Principle 6:

Principle 6:

Focus on the local relevance of public health problems with an ecological approach to health

As described by the Institute of Medicine, “an ecological approach assumes that health and well-being are affected by interaction among multiple determinants including biology, behaviour, and the environment.” This principle stresses the importance of considering health issues and the local context in which they occur, with data that is relevant, timely, and inclusive. It emphasizes an approach to health that extends beyond the individual, to the immediate and larger contexts in which families live, work, and play. In CBPR partnerships, the multiple determinants of health, such as social, economic, and physical environmental factors are examined through an interdisciplinary lens, and their interactions stressed(1). 

Competencies and/or conditions

  • Critical understanding of current local public health issues and theories on the determinants of health.
  • Appreciation for multiple methods and analytical traditions in population and health services policy research.
  • Ability to link immediate local issues to more broadly defined concerns, including for example, environmental justice, informal economy, improved housing, and supported well-being. 
  • Understanding of broader social, environmental, and economic issues, but additionally a focus on developing awareness of causes of local development issues and ‘education for political literacy and informed citizenship’(14).
    • The ability to link immediate problems with deeper aspirations constitutes an important characteristic of effective community leaders and can influence the ability to engage and retain community researchers in an ongoing process(15).
    • Enriched academic partners’ understandings of the needs, priorities, and health concerns of communities, organizations, and the public health system and lead to refined and new research questions.
    • Enhanced relevance, usefulness, and use of the research data by all partners involved.
    • Improved quality and validity of research by engaging local knowledge and local theory based on the lived experience of the people involved.
    • Development of innovative and sustainable solutions, while also helping ensure that the conversation addresses the root causes of health inequities and broader policy changes that can improve health outcomes.
    • Research products can be more tailored to meet the needs of implementing systems, implementers, and communities (Cargo, 2008).
    • Take a transdisciplinary approach to understand public health problems
    • Raise awareness about the root causes underlying health issues using problem tree analysis and other tools
    • Present opportunities for community partners to educate academic partners on community needs and preferences through various means
    • Use of mapping with community members to illustrate and provide powerful, visual data to help address a wide range of health disparities– see community research blog
    • Use of creative research methods to identify and highlight public health problems in relation to wider context; Photovoice Participatory video puts video cameras in the hands of community members, together with critical analysis of community assets and problems, to collect visual data and employ it in working for changes in programs, policies, and practices
    • Engage with public health agencies to help citizen groups gather and analyse information, negotiate public bureaucracies, interpret previous studies, and advocate for enforcement of existing laws
    • Create forums to bring formal and informal community leaders together to consider health issues within the context of the socioecological setting
    • Offer skills workshops and technical assistance on understanding health issues
    • A support community events that build sense of identity; create safe spaces for community members to discuss, analyse health issues
    • Conduct reflexivity sessions to ensure that the partnership (i.e. community members and academic researchers) analyse and reflect on successes and limitations of their actions within the wider socioecological context
    • Number of training/discussion workshops exploring public health issues within the wider context
    • Enhanced knowledge and understanding about community dynamics and conditions that affect health
    • Evidence of knowledge sharing about theories on determinants of health
    • Evidence of cross-country sharing of health and wellbeing issues explored and their links to ecological perspectives across contexts
    • Agreement on the health or related issues that community partners wish to address, and if needed, reframing the problem to ensure maximum relevance and the outcome(s) with which they are concerned.
    • Demonstrated evidence of refined research questions based on increased community awareness of public health issues
    • Evidence that a research/action proposal was designed and developed in full partnership with the team to ensure cultural relevancy, and benefits for both the team and the broader community
    • Evidence of transdisciplinary approaches to understanding health and wellbeing issues
    • Data collection/analysis visual outputs – blogs/vlogs
    • List of disciplines engaged in the research
    • Co-analysis workshops/processes documentation
    • Minutes from meetings between research partners and local organisations to jointly explore problems and solutions
    • Outputs (e.g. flipcharts, audio recordings, stories, narratives, etc.) from sessions exploring local health issues, roots causes and wider social determinants of health
    • Podcasts
    • Whats app conversations
    • Reflexivity sessions – Audio/written documents

*Please note that some statements are adaptations or direct quotes from the papers listed in the reference section