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Health and health determinants

Readings: Chapter 1 Jenna DeRieu

What is health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Definition from World Health Organization, 1948

Dimensions of Health: Physical

Presence/ absence of disease Body size, shape, and function Activities of Daily Living (ADL) Physical fitness

Dimensions of Health: Mental (Psychological) Health


- Mental wellness/illness - Emotional well-being

Dimensions of Health: Social

- Social Environments
- School, Church

- Personal relationships
- Family, work, romantic, team, etc.
- Social Networks Breadth and depth real or virtual

Models of Health
Medical Model
Focus: Individuals biology
Physiology, organ function

Cause of Disease
By an agent (virus), malady (something bad happened to them), or malfunction (birth deformity)

Treatment of Disease
Remove the agent or repair the malfunction

Health=absence of disease

Models of Health
Public Health Model
Focus: Context of individual and interactions
Environment Behavior Biology

Prevention of disease

Models of Health
From the medical model we get
Disease treatment or management Surgery

From the public health model we get

Disease prevention Environmental and behavioral interventions

Disease Prevention
Disease prevention
Actions or behaviors designed to keep people from getting sick Reduce or eliminate factors causing illness or injury Examples
Vaccines Anti-smoking campaigns

Health promotion
Policies and programs that promote behaviors to support health
Identify risk factors and people at risk Frequently focus on environmental change

Healthy People 2020

Set of goals and objectives with 10 year targets Guide national health promotion and disease prevention efforts
Measure progress for health issues

Goal: Improve health of all people in the United States

Attain high quality, longer lives free of preventable disease, disabilities

Healthy People 2020

12 Topic areas Access to health services Clinical preventative services Environmental quality Injury & violence Maternal, infant, child health Mental health Nutrition, physical activity, obesity Oral health Reproductive and sexual health Social determinants Substance abuse Tobacco Measurements Persons with medical insurance Measures of health (BP, BG) Air quality index Fatal injuries Infant mortality, pre-term birth Suicide Meet PA guidelines, BMI <30 Dentist use HIV status High school graduation Binge drinking in past 30 days Smoking status



Health determinants
The array of critical influences that determine the health of individuals and communities Surgeon General Biology Behavior Environment Access to health care Policy

Health Determinants: Biology

Family health history
- Genetics

Age Gender, race/ethnicity Personal history with illness/injury Biological aspects are non-modifiable

Health Determinants: Behaviors

Responses to external or internal stimuli
Actions and reactions Intentional actions

Of the the ten leading causes of death 4 of them are modifiable determinants responsible for chronic diseases

Health Determinants: Behaviors

1. Lack of physical activity/inactivity
disease risk and early death overweight and obesity risk

2. Unhealthy dietary intake

High saturated fat, high sodium, high calorie Heart disease, obesity

3. Excessive alcohol consumption

cardiovascular disease & other conditions, accidents

4. Tobacco use
Blood pressure and cardiovascular disease Cancer

Health Determinants: Social Environment

Social environment Interactions with family, friends, co-workers, neighbors Social institutions: Schools, Church, worksite Social services: Law enforcement, transportation, counseling Socioeconomic status Important social and economic health determinant Education Income Social/ cultural background Type of job/career

Health Determinants: Physical Environment

Built environment
Anything created or modified by humans in the communities and areas we live, work, and travel in Roads, buildings, transportation

Pollution and infectious agents

Environmental hazards or quality Exposure to: toxins, radiation, irritants Direct or indirect

Health determinants: Policies and Interventions

Local and national policies
Smoking bans Seatbelt laws Helmet laws Water safety Vaccinations

Health Determinants: Health Care

Access to health care specifically
45.4 million Americans do not have health care

Access to quality or consistent health care


Occurrence of death
Mortality rate: number of deaths in a populations in a given period of time
Usually expressed as a ratio

Population assessments
All-cause mortality life-expectancy Infant mortality

Top 10 leading causes of death in the United States, 2008 (Heron,2012)

Leading Causes of Death Among Americans Ages 15-24 (2007)

Rank 1 Cause Accidents Transport Non-transport Homicide Suicide Cancer Heart disease Number 15,897 10,928 4,969 5,551 4,140 1,653 1,369 Percent 46.8 32.2 14.6 16.3 12.2 4.8 4.0

2 3 4 5

National Center for Health Statistics, 2010.

