When we talk about determinants of health, many of us think of medical care, individual health behaviour or genetics. Improving health has thus often been a matter of improving the quality of health and medical services, changing health-related behaviours and exploring the ways in which genetic technologies can make our lives easier and healthier. While we do often recognize that social and physical aspects of our environments also impact health, we often do not know exactly how to influence this pathway in the interests of health.

This becomes clear when we look at the topic of socioeconomic status and health. The existing literature surrounding socioeconomic status and health has provided stark empirical documentation of the powerful influence that environments have on health. Yet there exists a tragic paradox in the literature on socioeconomic health inequities. On the one hand, this literature demonstrates that we do know something of how to link social and economic environments to health status, and that in a scientifically rigorous fashion. At the same time, however, it reveals our relative ignorance regarding how to influence environments to reduce those inequities. The little we do know about reducing socioeconomic health inequities emanates more from common sense than scientific insight. Epidemiology has shown us that environments influence health but has failed to show us how we can use those environments to promote health.

If public health professionals are to play a significant role in influencing environments for health, they need analytical instruments which enable them to link specific environmental conditions with the actions necessary to improve them. These instruments must also enable public health professionals to identify points of leverage for stimulating key actors to take the actions necessary to make environments more promoting of health.

Analytical Instrument for Mapping Environmental Conditions, Actions and Interventions

Our analytical instrument for mapping environmental condition, actors and interventions, starts with health. From there, we work up through the causal chain, emerging ultimately by the role of the health professional in designing interventions for creating more health-promoting environments. The analytical instrument comprises the links between six basic notions: a) Health b) Environmental conditions c) Environmental actions d) Environmental actors e) Methods for intervention f) Empowerment In essence, the instrument stipulates that: a) Many health outcomes are at least partially attributable to environmental conditions; b) Environmental actions influence health by promoting or inhibiting environmental conditions that are promoting or inhibitive of health; c) Environmental actors are those who assume such environmental actions; and d) Public health professionals can use methods for intervention to influence environmental actors to take health promoting health actions or can themselves undertake such actions. Using this instrument, we have analysed challenges from public health practice and comprised an empirical inventory of methods for environmental intervention in the form of what we term ‘scenarios’. Each scenario is categorized according to the kind of environment(s) it pertains to and is made up of some or all of the following components: a) A general scenario context that provides some context and background to the situation that is described; b) A description of health as it pertains to the scenario; c) The environmental condition necessary to improve or promote health; d) The environmental action(s) required to create the environmental condition; e) The environmental actor(s) that must take the environmental action f) An indication of whether or not the methods for intervention are directed through the community or not; g) The methods for intervention directed to the actor;; h) The methods for intervention directed to the community; i) The methods for intervention employed by the community; j) The determinants of community behaviour; k) The determinants of actor/agent behaviour; l) The conditions necessary for the methods for intervention to be successful; and m) Related literature that may aid in increasing your understanding of the scenario. ` We hope that both our analytical instrument of environmental health aetiology and empowerment and our empirical inventory of methods for intervention in the form of these web-based scenarios will aid you in designing interventions to improve environments for health. GO TO SCENARIOS