Community Organization and Systems Intervention

Human environments unarguably play a role in the promotion of health and well-being. By the term environments, we mean built and natural space but also the interrelated social, cultural, neighborhood, organizational, familial, and economic environments in which people take part. There are multiple mechanisms for environmental impacts on health and well-being. Some mechanisms are direct. For example, environments that are relatively free from toxic contamination and violent conflict promote health and well-being in a fairly direct biophysical way. Other mechanisms are less direct. For instance, countries with greater income inequality tend to have lower levels of population health, controlling for overall levels of income (Wilkinson & Pickett, 2006). This relationship appears to be moderated by local socioenvironmental factors, including social trust and social capital (Mansyur, Amick, Harrist, & Franzini, 2008). In this instance, the specific mechanisms for the impact of societal inequality on health outcomes remain unclear but likely include psychosocial and behavioral dynamics that vary according to a number of other environmental and contextual factors. Environments are dynamic. They are adaptable and malleable. Just as the environments in which people take part have an impact on them, so environments are impacted and changed by the human actions taken within them. Human environments contain various overlapping systems. For instance, one system that is increasingly recognized for its health impacts is the food system – a term that has been used to describe everything from agricultural policies and techniques to the distribution, marketing, preparation, and consumption of food and the associated influences on individual and population health. The food system can be imagined as a chain or a sequence, a cycle, a web or a network, or a set of concentrically nested ecological contexts. Integrating these conceptual models, Sobal, Khan, and Bisogni (1998) provide a definition of food and nutrition systems as “the set of operations and processes involved in transforming raw materials into foods and transforming nutrients into health outcomes, all of which functions as a system within biophysical and sociocultural contexts” (p. 853). Their conceptual model specifies subsystems (producer, consumer, nutrition) that, at various stages, determine the flow from resource inputs through the food and nutrition system to health outcomes. Although copious evidence exists supporting the links between systems and human health and well-being, relatively few attempts to promote health and well-being are designed to intervene on broader elements of systems. Instead, they focus on the individuals who take part in the system. For instance, the journalist and food system scholar Michael Pollan has done much to advance public understanding of the food and nutrition system. His work has illuminated the policies that have catalyzed the industrialization of agriculture, revealed the inconclusive state of the nutritional research that often informs expert advice, and given consumers pithy tenets for negotiating food and nutritional systems in ways that might improve their own health. Unlike many individual-level interventions, Pollan’s hope is not simply to inoculate consumers from the potential risks of their food environments. He hopes that their changed perspectives and consumer savvy (Pollan encourages consumers to “vote with your forks”) will, in aggregate, result in modifications in the production and distribution components of food systems that will be beneficial to population health outcomes. In effect, Pollan leaves systems change to the free market, waiting for food and nutritional systems to adapt to accommodate the changing preferences of individual consumers. Community Organization and Systems Intervention 303