Health outcomes are the result of a complex combination of factors including not only biological or genetic causes but also race, ethnicity, gender, sexual orientation, socioeconomic status, education level, mental health, geography, etc. (Disparities – Healthy People 2020, 2020). Health problems are influenced by policies, systems and environments (PSE) that make it easier to sustain unhealthy behaviors than to foster healthier choices.
Individual lifestyle choices are only one part of our ability to live healthy, productive lives. A mix of social, economic and physical factors drives health disparities, or “differences in the incidence (new cases), prevalence (all cases), mortality (death), and burden of diseases and other adverse health conditions that exist among specific population groups” (National Institutes of Health, 2002). Despite progress in cancer prevention, screening and treatment, a disproportionate share of uninsured, medically underserved and minority populations across the United States are impacted by cancer (American Cancer Society, 2009). Health disparities are nearly impossible to address without a multi-level, ecological or PSE change approach that considers the opportunities and challenges facing all people in the community.
Following several reports in the early 2000s from the National Academy of Medicine (NAM) focused on an increased recognition of social determinants of health and social ecological approaches to population health (NAM, 2000, 2002, 2004), the Centers for Disease Control and Prevention (CDC) convened the National Expert Panel on Community Health Promotion and the PSE change approach was born (Liburd & Sniezek, 2007; Comprehensive Cancer Control National Partnership, 2015). To achieve quicker change and foster healthier communities, one NAM report recommended policymakers and public health professionals (NAM, 2004):
- Support community and neighborhood empowerment
- Establish strategic partnerships
- Educate stakeholders and decision-makers
- Identify community leaders and build on existing resources
- Gather and use relevant data
- Maintain a focus on evaluation throughout the PSE change process
- Share successful strategies with other communities