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6 Organizations, Communities, and Society: Models and Interventions
Pages 241-273

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From page 241...
... The impact of social anc3 environmental conditions is most visible in the growing gap between the health behaviors anc3 health status of rich anc3 poor, white anc3 nonwhite (Krieger, 1994; Krieger et al., 1993; Lantz et al., 1998; Lillie-Blanton and LaVeist, 1996; Lynch et al., 1997; Williams and Collins, 19951. There is a need to better unclerstanc3 the role of organizational, community, anc3 societal factors in determining health.
From page 242...
... An organizational culture that supports health is likely to adopt policies, procedures, anc3 priorities that facilitate the healthy behaviors of employees; enhance employee health by reclucing environmental risk factors; facilitate healthy behavior on the part of clients, customers, or members; anc3 facilitate linkages to other organizations for health-enhancing purposes. The more health-enhancing policies an organization adopts, the more likely it is to be perceived as having a health-conscious culture (Basen-Enquist et al., 19981.
From page 243...
... INTERVENTIONS TARGETED AT ORGANIZATIONS Organizational change is an integral component of a comprehensive ecologic approach to health behavior change that emphasizes how incli' viclual decisions anc3 behaviors are influenced by the multiple layers of systems within which inclivicluals are embeciclec3 (Stokols, 19961. As im' portent components of the social anc3 physical environments, organizations exert considerable influence over the choices people make, the re' sources they have to aid them in those choices, anc3 the factors in the workplace that could affect health status (e.g., work overload, exposure to toxic chemicals)
From page 244...
... Studies of programs aimed at incliviclual risk factors also provide some support for the importance of changing the organizational context to support employee health behavior change (Glanz et al., 1996; Hennrikus anc3 Jeffery, 19961. The example of smoking-control efforts at the workplace is illustrative.
From page 245...
... Evaluated with a quasi-experimental design, the intervention organizations exhibited a significantly greater increase in organizational support for employee heart health than did the comparison organizations. Reducing Environmental Risk Factors Traditional worksite health promotion programs focus on individual change of personal risk factors.
From page 246...
... Erlgirleerirlg strategies modify technology or physical setting; admir~istrative strategies mollify the organizing arrangements or social fact tars; anc3 behavior charge strategies target beliefs, attitudes, anc3 skills. Examples of behavior change interventions in OSH include training to increase compliance with safety practices (Parkinson et al., 1989)
From page 247...
... 247 , In >- ~ =2 Y Zig .o _ ~ _ ~ ~ in In w~ E ~ ~ .O ~ (a G ~ E I ~ IN .Q o ~ ~ It ~ ~ ~ O In z O ~ ~ .m [L at: O In O (a G ~ ~ E tL ' o .
From page 248...
... Members of work teams that meet regularly or that have leaders trained in facilitating group problem solving report receiving more social support from their supervisors and experiencing less role ambiguity and higher job satisfaction (Heaney, 1991; Jackson, 1983 i. In addition to these behavior change and administrative strategies, environmental psychologists suggest that changes in the physical setting can reduce occupational stressors and enhance psychosocial resources (Sundstrom and Altman, 1989~.
From page 249...
... No direct empirical comparisons of incliviclual behavior change approaches with organizational~level change approaches to stress reduction have been concluctec3. Incleec3, an either/or approach is not likely to enhance understanding of the stress reduction process.
From page 250...
... Careful formative research is likely to illuminate important local issues anc3 challenges, anc3 stakeholclers' participation is likely to en' hance the program quality and increase commitment to follow through with the program activities. COMMUNITIES AND HEALTH Incliviclual~level risk factors, families, and organizations influence health behavior anc3 health status, anc3 so c30 social anc3 environmental
From page 251...
... There is a need to better explain how the broacler community anc3 societal factors help determine the health status of inclivicluals anc3 groups. Some important conceptual constructs regarding the nature of communities as they relate to health outcomes are cliscussec3 below.
From page 252...
... anc3 communitylevel change interventions (in which the emphasis is on working with anc3 strengthening communities of identity to foster social anc3 structural changes that are associated with the health status of the community as a whole)
From page 253...
