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Chapter 1

Health Sciences 4202A/B Chapter Notes - Chapter 1: World Health Organization, Cerebrovascular Disease, Cardiovascular Disease


Department
Health Sciences
Course Code
HS 4202A/B
Professor
Tamara Thompson
Chapter
1

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Chapter 1 Health Behavior in the Context of the “New” Public Health
Introduction
According to the World Health Organization (WHO), health is not merely the absence of disease or
infirmity; rather health should encompass a state of complete physical, mental, and social well-being
- Expanding on this definition at a seminal conference in Ottawa, Ontario, Canada, the WHO
reconceptualised health, in that it should be defined from an ecological perspective to encompass
the “extent to which an individual or group is able, on the one hand, to realize aspirations and
satisfy needs; and on the other hand, to change or cope with the environment. Health is, therefore,
seen as a resource of everyday life, not the objective of living; it is a positive concept emphasizing
social and personal resources, as well as physical capacities”
Health would seem to transcend an individual’s state of physical being at any given moment to also
include his or her ability to optimize his or her health and the availability of environmental resources
that enable him or her to maintain his or her health over time
An important goal for an nation is the health of its people, but we advocate that the means to this end
lie in adopting strategies that modify environments, settings, and policies/regulations while also
targeting the many individual factors that influence health
A key principle in health promotion involved understanding the nature of the diseases that are most
likely to occur in a population
At the 20th century, the top 3 causes of death were attributed to infectious disease agents that caused
pneumonia, tuberculosis, diarrhea, and enteritis
Early public health efforts were successful in implementing new biomedical advances (e.g.
vaccinations and antibiotics) and developing public health programs that remedied many types of
infectious diseases (e.g., water sanitation to reduce cholera), eradicated some diseases (e.g., smallpox),
and mitigated many afflictions
- However, as the incidence of these diseases decreased, chronic diseases (e.g., cardiovascular
disease, diabetes, and cancer) flourished
Toward the end of the 21st century, individual lifestyle behaviors such as, smoking, poor diet and
exercise, alcohol consumption, and the use of illicit drugs, were primary contributors to the 6 leading
causes of death
- These behaviors are deemed “lifestyle behaviors” because they take place within the context of
individuals’ everyday lives
- These specific lifestyle behaviors have been cited as actual causes of death because they have
been linked directly to the top 5 chronic diseases: heart disease, cancer, cerebrovascular disease,
respiratory disease, and diabetes
A person who contracts an infectious disease (e.g. cholera, pneumonia, or tuberculosis) would most
likely hold the perception that they were not healthy; however, it may not be as clear to those who
smoke, eat high-fat foods, do not exercise, consumer too much alcohol, or use illicit drugs that they
are unhealthy
- They may hold an inaccurate perception of their health, which is most likely due to the hidden
contribution of engaging in unhealthy lifestyle behaviors to the development of chronic disease,
rather than the more noticeable infectious or communicable disease
Chronic diseases manifest over time, are not always apparent, and may be long-lasting or recurring
This text emphasizes that public health initiatives to combat both chronic and infectious diseases and
improve the health of the public should be multidimensional that is, health-promotion efforts should
target systems and political structures to affect the underlying social determinants of health and their
corresponding health behaviors
- This emphasis on the significant role of environmental influences in shaping individual behavior
and affecting health is the driving force behind the “new public health”
Frieden pyramid illustrates the relative strength of 5 factors influencing public health, with the
largest (e.g., strongest) contribution coming from socioeconomic status
- New public health has an emphasis on social equity

