Looking at the influences on health in our country can be quite the challenge. The Social Ecological Model is a theory-based framework for understanding the impact of personal and environmental factors that determine health and for identifying points within the entire system for change/health promotion. In true systems format, social ecological theory addresses individual, interpersonal, community, organizational, and policy/environment.
As a nurse, these approaches to view how we are managing health as a country fits within my personal belief system. The Neuman systems model has been the foundation of my nursing practice for many years. Neuman’s theory defines the role of the nurse as in three levels, primary prevention to protect the normal line of defense within the individual, secondary prevention to strengthen internal lines of resistance, reducing the reaction, and increasing resistance factors of the individual and their support network, and tertiary prevention to readapt and stabilize and protect reconstitution or return to wellness following treatment which encompasses the role of community, and government policies.
Finding the place to influence change as a professional, or even as a citizen can be daunting when you look at the big picture. The systems or multi level approach to change, allows for the tasks at hand to be broken down in achievable increments, allowing for individual goals but also shows the responsibility of our community, provincial and federal government. If we were to look at Domestic Violence through this lens, we would be faced with the statistics showing that Spousal Violence against women between 1999 and 2004 in Canada declined (a 1% decrease), however Newfoundland and Labrador was the only province during this five year period to show an increase in spousal violence against women (a 2% increase). One has to wonder if the connections between low income, high unemployment, higher usage of alcohol, impact this statistic. The complexity of system impacts how we fare with the social determinants of health. Across the miles to the country of Jordan, there was research beginning around identified concerns with partner violence and took the social ecological approach to assess their current state. They looked at the perception of violence and its view in the culture. Inroads were able to be met at the individual as well as interpersonal levels (counsellors/health professionals), however the laws, and overall impact religion is having in violence will need more work to help generate change in that group.
The lessons here are simple, it takes system change, will all parts aiming for the same goal to help create results. Many layers of our systems need to interact with each other to allow for the greatest growth. Our health care system needs action plans that show how the determinants of health impact outcomes for individuals. People need knowledge, access to services, satisfactory employment, healthy food, balanced social opportunities, and education to live a healthy live. To often health professionals limit themselves to the medical model where health services are the primary focus of the intervention. In the case above, we would look after these women’s’ physical wounds, maybe explore the emotional impact and leave the rest of the work to someone else. Ensuring that society is looking at health through a Social Ecological lens just may be our only hope for full system change.
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Kathleen M. Flaherty, (2017) Neuman Systems Model in Nursing Practice https://nursekey.com/neuman-systems-model-in-nursing-practice/
Retrieved February 23, 2019
Sabbah, E. A., Chang, Y., & Campbell, H. N. (2017). Understanding Intimate Partner Violence in Jordan: Application of the Ecological Model. Perspectives in Psychiatric Care, 53(3), 156–163. https://0-doi-org.aupac.lib.athabascau.ca/10.1111/ppc.12157
VIOLENCE AGAINST WOMEN IN NEWFOUNDLAND AND LABRADOR https://www.gov.nl.ca/VPI/facts/violence_against_women_fact_sheet.pdf Retrieved February 23, 2019
von dem Knesebeck, O. (2015). Concepts of social epidemiology in health services research. BMC Health Services Research, 15(1), 1–4. https://0-doi-org.aupac.lib.athabascau.ca/10.1186/s12913-015-1020-z
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