The multilevel model of health is described as an approach of understanding the various levels in which individual’s risk factors influence the health of populations (Galea, 2015). It explores how social, biological, geographical, political and temporal factors shape the health of populations (Galea, 2015). A form of the multilevel model of understanding health is the ecological model. Health from an ecological perspective is a measure of the wellness of the individual dependent on the wellness of the community and vice versa (Dustin, Bricker, & Schwab, 2009). The ecological model is rooted from the ecological theory which argues that human development is influenced by a set of common interactions that may support or undermine it (Tehrani, Majlessi, Shojaeizadeh, Sadeghi & Hasani, 2016). The ecological model explores the complex links and relationships between health and its factors or determinants (The Women and Children Health Policy Center, 2013).
The ecological model depicts a vivid image of the interaction between factors at the four levels; which are individual, interpersonal, social environment, physical environment and public policies (Tehrani et al., 2016). The ecological model treats the interaction among the factors at each different level with equal importance to that of the influencing factors within a single level (World Health Organization, 2018). The individual level examines how personal characteristics such as age, gender, knowledge and attitude can cause changes in one’s behaviours. The social environment examines how interpersonal and culture interactions can affect the performance of an individual (Tehrani et al., 2016). The physical environment involves natural or man-made environments and involves the availability and accessibility of facilities that motivates the individual to take part in the physical environment (Tehrani et al., 2016). Last, public policies involve the rules, regulations and policies that affect health (Tehrani et al., 2016).
The ecological model can be used to examine the health of immigrant women. Culture, gender and the migration experience are viewed as determinants of health for immigrant women (Thurston & Vissandjée, 2005). The ecological model effectively depicts how individual behaviors, social environments, and physical environments of immigrant women influence their health and well-being (Thurston & Vissandjée, 2005). Factors such as language barriers, culture shock, social isolation and loneliness, feelings of loss of socioeconomic status, finding employment and establishing a source of income, working in unsafe or unhealthy work environments, discrimination, barriers in accessing healthcare services, and establishing a new home; can potentially result in negative outcomes in the health of immigrant women (Thurston & Vissandjée, 2005). According to Statistics Canada (2016), the employment rate between Canadian-born women and immigrant women is consistently higher for Canadian women than of immigrant women. Immigrant women unfortunately have challenges integrating into the labor market due to lacking educational credentials and work experience recognized by Canadian employers (Statistics Canada, 2016).
In Canada, the determinants of health play an important role in impacting the overall health of immigrant women. Immigrant women with limited education and low household income are much more likely to become smokers, hypertensive, obese, diabetic and develop mood disorders (Statistics Canada, 2016). Immigrant women aged 65 or older are at a higher incidence of diabetes in comparison to Canadian-born women (Statistics Canada, 2016). Immigrant women often experience decline in their health due to lack of social support. Upon arriving in Canada, immigrant women are often healthier than the average Canadian born person due to the “healthy immigrant effect” (Statistics Canada, 2016). But as immigrant women live in Canada year by year, they begin to experience decline in health due to stress related to language barrier, finding adequate source of income, and forming social networks in a new country (Statistics Canada, 2016). The active social support from family and community can often reduce the stress of migration and resettlement for immigrant women (Statistics Canada, 2016). The social networks and interactions promote help seeking, and overall physical and mental health (Statistics Canada, 2016).
It is evident that the interactions among the determinants of health for immigrant women can be quite complex. Therefore interventions in eliminating these negative outcomes for the immigrant women should not only focus on the individual level but also at the organizational levels in the form of institutional changes in polices and services (Thurston & Vissandjée, 2005). Health service delivery strategies and polices need to acknowledge that the unique barriers and needs immigrants face is very important for financial, linguistic and gender-sensitive support to be allocated to (Hyman, Patychuk, Zaidi, Kljujic, Shakya, Rummens, Creatore & Vissandjee, 2012). Formal and informal community based support systems and information sharing should also be considered as the foundation of health promotion and disease prevention strategies among immigrants (Hyman et al., 2012).
References
Dustin, D. L., Bricker, K. S., & Schwab, K. A. (2009). People and Nature: Toward an Ecological Model of Health Promotion. Leisure Sciences, 32(1), 3-14. Retrieved from http://0-eds.a.ebscohost.com.aupac.lib.athabascau.ca/eds/pdfviewer/pdfviewer?vid=1&sid=060bf01f-8148-4085-bae6-9515dcc44c89%40sessionmgr4010
Galea, S. (2015, May 31). The Determination of Health Across the Life Course and Across Levels of Influence. Boston University School of Public Health. Retrieved from https://www.bu.edu/sph/2015/05/31/the-determination-of-health-across-the-life-course-and-across-levels-of-influence-2/
Hyman, I., Patychuk, D., Zaidi, Q., Kljujic, D., Shakya, Y.B., Rummens, J.A., Creatore, M., & Vissandjee, B. (2012). Self-management, health service use and information seeking for diabetes care among recent immigrants in Toronto. Chronic Diseases and Injuries in Canada, 33(1). Retrieved from https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-33-no-1-2012/self-management-health-service-use-information-seeking-diabetes-care-among-recent-immigrants-toronto.html
Statistics Canada. (2016). The health of girls and women in Canada. Retrieved from https://www150.statcan.gc.ca/n1/pub/89-503-x/2015001/article/14324-eng.htm
Tehrani, H., Majlessi, F., Shojaeizadeh, D., Sadeghi, R., & Hasani, K. M. (2016). Applying Socioecological Model to Improve Women’s Physical Activity: A Randomized Control Trial. Iranian Red Crescent Medical Journal, 18(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884614/
The Women and Children Health Policy Center (WCHPC). (2013). The Ecological Model in Public Health [Video File]. Retrieved from https://www.youtube.com/watch?v=Rm00AzC-gEU
Thurston, W. E., & Vissandjée, B. (2005). An ecological model for understanding culture as a determinant of women's health. Critical Public Health, 15(3), 229-242. Retrieved from http://0-eds.a.ebscohost.com.aupac.lib.athabascau.ca/eds/pdfviewer/pdfviewer?vid=1&sid=a5ed6718-3df4-4b63-84c4-307431f86441%40sessionmgr4010
World Health Organization (WHO). (2018). The Ecological Framework. Retrieved from http://www.who.int/violenceprevention/approach/ecology/en/