How does a multilevel model of health intersect with a multilevel system of care?

This week we’ve been asked to find a multilevel model of health and explain how this model applies to a population, context, or chronic disease relevant to us, our practice, or our region. I work in public health and that means a lot of work is done at the population level to prevent and control communicable diseases.

When I was looking for multilevel models, I stumbled upon an article by Evans et al. (2018) that discussed an ecosocial of eco-epidemiological model. The ecosocial theory approach looks at all of the possible health inequalities in various groups being caused by a bunch of factors that intersect (Evans, et al., 2018). “Ecosocial theory encourages a broad vision for the determinants of health inequalities—including both the interlocking systems of oppression and privilege (sexism, racism, classism) implicated by intersectionality and other social processes.” (Evans, et al., 2018, p.65).

The reason it aligns with public health goals and mandates is because the work that I do, and the work done by the public health team in general, revolves around always looking for ways to examine how the delivery of healthcare and other pieces of social support impact the ability for someone to achieve the definition of what they feel is healthy. We know that this definition is different for everyone, and we understand that examining impacts on an individual and group level are equally important but that they can be very different (Evans, et al., 2018).

Like public health, multilevel modelling and this ecosocial theory want to know what can be done to prevent harms from happening and desire to acknowledge and shift the various contributors or factors in the moment of being diagnosed with a communicable disease or sustaining a harm (Galea, 2015). Hence, work is being done in our Wellbeing, Legislation, and Standards Unit on supporting access to healthy food; legislation about alcohol, tobacco, and cannabis labeling and advertisements; and Prevention and Control Unit work is being done creating education that targets people based on the data collected when conducting enhanced surveillance for a communicable disease.

In Assignment 2, I’ll elaborate further on how multilevel modelling can be applied to a specific situation within public health.

References

Evans, C. R., Williams, D. R., Onnela, J.-P., & Subramanian, S. V. (2018). A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Social

Science & Medicine, 203, 64–73. https://doi.org/10.1016/j.socscimed.2017.11.011

Galea, S. (2015, May 31). The determination of health across the life course and across levels of influence | SPH. Boston University School of Public Health. Retrieved February 21,

2025, from https://www.bu.edu/sph/news/articles/2015/the-determination-of-health-

across-the-life-course-and-across-levels-of-influence-2/