chronic diseases, promoting healthier environments, and fostering collaboration and coordination within communities.
- The Social-Ecological Model, used to address factors influencing behavior at different levels, guides community coalitions in their efforts to improve rural development and health-and-wellness.
- To reduce childhood overweight and promote general news, community coalitions implement policy-and-legislation changes such as banning smoking or imposing taxes on sugary beverages, which align with the tiers of the Health Impact Pyramid.
- Community development includes systems changes, like improving healthcare workflows or increasing access to green spaces, which are critical for shaping the context to support healthier behaviors.
- Science can contribute to rural development through resources like Coalitions Work, Iowa State University's 'Vision to Action: Take Charge Too', and the University of Wisconsin-Extension's Logic Model templates, aiding coalitions in making sustainable improvements in agriculture and health-and-wellness.
