HLTH 205 Final Exam

medical model of health

- focuses on the belief that disease originates from specific and identifiable causes.

- The causes of contemporary long-term chronic diseases in developed countries are often 'social'.

- Medicine and medical practice thus recognize that disease and the diseased body must be placed in a social context.

social model of health

- views health as influenced by a range of factors outside of the physical body.

- It views health as a social construct and therefore individual differences can arise due to lifestyle, access to health services, identity and structural or environmental factors such as poverty.

medical model of health

- focuses on the belief that disease originates from specific and identifiable causes.

- The causes of contemporary long-term chronic diseases in developed countries are often 'social'.

- Medicine and medical practice thus recognize that disease and the diseased body must be placed in a social context.

social model of health

- views health as influenced by a range of factors outside of the physical body.

- It views health as a social construct and therefore individual differences can arise due to lifestyle, access to health services, identity and structural or environmental factors such as poverty.

example of medical model of intervention

health care workers screening for a disease like HIV, and providing treatment for those found to be HIV-positive.

example of social model of intervention

might involve working with community members and organizations to understand the positive social and environmental factors that protect community members from becoming infected with HIV, and working with community-based organizations to strengthen and improve those social and environmental factors for all.

holistic model of health

- reflects understandings of health and wellness that are similar to how some Indigenous groupsconceptualize these ideas as a Medicine Wheel.

medicine wheel

divided in 4 quadrants:

physical, mental, spiritual, and emotional

unified model of health

- includes unification of elements like an ideal state, mental and physical fitness, a commodity, and personal strength

- uses Seedhouse's model as a requirement to achieve a person's full potential, where health is determined by the 4 components of health

definition of health

The state of complete mental and physical well-being of an individual, not merely the absence of disease or illness.

definition of wellness

The state of complete mental and physical well-being of an individual, not merely the absence of disease or illness.

definition of illness

A disease or period of sickness that affects an individual's body or mind and prevents the individual achieving his or her optimal outputs.

4 determinants of health

1. General Socio-economic, Cultural and Environment Conditions

2. Living and Working Conditions

3. Social and Community Networks

4. Individual Lifestyle Factors

& Age, Sex, and Hereditary Factors

social factor of health - income

Those with more income experience better health than do those with less income, particularly those living in poverty.

example: access to clean water, food, and medical services; differential rates of stress and anxiety; and differential ability to buy goods and services needed for healthy child development.

social factor of health - housing

housing's impact on health includes physical dangers, inadequate heating or cooling, dampness, overcrowding, poor build quality, environmental toxins like lead paint, or proximity to environmental hazards like factories that emit air pollution.

social factor of health - employment

- determines income and housing, and affects self-esteem, all of which are related to health. - Employment also has direct effects through exposure to hazardous substances, stress, and occupational norms.

- occupations with high demands, low control over work and work decisions, and low social support all negatively affect health.

social factor of health - gender

- women tend to be healthier than men.

- The authors explains that this is because women are more likely to report illnesses, visit the doctor (for some problems), and engage in healthy behaviours and avoid unhealthy ones.

- It also states that women and men are socialized differently, whereby women are socialized to be passive and dependent, and men are socialized to be aggressive and risk taking, leading to differences in health.

social factor of health - race

- race isassociated with health status with people in the privileged "white" category generally having the best health outcomes.

- race is strongly correlated with social determinants of health like income, employment, housing, and education.

- Other explanations include the effects of the stress of experiencing racism, the availability and quality of health services, or attitudes towards the health and medical establishments rooted in past negative experiences.

