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Writer's picturebabochka12
Nov 6, 20205 min read

DIABETES THROUGH THE LENS OF SOCIAL ECOLOGICAL MODEL

Updated: Nov 26, 2020

Introduction:


Awhile ago, when I used to work as a float nurse, I was often a part of a medical or a surgical department. Almost every other patient had a diabetes or complications from it. It made me wander what could of be done, not only on the individual, but also on government, or society levels to prevent from this devastating disease. In order to take hold of this chronic disease, we should analyze it from different angles. One of the ways to do this, is to look through the lens of multi-level model of health, such as Social Ecological Model. This blog posting will explain the diabetes, the Social Ecological Model, and the application of the model to the diabetes in the form of case study.


Health, determinants of health and diabetes:


In the earlier blog the subject of health was discussed. One of the newer definitions was offered, stating that health is a satisfactory and acceptable state of physical, mental, emotional, economic and social wellbeing (O. Ositadima et al., 2018). It is important that the definition does not focus on disease absence, but instead, on adaptation and functioning, then the health promotion focuses on enhancement of coping mechanisms. The definition would lead to the recommendations not only to improve the treatments, but also to reduce the risk factors that predispose to those diseases, such as smoking, bad eating habits, sedentary lifestyle, poor hygiene, and so on (N. Santorius, 2006). Which brings us to determinants of health. They are the factors that influence the person’s health. It is important to include them to understand how behavior shaped by the environment, and consistent with approaching health through those factors, so certain environmental changes could be implemented that would lead to a healthier behavior.


According to WHO, diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. About 422 million people worldwide have diabetes, and 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades (WHO, 2020). The increasing prevalence of diabetes in North America has become a major public health problem. Although genetics, ethnicity, and an individual’s lifestyle contribute to the development of this chronic illness, the social and environmental context of communities have received increasing attention as critical factors that contribute to this significant health issue (R. Whittemore et al., 2010).

Social Ecological Model:


Social Ecological Models are visual depictions of dynamic relationships among individuals, groups, and their environments. They derive from a systems orientation to human development, in which individuals are understood to influence, and be influenced by, people and organizations with whom they interact, available resources and institutions, and societal norms and rules (S. Golden et al., 2012). Social Ecological Models are unique in that they take into account the physical environment and its relationship to people at individual, interpersonal, organizational, community, and public policy levels. This perspective is based on the major philosophical construct of the model: Behavior does not occur in vacuum (L. Quinn et al., 2005).


To use the model effectively, one must understand the levels and how they interact with one another. The model consists of five levels (UNICEF, 2008):



The benefits of using the model:

· provides education for people

· proves it is less costly to prevent a disease then trying to cure it later

· encourages individual to take responsibility and have healthier lifestyle

It is a model that primarily focuses on health promotion and prevention.


Application of the Social Ecological Model to diabetes:


By applying the model, we can better understand how diabetes might affect a person from different angles. The model provides points at which different entities can interject to hopefully change said behavior on a certain level in hopes to prevent further harm or disease. The model is also useful in understanding the reasons as to why we behave the way we do (K. Aronika et al., 2015).

Using a case study, the issue of diabetes will be applied to better understand how the model can guide us with health promotion and prevention:

Mrs. Y is a female of Asian origin in her mid forties. She is a single mother of a 10 years old boy, and she lives in the same duplex that her parents , but in the separate apartment. The duplex is located in Brossard, Qc, in the area with a large Asian population. People are friendly and supportive in her neighborhood. Her father still works, but her mother is retired. Her mother cooks a lot of Asian food, mostly noodles, rice, and meats with sweet sauces. Both of her parents have diabetes, that are treated with oral hypoglycemic agents. Mrs. Y works as a grocery store cashier 8 hours 5 days a week, but often takes overtime shifts to be able to make extra money. She does not own a car and takes a bus to get to work, and usually feels tired after her work from standing all day and the long commute. She usually feeds on at work, by purchasing food at her workplace’s “ready to eat” counter. She often cannot resist buying fast food options, such as fries, deep fried chicken wings, etc. because, as per Mrs. Y “they are freshly made and smell too good”. During coffee breaks she likes to treat herself to a cupcakes or brownies from the bakery section. All her family used to be followed by the same family doctor, but since he retired a year ago, they struggle to find another one.

The Social Ecological Model can be applied to better understand how to address the complexities and interdependencies between the determinants of health at different levels, and where to target interventions to help clients like Mrs. Y:


As we can see, by applying this model, we can better understand the risk factors of clients like Mrs. Y and create health promotion and diabetes prevention strategies. The previous blog has a visual format of application of the model to diabetes.


Conclusion:


In conclusion, the Social Ecological Model can be very beneficial and effective when it comes to disease prevention and control. Behavioral, societal, and environmental factors determine a large portion of our health, whether it be the food we eat, or the air we breathe. By using this model to change behaviors on different levels at different stages in an individual’s life, not only are we preventing chronic disease and illness, but we are prolonging quality life years, in not only an individual’s life but sometimes populations as well. This model is a good model that explains that there are different factors that go into our environment and that lead to behaviors. By understanding these determinants of our health behavior, the model helps change behavior for the positive making early detection, proper treatment and more possible, providing to a state of overall better health in a population (K. Aronika et al., 2015).




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