1.2 Historical Context and Evolution of Behavioral and Social Sciences in Public Health
5 min read•august 7, 2024
The behavioral and social sciences have profoundly shaped public health approaches over time. From early sanitation efforts to modern ecological models, our understanding of health has evolved to encompass biological, psychological, and social factors.
Key theories like the and guide interventions today. engages local partners to address health disparities. These frameworks help public health professionals develop effective, culturally-relevant programs to improve population health.
Early Public Health Movements
Germ Theory and Sanitation Movement
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- proposed by Louis Pasteur and Robert Koch in the late 19th century revolutionized understanding of disease causation
- Proved that specific microorganisms (bacteria, viruses) caused specific diseases rather than miasma or bad air
- Led to development of antiseptic techniques in surgery (Joseph Lister) and pasteurization of milk to prevent spoilage and disease
- emerged in response to poor living conditions in rapidly industrializing cities of Europe and North America
- Focused on improving water quality, sewage disposal, food safety, and general cleanliness to prevent disease outbreaks (cholera, typhoid)
- Key figures included in England who advocated for separating sewage from drinking water and cleaning up slums
- In U.S., 's 1850 Report of the Sanitary Commission of Massachusetts was influential in promoting sanitary reforms
Social Reform and Public Health
- Social reformers in late 19th/early 20th centuries recognized link between poverty, poor living and working conditions, and ill health
- established community centers in poor urban areas to provide social services, education, and healthcare (' Hull House in Chicago)
- Progressive Era reformers advocated for child labor laws, minimum wage, housing regulations to improve health of working class
- emerged as a specialty to provide home-based care and health education to poor families
- Lillian Wald founded Henry Street Settlement in NYC in 1893, which became a model for public health nursing services
- Social reform efforts laid groundwork for understanding and importance of addressing root causes of disease and health disparities
Evolution of Health Models
Biomedical Model
- Dominant model of disease in Western medicine since 19th century
- Views disease as a deviation from normal biological functioning caused by specific pathogens or abnormalities in genes or physiology
- Focuses on diagnosing and treating individual patients' physical ailments
- Relies heavily on medical technology (diagnostic tests, drugs, surgery) to identify and fix biological problems
- Critiques of emerged in late 20th century
- Reductionist approach that neglects psychological, social, and environmental influences on health
- Defines health narrowly as absence of disease rather than positive well-being
- Patient is a passive recipient of expert medical care rather than an active participant in their own health
Biopsychosocial Model
- Proposed by in 1977 as an alternative to biomedical model
- Recognizes that biological, psychological, and social factors all play a significant role in human health and illness
- Biological factors include genes, physiology, neurochemistry
- Psychological factors include cognition, emotion, behavior
- Social factors include family, community, culture, socioeconomic status
- Encourages a more holistic and patient-centered approach to healthcare
- Considers the patient's subjective experience of illness and its meaning and impact on their life
- Emphasizes importance of doctor-patient relationship and communication
- May incorporate mental health care, social services, and health promotion alongside traditional medical treatment
Ecological Models of Health
- Ecological models view health as a product of multiple levels of influence, from individual to societal
- Intrapersonal level: individual characteristics (knowledge, attitudes, skills)
- Interpersonal level: social relationships and networks (family, friends, peers)
- Organizational level: rules, regulations, policies, and informal structures (schools, workplaces, churches)
- Community level: relationships between organizations, cultural norms, mass media
- Public policy level: local, state, and national laws and policies
- Implication is that health promotion efforts need to target multiple levels simultaneously to be effective
- Example: smoking cessation programs should include individual counseling (intrapersonal), peer support groups (interpersonal), workplace smoking bans (organizational), anti-smoking media campaigns (community), and higher tobacco taxes (policy)
- (Bronfenbrenner) and (Green & Kreuter) are examples of ecological planning models used in public health
Behavioral and Social Science Theories
Health Belief Model
- Developed in 1950s by to explain low participation in disease prevention and screening programs
- Proposes that a person's likelihood of engaging in a health behavior depends on their perceptions of:
- Susceptibility to the health problem
- Severity of the health problem
- Benefits of the preventive action
- Barriers to taking action
- Cues to action that trigger behavior (media campaign, advice from others)
- (confidence in one's ability to perform the behavior)
- Widely used to design health education messages and programs
- Example: promoting flu vaccination by emphasizing high risk of flu (perceived susceptibility), seriousness of flu complications (perceived severity), effectiveness of vaccine (perceived benefits), addressing concerns about side effects or cost (perceived barriers), offering reminders and convenient vaccine clinics (cues to action)
- Limitations: does not directly address social influences on behavior, assumes rational decision-making
Social Cognitive Theory
