Minds in control

Dates: :	November 28th and December 5th at 9:00 – 11:30am
Location:	November 28th at ISERP room 801 December 5th at MSPH 14th FL conference room
Facilitator:	Gina Lovasi

Framing questions

When considering a change to improve population health, does it matter who controls that change?  Is there something healthful about being in control of one’s circumstances?  What are the connections between feeling in control and health?

"Freedom is not worth having if it does not include the freedom to make mistakes."  –Ghandhi

"Liberty is precious - so precious that it must be rationed." –Vladimir Lenin

People value being in control and living free from the control of others.  In this seminar, I’d like to discuss ways that being in control may be conducive to health and longevity.  Several terms are closely related to the idea of “control” – efficacy, power/empowerment, freedom – and can be used in reference to individuals or groups.  In the first week, we’ll discuss how to measure control and how people perceive control over neighborhood change.  In the second week, our focus will shift to how one’s sense of control can be enhanced or diminished.  Readings for each week are at the bottom of this memo, but I hope they will launch us into a broader discussion.  Discussants are invited to bring to the table related applications in their own research or evidence relating to specific health outcomes.

An example and some theory

Because of my own interests in how the physical environment can be changed to promote physical activity and health, I’ll introduce a park placement scenario to make the following discussion more concrete.  One could easily consider a biking trail, transit system, or grocery store instead of a park. 

If public health officials decide people should exercise more, they could create additional parks so that every person is within a short walk of a park.  Park placement could then be chosen accordingly, and new parks built.  Such a “top down” approach might be initiated by a health department.  An alternative “bottom up” approach could instead be the result of area residents coming together to create a new park, perhaps purchasing and transforming an empty lot.  Local individuals and potential park users would control of the entire process, perhaps with assistance from other groups.  The goal of creating a new park would be based on a perceived need, and the implementation would reflect the opinions of some potential park users.  The effects of creating a park in this way might include not only increased physical activity, but also increased social cohesion and collective efficacy (to be directed toward future goals).

In his book Inequality Reexamined, Amartya Sen, discusses control as either instrumentally or directly beneficial.  Local control in our park example could be instrumentally important by choosing the types of park facilities most likely to be used, and could also have some direct benefits unrelated to the park per se.  Even if the two processes would create the same physical park, the outcomes (park use, physical activity by local residents, social environment) might be different because of how residents perceive and use the park.  Observational and intervention studies differ in the types of changes they capture, possibly contributing to discrepancies between the expectations based on observational studies and the results of intervention studies.  In other words, interventions from controlled studies may be experienced by the subjects as artificial and externally determined, leading to less positive outcomes than would be expected from a more “organic” or participatory process. 

Sen also distinguishes between the freedom to have one’s goals attained, and the freedom to attain one’s goals through one’s own effort.  Suppose people in the community want a park.  The goal of a new park is shared with the health department, and some community members might prefer not to be involved in the park’s creation.  Does it matter whether the park is “placed” there by an outside force, or “created” by the local residents?  In short, does it matter who controls the process, or just who’s goals are attained?

In her text Valuing Freedoms (in Ch 4, “Participation and Culture”), Sabina Alkire points out that participatory processes are generally more equitable, since decision-makers know that the poor or otherwise disadvantaged groups could speak out.  Because of this and the other social effects of making group decisions, she endorsed the principle of subsidiarity, which states that the most local agents capable of making a decision should make it.

 

Related scenarios and settings

The possibility of control being healthful extends to other areas of research.  Some occupational studies have focused on the dimensions of control and demand in the workplace, finding that high-demand, low-control jobs are detrimental to one’s health (for an example, see Schnall, Job Strain and Carciovascular Disease, Annual Review of Public Health, 1994).  At the community level, collective efficacy has been much studied in relation to crime and children’s health (for an example see Sampson, Beyond Social Capital: Spatial Dynamics of Collective Efficacy for Children, American Sociological Review, 1999).  Further, participation in the context of economic development has played a major role in the work of both Amartya Sen and Sabina Alkire, often in relation to “wellbeing” rather than health specifically.

I’ve invited Lance Freeman to be part of our seminar on minds in control because of his work on gentrification, another context in which control plays a crucial role.  In There Goes the ‘Hood, he reports on interviews with residents in two historically black New York City neighborhoods.  He explores the tension caused by gentrification, as welcome and unwelcome “improvements” are accompanied by demographic shifts.  Fresh produce may be appreciated and consumed, while also in some way tainted by the fact that it was provided “for someone else.”  Are the healthful resources less effective because of this?  Does a sort of learned helplessness or despair result when a privileged group enters the scene and accomplishes what the residents previously had not been able to accomplish?

Those without control of their circumstances can also be forced into indisputably worse circumstances, sometimes in the name of their own welfare.  Another Columbia researcher, Mindy Fullilove, has described how urban “renewal” and other improvement campaigns have disrupted of African American communities in her book Root Shock.  She describes a particular pain caused by the loss of home and community, which might be considered also a loss of control.

