KIN240:Principles of Biobehavioral Health (Set one)

Why are the terms health, wellness, and wellbeing often used together?

Because modern language commonly links them (e.g., “health and wellbeing”), even though they represent distinct concepts.

What problem arises from unclear definitions of health-related terms?

Confusion among consumers and professionals, difficulty advancing science, and increased misinformation and quackery.

How was health defined prior to 1940?

As the absence or avoidance of illness, disease, and debilitating conditions.

Was health considered a continuum before 1940?

No, it was viewed as a binary state (healthy vs. sick).

What aspects of health were emphasized pre-1940?

Physical abilities, especially the capacity to perform manual labor.

What aspects of health were largely ignored pre-1940?

Mental and social illness and disease.

How was wellness defined before 1940?

The state of being in good health.

Why were health and wellness used interchangeably pre-1940?

Because health was binary and wellness simply described being healthy.

WHO (1948) definition of health?

A state of complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity.

Why was the 1948 WHO definition progressive?

It expanded health beyond physical illness to include mental and social dimensions.

How did WHO define wellbeing historically?

The condition of existence.

How was health positioned within the wellbeing continuum?

Health was the positive endpoint of the wellbeing continuum.

What did the wellbeing continuum range from?

Illness, disease, and debilitation → health.

How was wellness redefined in the 1950s?

As the process by which one attains positive health.

What did wellness emphasize in the 1950s?

Health promotion through lifestyle change.

How did health, wellbeing, and wellness align briefly?

Wellbeing = continuum, health = endpoint, wellness = process.

How did commercialization affect wellness?

It became a marketing term for products and services loosely related to health.

How large is the wellness industry compared to pharmaceuticals?

About three times larger globally.

How is the term wellness viewed in health and medical fields?

Often negatively, due to misinformation and weak scientific grounding.

How did U.S. public health add to confusion?

By treating wellbeing as the positive endpoint of health.

What circular logic problem emerged?

Health and wellbeing were each defined as endpoints of the other.

How did medical groups worsen confusion?

By redefining wellness as a state of complete physical, mental, and social health.

Modern definition of health?

A state of adequate functioning of physical, mental, and social processes.

How is health conceptualized today?

As homeostasis between life demands and the ability to respond to them.

Is health a process or a product?

A product (outcome).

Can someone be healthy but still improve health?

Yes—adequate functioning does not equal maximal functioning.

Social determinants of health?

Education, healthcare access, community factors

Economic determinants of health?

Employment, insurance, medical bills.

Environmental determinants of health?

Housing, transportation, safety, access to care.

Behavioral determinants of health?

Lifestyle behaviors such as physical activity and nutrition.

Heritable determinants of health?

Genetic risk and learned behaviors

Modern definition of wellness?

A multidimensional subjective evaluation of one’s present state of being.

Examples of wellness indicators?

Happiness, contentment, life satisfaction, fulfillment.

Modern definition of wellbeing?

Subjective evaluation of one’s state within a specific dimension of wellness.

Key distinction between wellness and wellbeing?

Wellness is overall; wellbeing is dimension-specific.

How is wellbeing written in modern usage?

Always preceded by a dimension (e.g., physical wellbeing).

Is wellness a process in the modern model?

No, wellness is a product.

Can wellbeing change without maximizing all dimensions?

Yes, individuals have personal balance points.

Does the balance point change over time?

Yes, due to maturation, life stage, and life events.

Historical view of wellness variability?

Stable with little day-to-day variation.

Modern view of wellness variability?

State-dependent and sensitive to recent events.

Definition of physical activity?

Any bodily movement requiring energy expenditure above resting needs.

Definition of physical fitness?

Attributes related to the ability to perform physical activity.

Physical activity vs fitness (process vs product)?

Activity = behavior; fitness = attribute.

Five health-related components?

Cardiorespiratory endurance, body composition, muscular strength, muscular endurance, flexibility.

Activities of daily living?

Household and domestic tasks.

Occupational activity?

Work-related physical tasks.

Transportation activity?

Walking, biking, wheeling between destinations.

Leisure-time activity?

Exercise, sport, and recreation.

Light intensity?

30–39.9% HRR or 1.6–3.0 METs.

Moderate intensity?

40–60% HRR or 3.0–6.0 METs.

Vigorous intensity?

>60% HRR or >6.0 METs.

Endpoint definition of sedentary behavior?

Lowest end of activity continuum (<30% HRR or <1.5 METs).

Why did this perspective emerge?

Recognition of detraining effects and benefits of light activity

Independent construct definition of sedentary behavior?

