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The following resources
have been gathered to supplement the Curricula Enhancement Module Series.
Return to
the table of contents to navigate to resources from other modules.
Public Health in
a Multicultural Environment Resources
Journals,
Journal Articles, and Books, by Category (print materials that may be ordered
and/or purchased)
Electronic Resources and
Web links (electronic materials that may
be
accessed
at no
cost)
Journals, Journal
Articles, and Books, by Category
Community-Based Participatory
Research
American Journal
of Public Health, August 2003. This issue focuses on public health
advocacy and includes an article on challenges
and strategies
to obtain funding for Community-Based Participatory Research.
American
Journal of Public Health, September 2003, 93 (9). This issue focuses
on the built environment and health. The article “Jemez
Pueblo: Built and Social-Cultural Environments and Health Within
a Rural American Indian
Community in the Southwest” describes
a study that used participatory research to uncover sociocultural
and environmental
factors that indicate capacity for improving health.
Friere,
P. (1982). Creating alternative research methods: Learning to do
it by doing it. In B. L. Hall Gillette & R. Tandon (Eds.), Creating
knowledge: A monopoly? Participatory research in development. New Delhi: Society for Participatory Research in Asia.
Israel, B.
Schulz, A., Parker, E. & Becker, A. (2001). Community-based
participatory research: Policy recommendations for promoting
a partnership approach in health research. Education for Health, 14(2), 182-197.
Minkler, M., & Wallerstein,
N. (Eds.). (2003). Community-based participatory research for health. San Francisco:
Jossey-Bass.
Mohatt, G.V., Hazel,
K.L., Allen, J., Stachelrodt, M., Hensel, C. & Fath,
R. (2004). "Unheard Alaska: Culturally anchored participatory
action research on sobriety with Alaska Natives." American
Journal of Community Psychology, 33 (3-4), 263-273.
Rich, J.L. (2004).
"Positive results: Community/research partnerships bear fruit." HIV
Impact, July/August.
Washington,
D.C.: Office
of Minority Health. See http://www.omhrc.gov/OMH/sidebar/omh-publications.htm.
Viswanathan
M, Ammerman A, Eng E, Gartlehner G, Lohr KN, Griffith D, Rhodes S,
Samuel-Hodge C, Maty S, Lux, L, Webb L, Sutton SF, Swinson T, Jackman
A, Whitener L. (2004). "Community-Based Participatory Research: Assessing
the Evidence."
Evidence Report/Technology
Assessment No.
99, see http://www.ahrq.gov/clinic/evrptpdfs.htm#cbpr.
Socioeconomical
Factors, Health Disparities, and Social Justice
VIDEO. Race,
Class, and Health Town Meeting Video Teleconference (2000). According to the
Web site
from NACCHO, this
tape “explores racial
and class legacies associated with the social
determinants shaping the health of the nation.
Particular attention
is given to case studies from
communities examining how racial and class divisions
create inequities in health status and strategies
to eliminate them.” Order from http://www.naccho.org/prod125.cfm.
Acheson D. (1998).
Independent inquiry into health inequalities report. London: The Stationary
Office.
Adler, N. E., Boyce,
T., Chesney, M., Cohen, S., Folkman, S., Kahn, R., & Syme,
S.L. (1994). "Socioeconomic status and health:
The challenge of the gradient." American
Psychologist, 49(1), 15-24.
Alderete, E., & Vega,
W. A., Kolodny, B., & Aguilar-Gaxiola,
S. (2000). "Lifetime prevalence of and
risk factors for psychiatric disorders among
Mexican migrant farmworkers in California." American
Journal of
Public Health, 90(4), 608–614.
Azevedo-Garcia,
D., & Lochner, K. (in press). "Residential
segregation and health." In I. B. Kawachi & L.
Berkman (Eds.), Neighborhoods and
health. London: Oxford University Press.
Betancourt,
J., Green, A., & Carrillo, J. (2003,
July–August).
"Defining cultural competence: A practical
framework for addressing racial/ethnic
disparities in health and health care."
Public Health Reports, 118, 293–302.
Evans, G.W. (2004).
"The Environment of childhood poverty." American Psychologist, February/March,
77-92.
Goldman, N. (2001).
"Social inequalities in health: Disentangling the underlying
mechanism."
Annals
of the New York Academy
of Sciences, 118–139.
Hofrichter,
R. (Ed.). (2003). Health
and social justice: Politics,
ideology
and
inequity in
the distribution
of disease. San Francisco:
Jossey-Bass.
