Purpose of the review Environmental and social determinants of health often co-occur, particularly among socially disadvantaged populations, yet because they are usually studied separately, their joint effects on health are likely underestimated. Building on converging bodies of literature, we delineate a conceptual framework to address these issues.
Recent findings Previous models provided a foundation for study in this area, and generated research pointing to additional important issues. These include a stronger focus on biobehavioral pathways, both positive and adverse health outcomes, and intergenerational effects. To accommodate the expanded set of issues, we put forward the Integrated Socio-Environmental Model of Health and Well-Being (ISEM), which examines how social and environmental factors combine and potentially interact, via multi-factorial pathways, to affect health and well-being over the life span. We then provide applied examples including the study of how food environments affect dietary behavior.
Summary The ISEM provides a comprehensive, theoretically informed framework to guide future research on the joint contribution of social and environmental factors to health and well-being across the life span.
Keywords Total environment . Social determinants . Cumulative exposures . Life course . Health disparities
Some theories of health behavior focus on proximal cognitive predictors of behavior, some focus on expectancy-value formulations, some focus on social support and bonding processes, some focus on social learning processes, and some point toward personality and intrapersonal processes. Very few extant theories of health behavior incorporate several of these viewpoints, and those that do are limited in various ways. We propose a new comprehensive theory that integrates constructs from all previous theories. Triadic influence theory includes seven “tiers” of “causes” of behavior that range from very proximal to distal to ultimate, and three “streams of influence” that flow through the seven “tiers”: (I) cultural- environmental influences on knowledge and values, influencing attitudes, (2) social situation-context influences on social bonding and social learning, influencing social normative beliefs, and (3) intrapersonal influences on self determination / control and social skills, leading to self-efficacy. In addition to the direct influences of these streams, there are important inter-stream effects and influences that flow between tiers. The theory is intended to account for factors that have direct effecls as well as indirect effects on behavior. It is also intended to account for both new behaviors and regular behavior. Experiences with related behaviors and early experiences with a new behavior lead to feedback loops through all three steams adding to the prior influences of these streams. Our integration of existing theories leads to a meta-theoretical view that suggests higher order descriptions and explanations of health behavior, leads to a new and comprehensive view of health behavior change, and suggests new approaches for health promotion and disease prevention.
This is a very interesting article, and I would like to make a few epistemological and operational reflective commentaries that it evokes in me.
Interview with Humberto Maturana and Ximena Davila, of Matriztica School in Santiago, Chile.
Humberto Maturana is a renowned biologist and philosopher from Chile. He invented a theory of autopoiesis, about the nature of reflexive feedback control in living systems. Ximena Davila is a Professor from Chile who collaborates with Maturana, together they developed the dynamic vision that entangled the Biology of Knowledge and the Biology of Love that conform the basis for the Biological Matrix of Human Existence. Together they co-founded “la Escuela Matriztica de Santiago”.
In this interview, done by Cristina Moreno together with the staff members of the Methodist University of Sao Paulo, Brazil, Humberto Maturana and his colleague Ximena Davila offer their insights and reflections about the meaning of the Earth Charter and its relevance for today’s challenges.
The economic model according to which markets are self-equilibrating rests on a world-view of harmony and stasis that goes back to classical China, and was already fully rejected in all domains of science and also in political economy in the 19th century. Somehow it survives in textbook economics to this day. A new public administration needs to rest on modern scientific habits, recognizing that all biological, mechanical and social systems require effective regulation, not to “reduce externalities” but because otherwise they cannot exist at all. Once this is recognized, the task of government is to make regulation and public provision of services work well, minimizing predation, parasitism, force and fraud.
Human economies can be understood in more than one way.
- The private business economy is what economics textbooks are generally about.
- The public purpose economy consists of governments and their agencies as well as non-profits and international institutions like the World Bank or the United Nations. The public purpose economy is a collection of institutions that are justified by their stated intention to act for some broader good than their own profit or enrichment – though they may differ widely in their definitions of what is “good”.