READINGS CAN BE FOUND ON COURSEWORKS, PLEASE LOGIN WITH UNI AND PASSWORD

https://courseworks.columbia.edu/

Readings for week 1 

1. Alkire, S. (2005). Subjective quantitative studies of human agency. Social Indicators Research. 74(1): 217-60.

Abstract:  Amartya Sen’s writings have articulated the importance of human agency, and identified the need for information on agency freedom to inform our evaluation of social arrangements. Many approaches to poverty reduction stress the need for empowerment. This paper reviews subjective quantitative measures of human agency at the individual level. It introduces large-scale cross-cultural psychological studies of self-direction, of autonomy, of self-efficacy, and of self-determination. Such studies and approaches have largely developed along an independent academic path from economic development and poverty reduction literature, yet may be quite significant in crafting appropriate indicators of individual empowerment or human agency. The purpose of this paper is to note avenues of collaborative enquiry that might be fruitful to develop.

2. Freeman, L. (2006) Making Sense of Gentrification. There Goes the 'Hood. Philadelphia, Temple University Press.

Readings for week 2                  (READ TWO OF THE FOLLOWING)

1.  Lasker, R. D. & Weiss, E. S. (2003) Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research. J Urban Health, 80, 14-47; discussion 48-60.

Abstract:  Over the last 40 years, thousands of communities-in the United States and internationally-have been working to broaden the involvement of people and organizations in addressing community-level problems related to health and other areas. Yet, in spite of this experience, many communities are having substantial difficulty achieving their collaborative objective, and many funders of community partnerships and participation initiatives are looking for ways to get more out of their investment. One of the reasons we are in this predicament is that the practitioners and researchers who are interested in community collaboration come from a variety of contexts, initiatives, and academic disciplines, and few of them have integrated their work with experiences or literatures beyond their own domain. In this article, we seek to overcome some of this fragmentation of effort by presenting a multidisciplinary model that lays out the pathways by which broadly participatory processes lead to more effective community problem solving and to improvements in community health. The model, which builds on a broad array of practical experience as well as conceptual and empirical work in multiple fields, is an outgrowth of a joint-learning work group that was organized to support nine communities in the Turning Point initiative. Following a detailed explication of the model, the article focuses on the implications of the model for research, practice, and policy. It describes how the model can help researchers answer the fundamental effectiveness and "how-to" questions related to community collaboration. In addition, the article explores differences between the model and current practice, suggesting strategies that can help the participants in, and funders of, community collaborations strengthen their efforts.

2.  Cohen, D.A., et al., The built environment and collective efficacy. Health & Place (2007), doi:10.1016/j.healthplace.2007.06.001

Abstract:  Collective efficacy, i.e., perception of mutual trust and willingness to help each other, is a measure of neighborhood social capital and has been associated with positive health outcomes including lower rates of assaults, homicide, premature mortality, and asthma. Collective efficacy is frequently considered a ‘‘cause’’, but we hypothesized that environmental features might be the foundation for or the etiology of personal reports of neighborhood collective efficacy. We analyzed data from the Los Angeles Family and Neighborhood Study (LAFANS) together with geographical data from Los Angeles County to determine which social and environmental features were associated with personal reports of collective efficacy, including presence of parks, alcohol outlets, elementary schools and fast food outlets. We used multi-level modeling controlling for age, education, annual family income, sex, marital status, employment and  ace/ethnicity at the individual level. At the tract level, we controlled for tract-level disadvantage, the number of off-sale alcohol outlets per roadway mile, the number of parks and the number of fast food outlets within the tract and within 1/2 mile of the tract’s boundaries. We found that parks were independently and positively associated with collective efficacy; alcohol outlets were negatively associated with collective efficacy only when tract-level disadvantage was not included in the model. Fast food outlets and elementary schools were not linearly related to collective efficacy. Certain environmental features may set the stage for neighborhood social interactions, thus serving as a foundation for underlying health and well-being. Altering these environmental features may have greater than expected impact on health.

3.  Bandura, A. Growing primacy of human agency in adaptation and change in the electronic era. European Psychologist, 2002:7, 1-16.

Abstract:  The extraordinary advances in electronic technologies and global human interconnectedness present novel adaptational challenges and expanded opportunities for people to shape their social future and national life. The present article analyzes these pervasive transformational changes from an agentic theoretical perspective rooted in the exercise of perceived personal and collective efficacy. By acting on their efficacy beliefs, people ply the enabling functions of electronic systems to promote their education, health, affective well-being, worklife, organizational innovativeness and productivity and to change social conditions that affect their lives. Technology influences, and is influenced by, the sociostructural nature of societies. The codetermining sociostructural factors affect whether electronic technologies and globalization serve as positive forces that benefit all or divisive ones in human lives.

4.  Kaplan S, Kaplan R. Health, supportive environments, and the Reasonable Person Model. Am J Public Health. Sep 2003;93(9):1484-1489.

Abstract:  The Reasonable Person Model is a conceptual framework that links environmental factors with human behavior. People are more reasonable, cooperative, helpful, and satisfied when the environment supports their basic informational needs. The same environmental supports are important factors in enhancing human health. We use this framework to identify the informational requirements common to various health-promoting factors that are realizable through well-designed physical environments. Environmental attractors, support of way-finding, and facilitation of social interaction all contribute to the health-relevant themes of community, crime, and mode of transportation. In addition, the nearby natural environment, although often neglected, can serve as a remarkably effective resource.

Please bring any questions these readings raise to the table.  If you find it useful to write down your thoughts in advance please do so, and bring them to the seminar.

 

 

Some additional questions for discussion

What is the role of the population health researcher in addressing social problems or disparities?  Can those with the power to recommend and make changes do so without undermining the control of those we seek to help?  Is the “outsider” status of the researcher an asset or a hindrance?