• Robert L Ferrer and Alejandra Varela Carrasco.
• Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA. FerrerR@uthscsa.edu
• Ann Fam Med. 2010 Sep 1; 8 (5): 454460454-60.

AbstractBetter outcomes for chronic diseases remain elusive because success depends on events outside the control of the health care system: patients' ability to mange their health behaviors and chronic diseases. Among the most powerful influences on self-management are the social and environmental constraints on healthy living, yet the clinical response to these environmental determinants is poorly developed. A potential approach for addressing social determinants in practice, as well as planning and evaluating community responses, is the capability framework. Defined as the real opportunity to achieve a desired lifestyle, capability focuses attention on the material conditions that constrain real opportunity and how opportunity emerges from the interaction between personal resources and the social environment. Using examples relevant to chronic disease and behavior change, we discuss the clinical application of the capability framework.

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