Public health lect 13 - Lecture notes 13.1 PDF

Preview

Summary

Dr. Emily Youatt
health behvior...

Description

Health Behavior: Half the Problem - Our individual health behaviors influence population health - What are health behaviors? - any action taken by a person to maintain or regain good health, or to prevent illness or harm. - Often when people think about health behaviors, we think about the everyday choices people make. - What we eat, drink, how much we move, or what risks people choose to take or to avoid. 1) Importance of health behavior Or why this lecture matters - When we look at the causes or the factors that contribute to premature mortality or avoidable early death, we see the individual behaviors can be linked to about half of those premature deaths. (Half of all premature deaths are linked to health behaviors) - if we want to think about prolonging life, and specifically about prolonging healthy life, what we need to do is to focus our efforts on improving health behaviors, - Agreed among all of the major public health agencies ( the Centers for Disease Control, the Public Health Service, and the National Academies of Medicine) - not to say that we should ignore those other areas. - we need to continue to explore how genetics contribute to our overall health. - We need to invest in strategies to maintain a healthy physical environment and to improve both physical and social environments. An additional healthcare, or new medical advancements and technologies, will prolong life for some individuals. All of these factors matter - the greatest opportunity, lies in improving the actions people take to maintain their own good health. -

how does that knowledge of the importance of improving health behaviors align with healthcare expenditures?: pretty terribly. - Currently about 88% of health care expenditures are spent on medical services. While a 4% of funds are dedicated to efforts to improve health behavior. - this is an instance where scientific knowledge about what would be best for improving health at a population level is not driving how we spend as a nation. 2) Why do people engage in healthy behaviors? - Lack of knowledge - people engage in unhealthy behaviors because they just don't know that what they are doing is bad for them. - They lack the knowledge to understand the possible consequences of their actions. - Ex. 50 years ago, we were just beginning to understand how smoking cigarettes contributes to poor health- today

-

-

-

-

-

-

the medical community has a much clearer picture of the breadth of the damage smoking can do to almost every organ in the body. And most people have a general understanding that smoking is bad for your health. Lack of knowledge is one reason some people engage in some unhealthy behaviors.

Risk perception - people don't perceive a specific action as risky or don't think that the risks associated with engaging in unhealthy behavior apply to them. - Some people may fundamentally understand that a behavior like smoking is bad for health but don't believe they are personally at risk for those negative health consequences. - how risky an action seems, or how likely a person thinks they are to suffer the negative consequences of taking a health risk, may influence their behavior. Addiction - Some people are addicted to unhealthy behavior. - Smoking is an excellent example of how addiction can shape people's behavior. - Addiction has been talked about in terms of nicotine, alcohol, and drugs for the past few decades. And increasingly, people are talking about other substances, sugar for example, as addictive substances. - addiction to something, or even just the habit of consumption, are reasons people engage in unhealthy behavior. Peer pressure - Peer pressure may be another reason some people do things that are unhealthy. The need to fit in, especially when we are young, is a factor that may lead someone to smoke their first cigarette or try their first drink. - Young people might also see what is role modeled for them. positively or negatively, and copy these behaviors. - watching your parents exercise or drink in moderation can be beneficial, while seeing parents or older siblings smoke or drink to excess may create an expectation that these behaviors are normative or accepted in a family. - research shows that both peers and families importantly influence health behaviors especially early in life. Community norms - community norms act similarly. They provide a framework or template for what is normative or acceptable in a community setting. - A community might be a geographic space, like one's neighborhood or town, or it could be a religious or other social community. - Observing how others in the community behave may inform how individual members choose to act. - Cost is certainly a factor driving some individuals' health behaviors. It costs more to eat healthy, nutritious foods than it does to eat fast food. Exercise or being physically active may seem like a luxury to those who are working multiple jobs to make ends meet. Economic influence

-

Economic factors are yet another factor that shapes people's ability to engage in healthy behaviors - Benefits immediate, costs deferred - The benefits of engaging in unhealthy behaviors are often immediate, while the costs are deferred. - example: You won’t get heart disease tomorrow because I ordered an extra-large pizza today but it will taste better - We are a society built on instant gratification, and that has difficulty thinking about how today's actions will affect us in the long run. - Psychological environment - Someone's mental state, or their psychological environment, may affect their health behaviors. - People might engage in unhealthy behaviors, like smoking or drinking, to cope with anxiety or stress, or more serious psychological issues. - By the same token, some people will choose to exercise or increase their physical activity to improve their mental well-being. - Physical environment - The Physical environment may also limit or enhance the likelihood someone engages in healthy behaviors. - If you live in a safe neighborhood with sidewalks, good lighting, ample green space you may be more encouraged to be physically active. - Conversely, if you live in a place with no sidewalks. Where you don't feel safe going out after dark. Or where the air is thick with car exhaust or other air pollution. You may be less likely to go for a jog after work. - Policy environment - policies can also shape people's health behaviors. A good example of this is cigarette smoking. - Raising taxes on the price of cigarettes has a measurable influence on the amount people smoke. - Taxes, limitations on advertising, and the legality of substances influences people's behavior. - A lot of things that aren't good for our health are fun, or if not fun, then they are pleasurable, or provide some kind of positive reinforcement. - Even with sufficient knowledge, resources and healthy role models, people will make decisions that are not in the best interest of their long term physical health, it's just human nature. 3) Economic model - the Ecological Model, acknowledges that health and health behaviors are determined by influences at multiple levels or spheres of influence. This is an important model in public health - At the center of the model is the individual (intrapersonal) level - we think about factors that influence health or health behaviors that occur or can be assessed at the individual level. - we think about influences, like one's biological or genetic makeup, their physical ability or skills. - We also think about one's knowledge, preferences, beliefs, or attitudes. Self efficacy, or one's self-assessed belief that they can make a choice or enact a change - the interpersonal level - we think about how social relationships affect one's health behavior.

-

-

-

-

-

-

influences like peer pressure, and role modeling, and social support one might have from their friends, family, roommates, or partner. the institutional or organizational level - conceptualizes how one's involvement in social organizations like religious groups or institutions like one's school or workplace, shape health behavior. - includes both the social norms or expectations that exist in these settings - how the physical space may enhance or limit one's ability to engage in healthy behaviors. community level - broader, cross-cutting features of a neighborhood, or community, that may influence health behaviors. - This may encompass things like community initiatives, the physical characteristics of a neighborhood or a community, and the relationships between organizations within a community. Societal/ public policy level - how public policy or societal influences shape health behaviors. - influences from popular culture, advertising, the media, and evolving social norms. - encompasses factors like zoning laws, as well as the laws that regulate the sale or consumption of goods like cigarettes or alcohol.

that individuals are embedded into larger social systems. - Ex. why someone smokes may be influenced by their individual attitudes towards smoking or a genetic predisposition to addiction. - But there are other influences at the interpersonal, organizational, community and social policy levels, that shape the decision to smoke. Fundamentally, health behaviors are influenced by the ways individuals interact with their physical, social, and policy environment....