- race is closely tied to ethnicity and culture, which can affect health-influencing factors like health behaviours or the social and physical environment.

social factor of health - place

distribution of social determinants by geographic area, the makeup of the physical environment, and the norms and traditions associated with the culture or ethnicity

significance and results of the Whitehall studies

- study is important because it shed light on the causation of ill health among employees

- professionals had lower scores (better health), and unskilled workers had higher scores (lower quality of health)

- professional women had better health then professional men, whereas unskilled men had better health then unskilled women

- those with lower household incomes had higher scores (worse health quality), those with higher household incomes had lower scores (better health quality)

- men had smaller risk of mental illness then women

health intervention

any action or activity intended to affect health or one or more determinants of health.

categorizations of health interventions

structural, community, or individual

structural health interventions

targets general socioeconomic, cultural, and environmental conditions

- ex. trade policy, food labelling regulations

community health interventions

targets social and community networks and living and working conditions

- ex. food gardens, free fruit and vegetables at school

individual health interventions

targets individual lifestyle factors

- ex. nutrition education in school

death rate

Deaths per 1000 people per year

standardized death rate

Death rate after statistical adjustment for population characteristics.

perinatal death rates

Number of stillbirths and deaths in first 7 days after birth per 1000 live births.

neonatal death rate

Number of deaths occurring in first 28 days after birth per 1000 live births.

infant death rate

Number of deaths occurring in first year after birth per 1000 live births.

life expectancy

The average age a person can be expected to live, based on birth year.

Years of healthy days of life lost (or gained; YHDLL)

combines morbidity and mortality as measure of loss from disease or gain from intervention

Quality-adjusted life years (QALYs)

years of survival weighted for quality of life people are expected to have

Disability-adjusted life years (DALYs)

combines healthy years of life lost from disability and premature death

five ways differences in social determinants lead to differential health outcomes

1. behaviour or lifestyle

2. the life course

3. psychosocial factors

4. material conditions

5. access to health care services

two definitions of health promotion

1. to inform - inform people about the ways in which their behaviour and lifestyle can affect their health

2. raise awareness - raise awareness of the socioeconomic policies at national and local levels that aren't conducive to good health and to work to change those policies

significance of the Ottawa Charter for Health Promotion

- was result of international conferenced sponsored by WHO (world health organization)

- led to publishing of report of the EPP report

strategies of the EPP report

1. fostering public participation

2. strengthening community health services

3. coordinating public policy

three mechanisms for health promotion

- self care

- mutual aid

- healthy environments

effect of Ottawa Charter on the EPP report

defined 5 actions for health promotion

1. building public health policy

2. creating supportive environments

3. strengthening community action

4. developing personal skills

5. reorienting health services

3 roles that health promoters take

1. advocates

2. enablers

3. mediators

5 different approaches to health promotion

1. medical

2. behaviour change

3. education

4. empowerment

5. social change

medical approach to health promotion

concerned with preventing ill health and premature death through medical intervention

- popular because they're seen as a quick fix and because of high status of the medical field

behaviour change approach to health promotion

aims to encourage people to adopt healthy behaviours

ignores the social, political, and economic forces that constrain individual behaviour

as a result, can lead to victim blaming to people that are powerless to change their behaviour

ex. creating media campaign to encourage people to wear N95 masks in public

educational approach to health promotion

aims to increase knowledge and skills so people can make informed decisions about behaviour

doesn't attempt to motivate change in a particular direction like behaviour change approach does

ex. creating and distributing flyers and booklets to provide info about a disease

empowerment approach to health promotion

aims to help marginalized people and communites to understand their situation and gain control over it by developing skills so they can act to improve it

requires health promoters to step aside once community is empowered

ex. educator teaching community to understand and address their powerlessness

4 models of health promotion

1. Caplan and Holland's four paradigms (1990),

2. Beattie's model of practice (1991),

3. Tannahill and Downie's descriptive model (1996),

4. Tones and Tilford's empowerment model (2001).

Caplan and Holland's four paradigms - traditional paradigm

involves social regulation and objective knowledge

can be the typical expert-led approach under medical behavioural change approach model

Caplan and Holland's four paradigms - humanist paradigm

involves social regulation and subjective knowledge

is an educational approach to health promotion, where people learn to develop and use skills/resouces

Caplan and Holland's four paradigms - radical humanist paradigm

involves radical change and subjective knowledge

is an empowerment-based approach where people and communities understand and address determinants of their health