Krieger, N., & Higgins,
D. (2002). "Housing and health:
Time again for public health
action." American
Journal of Public Health, 92, 758–768.
Marmot, M. G., & Wilkinson,
R. G. (2000). The social determinants of health. London: Oxford University
Press.
Marmot, M., & Wilkinson,
R. G. (Eds.). (1999). Social determinants of health. Oxford: Oxford
University Press.
Roberts, E. M. (1997).
"Neighborhood social environments and
the distribution of
low birthweight in Chicago."
American Journal
of Public Health, 87(4), 597–603.
Shipler,
D. K. (2004). The
working poor: Invisible
in
America. New
York: Knopf
Publishing.
Engaging
and Enhancing Community
Kretzmann, J. P., & McKnight,
J. (1993). Building communities from the inside out: A path toward
finding and
mobilizing a community’s
assets. Chicago:
ACTA Publications.
McKay, M., Davis,
M., & Fanning,
P. (1995). Messages:
The communication
skills book. Oakland: New
Harbinger Publications.
McKnight,
J.
(1995). The
careless society:
Community
and its
counterfeits. New York: Basic
Books,
Harper Collins
Publishers.
Minkler
M. (Ed.). (1999).
Community
organizing & community
building
for health.
New
Brunswick:
Rutgers University
Press.
Tervalon,
M., & Murray-Garcia,
J. (1998).
"Cultural
humility
versus
cultural
competence:
A critical
distinction
in defining
physician
training
outcomes."
Journal
of Health
Care
for the
Poor and
Underserved, 99(2).
Vasquez,
H., & Femi,
I. (1993).
No
boundaries:
A manual
for unlearning
oppression
and building
multicultural
alliances. Oakland:
TODOS, Scherover-Simms
Alliance
Building
Institute.
Resources to Inform
Change Efforts
Allensworth, E.
M., & Rochin,
R. I. (1998).
"Ethnic transformation
in rural California:
Looking beyond
the immigrant
farm worker."
Rural Sociology, 63, 126-51.
Aspen
Institute.
(2002). Voices
from the
field II: Reflections
on comprehensive
community
change. Washington,
DC: Aspen
Institute.
Chaskin,
R., & Brown,
P. (1996).
"Theories
of neighborhood
change."
In R. Stone
(Ed.),
Core
issues
in comprehensive
community-building
initiatives. Chicago: Chapin
Hall
Center
for Children,
University
of Chicago.
Evans,
T.,
Garwick, A & Rinehart,
P.M.
(1999).
Improving
care
for
children with
special
health
care
needs
from
diverse
cultural
backgrounds:
An
action plan. Health
Resources & Services
Administration.
U.S.
Public
Health
Service.
http://www.ask.hrsa.gov/.
Friere
P.
(1973).
Education
for
critical
consciousness. New
York:
Seabury
Press.
Gladwell,
M. (2000,
2002). The
tipping point:
How little
things can
make a
big difference. New York:
Little, Brown
and Company.
Hofstede,
G. (1987).
Culture's consequences:
International differences
in work-related
values, abridged
ed. Beverly
Hills, London:
Safe Publications.
Scott,
G. (1990).
Resolving conflict
with others. Oakland: New
Harbinger Publications.
Tannen,
D. (1998).
The Argument
Culture: Moving
from Debate
to Dialogue. New York:
Random House.
Trompenaars,
F. (1993).
Riding the
waves of
culture: understanding
cultural diversity
in business. London: Nicholas
Brealey.
Individual
and Personal
Cultural
Perspectives
Baldwin,
J. A. (1963).
The
fire next
time. New York:
Random
House.
Fadiman,
A. (1997).
Spirit
catches
you and
you fall
down. New York:
Noonday
Press.
McIntosh,
P.
(1989, July/August).
"White
privilege:
Unpacking
the
invisible
knapsack."
Peace
and
Freedom, 10–12.
Takaki,
R.
(1993).
A
difference
mirror:
A
history of
multicultural
America. The Jossey-Bass
Social
and
Behavioral
Science
Series.
Boston:
Little,
Brown
and
Company.
Racism,
Discrimination, and Stereotyping
Clark, R.,
Anderson,
N.B., Clark,
V.R. & Williams,
D.R. (1999).
"Racism
as a stressor
for African
Americans:
a Biopsychosocial
model."
American
Psychologist, 54(10)
805-816.
