Advancing Policies/Systems Change

Address Social and Cultural Factors Along With the Physical Environment

Supporting and sustaining healthy choices requires changing both the physical and social environments together. Public health professionals have emphasized policy and the built environment because fundamental changes in practice are needed to supplement traditional health promotion. Health messages and programs can play an important role in informing, motivating and supporting healthy choices for some individuals, but they are insufficient and unsustainable if those individuals encounter a daily environment where healthy foods and opportunities for physical activity are not accessible (e.g., that they are safe, affordable and convenient). Similarly, research indicates that community environments play an important role in improving health. However, efforts to improve the physical environment are rarely sufficient to change people’s choices if social supports don’t also exist. When social and environmental supports are intentionally integrated, the effect can be significant.

Strong social and cultural factors challenge policy and environmental approaches and must be understood and ultimately addressed. Issues such as language, regional or ethnic eating traditions, cultural mores around body image or gender segregation, social isolation, family dysfunction, stress and depression discourage people from adopting healthier behaviors. It is important to understand challenges like these and honor social motivation along with physical opportunity. Then it may be possible for some organizations to tailor activities, settings, messages and clinical care to the needs of individuals while partnerships continue to work toward broader social change. This approach will help us deliver more fully on the promise of policy and environmental change for better health behavior.

Integrating social and environmental supports for populations is more challenging at scale. Partnerships find it challenging enough to combine policy and environmental change with health promotion and programs in individual schools, neighborhoods or very small towns. Across larger geographic or institutional scales, and as the complexity of influences increases, integrating approaches for a specific target population or behavior can become difficult. It is advisable to identify an appropriate policy target and scale for which the partnership can integrate other supports over time and to adjust timelines and expectations to the rigors of doing so. This helps ensure that ambition and leaps of faith do not overcome prudent planning and execution.

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