... conceptualizes purposive change in communities as being based on different configurations with respect to the agreementclisagreement dimensions of an issue, as well as other intervening variables. He posits three situations on a continuum that have different implications for community-level purposive change: ~ ~ ~ "issue consensus" where there is basic agreement within the community on an issue and how it should be resolvecl; (2)
From page 254...
... COMMUNITY LEVEL INTERVENTIONS It is beyond the scope of this chapter to provide an exhaustive review of the various approaches to community change interventions. Within the community-organizing literature there is extensive discussion of change models, such as community development, social action, commu
From page 255...
... involved community members in the Tenderloin district of San Francisco, focusing on low income elderly residents in single~room occu' pancy hotels. TSOP was established in 1979 by faculty anc3 graduate stu' dents at the School of Public Health, University of California, Berkeley, with the initial goals of enhancing mental and physical health by recluc' ing social isolation anc3 providing health education, anc3 of bringing together local residents to identify common problems anc3 solutions for ac3' ciressing those shared concerns (Minkler, 1992, 1997~.
From page 256...
... The project is a partnership between the University of Michigan School of Public Health, the Detroit Health Department, seven community-basec3 organizations (Butzel Family Center, Friends of Parksicle, Kettering Butzel Health Initiative, Warren/Conner Development Coalition, Islanciview Development Coalition, V.~.S.~.O.N., East Side Parish Nurse Network) , and the Henry Ford Health System.
From page 257...
... Of particular importance is having lay health advisors (Village Health Workers [VHWs]
From page 258...
... Study (Berkman and Syme, 1979) identified multiple risk factors associated with low income, including smoking, obesity, unmet needs for food and medical care, unsafe neighborhoocls, and lack of social supports (Kaplan, 1995~.
From page 259...
... As a result, people living in lowincome areas often are much less able to meet their needs for healthful foods. The public health response to social class differences in health behaviors must extend to changes in social structure to improve the clay- to- clay realities of low- income populations factors that clearly shape health behaviors anc3 health status.
From page 260...
... Therefore, a brief description of sev' eral important factors is presented to illustrate the importance of consic3' Bring them at the society level anc3 of assessing some of their interactions with those that function elsewhere. Government and Societal Constraints on Health Many social, economic, political, anc3 cultural factors are associated with health anc3 disease for which changes in incliviclual health behaviors alone are not likely to result in improved health anc3 quality of life.
From page 261...
... Using health targets incorporates a variety of approaches used at the government-level; national health campaigns anc3 legislation are cliscussec3 briefly below. Health Communication Campaigns Interventions can be aimed at incliviclual behavior providing eclucation or incentives for healthier choices.
From page 262...
... . Government also can help provide the means for safer behavior by removing legal impediments to behavior change (e.g., dismantling drug paraphernalia or needle prescription laws that impede access to sterile injection equipment)
From page 263...
... In 1992, WHO set the following target: "By the year 2000, the clifferences in health status between countries anc3 between groups within coun' tries should be reclucec3 by at least 25%, by improving the level of health of clisacivantagec3 nations anc3 groups" (Dahlgren anc3 Whiteheac3, 1992~. Approaches were aimed at reducing poverty (e.g., compressed income scales or progressive tax systems)
From page 264...
... Health Education Quarterly, 23, 175-188. Barzach, M
From page 265...
... Health Education Quarterly, 21, 199-220. Erdmann, T.C., Feldman, K.W., Rivara, F.P., Heimbach, D.M., and Wall, H.A.
From page 266...
... American Journal of Epidemiology, 125, 989-998.
From page 267...
... A review of health-related outcomes of multicomponent worksite health promotion programs. American Journal of Health Promotion, I I, 290-308.
From page 268...
... ( 1998~. Socioeconomic factors, health behaviors, and mortality.
From page 269...
... Health Education Quarterly, 16, 17-30. Minkler, M
From page 270...
... (1998~. Detroit's East Side Village Health Worker Partnership: Community-based lay health advisor intervention in an urban area.
From page 271...
... (1995~. Redesigning work systems to reduce stress: a participatory action research approach to organizational change.
From page 272...
... (1997~. Freirian praxis in health education and community organizing.
From page 273...
... ORGANIZATIONS, COMMUNITIES, AND SOCIETY 273 World Health Organization (WHO)


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