Moving upstream to promote a healthier nation

The Society for Public Health Education (SOPHE) proudly announces the publication of a Health Education & Behavior (HE&B) supplement devoted to the latest research and practice on policy and environmental approaches to foster healthy communities. The April 2015 supplement, "The Evidence for Policy and Environmental Approaches to Promoting Health," comprises a dozen peer-reviewed articles and two perspectives examining the state-of-the-evidence on what's working and what's needed at the community, institutional and societal levels to promote good health across diverse sectors.

Rather than focusing on individual health behaviors related to disease and disability, this manuscript collection describes promising "upstream" advances in social-ecological research related to injury, tobacco, cardiovascular disease/stroke, childhood obesity, and food policy. The authors use innovative methodological approaches and multi-level interventions that go beyond typical "boundaries" of health such as economic modifications, changing social norms, community empowerment, resource redistribution, and expanding social networks.

The articles point to key themes needed to effect policy and systems change such as "the importance of building partnerships and coalitions outside of traditional public health, (the need for) multi-level approaches that link income, institutions and health outcomes, and the power of market forces (to influence) health-directed policies," write HE&B supplement co-guest editors Jo Anne Earp, ScD, professor, health behavior, University of North Carolina Gillings Global School of Public Health, and Lisa Lieberman, PhD, professor, Health and Nutrition Sciences, Montclair State University.

Several manuscripts describe structural changes related to the food environment and their impact on health. Improving the availability and selection of nutritious foods in low-income food deserts, providing nutrition education with point of purchase information, and developing new partnerships with recreation offices helped to reduce health disparities in communities. Several other articles outline how multi-level structural interventions related to injuries were "game changers" that dramatically reduced deaths due to automobile crashes and increased pedestrian safety.

Although much has been written about the need for policy and environmental changes to improve health over the last 30 years, more urgent action is needed, writes Robin Mockenhaupt, PhD, chief of staff of the Robert Wood Johnson Foundation (RWJF), which supported the special supplement through the President's Grant Fund of the Princeton Area Community Foundation. "We need to reframe the conversation toward creating a culture of health rather than focusing on discrete actions or activities. RWJF is committed to building that culture, one which embodies a sense of community, civic engagement, and understanding of how one person's health affects the health of a family, a neighbor, a coworker, or the overall community."

Achieving this goal and initiating more structural "upstream" approaches will require researchers to explore new theoretical and methodological paradigms, and will require expanded public and private support. "While we have enormous challenges ahead in expanding our approaches to social-ecological research, doing so is imperative for improving not only the health of this generation but for all those to come," says Lieberman.