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Improving Health Will Take a Village

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John Allegrante (TC file photo)

John Allegrante (TC file photo)

By Patricia Lamiell

Early this month, a report published in the journal Health Education & Behavior, edited by TC Deputy Provost John Allegrante, Professor of Health Education, described a recent shift in national health priorities. The report, written by the architects of the Healthy People 2020 Objectives for a Nation, describes how Healthy People, a federally-led consortium of public and private organizations which has set the national agenda for health promotion and disease prevention for 30 years, will add “social determinants” to its 2020 health goals.

Health improvement is too multifaceted to be left to the health care sector alone, the report says. The nation’s approach to health care should include the study of social factors such as poverty, level of education and social structure and their effects on overall health, the report says.

In the article “Healthy People: A 2020 Vision for the Social Determinants Approach,” U.S. Assistant Secretary for Health Howard K. Koh, MD, MPH, and his colleagues outline the need for collective effort and expanded thinking to make true impacts on public health. “Health starts where people live, labor, learn, play and pray,” they write. “The social determinants approach makes the healthier choice the easier choice for all people throughout the life span," and it could “catalyze and broaden healthier public policies and private sector practices outside of what had been traditionally considered the public health domain.”

Koh and colleagues observe that the 2020 plan emphasizes the need to consider numerous aspects of the social structure that not only influence the health of populations but also “limit the ability of many to achieve health equity.” This broader perspective, combined with a vision for shared societal responsibility for change, leaves Healthy People 2020 “poised to promote a stronger legacy for a healthier nation and reaffirm a unity of purpose for the future,” Koh and colleagues conclude.

An accompanying commentary to Koh's piece written by Allegrante and Lawrence W. Green, of the University of California at San Francisco, applauds the new approach. Allegrante and Green outline the recent history of the public health education field in revealing and promoting social determinants of good health. Professional health educators have brought valuable perspective and skills over the past 40 years to the work of uncovering the social determinants of good health, as well as working in community mobilization, policy advocacy, capacity building and equity, they write.

“The added value we were prepared to bring to the field of public health (in the 1960s and 70s) was a focus on populations and communities with an ecological perspective, their organization and mobilization for social change.” write Green and Allegrante, who is also an Adjunct Professor of Sociomedical Sciences at the Mailman School of Public Health at Columbia University.

Allegrante, who was recently interviewed on American Entrepreneur Radio’s Dr. Bill Clower show, “The Culture of Health,” talked about the example of how education, as one of the key social determinants that Health People will focus on, influences health behaviors and health status.  The interview can be heard in its entirety at: http://recordings.talkshoe.com/TC-139/TS-568932.mp3

Both papers conclude that the country’s health improvement efforts must go beyond preventing or curing disease, to addressing its root causes. To do that, they write, health care providers, educators and policymakers must forge new public and private partnerships.

Health Education & Behavior  is published by the Society for Public Health Education (SOPHE) through SAGE Publications. The papers are available free online in Health Education & Behavior until mid-January at:  http://bit.ly/vyeRZb and http://heb.sagepub.com/content/38/6/558.full.pdf+html





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