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- In the order of strength, the remaining 4 factors involve making ecological changes that enable the
“easy” adoption of health-protective behaviors, the use of planned intervention programs shown
to have long-lasting effects on health behaviors, clinical interventions, and counselling/education-
based programs
- NOTE: clinical interventions occupy a relatively small fraction f the overall influence on the
health of a population
This chapter focus on the importance of health behavior (e.g., reducing unhealthy behaviors while also
promoting healthy ones) in achieving optimal health
Benjamin Franklin: “An ounce of prevention is worth a pound of cure”
- He believed that it is wiser and more cost-effective to try and prevent a disease from manifesting
rather than treat it
Public health embraces this; its mission is prophylaxis or prevention, of early mortality, morbidity,
and associated negative health outcomes
- Changing or modifying health behaviors that are associated with morbidity and early mortality is
considered one aspect of a prevention approach
Providing an overview of public health and describe the rationale for public health approaches that
target whole populations rather than only those individuals at heightened risk
Key Concepts
Why the Emphasis on Prevention?
Treatment can be very costly, not everyone has access to treatment, and further more, treatment is not
always a panacea; treatment cannot “fix” many health issues
The United States spends more on health care, both as a proportion of gross domestic product and on a
per capita basis, than any other country in the world
- Does not result in lower early mortality and morbidity rates
Diabetes is an example of a prime opportunity for improved population-based prevention
- Type 2 diabetes is the most common form of diabetes and has been linked to obesity, inactivity,
and genetic factors
- Ignoring the genetic component, obesity is considered a modifiable risk factor as it can be
changed
- If the rates of obesity and inactivity among the population were somehow reduced significantly, a
reduction in the prevalence of type 2 diabetes should be experienced as well, thereby reducing the
associated mortality rate
- Consider that 1/5 U.S. federal healthcare dollars spent treating people with diabetes
If treating people with diabetes represents 20% of healthcare dollars spent, then a better
approach may be to prevent diabetes rather than treat diabetes
To combat many of the lifestyle diseases afflicting its populace in the later part of the 20th century and
to enhance the health of its people, the United Sates created a national prevention agenda
- Further improvements could be achieved through a “renewed national commitment to efforts
designed to prevent disease and to promote health”
- Healthy People laid the foundation for a national prevention agenda that spanned a wide range of
health goals focused on reduced early mortality and morbidity, such as a reduction in smoking, an
increase in physical activity, and a reduction in injuries
Signified that the United States must take responsibility for the health of its people
The agenda has since been updated and goals re-examined every 10 years
Presently, Health People 2020 has built on the work of the past 3 decades and has
implemented a 10-year health-promotion program with 4 goals:
1. Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death
2. Achieve heath equity, eliminated disparities, and improve the health of all groups
3. Create social and physical environments that promote good health for all
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4. Promote quality of life, healthy development, and healthy behaviors across all life
stages
The focus is on different health areas (e.g. STDs, substance abuse, tobacco use, diabetes, cancer,
HIV), companied by 600 public health objectives and leading health indicators to measure the
progress toward meeting its goals
Health Behavior is Complex
Persuading a person to change his or her habitats is a major challenge indeed, especially when the
behavior is viewed as enjoyable (e.g. eating a hamburger) or when they may not have complete
control (e.g. a child whose parents makes the decisions about food or a person who can only afford
high-calorie foods of low nutritional value such as fast-food “bargains”)
e.g. Changing dietary habits such that whole foods (e.g. foods that are unrefined and unprocessed)
compose the majority of the daily calorie intake implies understanding (1) why people prefer
processed foods; (2) what people do not like about whole foods; (3) the benefits that people perceive
from consuming less processed foods; (4) the physical, economic, political cultural, and social barrier
that people perceive relative to the consumption of whole foods; (5) the barrier to stocking produce
and other whole foods among grocery stores; (6) the national and local policies that translate to the
cost-prohibitiveness of providing whole foods
- Reducing the obesity epidemic will involve health-promotion efforts that address all 6 of these
questions, with an emphasis on the latter 3
Before we can change behavior, we must understand the determinants of the behavior, the nature of
the behavior, and the motivation for the behavior
Influencers (also referred to as “drivers”) of behavior can theoretically be infinitesimal and can
include a range of factors, such as biological characteristics, personality characteristics, family, peers,
the community, society, and the built environment
The nature of behaviors can vary along many dimensions
- Once in a life time (e.g. polio vaccine), some on a daily basis (e.g. diet, exercise), and some are
conditional to the context (e.g. using a condom)
How do we start achieving prevention goals?
- First, understanding what factors contribute, cause, preceded, influence, and motivate health
behaviors, and then how to effectively modify those factors so that behavior change is achieved is
the basic premise of health promotion
Health promotion is an integral part of the “new public health” approach and involves 2 aspects:
research and practice
Public health professionals are increasingly recognizing that the mainstays of epidemiology and
healthcare service administration lack the ability to change population-level indicators of health
The realization is that changing behaviors in a population and creating environments conducive to
health behaviors are possibly the ultimate solutions to improve the health of the public
Health-promotion research is at the forefront of understanding the underlying individual,
environmental, and policy/regulatory factors that influence health behavior
- Conversely, health-promotion practice is at the forefront of designing an implementing
interventions to modify those factors and to ultimately change behavior
The tool used for health-promotion research and practice is theory
- A theory is a set of testable propositions that is used to explain a group of facts or phenomena
- In health promotion, theory enables researchers to better understand health behavior and make
predictions about how to change behavior
Prevention and the Public Health Approach
Prevention is the basic principle underlying the public health approach
From a public health perspective, the essence of prevention is creating healthy populations, meaning
that the incidence of chronic disease, infectious disease, and injury decline dramatically
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