Caplan and Holland's four paradigms - the radical structuralist paradigm

involves radical change and objective knowledge

is a social change approach in which social and structural determinants are identified and addressed

Beattie's Model of Practice

proposes two dimensions upon which health promotion practice differs

1. The focus of intervention, which can be individual or collective, and

2. The mode of thought and intervention, which can be objective and authoritative or negotiated and subjective.

Beattie's Model of Persuasion strategies

1. health persuasion

2. legislative action

3. personal counselling

4. community development

definition of public health

Activities based on a biomedical understanding of health which focus on the identification of health-related needs and population-based actions such as immunization and screening.

definition of primary prevention

Primary prevention aims to prevent disease or injury before it occurs. This is done by preventing exposure to hazards that cause disease.

ex. immunization

definition of secondary prevention

seeks to change health damaging behaviour to shorten episodes of illness and prevent progression of health management

ex. education about medication and self management for diabetics

definition of tertiary prevention

seeks to limit disability or complications arising from a chronic or irreversible condition and enhance quality of life

ex. education about use of disability aid and rehabilitation therapy

definition of health education

Activities to facilitate health-related learning and behaviour change.

definition of health literacy

The ability of individuals to access and critically assess information. Health literacy includes the ability to interact and express personal and societal needs for promoting health.

significance of the Nuremberg Trial

- had unethical experiments carried out by Nazi Germany on Jews and others in concentration camps before and during WWII

- the Nazi's were later put on trial, where judges wrote sets of principles for conducting ethical media research with human subjects, called the Nuremberg Code

significance of the declaration of Helsinki

- many of the ideas in the Nuremberg Code were incorporated by the WHO in the Declaration of Helsinki

- this declaration has influenced legislation and policy in many countries including Canada

two components of Informed consent

1. potential human research participant needs to be told about the info of the study, including whos' conducting it, what it's investigating, what the participant is required to do, and any potential risks or benefits in participating

2. participant needs to agree without any undue influence on the part of the researcher or anything else

unethical research ex. 1 - The Tuskee Syphilis Experiment in the US

- was conducted between 1932 and 1972, where the US Public Health Service wanted to study the progression of untreated syphilis in rural African-American men in Alabama

- participants were lied to and told they were receiving free healthcare, while the researchers with-held antibiotics so they can track the course of the disease

unethical research ex. 2 - The Canadian Indigenous child nutrition study

did experiments on hungry Indigenous children without their knowledge or consent, with some children experiencing no changes to their diets, with others being fed fortified flour mixture, which was banned and caused health issues

withheld nutritious foods

ethical principle of autonomy

respect for the rights of individuals and their right to determine their lives

ethical principle of beneficence

the commitment to do actions that are of benefit to other people or 'doing good'

ethical principle of non-maleficence

the obligation not to harm other people

ethical principle of justice

the obligation to act fairly when dealing with competing claims for resources or rights

ethical principle of honesty

the commitment to always tell the truth

what is an ethical dilemma

occurs when it isn't clear which of competing actions is the right or moral action because the ethical principles are in conflict with each other

deontology

an approach that assumes universal moral rules should guide all of our actions

- actions are seen as either right or wrong in all situations

- the ends do not justify the means

consequentialism

doesn't recognize universal moral laws

states that ends can justify the means, as long as good is maximized and harm is minimized

- various ethical principles are considered and balanced

definition of ideology

a set of beliefs or ideas which underlies and justifies the actions of government, corporations, or religious groups, or attempts to undermine these entities

4 types of health and welfare ideologies

1. socialism

2. social democracy

3. nationalist/neoliberal

4. neoconservative

conservative ideology

- encompasses, nationalism, neoliberalism, new rightism, and neoconservatism

- emphasizes personal responsibility

- government legislation and intervention should be minimized

- economy shouldn't be regulated

- individuals are free to make their own decisions

- core values include individualism, freedom, responsibility, and authority

- healthcare is individual responsibility

liberal ideology

- encompasses socialism, Marxism, and social democracy

- context is more important then personal responsibility

- government legislation and intervention are good ways to influence social outcomes