Federal
Interagency
Working
Group
on Limited
English
Proficiency,
comprehensive
information
geared
to
Federal
agencies,
recipients
of
Federal
funds,
and communities,
at http://www.lep.gov.
Jones,
C.
P. (2000).
"Levels
of
racism: A theoretic
framework
and
a gardener's
tale."
American
Journal
of
Public Health, 90,1212–1215.
VIDEO.
A
Tale of “O”.
(2003,
revised
edition).
A
bestseller
in
diversity
training, “O” is
a
parable
about
what
happens
to
any
new
or
different
kind
of
person
in
a
group.
Available
with
Instructor’s
and
User’s
Guides,
along
with
the
video,
from
http://www.hrpress-diversity.com/taleofo.html.
Also
available
with
option
to
rent
from
http://www.trainerstoolchest.com.
Rutstein,
N. (1993).
Healing racism
in America
: a
prescription for
the disease. Springfield, MA
: Whitcomb
Publishers.
Social
Capital
Kawachi,
I.
B. (1999).
Social
capital
and
community effects
on
population and individual
health. Annals
of
the
New York
Academy
of
Science, 896,120–130.
Kawachi,
I.,
Kennedy,
B., & Glass,
R.
(1999).
"Social
capital
and
self-rated
health:
A
contextual
analysis."
American
Journal
of
Public
Health, 89,
1187–1193.
Transformative
Leadership
and
Change
Management
Argyris,
C. (1992).
On Organizational
Learning Cambridge. Blackwell Publishers.
Argyris,
C. (1993).
Knowledge for
Action: A
Guide to
Overcoming Barriers
to Organizational
Change San
Francisco. Jossey-Bass
Publishers.
Capra,
F. (1996).
The Web
of Life:
A New
Scientific Understanding
of Living
Systems. New
York: Anchor
Books Doubleday.
Covey,
S.R. (1990).
The 7
Habits of
Highly Effective
People. New
York: Simon & Schuster.
Covey,
S. R.
(1990). Principle-Centered
Leadership. New
York: Simon & Schuster.
Bernard,
T. & Young,
J. (1997) The Ecology
of Hope: Communities
Collaborate
for Sustainability. East
Haven: New Society Publishers.
Block,
P. (1996)
Stewardship: Choosing
Service over
Self-Interest. San
Francisco: Berrett-Koehler
Publishers.
Bolman,
L.G. & Deal,
T.E. (1991). Reframing Organizations:
Artistry,
Choice and Leadership. San Francisco: Jossey-Bass
Publishers.
Dreachslin,
J. L., & Hunt,
P. L. (1996). Diversity
leadership. Chicago:
Health Administration Press.
Emery,
M. & Purser,
R.E. (1996). The Search
Conference: A Powerful Method for Planning
Organizational Change and Community Action. San
Francisco:
Jossey-Bass.
Fisher,
R. & Ury,W.
(1981). Getting to Yes:
Negotiating Agreement Without Giving
In. Boston: Houghton Mifflin.
Heifetz,
R. A.
(1994). Leadership
without easy
answers. Cambridge,
MA: Belknap
Press.
Kouzes,
J. M., & Posner,
B. Z. (1990). The leadership
challenge. San Francisco:
Jossey-Bass.
Kotter,
J.P. (1995).
"Leading change:
Why transformation
efforts fail."
Harvard Business
Review, March/April.
To order
online, see
http://harvardbusinessonline.hbsp.harvard.edu/b02/en/hbr/hbr_home.jhtml.
Senge,
P. M.,
Ross, R.,
Smith, B.,
Roberts, C., & Kleiner,
A. (1994). The fifth
discipline fieldbook: Strategies and
tools for building a
learning
organization. New York:
Currency & Doubleday.
Senge,
P.
M.
(1990).
The
fifth
discipline:
The
art
and
practice
of
the
learning
organization. New
York:
Currency & Doubleday.
Senge,
P.,
Kleiner,
A.,
Ross,
R.,
Smith,
B.;
Roberts,
C.
(1999).
The
Dance
of
Change:
The
Challenges
to
Sustaining
Momentum
in
a
Learning
Organization. New
York:
Currency.
Swartz,
P.
(1991).
The
Art
of
the
Long
View:
Planning
for
the
Future
in
an
Uncertain
World. New
York:
Currency/Doubleday.
Ury,
W.
(1991).
Getting
Past
No:
Negotiating
Your
Way
From
Confrontation
to
Cooperation. New
York:
Bantam
Books.
Wheatley,
M.J.
(1994).
