As first proposed by McLeroy and colleagues in 1988, the Social-Ecological Model posits that health is not solely determined by biological factors, but instead is influenced by a collection of subsystems that occur at various levels. Mainly, these levels include individual, interpersonal, institutional, community, and public policy. By taking an Ecological approach to understanding COVID-19 we are able to account for both the population- and individual-level determinants of health that are at play. This framework also affords us with the ability to think, design, and implement effective interventions while fully acknowledging the complex systems that lead to differential risk of disease. Understanding how multi-level social factors and systems not only produce inequities, but sustain them, is imperative to understanding health disparities both pre-COVID-19 and presently.
The characteristics of the individual which may include gender, religion, race, ethnicity, age, socioeconomic status, or sexual orientation as well as the attitudes, behaviors, and knowledge that influence health are shaped by such characteristics.
Formal and informal relationships with other individuals that may shape social identities or serve different roles in an individual’s life. These relationships may be familial or peer, may be serving as social or emotional support, and may span generations.
Institutions that shape behaviors and attitudes due to their organizational characteristics, regulations, rules (formal and informal), and cultural expectations. This may include safety, social stigma, or health initiatives.
The environment within defined boundaries an individual lives in that may promote certain social norms, provide access to resources, and offer social networks. Built environment, location of community, housing, transportations, community engagement, income level, health and educational facilities are components of communities.
Laws and policies may be at the local, state or federal level may be influential in determining health outcomes. Allocation of funds, policy initiatives that aim to address health behaviors, social equity, and overall infrastructure all are integral in shaping health outcomes.