The Socio-Environmental Context of Our Actions: Marginalization and Its Influence on Building a Culture of Health

By Knepper, Hillary; Sonenberg, Andrea et al. | Journal of Health and Human Services Administration, Spring 2018 | Go to article overview

The Socio-Environmental Context of Our Actions: Marginalization and Its Influence on Building a Culture of Health


Knepper, Hillary, Sonenberg, Andrea, Levine, Helisse, Journal of Health and Human Services Administration


INTRODUCTION

Resiliency is often interpreted today to be a characteristic necessary for recovery after emergency situations. However, given the current tensions surrounding healthcare, resiliency in healthcare has emerged as pivotal for improving community health (Fairbanks, Wears, Woods, Hollnagel, Plsek, & Cook, 2014; Wulff, Donato & Lurie, 2015). Yet, building a culture of health pivots on the influence of marginalization and social exclusion of communities. As Daly and Silver (2008) note, the tendency of social classes to cluster homogenously leads to a rift between resource rich and resource poor communities. In turn, community health resiliency is threatened as this homogeneity often results in the clustering of poor social determinants of health (Saha, 2014). Nonetheless, this presents opportunities in addition to challenges for those seeking to engage social capital to build a culture of health.

The impact of finance, economics, political science, healthcare practice, social work, public administration, legal and regulatory constructs, environmental context and advocacy all contribute to community health. While the Alma Ata of 1978 declares 'Health for All,' we must ask what this means today and who is responsible for achieving it (WHO, 2015)? Do we turn to governments, health care providers, the general population? Today, we realize that in order to achieve true population health equity and improve health outcomes, we must create a community-based culture of health, grounded in the integrated influence and opportunities provided by home, work, and economic prosperity (Lavizzo-Mourey, 2014). Yet, how do we create this community-based culture of health? By considering the environmental context of our actions. The concept of social ecology frames this view with particular attention to the influence of people, places and resources on public policy (Gaus, 1947). Further, Phelan, Link, and Tehranifar (2010) advise that simply understanding the nature of disease and prevention is inadequate to improve health outcomes. Rather a deeper understanding of the impact of context and socio-economics is necessary.

Indeed, opportunities for interdisciplinary and inter-sectoral collaborations are being attributed to improved health outcomes (Ezeamama et al., 2016). It may be argued that a fundamental shift toward building a culture of health depends upon substantive shifts in current approaches and delivery systems toward a more collaborative and community based approach (Trujillo & Plough, 2016).

The purpose of this two volume symposium is to engage a discussion about how marginalization affects community health and to explore the topic of building a culture of health through exploration of socio-environmental context and its influence. Through quantitative and qualitative research of often marginalized communities and individuals, the contributors to this symposium explore resilience and sustainability, consider the influence of policy, and contribute to the discussion on building healthy communities.

In the first volume of the symposium, Winter 2017, Moreno and Bock Mullins delved into the impact of marginalization and policy on community health in Structural exclusion and administrative burden within the Affordable Care Act: An exploratory study of Latinos in Arizona. Next, Day, Ashcraft, and Scott contributed to the literature on rural health collaborations in Creating a culture of health in rural Arkansas. Scutelnicu considered the impact of municipal planning on community health in How do healthy eating and active living policies influence the potential for a community's healthy behavior? The case of Mississippi State. Pink-Harper and Rauhaus followed with their focus on employers' impact on health in An exploratory study of Latinos in Arizona: Examining the impact of federal employee wellness programs and employee resilience in the federal workplace.

In this, the second volume, four articles continue with the exploration of this theme. …

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