1.8.1: The Social Ecological Model- Breast Cancer example

The Social Ecological Model (also called the Ecological Model, or Eco Model for short) demonstrates the interaction of factors that increase the risk of disease at four levels: individual (or intrapersonal); relationship (or interpersonal); community; and society (or societal). Some versions of the social ecological model include other layers, such as into "institutions" and "neighborhoods" (which could be understood to be part of the "community" level).

Risk factors interact across the different levels. For example, a lack of grocery stores in a neighborhood can influence the food behaviors of families and individuals. That's why the model is usually drawn as overlapping circles, not just a list of factors in each category. The Societal level is the biggest circle because it generally has the largest effect.

Figure \(\PageIndex{1}\): Social Ecological Model. (Public domain, Centers for Disease Control and Prevention [CDC])

In the example below, we focus on breast cancer, a disease. However, the social ecological model also works for understanding injuries and health-harming conditions. You could use this model to examine risk factors for suicide, or the roots of homelessness, for example.

Social Ecological Model: Breast Cancer

• At the individual level, we look at physical, demographic, and behavioral aspects of a person's life.
  • Genetics can increase a person's risk of breast cancer, as can other biological factors like the age at which one enters puberty or gives birth (if at all).
  • Some behaviors can have an effect on a person's risk for breast cancer, such as diet.
  • Some factors are in a person's control (to some extent), while others are not. For example, simply being female puts a person at greater risk of getting breast cancer, compared to being male. Yet not all females get breast cancer, and some males do.
• At the relationship level, we look for characteristics of the family and friends that might put a person at more or less risk of a disease.
  • For breast cancer, we might consider risk factors like the family's eating and exercise habits, the family's attitudes about preventative medical care or screening, the amount of stress in relationships (which may have an indirect role in susceptibility to cancer).
  • After a cancer diagnosis, the amount of social support there is to sustain the patient (from friends and family) during treatment and afterwards has an impact on recovery -- social support, therefore, is a protective factor we might aim to increase.
• At the community level, we look at characteristics of the neighborhood and the local institutions and organizations in that neighborhood.
  • Exposure to certain forms of pollution can put a person at risk of breast cancer.
  • Living in a neighborhood where it is difficult to obtain fresh fruits and vegetables creates risk. In this case, the community situation affects family and individual behaviors
• At the society level, we are interested in the policies (laws and regulations) and the societal norms (common attitudes and expectations) that may affect the risk of disease.
  • In the United States, for example, we know that African American women are less likely to survive breast cancer, even though White women are more likely to be diagnosed with breast cancer in the first place. One explanation is that something in the social policies of the United States that increases the risk for African American women of receiving a diagnosis late, when the cancer may be more difficult to treat, or receiving worse treatment for the disease.
  • Another example: the laws regarding pollution are determined at a societal level, and they may impact the risk of breast cancer and the distribution of that risk across the population.