Health capability profile offers public health tool for clinicians, health care professionals, social workers, policy makers, and individuals

With the goal of helping individuals, communities, and professionals identify how to promote people’s ability to be healthy and flourish, a new article  coauthored by Dr. Jennifer Prah of the University of Pennsylvania School of Social Policy & Practice (SP2) and Perelman School of Medicine presents a methodology applied to major causes of death in the United States and other pressing public health issues.

The methodology, published in the Journal of Epidemiology & Community Health, relies on the health capability profile (HCP), a comprehensive framework and method illuminating and assessing the individual and collective ability to be healthy.  Developed by Dr. Prah, the Amartya Sen Professor of Health Equity, Economics, and Policy and Director of the Ortner Center on Violence & Abuse and Founder and Director of the Health Equity and Policy Lab at SP2, the HCP comprises 15 inter-related components — eight internal and seven external — of an individual’s ability to achieve and maintain health.

The internal capabilities include health status and functioning; health knowledge; health-seeking skills and beliefs, and self-efficacy; health values and goals; self-governance and self-management; effective health decision-making; intrinsic motivation; and positive expectations. The external capabilities include social norms; social networks and social capital; group membership influences; material circumstances; economic, political, and social security; utilization and access to health services; and enabling public health and health care systems.

Together, these factors represent “dynamic, interactive, cumulative, lifelong individual abilities and societal conditions that together enable optimal health,” the authors write. Analyzing hypothetical case studies through the framework of the HCP, the authors identify shortfalls between the observed and optimal levels of each health capability, as well as detrimental or enabling interactions among capabilities.  Often the case studies point to the need for changes that would dismantle power structures and discrimination that are detrimental to well-being.

For example, in a case study about adverse childhood experiences, a child is raised in an economically stable household in a safe neighborhood — optimal material circumstances, according to the HCP.  However, while his mother is supportive of him, his father’s abusive behavior exposes him to a number of detrimental factors, enveloped in the social, economic, and political conditions that allow the abuse to continue. Eventually the child develops post-traumatic stress disorder, a mental health issue that impairs his ability to function.

The case studies include a number of examples that are relevant to the Ortner Center’s focus on research to end violence against women and girls. In a scenario about gender-based and sexual harassment, a woman is targeted  by a colleague with misogynistic and offensive comments. The woman’s knowledge and care about her own health are at optimal levels, but due to the social, economic, and political conditions that make the situation possible, as well as the systems that fail to hold the colleague accountable, she experiences harm to her mental health and her ability to do her job.

In a case study about intimate partner violence, a woman in an abusive relationship with her husband is experiencing a number of factors that are detrimental — including social, economic, and political conditions underlying the woman’s fear that reporting the abuse will result in retaliation and protection of the offender. However, the woman’s decision making is optimal, as are her utilization of and access to health services. In an optimal experience of the health care system, she is able to report her concerns to her physician, who identifies her abuse and works with her to develop a safety and exit plan and refers her to domestic violence counseling.

“These case studies highlight the need for codes of conduct that set clear standards of ethical and healthy behavior,” says Dr. Prah of the examples above. “Clear and enforced ethical standards of conduct transform detrimental social norms, social networks, and group membership influences.”

Overall, the case studies illustrate how individuals, communities, public health agencies, and policy-makers can use the HCP to identify and prioritize changes that are necessary to promote individual and collective health. In addition to adverse childhood experiences, gender-based and sexual harassment, and intimate partner violence, the case studies cover scenarios surrounding instances of cancer, a car accident, chronic lower respiratory disease, stroke, Alzheimer’s disease, diabetes, chronic kidney disease, pneumonia, suicide, COVID-19, alcohol use disorder, substance use disorder, tribal health, heart disease, LGBTQ+ stigma and discrimination, firearm violence, weight stigma, endometriosis/infertility,  traumatic brain and spinal cord injury, multiple sclerosis, and chronic hepatitis B virus infection.