Social Determinants of Health: Impl

Social Determinants of Health: Implications for Environmental Health Promotion
http://heb.sagepub.com/cgi/content/abstract/31/4/455 The online version of this article can be found at:
Published by:
http://www.sagepublications.com
On behalf of:
Society for Public Health Education
can be found at:Health Education & Behavior Additional services and information for
http://heb.sagepub.com/cgi/alertsEmail Alerts:
http://heb.sagepub.com/subscriptionsSubscriptions:
http://www.sagepub.com/journalsReprints.navReprints:
http://www.sagepub.com/journalsPermissions.navPermissions:
http://heb.sagepub.com/cgi/content/refs/31/4/455 Citations
http://heb.sagepub.com at UNIV OF SOUTH FLORIDA on February 24, 2010 Downloaded from
10.1177/1090198104265598 ARTICLEHealth Education & Behavior (August 2004) Schulz, Northridge / Social Determinants of Health August Social Determinants of Health: Implications for Environmental Health Promotion
Amy Schulz, PhD, MPH Mary E. Northridge, PhD, MPH
Inthisarticle,theauthorsdrawonthedisciplinesofsociologyandenvironmentalandsocialepidemiologyto furtherunderstandingofmechanismsthroughwhichsocialfactorscontributetodisparateenvironmentalexpo- suresandhealthinequalities.Theyproposeaconceptualframeworkforenvironmentalhealthpromotionthat considers dynamic social processes through which social and environmental inequalities—and associated healthdisparities—areproduced,reproduced,andpotentiallytransformed.Usingempiricalevidencefromthe publishedliterature,aswellastheirownpracticalexperiencesinconductingcommunity-basedparticipa- tory research in Detroit and Harlem, the authors examine health promotion interventions at various levels (community-wide,regional,andnational)thataimtoimprovepopulationhealthbyaddressingvariousaspects of social processes and/or physical environments. Finally, they recommend moving beyond environmental remediation strategies toward environmental health promotion efforts that are sustainable and explicitly designed to reduce social, environmental, and health inequalities.
Keywords: socialdeterminantsofhealth;healthdisparities;environmentalhealthpromotion;healthpromo- tion interventions; population health
Theproximate goalof thisarticleistocontributetotheconceptualizationof social determinantsofhealth,withaparticularfocusonenvironmentalhealthissues;themore ambitious long-term goal is to better ensure that environmental health promotion pro- gramsareexplicitlydesigned—andthereforemoreeffective—indecreasingdisparities inhealthwithinandacrosspopulationgroups.Ourparticularinterestslieinunderstand- ing how social and environmental inequalities contribute to health disparities. For instance,inequalitiesresultingfromracismandthedistributionofmaterialresourceslead to unequal burdens of physical,chemical,and biological exposures (i.e., disparitiesin environmental exposures) within and across communities (both geographically and sociallydefined).Socialinequalitiesalsocontributetounequalimpactsofenvironmen- tal exposures as communities experience differential access to resources that help to
455
AmySchulz,DepartmentofHealthBehaviorandHealthEducation,UniversityofMichigan,SchoolofPub- licHealth,AnnArbor.MaryE.Northridge,MailmanSchoolofPublicHealth,ColumbiaUniversity,NewYork. AddressreprintrequeststoAmySchulz,DepartmentofHealthBehaviorandHealthEducation,University ofMichigan,SchoolofPublicHealth,1420WashingtonHeights,AnnArbor,MI48109-2029;phone:[phone]; fax: [phone]; e-mail: [e-mail]. TheauthorswishtothankourcolleaguesDavidWilliams,BarbaraIsrael,LoraLempert,andElliottSclarfor contributionstotheframeworkdescribedinthisarticle.Furthermore,wearegratefulfortheconstructivecom- mentsreceivedfromparticipantsintheworkingconferenceonEnvironmentalHealthPromotion,LasVegas, Nevada,inMay2003.Inaddition,wethankSueAndersenforhercontributionstothepreparationofthisarticle.
Health Education & Behavior, Vol. 31 (4):455-471 (August 2004) DOI:10.1177/1090198104265598 © 2004 by SOPHE
at UNIV OF SOUTH FLORIDA on February 24, 2010 http://heb.sagepub.comDownloaded from
mitigatethenegativeeffectsofunequalburdens(e.g.,nutritiousfoodsandqualitymedi- cal care). Drawingonourrespectivedisciplinesofsociologyandepidemiology,wedelineate herevariousmechanismsthroughwhichsocialfactorscontributetodisparateenviron- mentalexposuresandthuscontributetohealthinequalities.Wefirstproposeaconceptual framework for understanding environmental health disparities that builds on and inte- gratesotherframeworks.Next,weexaminetheinterfacebetweensocialinequalitiesand four environmental health concerns in order to illustrate diverse mechanisms through which socioeconomic inequalities and aspects of the physical environment together shape health disparities by race/ethnicity, social class, gender, sexuality, and other so- ciallydefinedcategories.Weendbyrecommendingstrategiesformovingenvironmental health promotion efforts beyond environmental remediation and toward sustainable healthpromotionthatmayultimatelyr

Hasil (Bahasa Indonesia) 1:

