223795 Reducing social inequalities in health through action on settings : A conceptual framework

Monday, November 8, 2010 : 8:30 AM - 8:45 AM

Martine Shareck , Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
Katherine L. Frohlich, PhD , Department of Social and Preventive Medicine, University of Montréal, Montréal, QC, Canada
Blake Poland, PhD , Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Background : Health promotion seeks to move beyond an individual-based approach to health to one focused on settings where people live, work and play. Through its focus on the interplay between personal, organizational and environmental determinants of health, the settings approach offers great potential to modify social determinants of health and influence social inequalities in health. The definition of the approach and exactly what constitutes a settings-based intervention remain debated. This limits the conduct of impact evaluations of such interventions and our understanding of their effect on health inequalities. Methods : A critical review of literature published in the last fifteen years on theoretical and practical bases of the settings approach will be conducted. Initiatives targeting health within various settings (eg. schools, workplaces, neighborhoods) will be analyzed. Results : A preliminary literature scan indicates that a variety of social health determinants including nutrition, physical activity and housing can be targeted within settings such as schools or neighborhoods. Few studies documented how subgroups within these settings responded to the intervention and how its effects were socially distributed across the population. A conceptual framework articulating the links between changes within settings and social health inequalities will be presented. Conclusions : Settings-based interventions can reduce social inequalities in health. Information on the distribution of effects across population subgroups would increase our understanding of interventions' impact on health inequalities. The proposed conceptual framework could serve as a guide to the development, implementation and evaluation of interventions aiming to tackle health inequalities by targeting settings.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related research

Learning Objectives:
1. Formulate a comprehensive conceptual and practical definition of the settings approach. 2. Evaluate if programs aimed at settings have the potential to address and/or reduce social inequalities in health. 3. Assess how interventions aimed at settings could be designed to impact social health inequalities using a conceptual framework articulating the links between changes within settings and social health inequalities.

Keywords: Health Promotion, Social Inequalities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present on the settings-approach because I am a PhD candidate in Public Health and Health Promotion and my work concerns place-based influences on social inequalities in smoking. I was responsible for most of the work associated with this presentation and my research interests are directly linked to the topic of my talk.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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