The Significance of the City Setting

The settings approach

Over the past thirty years, the focus of health promotion has changed over individual-focused perspective to social and environmental determinants of health i.e. settings-based perspective. As the old perspective highlighted individuals’ independent decision-making processes, the modern one emphasises the importance and influence of the context or living conditions. Context or living conditions, in turn, is central for modern means of health promotion, where peoples’ health-related opportunities and behaviours are supported through organizational policies and environmental changes. Settings furthermore represent a fundamental aspect of practice, recognizing the particular needs and living, working, schooling, recreational circumstances of the target groups. This way the most appropriate channels for predisposing, enabling and reinforcing factors of health-related behaviours can be found.

The diminished focus on individuals in health promotion does not mean that individuals and their decision-making processes are ignored. Indeed, individuals’ behaviours and decision-making processes remain ultimate factors concerning their health, but the emphasis is more on settings and ecological factors that shape, limit or enhance those behaviours and decisions within the settings people act.

City and its sub-settings

When working with the settings-based way, the setting itself is also framed as a target of intervention. However, community-wide interventions usually involve multiple and varied settings, which in this case mean that city is one setting, which embody several other setting such as schools, healthcare/hospitals and sports clubs. This means that at city-level the focus is primary on how to get health issues on the agenda and decision-making process of local governments, community organizations and urban actors. Secondary, the aim is to create strategies that identify the social, environmental and economic determinants of health through which corporate and community culture can be changed. Settings-based work requires both vertical and horizontal activities. Vertical activities relate to actions and policies a city set-out for the sub-settings underneath it. Sub-settings rely on the definition of policies of the city in question e.g. general value and atmosphere towards physical activity (PA) as an example, PA strategy, urban planning concerning commute-related PA, expertise advisory help in PA and/or PA facilities. Horizontal activities point out cross-sectoral cooperation, i.e. health in all policies ideology. Various sub-setting actors should similarly cooperate on health-related issues in order to associate otherwise often limited resources.

Overall, layers of settings exist with many perspectives: from global to local, from public to voluntary via commercial, from “umbrella” settings to sub-settings and with policies, resources and practices influencing.

Sami Kokko
PhD, senior researcher
Research Center for Health Promotion
University of Jyväskylä
sami.p.kokko@jyu.fi