Key Content Areas in Multicultural Health

1. Definitions, Models, and Frameworks Related to the Public Health in a Multicultural Environment

Increasing organizational and individual capacities to provide public health in a multicultural environment requires knowledge and application of many key terms, models, and frameworks. Some of them have multiple definitions and applications. The following models and frameworks were selected because they have relevance for public health in a multicultural environment. A list of selected definitions appears in Appendix B.

Social Models & Frameworks in Multicultural Health

For the purposes of this module, a social framework is a paradigm or model that envisions how various concepts, policies, institutions, groups, or individuals interact to produce a systematic approach to multicultural health.

Leading frameworks to enhance understanding, research, and interventions to improve the health of multicultural populations included:

• Ecological Model: The health of populations and individuals is influenced by the interaction of biological, environmental, and behavioral factors. The IOM recommends use of the ecological model as the basis for public health education and interventions (IOM, 2003). Some Schools of Public Health, such as the University of California at Berkeley (UC Berkeley), are using this model as the basis for teaching, research, and community interventions to improve health. The model is the cornerstone of Berkeley’s recently developed strategic plan, along with a commitment to associated interdisciplinary action and social justice to improve public health. The diagram below is from UC Berkeley School of Public Health Strategic Plan 2003-2007.

• Healthy People 2010: This initiative established a national goal of eliminating health disparities by 2010. It recommends that organizations and communities design, implement, and evaluate interventions using the following framework. The framework incorporates elements of the ecological model and also includes policy and health care factors.

• Community/Place-Based Factors (Reducing Health Disparities Through a Focus on Communities, Policy Link, 2002): The effect of the interaction of three categories of risk and protective factors that affect neighborhood and individual health:
  • Social and Economic Factors: levels of poverty, racial and economic segregation, social networks, social organization, and political organization
  • Physical Environment: both the characteristics of the physical environment, such as air and water and quality housing conditions, and the relative connectedness or isolation of a community to resources and opportunities
  • Services: the level of access to and quality of health services and other supportive public, private, and commercial services that lead to healthy living

• Life-Course Approach: Neighborhoods’ effect on health change overtime, depending on many factors, including age. A life-course approach to research and interventions looks at how neighborhood factors affect health and health behavior over a person’s lifetime.¹

• Critical Pathways: Analysis of the pathways that influence health from root causes through injury and illness. The pathways include Root Factors-Behavioral and Environmental Factors-Medical Services-Disparities in Health.²

• Spectrum of Prevention: Developed by Larry Cohen and Contra Costa County, the Spectrum of Prevention provides a multilevel framework for addressing the social, community, environmental, and individual factors related to health and making sustainable change. It is now a key framework promoted by Prevention Institute. The framework includes:

• Community-Based Participatory Research: Community-Based Participatory Research (CBPR) in health is a collaborative approach to research that equitably involves all partners in the research process and recognizes the strengths that each brings. It starts with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and to eliminate health disparities.³ CBPR “turns on its head” the more traditional applied research paradigm in which the outside researcher determines the question, the tools, the interventions, and the type of results and outcomes documented and valued.⁴

  The following are some fundamental characteristics of CBPR: participatory and cooperative, engaging community members and researchers in a joint process. CBPR is also a co-learning process, involves systems development and local community capacity building, empowers participants to gain more control over their lives, and achieves a balance between research and action.⁵ The IOM, the CDC, and other agencies are recommending that CBPR be one of the six areas on which academics and organizations should place a greater emphasis.

References
¹ Policy Link, 2002.
² Health for All, 2003.
³ Minkler and Wallerstein, 2003.
⁴ Gaventa, 1993.
⁵ Israel et al., 1998.