The Social Ecological Model (SEM) is a framework used to understand the multifaceted levels within a society and how individuals and the environment interact within a social system (Lumen Learning, n.d.). The model was originally developed by Urie Brofenbrenner in the 1970’s, focusing on child development within a complex system of relationships in the child’s environment (Guy-Evans, O., 2020). Building on this multilevel framework, McLeroy, Bibeau, Steckler, and Glanz offered a model of five nested hierarchical levels of influence specific to health behaviours (Golden, S. & Earp, J., 2012).
Socio-ecological model: framework for prevention, centres for disease control. Available from the Centres for Disease Control and Prevention (CDC). http://www.cdc.gov/vioenceprevention/overview/social-ecologicalmodel.html. 4
The Borgen Project blog by S. Poux (2017) uses the UNICEF model of the SEM to describe the five levels of influence. The first level is the Individual level which considers a person’s traits and identities as well as age, education level, sexual orientation, and economic status. The second level is the Interpersonal level which takes into account the person’s family, friends, relationships, and social networks. The third level is the Organizational level which includes organizations such as schools and workplaces. The fourth level is the Community level which focuses on organizations, institutions, businesses, and built environments such as cities, parks, and walkways. The fifth level is the Public Policy level which includes policies, laws, and regulations that can effect change at the local, national, and global level. The reciprocal nature of the model, utilizing a combination of interventions at all levels, allows for the most effective approach to public health prevention and control in promoting health behaviour change.
Social Determinants of Health
Public Health Agency of Canada – Social Determinants of Health (2019).
https://www.google.com/search?q=social+determinants+of+health+youtube&oq=&aqs=chrome.2.69i59i450l8.7789195j0j15&sourceid=chrome&ie=UTF-8
The Social Determinants of Health (SDH) must be considered when examining the Social Ecological Model’s framework. The Canadian Public Health Association defines the social determinants of health as the social and economic factors that influence people’s health (Canadian Public Health Association, n.d.). These factors include income, education, employment, food security, access to health services, aboriginal status, gender, and race. The Chief Provincial Public Health Officer (CPPHO) of Manitoba recognizes that some populations experience a disproportionate burden of poor health outcomes and shorter life expectancy. These include Indigenous peoples, newcomers, people living in poverty, and people experiencing long-term unemployment and homelessness (Manitoba Health, Seniors and Active Living, 2018). First Nations, Metis and Inuit peoples face persistent health gaps resulting from historic and contemporary traumatic experiences related to racism and colonization (Manitoba Health, Seniors and Active Living, 2018). The Public Health Agency of Canada (2011), reports that second only to Newfoundland, Manitoba has the highest prevalence of self-reported obesity of Aboriginal adults aged 18 and older. Among Aboriginal women, as income decreases, obesity tends to increase. Obesity among children and youth is also high (Public Health Agency of Canada, 2011).
The Social Ecological Model can be used to understand weight-related and obesity among Aboriginal women and children in Canada. A sociological model offers a framework to represent the reciprocal interaction between individual behaviours and the environment in the development of obesity (Willows, Hanley & Delormier, 2012).
Fig. 1. Ecological model for understanding obesity in children, which illustrates the reciprocity among levels that influence active living, the consumption of healthy foods, and weight status, and which recognizes that historical factors encompass and influence all ecological levels. (Willows, Hanley & Delormier, 2012).
Levels of Influence
At the Individual level, factors influencing obesity in Aboriginal women and children include age, gender, education and knowledge about nutrition and physical activity, economic status and cultural influences. Willows et al., (2012) state that obesity is the result of physical inactivity and/or excess intake of calories. However, the majority of these calories come from less healthy food options. Many Indigenous peoples suffer from undernutrition defined as “insufficient intake of energy and nutrients to meet an individual’s needs to maintain good health (Maleta, K. 2006. p,189). Foods consumed by Aboriginal women and children tend to be non-traditional foods of poor quality (Willows et. al., 2012). Aboriginal peoples, especially those living in urban centres, may not have the ability or resources to access traditional foods. According to the Southern Chief’s Organization Inc. (n.d.), 62% of First Nations in Manitoba live in poverty, and even with income assistance, they remain well below the poverty line. This has a direct impact on food security and the ability to obtain nutritious foods.
At the Interpersonal level, factors influencing this population include family, friends, peer supports, as well as family feeding and parenting practices. Family members and peer groups can have a significant impact on attitudes and perceptions of food, what foods are available, and what types of foods are provided and consumed. Determinants of health that can contribute to unhealthy eating patterns at this level include lone parent households, multi-child households and overcrowding. Due to low-income levels, there may not be enough food for everyone to share. Healthy foods may be unaffordable leading to the consumption of low cost, high calorie foods increasing the risk for obesity (Willows et. al., 2012).
At the Organizational level, influencing factors include schools, childcare facilities, and workplaces. Within the school or childcare environment, children may have the opportunity to participate in breakfast and/or lunch programming. Children may take part in, and learn about, the positive impacts of physical activity. These skills and knowledge can be relayed to family members to increase awareness around healthy eating and physical fitness. Community feasts encourage sharing of traditional foods and cultural practices as well as facilitating social connections and support networks (Willows et. al., 2012). These factors can influence the trajectory of the incidence of obesity among Aboriginal populations through the education of children and youth.