Prolonged inactive wakeful behavior in sitting or reclining postures.

What does 'sedere' mean?

To sit.

Why separate sedentary behavior from physical activity?

It is behaviorally distinct and has independent health effects.

How is sedentary behavior classified in this model?

On its own continuum from low to very high sedentary behavior

What shift in public health focus is emphasized in modern epidemiology?

A shift from focusing primarily on mortality (death) to also emphasizing morbidity (disease, illness, and impairment)

How did the COVID-19 pandemic highlight misunderstandings in public health?

It exposed confusion about causes of death, the value of preventing non-fatal disease, and how epidemiology informs public health priorities.

What misconception is reflected in the phrase “If it doesn’t kill me, why should I care?”

It ignores morbidity, long-term impairment, and reduced wellbeing that can occur even when individuals survive a disease.

What is the Immediate Cause of Death?

The final disease or condition that directly results in death

How is Immediate Cause of Death defined by the National Vital Statistics System?

The final disease or condition resulting in death.

What is the Underlying Cause of Death?

The disease or injury that initiated the chain of events leading directly to death.

How does the World Health Organization define the Underlying Cause of Death?

The disease or injury that initiated the train of events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury.

Why are death certificates important beyond legal purposes?

They provide critical mortality data for public health surveillance and epidemiology.

What system classifies causes of death internationally?

The International Classification of Diseases (ICD).

What challenge arises when classifying causes of death?

Many individuals have multiple comorbid conditions that contribute to death.

What precedent did the ICD establish in 1948?

Mortality statistics should be based on the single underlying cause of death while allowing up to 20 additional contributing causes.

What role does the National Vital Statistics System (NVSS) play in the U.S.?

It mandates required information on death certificates and differentiates immediate vs. underlying causes of death

In a diabetic driver who dies after a hypoglycemic event causes a car crash, what is the underlying cause of death?

Diabetes.

In that same example, what is the immediate cause of death?

Massive blood loss from the accident.

Why is diabetes considered the underlying cause in this case?

It initiated the chain of events leading to death.

In a patient with congestive heart failure who dies after viral pneumonia, what is the underlying cause of death?

Viral pneumonia.

What is the likely immediate cause of death in the viral pneumonia example?

Respiratory failure.

How is congestive heart failure classified in this example?

A significant contributing condition, not the cause of death.

Why can causes of death vary between physicians?

They represent a medical opinion based on professional judgment.

What is Mortality Rate?

The number of deaths divided by the population.

What organization compiles U.S. mortality data?

The National Vital Statistics System (NVSS).

Approximately how many death records does the NVSS process annually?

Over 2 million.

What types of mortality data does the NVSS provide?

Annual mortality across all causes and quarterly estimates for the 15 leading causes of death.

Which two diseases account for nearly half of all U.S. deaths?

Cardiovascular disease and cancer.

What percentage of U.S. deaths do cardiovascular disease and cancer account for combined?

48.4%.

Since the 1940s, how have mortality rates changed for cardiovascular disease and cancer?

Cardiovascular disease mortality decreased by over 70%; cancer mortality decreased by over 30%

Why can mortality rates be misleading?

They do not represent individual risk of developing or dying from a disease.

What field estimates an individual’s risk of disease or death?

Actuarial science.

What factors does actuarial science consider?

Demographics, environment, personal and family history, and risk factors

What is Survivorship Bias?

A selection bias where conclusions are drawn only from individuals who survive a selection process.

How does focusing only on mortality reflect survivorship bias?

It ignores individuals who survive but live with disease-related impairment.

What is the Natural History Perspective of Disease?

The standard progression of disease from susceptibility to resolution.

What are the four stages of the Natural History Perspective of Disease?

Susceptibility → Incubation → Symptom presentation → Resolution.

What are the three possible outcomes of disease resolution?

Recovery, disability–impairment, or death.

What is Morbidity Rate?

The number of clinically ill individuals divided by the population.

Why is morbidity important in public health?

Survival does not guarantee freedom from long-term health impairment.

What trend has been observed in cardiovascular disease morbidity?

Relatively minimal change in diagnosis rates over the past 20 years.

What trend has been observed in cancer morbidity?

An increase in diagnoses.

What does this suggest about public health progress?

Diseases are not eliminated; people are simply less likely to die from them

How can morbidity affect wellbeing even when mortality decreases?

Individuals may live longer with disease-related limitations and reduced quality of life.

What is the Iceberg Principle of Disease Presentation?

Most individuals with a disease are subclinical or undiagnosed, while only a small portion are clinically apparent.