- Developed by , emphasizes reciprocal interaction between individual, environment, and behavior
- Key constructs include:
- : learning new behaviors by observing others' actions and their consequences (positive or negative reinforcement)
- Outcome expectations: anticipated consequences of a behavior, which can be physical, social, or self-evaluative
- Self-efficacy: person's confidence in their ability to perform a behavior, affected by past experiences, social modeling, verbal persuasion, and emotional arousal
- Has been applied to wide range of health behaviors, including physical activity, nutrition, and substance use prevention
- Example: mass media campaigns featuring admired celebrities (social modeling) to promote healthy eating (observational learning), emphasizing benefits like improved energy and appearance (positive outcome expectations)
- Recognizes importance of environmental influences and social support on individual behavior change
Community-Based Participatory Research
- Approach to research that involves equitable partnership between academic researchers and community members in all phases of the research process
- Community members help define the research questions, design the study, collect and interpret data, and disseminate findings
- Aims to combine knowledge and action to achieve social change to improve health and eliminate disparities
- Principles include:
- Building on community strengths and resources
- Fostering co-learning and capacity building among all partners
- Balancing research and action for mutual benefit of all partners
- Focusing on local relevance of public health problems and ecological perspectives
- Involving a long-term process and commitment to sustainability
- Example: in Los Angeles, a coalition of community organizations, health agencies, and university researchers working to improve health in the African American community
- Used CBPR approach to assess health needs and assets, develop and test family health education program, and advocate for policy changes
- Documented improvements in participants' self-efficacy, health behaviors, and health outcomes, as well as increased community capacity and trust in research
- Challenges include power imbalances, conflicting priorities, time demands, and need for flexibility and cultural competence
Key Terms to Review (22)
Albert Bandura: Albert Bandura is a renowned psychologist best known for his contributions to the field of social learning theory and his development of the concept of self-efficacy. His work emphasizes the importance of observational learning, imitation, and modeling in human behavior, linking individual actions to broader social influences. Bandura's theories have played a significant role in shaping modern understandings of behavior change in health contexts, particularly through frameworks that address how individuals learn from their environments.
Biomedical model: The biomedical model is a framework that views health primarily as the absence of disease and emphasizes biological factors in the understanding and treatment of health issues. This model separates the physical body from psychological and social factors, leading to a focus on diagnosis and treatment through medical interventions rather than considering broader social influences on health.
Biopsychosocial model: The biopsychosocial model is an integrative approach that considers biological, psychological, and social factors in understanding health and illness. This model emphasizes that human health cannot be fully understood by looking solely at biological aspects, as it incorporates the complex interactions between an individual's biology, their mental state, and the socio-environmental influences they experience. This holistic perspective is crucial for addressing both physical and mental health effectively.
Community-based participatory research: Community-based participatory research (CBPR) is an approach that involves community members in the research process to address health issues and promote equity. This method fosters collaboration between researchers and communities, ensuring that the research is relevant and beneficial to those affected by the issues being studied.
Ecological Models of Health: Ecological models of health emphasize the complex interplay between individual, interpersonal, community, and societal factors in understanding health behaviors and outcomes. These models recognize that health is not only influenced by personal choices but also by the broader environment, including social norms, policies, and community resources, highlighting the importance of multiple levels of influence in public health strategies.
Edwin Chadwick: Edwin Chadwick was a 19th-century English social reformer known for his work in public health and sanitation, particularly during the Industrial Revolution. He played a critical role in highlighting the connection between poor living conditions and public health, advocating for sanitation reform, and ultimately leading to significant legislative changes in health policy.
George Engel: George Engel was a prominent American psychiatrist and medical doctor known for his contributions to the field of health and medicine, particularly for developing the biopsychosocial model. This model emphasizes the importance of understanding health and illness through the interactions of biological, psychological, and social factors, marking a significant shift in how public health views and addresses health issues.
Germ theory: Germ theory is the scientific principle that proposes that microorganisms, specifically bacteria and viruses, are the primary cause of many diseases. This theory revolutionized public health by shifting the focus from miasma or 'bad air' as the cause of disease to the understanding that pathogens are responsible for infections and illnesses, leading to advancements in hygiene, sanitation, and medical practices.
