Growing evidence shows that unequal distribution of wealth and power across race, class, and gender produces the differences in living conditions that are "upstream" drivers of health inequalities. Health educators and other public health professionals, however, still develop interventions that focus mainly on "downstream" behavioral risks. Three factors explain the difficulty in translating this knowledge into practice. First, in their allegiance to the status quo, powerful elites often resist upstream policies and programs that redistribute wealth and power. Second, public health practice is often grounded in dominant biomedical and behavioral paradigms, and health departments also face legal and political limits on expanding their scope of activities. Finally, the evidence for the impact of upstream interventions is limited, in part because methodologies for evaluating upstream interventions are less developed. To illustrate strategies to overcome these obstacles, we profile recent campaigns in the United States to enact living wages, prevent mortgage foreclosures, and reduce exposure to air pollution. We then examine how health educators working in state and local health departments can transform their practice to contribute to campaigns that reallocate the wealth and power that shape the living conditions that determine health and health inequalities. We also consider health educators' role in producing the evidence that can guide transformative expansion of upstream interventions to reduce health inequalities.
Recovery-oriented practice (ROP) is being steadily adopted worldwide. The current research examined the perspectives of clinicians about ROP pre-implementation at a clinical mental health service. The method was a survey consisting of fourteen questions regarding implementation of ROP and clinicians reported self-efficacy about work within a ROP framework. The research design was mixed methods couched within a narrative approach. It was exploratory and social constructivist in nature. This article explores quantitative data. Participants were 203 mental health clinicians from multidisciplinary backgrounds—including social work, nursing, occupational therapy, psychiatry, psychology, other medical and other allied health. There were 142 females, 46 males; 15 did not specify their sex. Results showed that clinicians perceived their practice was recovery-oriented 83.6 per cent of the time. Overall, 81 per cent chose the most recovery-oriented statement prior to formal training in ROP. This study concludes that clinicians are committed to the implementation of ROP. They do not believe ROP is easy to implement; however, they do believe it can be successfully implemented in the clinical treatment setting. With the support of stakeholders, these findings may be used to aid the ongoing implementation of ROP into the study service, and add to social work literature.
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