Leadership
and
the
New
Science:
Learning
about
Organization
from
an
Orderly
Universe. San
Francisco:
Berret-Koehler
Publishers.
Electronic
Resources
Leadership for
Policy Change: Strengthening Communities of Color through Leadership
Development, a report by Policy Link, calls for the intentional
recruitment of persons of color for leadership training. This report
also emphasizes the importance of a demonstrated commitment to social
justice. See http://www.policylink.org/publications.html.
The Center for the
Health Professions, in partnership with the California Association
of Public Hospitals and Health Systems and the California Health Care
Safety Net Institute, "LEADing Organizational Change: Advancing
Quality Through Culturally Responsive Care." The California Endowment
funded this project, and its Principal Investigator is Sunita Mutha,
M.D.See http://futurehealth.ucsf.edu/cnetwork/index.html.
Directory of
Funding Sources for Community-Based Participatory Research (2004).
S. D. Seifer, J. Kauper-Brown, & A. Robbins (Eds.). Community-Campus
Partnerships for Health. Available for download from http://depts.washington.edu/ccph/.
Public health and
aging: Trends in aging—United States and worldwide (2003). Morbidity
and Mortality Weekly Report, 52(06), 101–106. Retrieved
from Internet on July 12, 2004, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5206a2.htm.
The Office of Civil
Rights has resources on health disparities, limited English Proficiency,
national origin discrimination, and New Freedom Initiative – Disability
at http://www.hhs.gov/ocr/.
Joseph Rowntree Foundation.
This foundation’s Web site has information and resources to support
community-based participatory action research methodologies, http://www.jrf.org.uk/home.asp.
Low Pay, High
Risk: State Models for Advancing Immigrant Workers’ Rights (updated
November 2003). From the National Employment Law Project, http://www.nelp.org.
Community Solutions
to Health Disparities Database at http://www.apha.org/NPHW/solutions/.
Minority Healthcare
Quality, Improvement Strategies (2004) from the Agency for Healthcare
Research and Quality, see http://www.ahrq.gov/clinic/tp/minqualtp.htm.
Community-Based Participatory
Research: Assessing the Evidence from the Agency for Healthcare Research
and Quality, available online in .pdf version, see http://www.ahrq.gov/clinic/evrptpdfs.htm#cbpr.
Resource from policy
link on how community builders achieve equitable development of healthy
communities. See http://policylink.org/EquitableDevelopment/.
Grantmakers in Health,
with support from the California Endowment and the Robert Wood Johnson
Foundaton, published a report, In the Right Words: Addressing Language
and Culture in Providing Health Care (2003). This report describes
the consequences of language barriers on health care outcomes, provides
an overview of relevant laws and policies, and highlights strategies
for improving language access. It is available for download from http://www.calendow.org/reference/publications/pdf/cultural/In_the_Right_Words082003.pdf.
Models and resources
for collaboration from the Prevention Institute at http://www.preventioninstitute.org/tools.html#eightsteps.
NACCHO offers such
publications as The Social Determinants of Health and Health Inequities (2002),
which includes interdisciplinary readings that cover research and analysis
on health inequities, social determinants of health, and social and
economic inequality more broadly. For this publication and others,
see http://www.naccho.org.
APHA policy statements
on Research and Intervention on Racism as a Fundamental Cause of
Ethnic Disparities in Health (2001); Support for Culturally
and Linguistically Appropriate Services in Health and Mental Health
Care (2001); Protection of the Health of Resident Immigrants
in the United States (2001); and Effective Interventions for
Reducing Racial and Ethnic Disparities in Health (2000) at http://www.apha.org/legislative/policy/.
Harvard School of
Public Health, the Public Health Disparities Geocoding Project Monograph.
Geocoding and monitoring U.S. socioeconomic inequalities in health:
An Introduction to using area-based socioeconomic measures. See http://www.hsph.harvard.edu/thegeocodingproject.
The Implications
of Cultural and Linguistic Competence for Evidence-Based Practice
(Public
Health in a Multicultural Environment: Appendix A)
Developed by
Tawara Goode, NCCC, 2004
- Is there a
structure within the program to bridge the gap between current
research and implications for clinical practice for racially
and ethnically diverse groups?
- Are there
program staff who routinely survey research studies and emerging
bodies of evidence?
- Is there a
mechanism to examine research findings and their implications
for policy and clinical protocols within the program?
- Is there a
program emphasis to either contribute to and/or examine current
research related to ethnic and racial disparities in health and
quality improvement?
