There are many factors in the Social Ecological Model that influence health and health behavior. These include intrapersonal factors, interpersonal factors, one’s environment, relationships among community organizations, and public policy. A significant and dynamic inter-relationship exists among these levels (U.S. Department of Health and Human Services, 2008). To reduce health disparities and improve the health of the public, interventions must address all of these health determinants simultaneously in a multilevel approach.

Multilevel interventions target the causes of health disparities by intervening at each level; it does not focus on a single health determinate. This multilevel approach can be applied when addressing obesity, a widespread public health issue.

The following video presented by Marjory Ruderman at Johns Hopkins School of Public Health applies the ecological model to obesity (4:44-8:21):

https://www.youtube.com/watch?v=xhUxOZRn_4E

In addition, Dr. Maya Adam at Stanford University looks more closely at how a child’s environment can influence rates of childhood obesity in this video:

Let’s look more closely to see how multilevel interventions can be used to address the issue of childhood obesity:

Intrapersonal

Factors

• Genetics
• Knowledge, attitude, and behavior related to diet and exercise

Possible Interventions

• Programs aimed to inform children about which foods are healthy and nutritious
• Reward kids for making healthy food choices
• Encourage physical activity

Interpersonal

Factors

• Food choice (increase in consumption of fast foods and processed foods)
• Family behaviors
• The context of food in family relationships
• Cultural meanings of thinness and fatness

Possible Interventions

• Educate the whole family about food quality and nutritional value
• Encourage parents to set a good example by eating healthy foods and exercising

Institutional

Factors

• Food choices at school
• Opportunity for exercise (today, there is an increased amount of screen time decreasing the likelihood that children will go outside and play)
• Access to health promoting services

Possible Interventions

• Provide a nutrition class in school
• Schools can have sports teams and other after school activities to promote physical activities
• Schools can promote healthy lunch options

Community

Factors

• Access to affordable foods
• Safe sidewalks, parks and bike paths
• Community norms on acceptable weight
• Living in a food desert

Possible Interventions

• Provide sidewalks and safe lighting to encourage community members to walk
• Lead community programs that encourage physical activity like planting trees in neighborhoods
• Have local farmers markets or fresh food trucks to promote eating fruits and vegetables
• Have community leaders hold forums discussing the health risks of obesity

Policy

Factors

• Regulation of school food programs
• Regulation of labels on food products
• Government farm subsidies
• Regulation of big food corporations
• Taxes on food
• USDA food regulators

Possible Interventions

• Regulate the amount of sugar, fat and salt that can go into processed food
• Enact policy that increases the health standards of school lunches
• Tax sugary beverages

(Staniford, Breckon & Copeland, 2012)