Moving on Upstream

The Role of Health Departments in Addressing Socioecologic Determinants of Disease

Public health departments must address all factors in the community that are responsible for affecting health status.

The interrelationship between health and education, housing, jobs, income, and racial and ethnic discrimination is well documented. Given that the mission of public health is to "create conditions in which people can be healthy," what is the role of public health departments in addressing sociological determinants of disease, given the recommendations of the Robert Wood Johnson Commission to Build a Healthier America?

These authors suggest that public health departments are responsible to address broader health issues that influence the health of the community. Therefore, they must move "further upstream" and begin to address such issues as housing and the built environment, early childhood development, food deserts and neighborhood safety.

Historically, public health has periodically shifted its focus. Early public health efforts were centered on infectious diseases before changing focus to chronic disease and interventions. Now another shift is called for—from focusing on the proximal risk factors and interventions for disease (tobacco, diet, exercise and drug use as related to heart disease, cancer and stroke, for example) to those more distally responsible for health (such as health disparities, education, and social and economic factors).

Education, business, clinical practitioners, public health and government should collaborate to create environments conducive to sustained health improvements.