- Is there a
mechanism to keep abreast of new developments in pharmacology,
particularly as they relate to racially and ethnically diverse
groups?
- Does the program
have a systematic approach to provide evidence-based or best
practice interventions that have proven efficacy for specific
racial and ethnic populations?
- Is there a
forum to share research findings and interests related to racial
and ethnic disparities in health?
- Are there
incentives and grant support to pursue and/or contribute to research
on racial and ethnic health disparities?
Definitions
(Public Health in a Multicultural Environment:
Appendix B)
This list is
a selection of definitions. These may be adapted or additional
terms used and tailored to the conditions, preferences, and needs
of specific
organizations and/or specific communities.
Culture: Numerous
definitions of culture exist from anthropology, psychology, and
other disciplines. A frequently cited article by Kroeber and Kluckhohn
in 1952 found 164 definitions of culture. Although there is not
an agreed-on definition, a useful definition for purposes of examining
culture and health is “a set of learned and shared beliefs
and values that are applied to social interactions and to the interpretation
of experiences. Individuals will often embrace more than one culture
at the same time” (Mutha, Allen, & Welch, University
of California, San Francisco (UCSF), 2002).
Culture: “Culture
consists of patterns, explicit and implicit, of and for, behavior
acquired and transmitted by symbols, constituting the distinctive
achievement of human groups, including their embodiments in artifacts;
the essential core of culture consists of traditional (i.e., historically
derived and selected) ideas and especially their attached values;
culture systems may, on the other hand, be considered as products
of action, on the other as conditioning elements of further action.” (p.
181) of Kroeber, A. L., & Kluckhohn, C. (1952). Culture:
A critical review of concepts and definitions. New York: Random
House.
Concept of
Culture: The understanding that culture plays a controlling
role in shaping how people perceive reality, acquire a sense
of self, think, feel, behave, and understand the behaviors of
others. It includes an understanding that there is variation
in the degree and extent of a shared culture among individuals
in a cultural group.
Ethnocentrism: The
assumption that the beliefs, values, norms, and behaviors of one’s
own culture are the correct ones and that those of other cultures
are inferior or misguided.
Cross-cultural: Action
or understanding that involves a comparison of or action across
more than one culture.
Acculturation: “Those
phenomenon which result when groups of people having different
cultures come into continuous first hand contact, with subsequent
changes in the original pattern of either or both groups” (Redfield,
Linton, & Herskovits, 1936). Given the significant historical
and projected influx and growth of immigrant populations, acculturation
is an important factor to consider in delivering services to multicultural
populations and in leading a diverse workforce. Birman developed
a two- factor model that described four types of acculturation
to the culture of origin and new host culture (Birman, 1994). These
included biculturalism, assimilation, marginalization, and separation/traditionalism.
Health behavior, beliefs, and mediating factors such as social
capital may be influenced by these factors. Therefore, they should
be studied and considered for intervention. Acculturation changes
over time and varies by the age of the individual or group. Health
status may also change over time.
Culture and
Health: Culture plays a critical role in an individual’s
approach to health and healthy living. Cultures vary in perceptions
of illness and their causes; beliefs with respect to health,
healing, and wellness; adoption of health behaviors; and attitudes
toward providers and the health care system (Goode & Dunne,
2003).
Medical Pluralism: The use of treatments or healing
from more than one medical system simultaneously or consecutively.
Multicultural: Characterized
by two or more cultures.
Multicultural
Health: Organizations and individuals interacting, communicating
with, and/or delivering health services to individuals and populations
representing multiple cultures. The focus in multicultural health
care is on providing public health functions and/or health care
services to individuals, groups, and communities representing
multiple cultures and those representing specific individual
cultures.
Cultural
Competency and Proficiency: There are many definitions.
Please refer to the extensive definitions in Section
B, Cultural & Linguistic Competence: Rationale, Conceptual
Frameworks, and Values.
Cultural
Humility: A process of lifelong commitment to self-evaluation
and self-critique, to readdressing the power imbalances in patient-physician
and/or organization dynamics and to developing mutually beneficial
and non-paternalistic clinical and advocacy partnerships with
communities. The process involves active engagement in a lifelong
process that individuals enter into with patients, communities,
colleagues, and themselves. The process requires humility to
develop and maintain mutually respectful and dynamic partnerships
(Tervalon & Murray-Garcia, 1998).
Organizations
and Individuals Responsible for Public Health: Because of
the multitude of social, environmental, and behavioral factors
that influence the health of multicultural populations, responsibility
for public health includes but extends beyond health care and
public health organizations and providers. This responsibility
includes all individuals, systems, and institutions in a community
or region.
