First, a couple of disclosures for context. I am not Courtney. I am Courtney’s uncool mom. I’m going to write about a basic principle of “public health” and how it can impact change in your life. Though some of my best friends are nationally acclaimed public health professionals, I was actually a business management major in college and a social services policy wonk for over 30 years.

Why does any of that matter? Because I discovered something really powerful by working in a large governmental health and social services agency and managing projects with these really smart public health types for 20 of those 30 years. And this geeky concept applies to so much in our everyday lives, explains so much, that I shared it with my daughter, who exclaimed, “You’ve got to blog this!”

An ecological model for real change

What “this” is, is the socio-ecologic or social ecological model. DON’T click that “back” button! It’s really simple, I promise.


Individual: It all starts here

Each person, with their unique genetic code, their intellect, their skills and talents, age, gender and health status, is very much influenced by policies, systems and environments that are constantly interacting for the good—or not so good. WAIT. It gets simpler.

Change the policies, systems and environments surrounding the person, and you will change their outcomes.

Microsystem: Family, Friends, and Associates

A person does not live in a vacuüm. They live and interact with a social network—or microsystem. This includes family, peers, teachers, doctors, coaches, and others that interact with the individual daily, and initially teach them about the world and how to live in it. As we get older, our microsystem could include fellow members of a club, church choir, gang, work unit or sports team. Our interactions with this network heavily influence our decisions, opinions, choices, motivations, habits and activities.

Exosystem: Community

But wait. Individuals live in a community that also influences their outcomes and achievements. They may not interact directly, but the community’s interactions with the social network (the microsystem) influence the individual. This is called an exosystem. For example, as a child, my parents’ employer has an indirect impact on me—the amount of time they spend away from me, their earnings, the reliability of this employer, their job satisfaction with the employer—all of these factors influence me.

The strength and availability of the health care services in my community, the quality of the education provided, local politics, community amenities and services available, my neighbors and their activities, the media—all influence me. It’s literally ALL ABOUT ME, right? At least indirectly. As we get older, things like safe housing, jobs, transportation, community-based resources—I don’t relate with them personally, but they definitely impact my choices, habits, activities.

Mesosystem: How the systems interact

Then, there’s this thing called a mesosystem, which is a fancy word to describe how all these systems—these circles of influence—relate with one another—within systems and across systems: how my family interacts with the teacher and the church, or with the neighbors and the community services; or how healthcare services do or {more likely} don’t interact with the social services system to make sure we are treating the whole person and all their issues and concerns and needs. So this is like a connector.

Macrosystem: Society

But wait. There’s one more really important one. Society. The big enchilada. Governments, laws and social norms. One example as relevant today as it was when I was a little girl, unfortunately, is race and prejudice. While racism can occur in any and all of the ecosystems that I’ve described before, if laws in place include implicit or explicit bias, then they create an environment where prejudice and social injustice can prevail.

What does this all mean?

If we want to teach kids that hard, honest work is valued, but as a society we elevate and reward just the opposite, that, too can influence personal choices, habits and activities if other systems aren’t strong enough to counter that message.

Another disclosure. There are a lot of these models out there, with different labels, with different factors and elements in different circles of influence that could be different from mine. That’s why it was important to confess that this isn’t my area of expertise. But the main point, regardless of my education and experience, holds true. We are not alone. Place matters. Policies, systems and environments matter. So if we want to make big changes in our lives, we need to look beyond our own capabilities and capacities to the circles of influence that surround us.

My personal story

I went through a really tough time on a project at work. Someone actually said to me, “I’ve seen people go through things like this and they don’t come back from them.” Encouraging words, right? That comment still echoes in my mind from time to time because I DID come back to do other things successfully, things that were more fulfilling to me than that project.

For me, I had to change the circle of friends around me. I entered an entirely new level of faith and engagement at my church. I also wrapped myself in family and worked as hard as I could. Then I changed the circle of colleagues with whom I spent time. It changed my perspective significantly, because I changed the internal message, changed perspective, viewed the importance of my job more in balance with my overall value as a person and a child of God, and renewed my optimism about life in general and my abilities specifically. It was changing and rearranging the elements in my social network and becoming more aware of interrelationships with the community that allowed me to “come back”, despite the dire prediction of my colleague (who was temporarily rearranged until such time as my self-confidence returned).

These social-ecological systems are tied to our resilience. Bad things happen to everyone. But I think our capacity to come back and the speed at which we can come back are dependent on ourselves AND those circles of influence in our lives.

What is your plan for change?

What do you think? Who and what are in your circles? Do you know? When you think about what you want for life and why, who or what in your life influences that? The more important question could be—what can you do to make sure your children’s circles of influence are safe, healthy and thriving? I’d love to hear your thoughts in the comments.

Dale Fleming speaking at community screening of “Resilience”

I’m going to unabashedly plug Live Well San Diego, San Diego County’s vision for a region that is healthy, safe and thriving, and encourage you to visit livewellsd.org to learn more. Much of what we’re doing in San Diego County to improve policies, systems and environments—those circles of influence—can be done in any community, in any home. Do something. Self-awareness is important. And small changes can make a big impact in your life and in the lives of those around you. Take care and live well!

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