Health Belief Model: The Health Belief Model is a psychological framework that helps explain and predict health behaviors by focusing on individuals' beliefs about health conditions. It emphasizes the role of perceived susceptibility, perceived severity, perceived benefits, and perceived barriers in determining whether a person will take action to prevent, screen for, or control a health condition. This model is significant in understanding why people engage or do not engage in health-promoting behaviors.
Healthy African American Families Project: The Healthy African American Families Project is a community-based initiative aimed at improving health outcomes and reducing health disparities among African American families. This project emphasizes the importance of culturally relevant approaches to health education and interventions, recognizing the unique challenges faced by these communities. By fostering family involvement and community engagement, the initiative seeks to empower individuals and promote better overall health through tailored strategies and resources.
Jane Addams: Jane Addams was a pioneering social reformer and activist in the late 19th and early 20th centuries, known for her role in founding Hull House in Chicago, which served as a community center for immigrants and the poor. Her work highlighted the importance of social welfare and community engagement in public health, emphasizing that improving social conditions is essential for enhancing individual health outcomes.
Lemuel Shattuck: Lemuel Shattuck was an influential American public health advocate and statistician known for his pioneering work in the field of public health during the 19th century. His groundbreaking report in 1850 laid the foundation for modern public health systems, highlighting the importance of health data collection and the role of social factors in health outcomes.
Observational Learning: Observational learning is a process in which individuals learn by watching the behaviors of others and the consequences that follow. This type of learning emphasizes the role of social influences in shaping behaviors, highlighting how people can acquire new skills and knowledge without direct experience. It connects deeply with understanding how individuals interact with their environments and how social contexts influence health-related behaviors.
Precede-Proceed Model: The Precede-Proceed Model is a comprehensive framework used for designing, implementing, and evaluating health promotion programs, emphasizing the importance of understanding the underlying factors influencing health behaviors before developing interventions. This model outlines a systematic approach that begins with assessing community needs and concludes with evaluating the effectiveness of the implemented programs, connecting various aspects of public health.
Public Health Nursing: Public health nursing is a specialized field of nursing that focuses on promoting and protecting the health of populations through community-based interventions. This practice integrates nursing science with public health principles to address social determinants of health, prevent disease, and improve overall community well-being. By emphasizing health education, advocacy, and collaboration with other sectors, public health nursing plays a crucial role in the evolution of behavioral and social sciences in public health.
Sanitation movement: The sanitation movement was a public health campaign that emerged in the 19th century, aiming to improve environmental conditions to prevent disease and promote health through better sanitation practices. This movement emphasized the importance of clean water, proper waste disposal, and the overall hygiene of urban areas, which were critical issues during a time of rapid industrialization and urbanization.
Self-Efficacy: Self-efficacy refers to an individual's belief in their capability to perform tasks and achieve goals, significantly influencing their motivation and behavior. This concept connects deeply with how people approach challenges, make decisions about their health, and engage in preventive behaviors. A strong sense of self-efficacy can empower individuals to take control of their health and overcome obstacles in various contexts.
Settlement House Movement: The Settlement House Movement was a social reform initiative that began in the late 19th century, aimed at providing community services and support to the urban poor in industrialized cities. It focused on improving living conditions through education, healthcare, and social services, promoting social integration and empowering marginalized communities. This movement laid the groundwork for the development of modern social work and public health initiatives by addressing the needs of individuals and families in urban settings.
Social Cognitive Theory: Social Cognitive Theory is a psychological framework that emphasizes the role of observational learning, imitation, and modeling in behavior development. It explains how individuals learn from their environment, the influence of social interactions, and the reciprocal interactions between personal factors, behavior, and the environment.
Social Determinants of Health: Social determinants of health are the conditions in which people are born, grow, live, work, and age, which significantly affect their health outcomes. These factors include socioeconomic status, education, neighborhood environment, and access to healthcare, shaping individuals' opportunities for a healthy life.
Social Ecological Model: The social ecological model is a theoretical framework that emphasizes the interplay between individual, relationship, community, and societal factors in understanding health behaviors and outcomes. It highlights that behavior is influenced not only by personal choices but also by the surrounding environment and social context, providing a comprehensive approach to public health.
U.S. Public Health Service: The U.S. Public Health Service (PHS) is a division of the Department of Health and Human Services, primarily responsible for protecting and promoting public health. Established in the late 18th century, the PHS has evolved significantly, reflecting changes in public health needs and understanding over time. Its mission encompasses disease prevention, health education, and health promotion efforts, which have been instrumental in shaping the landscape of behavioral and social sciences in public health.