April 2005, Vol 95, No. 4 | American Journal of Public Health 552
© 2005 American Public Health Association
Learning From Doing
Deborah Holtzman, PhD, MSW, Associate Editor
The articles in this issue explore a "social determinants of health" framework and its application to implemented and planned programs, thereby encouraging "learning from doing" in public health practice. A common thread running through these articles is community participation in the process of change. Some of the articles refer specifically to participatory action research or community-based participatory research approaches, which engage groups from affected communities in understanding and addressing the problems under study. Inherent in these approaches are notions of social action, community mobilization, group empowerment, grassroots policy development, environmental change, and community capacity building to effect change. Thus, these articles embrace a broad view of population health rather than narrowly focusing on individual behavior change.
Designing public health programs around community partnerships highlights the importance of a realistic understanding of community. The term "community" as used in these programs evokes an image of a group of people who share values and interests and collectively pursue common goals. However, social research has shown that such an idealized image is usually mistaken. Communities are populated by competing groups with marked inequalities and conflicting interests. Those using a social determinants of health framework to explain disparities must take into account this understanding of community.
With regard to a social determinants of health approach, 2 core questions must be asked. First, is such a framework effective in reducing health disparities? Although the articles in this issue do not answer the question, they do suggest the promise of such an approach. Also addressed in the articles is the application of this approach, which is crucial for future study. Only by incorporating relevant social theory into the foundations of public health research and practice can we fully appreciate what transpires. Second, if such an approach is effective, how do we translate the theory into public health practice?
Reducing health disparities is a daunting undertaking. To change behaviors, it is not sufficient to strengthen family resources and improve environments in the present. Just as important are occupational and lifestyle expectations for the future, because these expectations determine present motivations and behaviors. When people expect secure and prosperous futures, they are more likely to change their present behaviors to achieve these goals. Effective public health programs must therefore address both present circumstances and future expectations.
Eliminating health disparities is a primary goal of the Centers for Disease Control and Prevention (CDC). Over the past several years, there has been increasing interest in and attention to the role of social determinants in health disparities, as evidenced by the creation of a formal work group at CDC. In 2002, CDC supported a grant program that specifically solicited applications employing a community-based participatory research approach. Some of these projects used a social determinants of health framework to examine disparities. In addition, a recent CDC reorganization established a number of teams and work groups to identify key issues. Among the critical science-related issues identified was a social determinants of health approach to research and practice.
It is not sufficient, however, to adopt this approach without considering how and by whom the approach is applied, considerations that are implicit in the articles in this issue. We all have an opportunity to learn from the experiences presented here by researchers carrying out the essential work of public health, including efforts to eliminate health disparities.
Copyright © 2005 by the American Public Health Association
