Letters

March 2001, Vol. 91, No. 3 American Journal of Public Health 465

Research

A Definition of SocialEnvironment

Recently, interest in the social environ-ment and its influence on population healthhas increased among both public health re-searchers and practioners. This interest isdemonstrated by a recent request for applica-tions from the National Institutes of Health ti-tled Health Disparities: Linking Biological andBehavioral Mechanisms with Social and Phys-ical Environments.1

Despite the upsurge of interest and an in-creasing number of publications focused on thisimportant issue, a clear and comprehensive de-finition of social environment has proved elu-sive. We would like to offer the following def-inition, in hopes that it will prove useful to ourcolleaguesif only as a touchstone for debate.

Human social environments encompass theimmediate physical surroundings, social re-lationships, and cultural milieus within whichdefined groups of people function and inter-act. Components of the social environmentinclude built infrastructure; industrial and oc-cupational structure; labor markets; social andeconomic processes; wealth; social, human,and health services; power relations; govern-ment; race relations; social inequality; cul-tural practices; the arts; religious institutionsand practices; and beliefs about place andcommunity.The social environment subsumesmany aspects of the physical environment,given that contemporary landscapes, waterresources, and other natural resources havebeen at least partially configured by humansocial processes. Embedded within contem-porary social environments are historical so-cial and power relations that have become in-stitutionalized over time. Social environmentscan be experienced at multiple scales, oftensimultaneously, including households, kinnetworks, neighborhoods, towns and cities,and regions. Social environments are dynamicand 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, becausethese areas are connected through larger re-gional, national, and international social andeconomic processes and power relations.

Elizabeth Barnett, PhDMichele Casper, PhD

Elizabeth Barnett is with the Office for Social En-vironment and Health Research, Robert C. ByrdHealth Sciences Center, West Virginia University,Morgantown. Michele Casper is with the Centers forDisease Control and Prevention, Atlanta, Ga.

Requests for reprints should be sent to Eliza-beth Barnett, PhD, Office for Social Environmentand Health Research, Robert C. Byrd Health Sci-ences Center, West Virginia University, PO Box 9190,Morgantown, WV 26505-9190 (e-mail: ebarnett@wvu.edu).

Reference1. National Institutes of Health. Health Disparities:

LinkingBiologicalandBehavioralMechanismsWithSocial and Physical Environments. Bethesda, Md:National InstitutesofHealth;2000.RFAES-00-004.

To the Editor

Public Health Is Already aProfession

An editorial in the June 2000 issue of theJournal was titled ItsTime We Became a Pro-fession.1The clear implication of both this titleandthebodyoftheeditorialwasthatpublichealthisnotalreadyaprofessionthat is recognizedfrombothwithinandoutside the field.While it isdif-ficult todisagreewith theauthorsassertion thatschoolmarmsandinvestmentbankers . . .arenotpublichealthprofessionals, it iseasytodisagreewith their contention that public health as a pro-

fession requires a single standard for entry intothe credentialing process or that such a creden-tial will somehow magically produce more de-finition, appreciation, and visibility for publichealth as an important social endeavor.

The public health profession has had thedistinction of, and gained immeasurably from,including many persons from a wide range ofdisciplines. 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 PublicHealthAmerican Public Health Associationjoint task force to which the authors refer hasconcluded that professionalization would ben-efit public health enormously. Would it not bemore accurate to state that more professional-ization would benefit public health? To turn ablind eye to current levels of public health pro-fessionalism may only serve to reduce themoraleand, in the eyes of others, the credi-bilityof the tens of thousands of public healthprofessionals who currently go about their dailyduties in service of the profession.

The authors are concerned about the vis-ibility, respect, and compensation of the publichealth workforce . . . [and] the professions im-pact on policy and legislation, as well as theaudibility and coherence of its voice.While con-ceding that many public health professionals(their quotation marks) have extensive graduateeducation in other disciplines, they argue thatthese individuals impact is reduced becausethey have not been exposed to the core com-petencies and values common to all publichealth professionals. This reasoning appearscircular. Furthermore, it misses the mark by try-ing to explain policy and legislative failures bythe lack of a common credential.

The authors seem to be arguing for a na-tional system of credentialing. They can makethis argument without jumping to the conclu-sion that we in public health have not yet be-come a profession.

Arthur Cohen, MPH, JD