Letters
March 2001, Vol. 91, No. 3 American Journal of Public Health 465
Research
A Definition of “Social
Environment”
Recently, interest in the social environ-ment and its influence on population health has increased among both public health re-searchers and practioners. This interest is demonstrated by a recent request for applica-tions from the National Institutes of Health ti-tled Health Disparities: Linking Biological and Behavioral Mechanisms with Social and Phys-ical Environments.1
Despite the upsurge of interest and an in-creasing number of publications focused on this important issue, a clear and comprehensive de-finition ofsocial environmenthas proved elu-sive. We would like to offer the following def-inition, in hopes that it will prove useful to our colleagues—if only as a touchstone for debate.
Human social environments encompass the immediate physical surroundings, social re-lationships, and cultural milieus within which defined groups of people function and inter-act. Components of the social environment include built infrastructure; industrial and oc-cupational structure; labor markets; social and economic processes; wealth; social, human, and health services; power relations; govern-ment; race relations; social inequality; cul-tural practices; the arts; religious institutions and practices; and beliefs about place and community. The social environment subsumes many aspects of the physical environment, given that contemporary landscapes, water resources, and other natural resources have been at least partially configured by human social processes. Embedded within contem-porary social environments are historical so-cial and power relations that have become in-stitutionalized over time. Social environments can be experienced at multiple scales, often simultaneously, including households, kin networks, neighborhoods, towns and cities, and regions. Social environments are dynamic and change over time as the result of both
internal and external forces. There are rela-tionships of dependency among the social en-vironments of different local areas, because these areas are connected through larger re-gional, national, and international social and economic processes and power relations.
Elizabeth Barnett, PhD Michele Casper, PhD
Elizabeth Barnett is with the Office for Social En-vironment and Health Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown. Michele Casper is with the Centers for Disease Control and Prevention, Atlanta, Ga.
Requests for reprints should be sent to Eliza-beth Barnett, PhD, Office for Social Environment and Health Research, Robert C. Byrd Health Sci-ences Center, West Virginia University, PO Box 9190, Morgantown, WV 26505-9190 (e-mail: ebarnett@ wvu.edu).
Reference
1. National Institutes of Health.Health Disparities: Linking Biological and Behavioral MechanismsWith Social and Physical Environments. Bethesda, Md: National Institutes of Health; 2000. RFA ES-00-004.
To the Editor
Public Health Is Already a
Profession
An editorial in the June 2000 issue of the Journal was titled “It’s Time We Became a Pro-fession.”1The clear implication of both this title and the body of the editorial was that public health is not already a profession that is recognized from both within and outside the field. While it is dif-ficult to disagree with the authors’assertion that “schoolmarms and investment bankers . . . are not public health professionals,” it is easy to disagree with their contention that public health as a
pro-fession requires a single standard for entry into the credentialing process or that such a creden-tial will somehow magically produce more de-finition, appreciation, and visibility for public health as “an important social endeavor.”
The public health profession has had the distinction of, and gained immeasurably from, including many persons from a wide range of disciplines. In fact, one need only view the mast-head of the Journal as evidence of this variety. The MPH degree has been widely but not uni-versally earned by public health professionals. The Association of Schools of Public Health–American Public Health Association joint task force to which the authors refer “has concluded that professionalization would ben-efit public health enormously.” Would it not be more accurate to state that more professional-ization would benefit public health? To turn a blind eye to current levels of public health pro-fessionalism may only serve to reduce the morale—and, in the eyes of others, the credi-bility—of the tens of thousands of public health professionals who currently go about their daily duties in service of the profession.
The authors are concerned about “the vis-ibility, respect, and compensation of the public health workforce . . . [and] the profession’s im-pact on policy and legislation,” as well as the audibility and coherence of its voice. While con-ceding that many public health “professionals” (their quotation marks) have extensive graduate education in other disciplines, they argue that these individuals’ impact is reduced because they have not been exposed to the “core com-petencies and values common to all public health professionals.” This reasoning appears circular. Furthermore, it misses the mark by try-ing to explain policy and legislative failures by the lack of a common credential.
The authors seem to be arguing for a na-tional system of credentialing. They can make this argument without jumping to the conclu-sion that we in public health have not yet be-come a profession.
