Public health is concerned with supporting, improving, and protecting the health of communities. Public health focuses on entire populations and considers how genetics, personal choices, and the environments in which people live, work, and play impact health.
In this section, we address the role that physical and social environments play in health, how bystander intervention can foster community, and how different health outcomes can be related to the unequal distribution of resources.
It is commonly understood that personal health practices and coping skills are important aspects of supporting mental and physical health. Often health status is strictly attributed to individual choices and genetics. Research, however, indicates that there are many additional determinants of health that significantly contribute to differences seen in health status across various populations.
These determinants include factors such as employment, income levels, education levels, physical environment, social environment, and access to health care. Independent of biological differences, epidemiological research shows that these social conditions affect health status.
Exposure to various health determinants is associated with place. For instance, place establishes someone’s exposure to chemical agents, air pollution, crime or neighborhood violence and someone’s access to services, affordable nutritious food, and recreational opportunities. Increasingly, it is recognized that the physical environment may affect what people’s choices and therefore their health.
In poor neighborhoods, where members of marginalized groups disproportionately live, “junk” food, soda, and cigarettes are readily available in small markets. Grocery stores that sell fresh foods are scare and the produce is expensive, farmer’s markets are rare, and fast food restaurants and liquor stores are common. That said, neighborhood has been found to be an independent risk factor for health outcomes after controlling for income, education, and occupation.
The social conditions in which people live, work, play, and grow affect their health and well-being. These factors include income levels and educational opportunities. In addition, religious, political, and economic structures and hierarchies shape the conditions in which people live.
Adequate resources, reliable positive social relationships, and a sense of one’s ability to shape one’s destiny are key factors that have been shown to help or hinder good health.
Bystander intervention training has the potential to reduce harmful incidents on campus by helping students develop a wide lens for recognizing situations where help is needed, as well as the necessary skills to successfully intervene.
It also fosters norms for mutual helping and responsibility and provides a foundation for building community on the college campus. Rather than emphasizing intervention skills in specific domains, this approach is designed to help students develop an overarching “helper” identity and to cultivate a bystander skill set that can be applied across situations (alcohol toxicity, gender violence across identities, bullying, bike safety, for example).
Health disparities are differences in outcomes and status among or between populations. For instance, sickle cell anemia is prevalent in populations whose genetic origins are from geographic locations where malaria was prevalent. Sickle cell anemia is protective against sickness and death from malaria. This CDC map illustrates the geographic locations where malaria is present and sickle cell trait also predominates.
Health equity refers to how the difference in distribution of resources creates unequal outcomes among groups. For instance, differential access to treatment for sickle cell anemia can create unequal health outcomes.
In addition, before there is a health problem and treatment is required, social factors in which resources are unequally distributed set the stage for unequal outcomes. For example, children who live in old or substandard housing have increased exposure to lead in their environment, which can lead to myriad health problems. Also, people who are poorly nourished and stressed are more vulnerable to the impact of lead. This illustrates the double impact of health equity factors.
Robert Wood Johnson Foundation: Overcoming Obstacles to Health