title: Upending the social ecological model to guide health promotion efforts toward policy and environmental change.
abstract: Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere.
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA sgolden@email.unc.edu.
authors.forename: Shelley D
authors.initials: SD
authors.lastname: Golden
authors.affiliation: Texas A&M University, College Station, TX, USA.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McLeroy
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Green
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Jo Anne L
authors.initials: JA
authors.lastname: Earp
authors.affiliation: Montclair State University, New Jersey, NJ, USA.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Lieberman
mesh_terms: D004777:Environment; D006266:Health Education / Q000458:organization & administration*; D040441:Health Educators / Q000191:economics / Q000458:organization & administration*; D006291:Health Policy; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008962:Models, Theoretical; D011057:Politics; D024382:Professional Role; D012931:Social Environment
keywords: environmental change; public policy; social ecological model; structural interventions