Healthy eating and exercising to reduce diabetes: exploring the potential of social determinants of health frameworks within the context of community-based participatory diabetes prevention.

OBJECTIVES We examined a community-based participatory diabetes intervention to identify facilitators of and barriers to sustained community efforts to address social factors that contribute to health. METHODS We conducted a case study description and analysis of the Healthy Eating and Exercising to Reduce Diabetes project in the theoretical context of a conceptual model of social determinants of health. RESULTS We identified several barriers to and facilitators of analysis of social determinants of a community-identified disease priority (in this case, diabetes). Barriers included prevailing conceptual models, which emphasize health behavioral and biomedical paradigms that exclude social determinants of health. Facilitating factors included (1) opportunities to link individual health concerns to social contexts and (2) availability of support from diverse partners with a range of complementary resources. CONCLUSIONS Partnerships that offer community members tangible resources with which to manage existing health concerns and that integrate an analysis of social determinants of health can facilitate sustained engagement of community members and health professionals in multilevel efforts to address health disparities.

[1]  J. Sobal,et al.  Food Choice: A Conceptual Model of the Process , 1996, Appetite.

[2]  G. Kaplan,et al.  Part III Summary , 1999 .

[3]  Marion Nestle,et al.  Food Politics , 2002 .

[4]  The political context of social inequalities and health , 2001 .

[5]  B. Swinburn,et al.  Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. , 1999, Preventive medicine.

[6]  P Whelton,et al.  Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. , 1995, Hypertension.

[7]  David R. Williams,et al.  Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health , 2001, Public health reports.

[8]  S. Kumanyika.  Racial and ethnic issues in diet and cancer epidemiology. , 1994, Advances in experimental medicine and biology.

[9]  A. Schulz,et al.  Social Determinants of Health: Implications for Environmental Health Promotion , 2004, Health education & behavior : the official publication of the Society for Public Health Education.

[10]  Bruce G. Simons-Morton,et al.  Social science theory in health education: time for a new model? [editorial] , 1993 .

[11]  David R. Williams,et al.  Understanding and Reducing Socioeconomic and Racial/Ethnic Disparities in Health , 2000 .

[12]  M. C. Marshall.  Diabetes in African Americans , 2005, Postgraduate Medical Journal.

[13]  S. Wing,et al.  CHANGING ASSOCIATION BETWEEN COMMUNITY OCCUPATIONAL STRUCTURE AND ISCHAEMIC HEART DISEASE MORTALITY IN THE UNITED STATES , 1987, The Lancet.

[14]  Shuming Bao,et al.  Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. , 2005, American journal of public health.

[15]  D. Stokols.  Translating Social Ecological Theory into Guidelines for Community Health Promotion , 1996, American journal of health promotion : AJHP.

[16]  R. Brownson,et al.  Environmental and policy determinants of physical activity in the United States. , 2001, American journal of public health.

[17]  Amy J. Schulz,et al.  Addressing Social Determinants of Health: Community-Based Participatory Approaches to Research and Practice , 2002, Health education & behavior : the official publication of the Society for Public Health Education.

[18]  Steve Wing,et al.  The contextual effect of the local food environment on residents' diets: the atherosclerosis risk in communities study. , 2002, American journal of public health.

[19]  J. R. Dunn,et al.  Social inequality, population health, and housing: a study of two Vancouver neighborhoods. , 2000, Social science & medicine.

[20]  D. Stokols.  Establishing and maintaining healthy environments. Toward a social ecology of health promotion. , 1992, The American psychologist.

[21]  K. Flegal,et al.  Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. , 2004, JAMA.

[22]  S Wing,et al.  Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women. , 1992, American journal of public health.

[23]  E. Eng,et al.  Lay health advisors as community change agents. , 1992 .

[24]  B. Smedley,et al.  Unequal Treatment: Con-fronting Racial and Ethnic Disparities in Health Care , 2002 .

[25]  Ingrid Gould Ellen,et al.  Does neighborhood matter? Assessing recent evidence , 1997 .

[26]  M. Marmot,et al.  The relationship between job strain and coronary heart disease: evidence from an English sample of the working male population , 2001, Psychological Medicine.

[27]  Qi Zhang,et al.  Socioeconomic inequality of obesity in the United States: do gender, age, and ethnicity matter? , 2004, Social science & medicine.

[28]  C Duncan,et al.  Health-related behaviour in context: a multilevel modelling approach. , 1996, Social science & medicine.

[29]  David R Williams,et al.  Racial and spatial relations as fundamental determinants of health in Detroit. , 2002, The Milbank quarterly.

[30]  Meredith Minkler,et al.  Community-Based Participatory Research for Health , 2002 .

[31]  R. Hummer.  Black-White Differences in Health and Mortality: A Review And Conceptual Model , 1995 .

[32]  Bruce G. Link,et al.  Social Conditions as Fundamental Causes of Disease , 1995 .

[33]  K. Flegal,et al.  Increasing Prevalence of Overweight Among US Adults: The National Health and Nutrition Examination Surveys, 1960 to 1991 , 1994 .

[34]  P Diehr,et al.  Community-level comparisons between the grocery store environment and individual dietary practices. , 1991, Preventive medicine.

[35]  K. Flegal,et al.  Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults: The Third National Health and Nutrition Examination Survey, 1988–1994 , 1998, Diabetes Care.

[36]  S. James.  Primordial prevention of cardiovascular disease among African-Americans: a social epidemiological perspective. , 1999, Preventive medicine.

[37]  M. Marmot,et al.  Social class and coronary heart disease. , 1981, British heart journal.

[38]  K. Travers,et al.  The social organization of nutritional inequities. , 1996, Social science & medicine.

[39]  G W Heath,et al.  Leisure-time physical activity among US adults. Results from the Third National Health and Nutrition Examination Survey. , 1996, Archives of internal medicine.

[40]  Bruce G. Simons-Morton,et al.  Social socience theory in health education: time for a new model? , 1993 .

[41]  K. Brownell,et al.  Food fight : the inside story of the food industry, America's obesity crisis, and what we can do about it , 2004 .

[42]  A. Baum,et al.  Socioeconomic Status and Chronic Stress: Does Stress Account for SES Effects on Health? , 1999, Annals of the New York Academy of Sciences.

[43]  G L Stoddart,et al.  Producing health, consuming health care. , 1990, Social science & medicine.

[44]  M. Marmot,et al.  Socio-economic factors in cardiovascular disease. , 1996, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.