I have chosen to explore a comparison between Cape Breton Island in Nova Scotia and northern communities in Manitoba considering the levels of influence from the perspective of both the Dahlgren-Whitehead Model and the Social Ecological Model. While the focus of my paper is on obesity and its health implications, Lindsay wrote an excellent piece on cardiac care in Cape Breton. Her paper begins with a description of the island’s beautiful landscape and rich history before delving into a discussion about the high rates of heart disease seen in this region.
The Dahlgren-Whitehead model is used to examine the influencing factors related to the incidence of heart disease. This model, once rejected by the World Health Organization, is now seen as one of the most respected health models used around the world. Its beauty is in its simplicity. The authors describe it as “a visual representation of the main determinants of the health of populations, conveying the message that many are social determinants, forming interconnected layers of influence and amenable to organized action by society” (Dahlgren & Whitehead, 2021, p. 22). The levels of influence, featured in a rainbow design, include individual lifestyle factors, social and community networks, living and working conditions including unemployment, housing, health care services, education and food production and, lastly, general socio-economic, cultural and environmental conditions. An updated version of the model by Rice & Sara (2019), has an added layer representing the virtual world including information and communication.
The Social Ecological Model (SEM) is a multilevel framework offering five nested hierarchical levels of influence (Golden, S. & Earp, J. 2012). These include the Individual level, the Interpersonal level, the Organizational level, the Community level and the Public Policy level. The two models show similar levels of influence that demonstrate how individuals and their environments interact within a social system. The Social Determinants of Health, defined as the social and economic factors that influence people’s health (Canadian Public Health Association, n.d.), are a key component in both models, particularly in the Dahlgren-Whitehead model, where the focus is on health promotion rather than disease risk. The most important aspect of both models is the representation of the reciprocal nature of the levels of influence and the interconnectedness between the individual and the concentric levels of influence.
The incidence of obesity and heart disease are significant in both Cape Breton and northern Manitoba. The factors influencing heart disease (which may be considered one of the consequences of obesity) and obesity are similar. In comparing the models, the levels of influence in the SEM tend to be more categorically defined, whereas the Dahlgren-Whitehead model tends to be more fluid between levels. Factors such as income, education, employment, food security, Aboriginal status, and geographical location all have a direct and profound impact on individual health. Many Cape Breton residents, as well as those living in Manitoba’s northern communities, share similar lifestyle factors. There are numerous Indigenous communities in these areas and many of these people live on-reserve. There are high rates of poverty along with some of the highest rates of child poverty in the country. There is high unemployment as well as low education levels. Geographically, these populations live in rural areas with the nearest town often being many miles away. There may be a small health centre in the community, but more intensive treatment and care would require a long drive to a city. In Cape Breton, bus service is limited to the main town. Many northern communities once relied on bus service to travel between communities and to metropolitan areas in Manitoba. Unfortunately, a national bus service no longer exists which has been devastating for these communities. In the case of northern Manitoba, many communities are only accessible by air transport. Another major factor of influence in Cape Breton communities is the shift away from a coal producing industry to a service-based economy. This type of shift is challenging for those people who have worked in a resource-based environment for many years and do not have the education, resources or time span to learn new skills to be able to smoothly transition to a new economic base. Of course, there are many more factors that can be considered when comparing these two locations.
I think the factors of influence between regions tend to be more similar than they are dissimilar. Individuals, interpersonal relationships, social connections and community networks, income, education, housing, health care services, built environments, and local and provincial government bodies are generally not all that different from location to location. From my perspective, it is clear that, regardless of the model used to examine the multifaceted levels of influence, the challenges in achieving health equity within populations, are the same ones that are pervasive throughout this country and beyond. To reiterate, it is the interconnectedness between the levels of influence and their reciprocal nature that has the greatest impact on population health and well-being.
References:
Dahlgren, G. & Whitehead, M. (2021). The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health, 119, 20-24.
Golden, S. & Earp, J. (2012). Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education and Behavior Health Promotion Interventions. Health Education & Behavior, 39(3), 364-372.
Rice, L. & Sara, R. (2019). Updating the determinants of health model in the Information Age. Health Promotion International, 34(6), 1241–1249.
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