Determinan sosial Kesehatan: implikasi untuk promosi kesehatan lingkunganhttp://Heb.sagepub.com/CGI/Content/Abstract/31/4/455 versi online artikel ini dapat ditemukan di: Diterbitkan oleh:http://www.sagepublications.com Bertindak untuk: Masyarakat untuk pendidikan kesehatan masyarakat dapat ditemukan di: Pendidikan Kesehatan & perilaku tambahan layanan dan informasi untuk http://Heb.sagepub.com/CGI/alertsEmail Alert: http://Heb.sagepub.com/subscriptionsSubscriptions: http://www.sagepub.com/journalsReprints.navReprints: http://www.sagepub.com/journalsPermissions.navPermissions: http://Heb.sagepub.com/CGI/Content/refs/31/4/455 kutipanhttp://Heb.sagepub.com di UNIV OF SOUTH FLORIDA pada 24 Februari 2010 di-download dari 10.1177 1090198104265598 ARTICLEHealth Pendidikan & perilaku (Agustus 2004) Schulz, Northridge / sosial faktor-faktor penentu kesehatan Agustus determinan sosial Kesehatan: implikasi untuk promosi kesehatan lingkunganAmy Schulz, PhD, MPH Mary E. Northridge, PhD, MPHInthisarticle, theauthorsdrawonthedisciplinesofsociologyandenvironmentalandsocialepidemiologyto furtherunderstandingofmechanismsthroughwhichsocialfactorscontributetodisparateenvironmentalexpo-suresandhealthinequalities. Theyproposeaconceptualframeworkforenvironmentalhealthpromotionthat menganggap dinamis proses sosial melalui kesenjangan sosial dan lingkungan yang — dan terkait healthdisparities — areproduced, direproduksi, andpotentiallytransformed. Usingempiricalevidencefromthe publishedliterature, aswellastheirownpracticalexperiencesinconductingcommunity-basedparticipa-tory penelitian di Detroit dan Harlem, kedua penulis menguji intervensi promosi kesehatan di berbagai tingkat (masyarakat luas, regional, andnational) thataimtoimprovepopulationhealthbyaddressingvariousaspects proses sosial dan/atau lingkungan fisik. Akhirnya, mereka merekomendasikan bergerak di luar rehabilitasi lingkungan strategi terhadap upaya promosi kesehatan lingkungan yang berkelanjutan dan secara eksplisit dirancang untuk mengurangi sosial, lingkungan, dan Kesehatan kesenjangan.Kata kunci: socialdeterminantsofhealth; healthdisparities; environmentalhealthpromotion; healthpromo-tion intervensi; Kesehatan pendudukTheproximate goalof thisarticleistocontributetotheconceptualizationof sosial determinantsofhealth, withaparticularfocusonenvironmentalhealthissues; themore ambisius tujuan jangka panjang adalah untuk lebih baik memastikan bahwa kesehatan lingkungan promosi pro-gramsareexplicitlydesigned — andthereforemoreeffective — indecreasingdisparities inhealthwithinandacrosspopulationgroups. Ourparticularinterestslieinunderstand-ing bagaimana sosial dan lingkungan ketidaksetaraan berkontribusi pada Kesehatan kesenjangan. Misalnya, inequalitiesresultingfromracismandthedistributionofmaterialresourceslead untuk tidak seimbang beban fisik, kimia, dan biologi eksposur (yaitu, disparitiesin paparan lingkungan) dalam dan di komunitas (baik geografis dan sociallydefined). Socialinequalitiesalsocontributetounequalimpactsofenvironmen - tal eksposur sebagai masyarakat pengalaman diferensial akses ke sumber daya yang membantu455AmySchulz,DepartmentofHealthBehaviorandHealthEducation,UniversityofMichigan,SchoolofPub- licHealth,AnnArbor.MaryE.Northridge,MailmanSchoolofPublicHealth,ColumbiaUniversity,NewYork. AddressreprintrequeststoAmySchulz,DepartmentofHealthBehaviorandHealthEducation,University ofMichigan,SchoolofPublicHealth,1420WashingtonHeights,AnnArbor,MI48109-2029;phone:[phone]; fax: [phone]; e-mail: [e-mail]. TheauthorswishtothankourcolleaguesDavidWilliams,BarbaraIsrael,LoraLempert,andElliottSclarfor contributionstotheframeworkdescribedinthisarticle.Furthermore,wearegratefulfortheconstructivecom- mentsreceivedfromparticipantsintheworkingconferenceonEnvironmentalHealthPromotion,LasVegas, Nevada,inMay2003.Inaddition,wethankSueAndersenforhercontributionstothepreparationofthisarticle.Health Education & Behavior, Vol. 31 (4):455-471 (August 2004) DOI:10.1177/1090198104265598 © 2004 by SOPHE at UNIV OF SOUTH FLORIDA on February 24, 2010 http://heb.sagepub.comDownloaded from mitigatethenegativeeffectsofunequalburdens (e.g.,nutritiousfoodsandqualitymedi-cal care). Drawingonourrespectivedisciplinesofsociologyandepidemiology, wedelineate herevariousmechanismsthroughwhichsocialfactorscontributetodisparateenviron-mentalexposuresandthuscontributetohealthinequalities. Wefirstproposeaconceptual kerangka untuk memahami lingkungan Kesehatan kesenjangan yang dibangun berdasarkan dan inte-gratesotherframeworks. Selanjutnya, weexaminetheinterfacebetweensocialinequalitiesand empat masalah kesehatan lingkungan untuk menggambarkan berbagai mekanisme melalui mana kesenjangan sosial ekonomi dan aspek lingkungan fisik bersama-sama membentuk Kesehatan kesenjangan oleh ras/etnis, kelas sosial, jender, seksualitas, dan lainnya sehingga-ciallydefinedcategories. Weendbyrecommendingstrategiesformovingenvironmental upaya promosi kesehatan luar rehabilitasi lingkungan dan ke arah healthpromotionthatmayultimatelyr berkelanjutan