Galea, S. (2015, May 31). The Determination of Health Across the Life Course and Across Levels of Influence: SPH: Boston University. Retrieved June 12, 2019, from. In the first part of this Dean’s Note, I suggested that a life course perspective can be a useful and essential organizing approach for population health science. I have, in previous work, suggested that life course approaches and multilevel approaches may be the two most important paradigmatic shifts in population health science in recent decades. Building then on the first part of this note, here I comment on multilevel approaches. A multilevel approach to population health is predicated on the understanding that exposures at many levels of organization work together to produce health outcomes. These exposures are positioned both up and downstream of individual-level risk factors [see Figure 1] and include determinants of population health that are social, biological, geographic, political, and temporal in nature.
Figure 1. Kaplan GA. Importantly, multilevel perspectives do not simply “add” isolated “risk factors” at other levels of influence to our prediction models. Figure 2. Sandro. Thongs, G., & Gahman, L. (n.d.). In the Caribbean, colonialism and inequality mean hurricanes hit harder. Retrieved October 23, 2017, from. Hurricane Maria, the 15th tropical depression this season, is now battering the Caribbean, just two weeks after Hurricane Irma wreaked havoc in the region. The devastation in Dominica is “mind-boggling,” wrote the country’s prime minister, Roosevelt Skerrit, on Facebook just after midnight on September 19. The next day, in Puerto Rico, NPR reported via member station WRTU in San Juan that “Most of the island is without power…or water.” Among the Caribbean islands impacted by both deadly storms are Puerto Rico, St Kitts, Tortola and Barbuda. In this region, disaster damages are frequently amplified by needlessly protracted and incomplete recoveries.
In 2004, Hurricane Ivan rolled roughshod through the Caribbean with wind speeds of 160 mph. The region’s economy took more than three years to recover. Grenada’s surplus of US$17 million became a deficit of $54 million, thanks to decreased revenue and the outlays for rehabilitation and reconstruction. Risk, vulnerability and poverty.