Disease occurrence
Morbidity rate: Incidence of disease among members of a population

Diseases or conditions that co-occur with each other Example: Obesity co-morbidities
Diabetes, asthma, arthritis, cardiovascular disease

Quality of life
Quality of life
Subjective evaluations of the positive and negative aspects of ones life individuals perception Encompasses wellness concepts Influenced by health, environment, living situation, occupation/school

Health related quality of life (HRQOL)

Measures of health the directly impact the subjective evaluation of ones physical and mental well-being Associated with health risks, functional status, social support, socioeconomic status
Source: http://www.cdc.gov/hrqol/concept.htm

Morbidity and Mortality: Risk Factors

Risk factors A condition that increase ones chance of disease or injury (or death) Condition any attribute, characteristic or exposure of an individuals likeliness Controllable AND uncontrollable

Risk factors
Controllable Diet Physical activity Smoking status Substance use and abuse Coping mechanisms Compliance with treatment/medications Uncontrollable Age Sex Race/ethnicity Genetics
Physiology/metabolism Susceptibility to disease

Evaluating Credibility
Credibility= Believability
Confidence in the truth of information AND interpretations We believe someone is telling the truth We believe that truth is accurate

Concepts well return to in health sciences research: Validity: Is it true? quality criterion degree of accuracy in a study s conclusions
Do we believe they found a true association or relationship? (internal validity) Do we believe it can be applied to real life? (external validity)

Evaluating Credibility of Health Websites

ANYONE can publish on the internet No review by anyone else No standards for content It s up to readers to be sure they are reading credible information by assessing: Accuracy Authority Bias/Objectivity Currency/Timeliness Coverage
(the same could apply for books, magazines, etc)

Evaluating Websites
1. Accuracy
Look for evidence: - is the info based on scientific research? - are the sources cited to support facts, claims, outcomes? - Are these sources credible? Assess quality:
How do websites review their info? Id there an editorial board

Evaluating Websites
2. Authority Author
Who wrote the article or supports the website? What are their credentials? Who are they affiliated with?

Is their an editorial board? Is their a policy of mission statement? What are their credentials?

Evaluating Websites
3. Bias/Objectivity
Is this information showing just one point of view? What is the purpose for the website or article? Is advertising used? Is that point of view polarized? Or unsubstantiated
This is a miracle fruit!! ORAC is over 3,500 which is hundreds of times higher than your average fruit This is THE WORST food you can eat!! Your body will feel its toxic effects for years

Evaluating Credibility of Health Websites

4. Currency/Timeliness
How recently was the article written or the website updated? Do the links still work

Keep in mind: Medical treatments change as new research is completed Old sources may be inaccurate or wrong based on new information

Evaluating Credibility of Health Websites

5. Coverage Is this info complete? Do they have links to other sites or info?

6. Privacy Check for privacy policies What kind of registration do you need to see the pages
What do they do with this information?

Evaluating Credibility: My Sources

National Library of Medicine (supported by the NIH) http://www.nlm.nih.gov/medlineplus/healthywebsurfing. html National Network of Libraries of Medicine http://nnlm.gov/outreach/consumer/evalsite.html Evaluating Web-Based resources: http://nccam.nih.gov/health/webresources

Five Quick Questions for Evaluating Health Websites

Who? Who runs the Web site? Can you trust them? What? What does the site say? Do its claims seem too good to be true?

When? When was the information posted or reviewed? Is it up-to-date?

Where? Where did the information come from? Is it based on scientific research? Why? Why does the site exist? Is it selling something?