Six levels of public health action

Within those three domains of public health, we could think of public health working at six levels of public health action.

Social

The first level of public health action is ‘social’, for example changing social norms about wearing seatbelts, or drink driving, or wearing face coverings in the pandemic.

Biological

The second levels is ‘biological’, for example vaccinations. We all know how important to rush to develop a Covid-19 vaccination was.

Environmental

The third level of public health is ‘environmental’, for example encouraging green transport, outdoor air quality, reducing pollution, surface and ground water quality, toxic substances and hazardous wastes, and the effects of climate change on public health.

Behavioural

The fourth level of public health action could be seen as ‘behavioural’, which entails action to encourage individual and population health behaviour change, helping individuals to stop smoking, or educating the public about the risks of Covid-19 in order for people to adhere to social distancing measures.

Legislative

The fifth level is ‘legislative’, which refers to policies to improve public health, for example in the UK the smoking ban was implemented in 2007, which meant it became illegal to smoke in public enclosed places. Other examples of legislative action are the tax on soft drinks, or also known as the ‘sugar tax’, or emergency regulations to tackle breaching social distancing restrictions and fines or police action to disperse gatherings.

Structural

The sixth level of public health action refers to public health’s contribution to ‘structural’ changes. This refers to how the structure of societies, with its social contexts and roles, impacts on public health resulting in inequalities in health. In other words, health is dependent on context as well as social status and this can result in health inequalities between countries, as well as within countries.

Discussion

Can you provide any examples where the structure of a society might lead to health inequalities?

Post your thoughts in the comments section below, and consider and discuss the response of at least one other learner.