- economy should be regulated

- government or collective actions are good ways to encourage choice

- core values include equality, collective responsibility, humanitarianism, social harmony

- healthcare should be universally available

conservative party

can be described as centre-right to right wing

- espouses neoliberalism

- health promotion methods this party supports is the Individualist Paternalist (conservative) category

liberal party

centre to centre-left party

- espouses social democratic health and welfare ideology

- most likely to support collective and individual participatory (new left) health promotion methods

new democratic party

centre-left to left-wing

- espouses mostly socialist ideology

strongly supports labour rights and is likely to support Collective Paternalist (socialist) health promotion methods

Bloc Quebecois

party that promotes what it sees are the best interests of Quebec and Quebeckers

green party

supports policies it sees that contribute to environmental sustainability and reversing climate change

peoples party

far right party that can be described as anti-government and anti-immigration

primary health care

involves an emphasis on promotion and prevention in addition to treatment

- incorporates a broad, holistic understanding of health

public health institutions in Canada

1. Canada's Federal System

2. The Public Health Agency of Canada

canada's federal system

responsibility for various aspects of health and health care are shared by federal, provincial, and local institutions and agencies

the public health agency of Canada

national body focused on disease and injury prevention, responding to threats to public health and promoting health

two provincial institutions responsible for public health promotion

1. The Ministry of Health

2. The Public Health Ontario, which reports to the Ministry of Health

The ministry of health

primarily responsible for administering Ontario's universal healthcare system, OHIP, treating disease

The Public Health Ontario

- responsible for detecting and responding to infectious disease outbreaks and environmental incidents, addressing challenges of improving health, and educating Ontario's health workforce

3 categories of professions involved in health promotion and primary healthcare

1. wider contributors - people who influence public health but may not know it (ex. teachers, social service employees)

2. practitioners - people who may do public health work (community public health nurses, school nurses)

3. specialists - employees with public health training who develop and administer public health programs (public health consultants)

4 core health promotion principles

participation, collaboration, empowerment, and equity

core health promotion: participation

- public having a say in policymaking process and decisions about their own treatment and care

- ex. supporting self-help groups in the community, seeking feedback from the community on service provision

core health promotion: equity

refers to both material resources and power

providing equal services for people with equal needs and working to reduce known inequalities in health

core health promotion: collaboration

the promotion and maintenance of health does not belong to one professional group or sector, based on the understanding that individual and community well-being is determined by social, environmental, and economic systems

core health promotion: empowerment

A process through which people gain greater control over their lives and health.

The Health Belief Model

developed to help explain why people weren't engaging in preventive behaviour (like getting vaccines)

- focuses on beliefs and perceptions people have about a particular behaviour and disease and injury

The Theory of Reasoned Action

developed to explain why people engage in particular behaviours

- states that people's attitudes towards a behaviour and their beliefs about what significant other's think about a behaviour predicts their intention to engage and their actual engagement with a behaviour

The Theory of Planned Behaviour

extension of theory of reasoned action

- adds additional layer of perceived behaviour control, which discusses how much a person believes they are in control of their behaviour and how much they feel external factors can either support or inhibit them from engaging in a behaviour

The Stages of Change Model

developed to explain addictive behaviours

- people can be at various levels of readiness when it comes to making behaviour changes relating to addiction

- key idea in this model is knowing what stage a person is in to help design intervention strategies effective for them

5 prerequisites for successful behaviour change

1. The change must be self-initiated by the person.

2. The behaviour must become highly important to the person.

3. The importance of the behaviour to the person must appear over a period of time.

4. The behaviour is not part of the person's coping strategies.

5. Social support is available to the person to help with behaviour change.

3 ways health promoters can encourage behaviour change

1. providing information

2. educating

3. counselling

5 key principles of community-centered approaches

1. participation

2. community empowerment

3. community led

4. social justice

5. asset-based (identify and promote community characteristics that have potential to improve)