At the Community level, influencing factors include businesses such as grocery stores and restaurants, recreational facilities, and other built environments such as playgrounds, parks and walking paths. Many low-income populations live in the core area of Winnipeg. A major issue in this area is lack of access to a supermarket. Residents have to rely on public transit or taxi service for transportation to a grocery store. Neighbourhood convenience stores are limited in their selections of healthy foods and tend to be very expensive. In the city setting, there are many fast-food restaurants featuring unhealthy food items, generally, at a relatively low cost. Urban Aboriginal families more often describe food insecurity as being related to more limited access to traditional foods, than those living on reserve (Neufeld et al., 2020). For on-reserve communities in Manitoba’s north, food supplies must be delivered, either by air or rail, significantly contributing to inflated prices and less fresh food options. A study by Wendimu, Desmarais & Martins (2018) concluded that in addition to limited availability of healthy foods, food prices in First Nations communities were significantly higher than in Winnipeg or non-First Nations urban centres. The two main reasons for high food prices were a lack of competition among retailers and the high transportation costs faced by retailers in First Nations communities without access to an all-weather road (Wendimu, Desmarais & Martins (2018). Built environments such as parks, walking paths, and playgrounds can also have an impact on activity levels and obesity. In urban centres there may be less access to safe playgrounds and parks. Recreational facilities may require membership fees making them inaccessible to low-income populations. On-reserve populations face limitations for physical activity due to weather, hazardous roads, safety, and aggressive animals (Government of Canada 2017). These factors impact access to both nutritious foods and physical activity.
At the Public Policy level, influencing factors include local, provincial and federal policies, laws, and regulations, historical factors such as colonization, intergenerational trauma from residential school experiences, and loss of traditional lands, language and culture. Government enactment of Indian Reserves forced many Aboriginal peoples to dwell in regions that were unsuitable for traditional hunting, fishing, and agricultural activities (Willows, et al., 2012). Indigenous People’s reduced access to the land and resources of their traditional environments can impact health (Neufeld et al., 2020). The study by Wendimu et al., (2018), identified a need for decolonizing food systems and building Indigenous food sovereignty. This would include decreasing dependency on store-bought foods by ensuring Indigenous peoples have access to their traditional hunting, trapping, fishing, and harvesting areas. When Indigenous communities lose the ability to use and enjoy the resources of their homelands, this can lead to the loss of Indigenous knowledge, reduced use of language, and decreased moral values of traditional food systems, such as sharing (Neufeld et al., 2020).
Implications
Obesity is not only a serious health condition in itself but significantly increases the risk of an individual developing other chronic diseases. Being overweight or obese is a main risk factor for the development of Type 2 Diabetes (Mayo Clinic n.d.). Diabetes, in particular, is highly prevalent in Aboriginal populations and presents many health consequences such as cardiovascular disease, kidney disease, neuropathy, blindness and amputations.
Conclusions
Within the framework of the SEM, it is clear that the levels of influence do not stand alone, nor can they be separated out. They are intertwined, each affecting the other. An ecological model is fitting in the study of obesity among Aboriginal women and children because food choices are not simply made by individuals but are influenced by a range of social and environmental processes, and the interactions or relationships among these factors (Neufeld & Richmond, 2020). Intervention across all levels of influence could begin to address the prevalence of obesity within this population, with focus at the public policy level having a profound and long-lasting impact on Aboriginal health and well-being.
References:
Canada Public Health Association (n.d.). What are the social determinants of health?
Golden, S. & Earp, J. (2012). Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education and Behaviour Health Promotion Interventions. Health Education & Behaviour, 39(3), 364-372.
Government of Canada. (2017). The Chief Public Health Officer’s Report on the State of Public Health in Canada: Designing Healthy Living.
Public Health Agency of Canada. (2011). Obesity in Canada – Determinants and contributing factors.
Guy-Evans, O. (2020). Brofenbrenner’s Ecological Systems Theory. Simply Psychology.
Lumen Learning (n.d.). Core Principles of the Ecological Model.
Manitoba Health, Seniors and Active Living (2018). Chief Provincial Public Health Officer Position Statement on Health Equity.
Mayo Clinic (n.d.). Type 2 Diabetes.
Meleta, K. (2006). Undernutrition. Malawi Medical Journal, 18(4), 189-205.
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Neufeld, H., Richmond, C. & The Southwest Ontario Aboriginal Health Access Centre. (2020). Exploring First Nation Elder Women’s Relationships with Food from Social, Ecological, and Historical Perspectives. Current Developments in Nutrition, 4(3), 1-11.
Poux, Sabine. (2017, August 5). Social-Ecological Model Offers New Approach to Public Health. The Borgen Project. [Blog].
Public Health Agency of Canada. (2011). Obesity in Canada – Determinants and contributing factors.
Public Health Agency of Canada. (2019, May 28). Social Determinants of Health. [Video]. You Tube.
Wendimu, M., Desmarais, A. & Martens, T. (2018). Access and affordability of “healthy” foods in northern Manitoba? The need for Indigenous food sovereignty. Canada Food Studies, 5(2), 44-72.
Willows, N., Hanley, A. & Delormier, T. (2012). A socioecological framework to understand weight-issues in Aboriginal Children in Canada. Applied Physiology, Nutrition and Metabolism, 37(1), 1-13.
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