I agree that at times the structural determinants are over emphasised or perhaps inaccurately described (over simplified discussions concerning variables and their influence on health outcomes). An example being models that emphasis the % of health impacted by environmental factors Vs medical Vs behavioural for instance.
My slight challenges and thoughts are:
I think "good" public health practice draws also on wider theories that recognise individual behaviour - COM-B as a fairly balanced model. Also power dynamics theories such as those that explore empowerment, and assets based approaches to practice. Those recognize the harm in viewing populations impacted by inequitable structural hazard exposures as being passive / in need etc.
I think in practice there is recognition that front line professionals who are well placed to have conversations about behaviors lack either the competence or confidence or both to challenge unhealthy behaviors and there are training programs aimed at addressing this. How well communities and individuals feel it socially acceptable to challenge behavior of friends and family I am less confident in and unsure how much that has changed.
Finally, I think in part the emphasis in practice on structural factors is about influencing resource allocation. So for example, some services such as access to smoking cessation may require less advocacy while the need for better quality housing may be seen as a factor that requires more emphasis?
Thanks Bex, great thoughts. Ah yes the US County Health Rankings diagram springs to mind as being used a lot to illustrate the structural point - the 80% is outside of clinical care figure - possibly over illustrating it. Agree drawing on multiple models is the wise move. Do you see that in practice? I tend to see the structural ones out front the most so curious what others are experiencing. Hmm good final point on resource allocation too, and agree, some issues are more accepted than others so need different framing and energy. Re health professionals talking to patients about ticklish topics - are we thinking MECC and other training? That's been around a while. Made any breakthroughs? or something more fundamental still not addressed that allows those conversations.
I agree that at times the structural determinants are over emphasised or perhaps inaccurately described (over simplified discussions concerning variables and their influence on health outcomes). An example being models that emphasis the % of health impacted by environmental factors Vs medical Vs behavioural for instance.
My slight challenges and thoughts are:
I think "good" public health practice draws also on wider theories that recognise individual behaviour - COM-B as a fairly balanced model. Also power dynamics theories such as those that explore empowerment, and assets based approaches to practice. Those recognize the harm in viewing populations impacted by inequitable structural hazard exposures as being passive / in need etc.
I think in practice there is recognition that front line professionals who are well placed to have conversations about behaviors lack either the competence or confidence or both to challenge unhealthy behaviors and there are training programs aimed at addressing this. How well communities and individuals feel it socially acceptable to challenge behavior of friends and family I am less confident in and unsure how much that has changed.
Finally, I think in part the emphasis in practice on structural factors is about influencing resource allocation. So for example, some services such as access to smoking cessation may require less advocacy while the need for better quality housing may be seen as a factor that requires more emphasis?
Thanks Bex, great thoughts. Ah yes the US County Health Rankings diagram springs to mind as being used a lot to illustrate the structural point - the 80% is outside of clinical care figure - possibly over illustrating it. Agree drawing on multiple models is the wise move. Do you see that in practice? I tend to see the structural ones out front the most so curious what others are experiencing. Hmm good final point on resource allocation too, and agree, some issues are more accepted than others so need different framing and energy. Re health professionals talking to patients about ticklish topics - are we thinking MECC and other training? That's been around a while. Made any breakthroughs? or something more fundamental still not addressed that allows those conversations.