- The core economy is where households and communities carry on their internal activities of production, distribution and consumption. The core economy’s justification and purpose is the survival and well-being of its members. It is located in home, family, and neighborhood; places that function as markets for emotional, social, and civic transactions. This paper will consider some distinguishing characteristics of these three economies – in particular: their goals or justifications; what currency they use; what kind of demand they respond to; and how they define and reward work.
The second half of the paper will offer reflections on the harms caused by an excessive dominance of the private business economy over the other two, with thoughts on some of what will be required to redress this balance. It will conclude with an image of a healthier relationship between humanity and our natural environment – a relationship that will inevitably come about, whether we choose to move into it positively, or are forced into it by breakdowns in all of our economies resulting from natural and social disasters.
Yesterday, a soundclip recorded at a political rally the night before was being circulated on social media which troubled me dearly, as the tone and message was confrontational, gangster in style, and negative in its nature.
In mainstream economics scripting, government is either bumbler or villain. Cast as market fixer, intervenor, enforcer or redistributor, the state cannot but act inefficiently or, worse, illegitimately. Public goods and collective action are called “problems,” the commons a “tragedy.” Even today’s so-called “public economics,” as represented by the “public choice” school, is decidedly anti-public. It was not always thus. More than a century ago, economists theorized the state as a framework of collective agency for public purpose and understood government as a producer meeting collective needs. A cogent concept of “the public economy” guided this nascent field of public economics, long since lost to historic upheavals and repression by proponents of market-centric rational choice theory.
This paper rejects today’s orthodoxy and its artful, but artificial, construct that subverts the ability of the public economic system to produce on behalf of the polity. I call instead for the embrace of a new public economics that returns to lost roots while breaking new ground by taking into account the biophysical imperatives of production. The model offered here takes a systems perspective (as did Quesnay and early 18th- century Physiocrats); recognizes a public economy with distinctive purpose and drivers (as did the “German Public Economics” theorist Gerhard Colm in the 1920’s); and focuses on government as a producer (as did Paul Studenski in the 1930s-50s). Finally, it draws on two centuries of physics and on 21st century systems ecology in recognizing biophysical imperatives inherent to production. Developing and promoting a cogent theory of the public economy system is vital to the effective operation and, ultimately, the survival of the governmental systems by which democratic nation-states function today. The simplistic type-casting of government, the “market-failure” rationalization for state action, the invalid imposition of market axioms and assumptions on the public domain, the disregard of public purpose must all be rejected. It is time for a Reformation of public economics.
I have been involved in studying and working within what is now called the Anthropocene for almost 50 years, and in all that time, not only have we failed to make much progress, but the state of the Earth’s ecosystems has generally worsened. Yet somehow we must create a world in which everyone on Earth has good health and a good quality of life—a matter of social justice—while living within the physical and ecological constraints of the one small planet that is our home; this is the focus of the new field of planetary health. Our worsening situation is not due to lack of knowledge, science and technology; in broad terms, we knew most of the challenges and many of the needed solutions back in the 1970s. Instead, the challenges we face are social, rooted in cultural values, political ideologies, legal and economic systems, ethical principles and spiritual/religious beliefs. Therefore, we have to move beyond science and technology and address these broader socio-cultural issues by engaging in economic, legal and political work, complementing and supplementing ‘head stuff’ with ‘heart, gut and spirit stuff’, and working from the grass roots up.
One of these days, perhaps, there will come a writer of opinions less humdrum than those of Dr. (Alfred Russel) Wallace, and less in awe of the learned and oﬃcial world . . . who will argue, like a new Bernard Mandeville, that man is but a degenerate monkey, with a paranoic talent for self-satisfaction, no matter what scrapes he may get himself into, calling them ‘civilization,’ and who, in place of the unerring instincts of other races, has an unhappy faculty for occupying himself with words and abstractions, and for going wrong in a hundred ways before he is driven, willy-nilly, into the right one. (CN 3: 17–18, 1901).