Social Frameworks for Nutrition

Social-Ecological Model Revisited

Now, let's take a more in-depth look at the model introduced in the last unit, as we explore the social frameworks for nutrition and healthy aging. Below is the illustration of the model from the DGA's and consists of four layers: Social and Cultural Norms and Values, Sectors, Settings, and Individual Factors.

Settings

Think of the immediate surroundings- where does the older adult live, with whom? What food and activity-related options exist on the street outside, in the neighborhood, within walking distance? What transit options exist? Are the markets offering culturally appropriate foods?

Individuals make choices in a variety of settings, both at home and away from home. Away-from-home settings include early care and education programs (e.g., child care, preschool), schools, worksites, community centers, and food retail and food service establishments. These organizational settings determine what foods are offered and what opportunities for physical activity are provided. Strategies to align with the Dietary Guidelines that are implemented in these settings can influence individual choices and have the potential for broader population-level impact if they are integrated with strategies by multiple sectors. In combination, sectors and settings can influence social norms and values.

Continuum of Care

The concept of a continuum of care is useful to consider in the context of 'settings' in a social framework for older adults. It is not unique to aging adults. It is used in a number of settings to describe wrap-around services over a range of needs and timelines. You may be familiar with the term as it relates to persons experiencing housing insecurity or houselessness, infants, children and mothers, or persons with developmental disabilities.

Look over this page of Definitions related to continuum of care and consider where intersections exist with older adult settings.

Among aging discourse, the continuum of care describes settings where older adults reside as they grow older and the services they may required as their needs change. The continuum ranges from In-Home Care, Independent Living Community, Assisted Living Community (Memory Care), and Continuing Care Retirement Community (CCRC). It is very important to emphasize that the continuum refers to a range of settings/services in which older adults may reside but the continuum does not represent 'independence' at one extreme and 'total dependence' at the other.

Aging-in-place refers to aging adults choosing to remain in their home as they age (in-home care on the continuum). Sometimes the term is misinterpreted to mean 'independently aging' but in reality, aging in place will likely require many types of support from family, friends and the community in order to age at home. For more information on the topic, check out Aging In Place-National Institute on Aging.

Sectors

This layer relates to many policy opportunities (or barriers). How does the society and its government anticipate and/or respond to the needs of the people?

Sectors include systems (e.g., governments, education, health care, and transportation), organizations (e.g., public health, community, and advocacy), and businesses and industries (e.g., planning and development, agriculture, food and beverage, retail, entertainment, marketing, and media). These sectors all have an important role in helping individuals make healthy choices because they either influence the degree to which people have access to healthy food and/or opportunities to be physically active, or they influence social norms and values. Positive influences on social norms and values can occur through effective health promotion and marketing strategies.

Professionals in these sectors have many opportunities to identify and develop strategies that help individuals align their choices with the Dietary Guidelines. Strategies could include supporting policy and/or program changes, fostering coalitions and networks, developing or modifying products and menus, and/or creating opportunities to be physically active. To ensure widespread adoption of these sectoral efforts, complementary efforts can include training, education, and/or motivational strategies.

We will spend more time looking at the influence of sectors, from community programs and policies in Unit 7.

Social & Cultural Norms & Values

Social and cultural norms are rules that govern thoughts, beliefs, and behaviors. They are shared assumptions of appropriate behaviors, based on the values of a society, and are reflected in everything from laws to personal expectations. With regard to nutrition and physical activity, examples of norms include preferences for certain types of foods, attitudes about acceptable ranges of body weight, and values placed on physical activity and health. Because norms and values are prevalent within a community or setting, changing them can be difficult. However, changes to sectors and settings—as previously discussed—can have a powerful effect on social and cultural norms and values over time and can align with the Dietary Guidelines.

There are values of socialization and conviviality associated with food and nutrition and wellness. Read this brief article that summarizes these issues for older adults: NPHA Loneliness Report and this policy brief from AARP Foundation: Older Adults and Unmet Social Needs.

For additional articles on social and cultural norms & values, you might enjoy these two articles: Social Influences on Eating and Life Course Perspective- Food, Time, Choice.