Health Disparities: Differences
in the incidence, prevalence, and burden of disease and other adverse
conditions that exist among specific population groups. Many organizations
are now using the term health inequities instead of disparities
because it more accurately reflects that the root causes are related
to societal, economic, and health care inequities.
Social Determinants: The
social conditions in which people live daily including interactions
with family, friends, community members, and institutions that
have an influence on their health risks and behavior, lifestyle,
and access to care and treatment.
Risk and
Protective Factors: Factors that exist among communities
and/or cultures that either increase or protect against health
risk. Risk factors include racial and economic segregation, concentrated
poverty, lack of social support, cultural practices, and lack
of organizational and political power, etc. Protective factors
include cohesion and sense of community, social support from
friends and families, cultural practices, access to affordable
high-quality housing, and civic engagement. Different cultural
groups within the same physical community may have different
risk and protective factors. Different cultural groups also have
culturally driven behaviors that protect or cause risk for individuals
within those groups.
Social Capital: Social
capital can be a key protective factor: “Those features of
social organization, such as the extent of interpersonal trust
among citizens, norms of reciprocity, and destiny of civic associations
that facilitate cooperation for mutual benefit” (Kawachi,
Kennedy, Gupta, & Prothrow-Smith, 1997). An individual, group,
or community’s level and nature of social capital are mediating
factors , along with other risk and protective health factors.
Primary Prevention: Addressing
the underlying causes of disease before poor health occurs. Taking
action before a condition arises rather than when problems already
exist. It focuses on changing conditions at the community level
rather than at the individual or group level. It also focuses on
system-level change (Eliminating Health Disparities: The Role
of Primary Prevention, Prevention Institute, 2002). Upstream
interventions are viewed as primary prevention.
Syndemics: Two
or more afflictions interacting with each other (CDC, retrieved
from Internet August 19, 2004). A syndemic orientation is primarily
distinguished from other perspectives by its explicit emphasis
on examining connections between health-related problems. With
this concern, it offers a broader framework for understanding how
multiple health problems interact in particular communities. A
syndemic orientation elevates public health inquiry beyond its
many individual categories to examine directly the conditions that
create and sustain overall community health.
“The
syndemic model provides an important intermediate model that
frames the investigation of community level outcomes in terms
of individual behavior, local processes, and higher level processes.
The syndemic model raises difficult questions and challenges
public health to address the root causes of health disparities.
By introducing a multi-level, dynamic epidemiological perspective,
it points toward the need to develop and evaluate systems-
and community-level interventions that target linked processes” (MacQueen,
in Breslow et al., 2002).
Whereas the usual
public health approach begins by defining the disease in question,
a syndemic orientation first defines the community in question.
With this frame of reference, it goes on to identify links among
the entire set of issues that create excess burden of disease among
the community's members. In practice, a syndemic orientation follows
a specific line of questioning: Who is sick, and with which diseases?
Why those people? Why those diseases? What can be done to create
(or restore) the conditions for optimal health? Under what circumstances
do interventions contribute to improvements in health status and
health equity? (CDC, 2004 see http://www.cdc.gov/syndemics/).
Built Environment: The
man-made infrastructure of a community such as street design, public
transportation, and permitted uses of buildings. Design and use
influence behavior, including physical activity/nutrition, and
tobacco and alcohol use. Design and use also affect such priority
issues as mental health and trauma. This concept of built environment
also includes the health care setting itself. Innovation in built
environments is exemplified in the work of (1) Ulricht and Zimring
of Georgia Tech University and the Center for Health Design (http://www.healthdesign.org/),
bringing evidence-based design for hospitals, to decrease staff
error; to decrease patient, family, and staff stress; and to enhance
comfort; and (2) The Initiative on Active Living includes programs
to stimulate and support research that will identify environmental
factors and policies that influence physical activity (http://www.rwjf.org).
These are funded and highlighted by the Robert Wood Johnson Foundation.
Social Structure: The
overall arrangements and relationships, including power and resource
differentials, among a society’s individuals, groups, and
institutions. The ability of public health professionals to enact
their roles in providing care to the population is heavily impacted
by social structural variables. The health status of individuals
or groups within a society is likewise dependent on social structural
factors. When there are clear disparities in the health status
of groups within a society, aspects of the social structure must
be examined and, if necessary, changed through advocacy and action
to achieve social justice in the health of the public.
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