Many social factors that burden health (e.g. environmental pollution, unemployment) can hardly be changed in the district. Nevertheless, health promotion in the district can have a positive impact on people’s health chances.
If a health-promoting offer is planned, it is important to determine which factors should be changed with regard to health. Is the project, for example, about different behaviour, should health burdens in the urban district be reduced or should framework conditions be designed in such a way that the conditions for health-promoting behaviour in everyday life are improved?
Health and well-being depend on a variety of factors. Apart from age, gender and genetic make-up, most of these factors can be influenced. Margret Whitehead and Göran Dahlgren (1991) have outlined the different levels at which these factors act:
- personal behaviours and lifestyles (first level)
- the support and influence of the social environment (second level)
- living and working conditions (third level)
- economic, cultural and physical environmental conditions (fourth level)
In health promotion and prevention, a distinction is made between two objectives:
- Measures that are intended to change individual factors, e.g. courses on healthy eating habits or smoking cessation, are referred to as behavioural measures.
- Measures that are intended to change factors that affect the individual from the outside are referred to as relationship-related.
However, the different strata are not considered in isolation, they influence each other. For example, working and living conditions or social networks also have an influence on individual lifestyles.
Under the term “social determinants” of health, the World Health Organization has worked out the central aspects of living and working conditions and lifestyle that determine people’s health. The following table explains which social conditions (determinants) influence health and gives some examples of how they can affect the neighbourhood. The table can also be used as a checklist to identify positive or negative factors in the neighbourhood.
People in a difficult social situation are often exposed to great burdens due to their life situation, e.g. unemployment, low income, difficult housing situation, and at the same time often do not have sufficient resources and competences to cope with them, e.g. support through social networks, offers of professional support or the competence to use them.
This applies in particular to
- People with a low income,
- Persons with low occupational status (e.g. unskilled workers),
- persons with a low level of education (e.g. without a qualified school leaving certificate) and
- specific target groups such as the homeless, addicts, people with disabilities.
In addition to many difficulties, the rainbow model and the presentation of determinants of health clearly show that groups and individuals always have the most diverse resources and potentials. These are specifically addressed by health promotion. The target groups must be involved in the planning and development of services. Only then can interventions lead to a lasting change in everyday life.
The most promising interventions are those that not only appeal to individuals and try to change their behaviour patterns, but also take their life contexts into account.