1.8: Contrasting Models for Understanding Public Health Problems

As discussed in the previous section, finding out what causes negative health outcomes and how to change these outcomes is a complicated process. Fortunately, there are different models that we can use when we try to understand and solve health problems. These models provide a framework with which public health professionals can identify different points at which to intervene in order to prevent diseases and improve health outcomes.

The Biomedical Model addresses health issues “as a function of risk factors, symptoms, diagnoses, and treatments.” (Acolin & Fishman, 2023) A doctor using the biomedical model might ask you about your symptoms and health-history, order different lab tests for you and ultimately make a diagnosis. This model attempts to identify a causal relationship between risk factors and diseases, ultimately to identify treatments and solutions. The biomedical model can also be used in public health. For example, we might identify that the leading cause of death for Americans is heart disease. Scientific literature identifies that one of the major risk factors for heart disease is obesity. Therefore, we might design education for individuals on weight management, create clinical weight-loss programs, research weight-loss medication, or even develop policies (such as getting government funds to pay for specific obesity-prevention programs, or requiring labels on high-calorie foods).

Figure \(\PageIndex{1}\): (Photo by Freerange Public Domain Archives from Freerange Stock)

The Social Ecological Model identifies health outcomes as influenced by “the interaction between the individual, the group/community, and the physical, social, and political environments'' (Clinical and Translational Science Awards (CTSA) Consortium’s Community Engagement Key Function Committee 1997/2011). This could be illustrated by nutritional habits. What we eat on a daily basis is often our familiar foods, perhaps those we grew up enjoying, or can be influenced by close relationships such as friends, roommates or a significant other. In this way, the individual’s behaviors are influenced by their close relationships - what they were fed as a child growing up, what they tend to eat-out with friends, or what their significant other eats. These are all influenced by the community in which they live - which could be their geographical location but also includes cultural, and/or religious norms. In turn, this community food is also influenced by the society at large: what food is grown, produced and sold in that region, what is affordable and accessible, etc. Using the social-ecological model, a public health practitioner might attempt to address policies to prevent obesity, like banning sugar-sweetened beverages of a specific size. Or they might address access to fruits and vegetables by coordinating a public-private partnership to put a grocery store in a neighborhood that doesn't have one, in order to change that community’s access to health-promoting foods. Perhaps a healthy cooking class might be offered at a community center - thus hopefully having a positive effect on the individual’s nutritional knowledge and skill, and also on the nutritional habits of the attendee’s families. The diagram in Figure \(\PageIndex{2}\) was developed by the CDC in 2007, and is used to visually represent the social-ecological model.

Figure \(\PageIndex{2}\): The Social Ecological Model - A Framework for Prevention