Over the past month, I have been reflecting on the definition of health and the determinants of health. It has been clear that health needs to encompass a multilevel model with a focus on the health of both the individual and the population. Let's use the socio-ecological model to focus on the importance of children's health.
Social Ecological Model (SEM)
Figure 1: The National Centre for Disease Control and Prevention (CDC, 2018)
This model (Figure 1) from CDC (2018) depicts how risk factors can influence each level and considers the interaction between the individual, relationship, community and society. Looking at this from a public health perspective, using an 'ecosocial framework' (Figure 2) supports the need to identify social, cultural and economic forces through population health strategies that addresses the interplay between the ecological and social determinants of health (CPHA, 2015).
Children's Health & SEM
Over the many years as a public health leader, supporting children and their families has been an integral factor to improve population health. Children thrive when they have regular interactions with supportive adults such as their parents, extended family members, caregivers, educators. Childhood experiences (both positive and negative), including physical, emotional, mental and sexual, have lifelong impacts and shape our development. The Alberta Family Wellness Initiative (AFWI) discusses toxic stress from adverse childhood experiences (ACES) and research has shown this can lead to negative health outcomes through the lifespan. ACES is defined as negative events that are stressful and/or traumatizing occuring before the age of 18 (Canadian Centre on Substance Use and Addiction, n.d).
If we broaden our scope to look at the root of many family challenges, we will see how adversity in childhood can also arise from past and ongoing forms of colonialism, racism, childhood poverty, a lack of stable housing, weak social supports and other individual and systemic barriers. (Ellis & Dietz, 2017; McEwen & Gregerson, 2019).
Using the social ecological model provides the opportunity to identify and develop strategies addressing factors related to the individual (i.e. children), relationships (i.e family/caregivers), community (i.e. educators, access to services, supports available), and society (i.e. cultural norms, racism, systemic barriers). Here is a short video that provides a great example of Urie Bronfenbrenners ecological systems theory to support the importance of the SEM model to promote children's health.
Created by: Maggie Norris (September, 2017)
As we continue to move forward in considering strategies to promote child health, the social ecological model emphasizes the broader social factors that influence child/family resilience and their connections including family supports related to housing, jobs, transportation, neighborhood safety, social support, and access to resources (Bethell et al., 2019).
References
Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatrics, 173(11), e193007. https://doi.org/10.1001/jamapediatrics.2019.3007
Canadian Public Health Association (CPHA). (2015, May). Global change and public health: Addressing the Ecological Determinants of Health. Canadian Public Health Association: Discussion Document. Retrieved October 23, 2022, from https://www.cpha.ca/sites/default/files/assets/policy/edh-discussion_e.pdf
Canadian Centre on Substance Use and Addiction (n.d.). Adverse Childhood Experiences. Retrieved October 23, 2022, from https://www.ccsa.ca/adverse-childhood-experiences
Centre for Disease Control and Prevention. (January, 2022)The Social-Ecological Model: A Framework for Prevention |Violence Prevention|Injury Center|. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html
Ellis, W. R., & Dietz, W. H. (2017). A new framework for addressing adverse childhood and community experiences: The building community resilience model. Academic pediatrics, 17(7), S86-S93.
McEwen, C. A., & Gregerson, S. F. (2019). A Critical Assessment of the Adverse Childhood Experiences Study at 20 Years. American Journal of Preventive Medicine, 56(6), 790–794. https://doi.org/10.1016/j.amepre.2018.10.016
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