Shifting Public Health Practice to Advance Health Equity

Knight, Erin

doi:10.1097/phh.0b013e31829959fb

Cited by 20 publications

(14 citation statements)

References 17 publications

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“…Advancing health equity relies upon understanding the central role of social determinants of health in influencing individuals' contexts, options, and behaviors-and thus their health outcomes. Numerous studies affirm that health outcomes and disparities result not strictly or even primarily from individual behaviors or genetics, but from policies, structures, and systems that circumscribe individuals' choices, access, and knowledge (1)(2)(3)(4)(5). Recognizing the impacts of these factors, the field of public health has increasingly promoted a social ecological approach to understanding (6) by Tasha Golden (7).…”

Section: Introductionmentioning

confidence: 99%

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Public Health's Next Step in Advancing Equity: Re-evaluating Epistemological Assumptions to Move Social Determinants From Theory to Practice

Golden

Wendel

2020

Front. Public Health

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The field of public health has increasingly promoted a social ecological approach to health, shifting from an individual, biomedical paradigm to a recognition of social and structural determinants of health and health equity. Yet despite this shift, public health research and practice continue to privilege individual-and interpersonal-level measurements and interventions. Rather than adapting public health practice to social ecological theory, the field has layered new concepts ("root causes," "social determinants") onto a biomedical paradigm-attempting to answer questions presented by the social ecological schema with practices developed in response to biomedicine. This stymies health equity work before it begins-limiting the field's ability to broaden conceptions of well-being, redress histories of inequitable knowledge valuation, and advance systems-level change. To respond effectively to our knowledge of social determinants, public health must resolve the ongoing disconnect between social ecological theory and biomedically-driven practice. To that end, this article issues a clarion call to complete the shift from a biomedical to a social ecological paradigm, and provides a basis for moving theory into practice. It examines biomedicine's foundations and limitations, glosses existing critiques of the paradigm, and describes health equity challenges presented by over-reliance on conventional practices. It then offers theoretical and epistemological direction for developing innovative social ecological strategies that advance health equity.

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Section: Introductionmentioning

confidence: 99%

“…Recognizing the impacts of these factors, the field of public health has increasingly promoted a social ecological approach to understanding (6) by Tasha Golden (7). population health, 1 (see Figure 1), and the language of social determinants has become a central focus in the literature (3).…”

Section: Introductionmentioning

confidence: 99%

Public Health's Next Step in Advancing Equity: Re-evaluating Epistemological Assumptions to Move Social Determinants From Theory to Practice

Golden

Wendel

2020

Front. Public Health

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“…These factors inevitably influence health communications, health care delivery and access, provider-consumer relationships, intervention effectiveness, data accuracy, and approaches to community capacity-building. As Knight (2014) argued, "research must reflect community priorities, be meaningful to the community, and be better connected to the lived experiences of people most affected by health inequities. In this way, different kinds of knowledge inherent in communities should be valued" (p. 193).…”

Section: Cultural Responsivenessmentioning

confidence: 99%

“…As Knight (2014) argued, "the field…needs to gather and share data to tell a different kind of story that shifts the focus from individuals to communities and from behavior to structures" (p. 193). Because the analyzed surveys were individual-focused, they did not accommodate the emergence of participant knowledge related to structural and societal factors.…”

Section: Moving Health Beyond the Individualmentioning

confidence: 99%

“…Given these benefits, it is reasonable to expect that some funds currently allotted for public health needs assessments, surveys, focus groups, and interviews should instead be channeled to local arts programs, events, or initiatives-particularly among marginalized populations. Knight (2014) noted the "need for a more politically active public health practice, which includes interventions in…the cultural realm, and prioritizes empowerment of individuals and communities that experience social disadvantage" (p. 194). 122 By directing funding to arts-inclusive practices, public health could support local, valued cultural practices based not on charity or even (strictly) on health promotion goals, but on the recognition of these practices as the powerful sources of meaning and knowledge that they have always been.…”

Section: Implications For Research Fundingmentioning

confidence: 99%

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Innovation and equity in public health research : testing arts-based methods for trauma-informed, culturally-responsive inquiry.

Golden¹

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As the field of Public Health has shifted from a biomedical paradigm to a social ecological approach, focusing on health equity and social determinants of health, it has increasingly acknowledged the roles of culture and trauma in health outcomes. The field has responded by modifying some research practices, but continues to prioritize conventional methodologies-with few options designed to foreground trauma-and cultural-responsiveness. Unfortunately, to the extent that conventional approaches require health to be defined, communicated, or valued according to dominant norms, they risk perpetuating inequities. Health equity therefore requires the development of research methodologies that increase inclusivity and access, elicit and apply diverse knowledges, reduce intrusion, and incorporate sociocultural factors. Using design thinking, and drawing upon critical theory, hermeneutics, photovoice, and arts in health research, this study developed and tested three methodological prototypes for researching a potentially traumatizing topic (violence) among a vulnerable population (young women ages 11-21). The first prototype collected vi creative writing from an ongoing youth detention intervention; the second utilized a themed citywide writing contest; and the third obtained the script for a play about sexual and relational violence, written and performed by local survivors without researcher elicitation. Methods: All prototype-generated data (combined n = 126) were iteratively analyzed for documented experiences, needs, assets, and priorities related to violence. Four conventional violence-related surveys, administered among the three sample populations (combined n = 1862), were also analyzed. Extensive comparative evaluations were then conducted of all findings and methods, assessing quality/quantity of information, trauma responsiveness, and cultural responsiveness. Results: Findings from the arts-based methods addressed 64 to 89 percent of the same variables as the surveys, while the surveys addressed only 36 to 49 percent of the artsbased data variables. The three prototypes juxtaposed needs with assets, accommodated expressive choice, and involved minimal researcher intrusion-rendering them trauma and culturally responsive. They also generated impactful insights inaccessible via surveys, such as unconventional definitions of violence. The prototypes aided disclosure (thus improving data), were time-and cost-effective, and offered significant potential for research reciprocity. As such, they offer promising models for continued methodological innovation in advancement of health equity. vii TABLE OF CONTENTS

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Role of the Community and Community-Based Participatory Research in Elder Abuse

Chang

Dong

2017

Elder Abuse

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Shifting Public Health Practice to Advance Health Equity

Abstract: Recommended shifts in practice may be facilitated by revisiting our understanding of the 3 core functions of public health-assessment, assurance, and policy development.

Cited by 20 publications

References 17 publications

Public Health's Next Step in Advancing Equity: Re-evaluating Epistemological Assumptions to Move Social Determinants From Theory to Practice

Public Health's Next Step in Advancing Equity: Re-evaluating Epistemological Assumptions to Move Social Determinants From Theory to Practice

Innovation and equity in public health research : testing arts-based methods for trauma-informed, culturally-responsive inquiry.

Role of the Community and Community-Based Participatory Research in Elder Abuse

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