Promoting Healthy Environments

Stokols, D. (1992). 'Establishing and maintaining healthy environments: Toward a social ecology of health promotion.' American Psychologist, 41(1), 6-22.

In this paper, Stokols (1992) proposes that we need to focus not only upon individual behaviour change, but also upon health-promoting environments. He argues that, although environmental problems on a global scale may seem overwhelming, nevertheless, much progress can be made at local levels to create and maintain healthy environments.

Analyses that define health simply as the absence of personal illness or injury … give little or no consideration to issues of collective well-being (sic) (eg social cohesion and sense of community; S.B. Sarason, 1974) and optimal states of wellness (eg strong feelings of personal commitment to one's social and physical milieu). The terms 'disease prevention' and 'health protection' have been used to describe various medical and public health strategies aimed at preventing the onset of physical and mental illness (eg inoculation against infectious diseases, enhanced community sanitation services, reduction of workplace hazards, and governmental regulation of food and drug safety). The concept of 'health promotion', however, differs from the disease prevention orientation in that it places greater emphasis on the role of individuals, groups and organisations as active agents in shaping health practices and policies to optimize (sic)both individual wellness and collective wellbeing. (p. 7)

Stokols argues for an ecological perspective of health promotion. As the term 'ecology' refers to the interrelationships between organisms and their environment, so 'social ecology' refers to how people relate to their social, institutional and cultural environment. Stokols (p. 2) asks us to consider the question:

What environmental qualities of organisational and community settings are especially health promotive?

However, he also points out that the healthfulness of a situation, and the wellbeing of the people in that situation, form a system of complex interactions between the physical environment (eg geography, architecture and technology), the social environment (eg culture, economics and politics) and personal characteristics (eg genetic heritage, psychological dispositions and behavioural patterns).

He argues for a multifaceted, multiple-level approach to health promotion that covers:

family members who make efforts to improve their health practices, corporate managers who shape organisational health policies, and public health officials who supervise community health services. (p. 9)

Stokols refers to Antonovsky's (1979, cited in Stokols, 1994, p. 17) use of the word 'salutogenesis' to describe the study of the causes of emotional and physical wellbeing (as opposed to the more usual study of the causes of ill health). This includes studying psychogenic factors in health, such as a person's sense of coherence that enables them to resist the potentially negative consequences of stressful life events, as well as biological, behavioural and environmental processes that reduce vulnerability to illness and promote wellbeing.

Stokols provides some criteria for health-promotive environments (Stokols, 1992, p.12).

Facets of healthfulness	Environmental resources	Behavioural, psychological and physiological outcomes
Physical health	Injury-resistant design; ergonomically sound design; physical comfort; non-toxic and non-pathogenic environment	Physiological health; absence of illness symptoms and injury; perceived comfort; genetic and reproductive health
Mental and emotional wellbeing	Environmental controllability and predictability; environmental novelty and challenge; low distraction; aesthetic qualities; symbolic and spiritual elements	Sense of personal competence, challenge and fulfilment; developmental growth; minimal experience of emotional distress; strong sense of personal identity and creativity; feelings of attachment to one's physical and social milieu
Social cohesion at organisational and community levels	Availability of social support networks; participatory design and management processes; organisational flexibility and responsiveness; economic stability; low potential for intergroup conflict; health-promotive media and programming	High levels of social contact and cooperation; commitment to and satisfaction with organisation and community; productivity and innovation at organisation and community levels; high levels of perceived quality of life; prevalence of health-promotive, injury-preventive and environmentally protective behaviour.

Stokols argues that the 'contextual scope' of health promotion must consider spatial, temporal and sociocultural scope. In particular, sociocultural scope includes issues such as supportive interpersonal relationships that can enhance individual emotional and physical wellbeing and reduce the stressful consequences of negative life events. He provides the example where shared goals among group members may provide a structural basis for cooperation, even when occasional conflicts develop. Here, the work situation is likely to have both formal and informal mechanisms of conflict resolution in place.

A related article can be found at The School as a System