kpe162 - Physical Activity and Healthy Lifestyles #1-5

The World Health Organization defines **health** as

"a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity".

**Holistic**

Health has many components - physical, mental, social - and they all need to be well for someone to be healthy.

**Wellness**

Being able to function and having sufficient resources to do things including work and play, to enjoy life, have relationships and support, and so on.

**Mortality**

Death rates (*i.e*. - deaths per unit time, often normalized per unit population, such as "annual deaths per 100,000") or lifespan (*e.g*. - age at death or life expectancy)

**Morbidity** 

Disorder (disease, injury, dysfunction)

**Prevalence** 

The total number of cases of a disorder at a point in time, or during a specified interval.

**EX:** the total number of COVID-19 cases in Ontario in July 2020

**Incidence** 

The number of new cases in a specified time interval.

**EX:** the number of new COVID-19 cases in Ontario in July 2020.

**Fitness** 

Speed, strength, power, endurance to name just a few.

**Functional Capacity**

Literacy, or the ability to accomplish any specific task; for example, to live independently, to work, to read, to play a sport and so on.

**Psycho-Social State**

Measures of happiness, relationships, income, education, and housing to name a few.  

**Quantitative** **measures**

Indicators that you can describe with numbers.

**Some of them can be argued to measure "well-being" only when applied to**

populations, and not to individuals.

**Social determinants of health**

Correlates (and perhaps causes) of many physical or psychological components of health.

The World Health Organization tracks

1,530 indicators of population health

**Correlation**

Statistics that describe types of co-variation of phenomena.

**Correlation co-efficient**

A number between -1 and 1 that expresses how closely two indicators of observable phenomena vary with each other.

**A co-efficient of +1 means they**

always vary together precisely, in lock-step so to speak.

**Co-efficient of -1 means**

step in opposite directions. 

**Correlation is observed with**

descriptive studies

**Descriptive studies**

Observe and describe relationships between variables or indicators in a system without manipulating or controlling those variables.

**Causation** (a.k.a. causality, causal relation, or cause-and-effect) is a relationship

between phenomena in which one (the cause) occurs before the other, and it contributes to or is (at least partly) responsible for the production of the occurrence of the other (the effect).

**Causation** is typically inferred from 

experimental studies

**Experimental studies**

Some (independent) variables are controlled or manipulated, while other (dependent) variables are simply observed.

* It can also be deduced using logic in some cases, or inferred using Pearl's paradigm for causal inference.

All causally-related phenomena are

correlated

**Ontology** **/ Metaphysics**

What exists?  What is real or true?

**Epistemology** 

How can we know what is real or true?

**Ethics** 

What is moral or good?

**Esthetics** 

What is beautiful?

(Sapiential, moral, or social) **authority** 

We often believe what we are told by people whom we respect, whether that is our parents, religious leaders, friends, teachers, leaders or others.

**Objective evidence / science**

Multiple rational observers agree about what they observe.

 The scientific method uses **observations** made with our senses and / or technology that enhances our senses to 

**provide evidence** that tests (supports or refutes) **hypotheses** based on assumptions, theories and / or truth claims. 

Types of evidence

1. evidence of causation
2. **evidence of correlation**
3. **evidence on the basis of authority or "expert opinion"**

Evidence of causation from 

**experimental studies** (highest)

Evidence of correlation derived from 

descriptive studies

Evidence on the basis of

authority or "**expert opinion**" (lowest)

**Quantity** of evidence

2 experiments or 20? 1 expert or 100? 

**Quality** of evidence

Well-structured, without confounds, sufficient subjects for statistical power, academically-peer-reviewed? 

**Population**    

About or for whom is the truth claim being made?

**Intervention**

What is the treatment or health intervention being considered?

**Control / Comparator** 

With whom is the population being compared?

Process for structuring questions about truth claims is known as the 

Pico Process

**Outcome** 

What is the effect being claimed or observed?

Why was “PICO” changed to “PECO?”

"Intervention" is not so applicable; but it can be replaced the more general concept of "exposure”

***Determinants of health*** 

All phenomena correlated with health outcome measures.

We are not implying or inferring causation when we refer to something as a

determinant of health.

Physical determinants of health

• UV radiation

• trauma

• heat

Chemical determinants of health

• toxins

• vitamins

• drugs

Biological determinants of health

• viruses

• foods

• aging

Behavioural determinants of health

• smoking

• exercise

• hygiene

Psychological determinants of health

• mood

• anxiety

• thoughts

Social determinants of health

• income

• education

• race

Spiritual determinants of health

• religious beliefs

Irreversible / Uncontrolled

• age

• genetic sex

• past history of disease

In Between Control / Reversibility

• aerobic fitness

• weight

• income

Mostly Reversible / Controlled

• current physical activity level

• dietary intake

• smoking

External

• UV radiation

• viruses

• health care systems

Internal

• blood pressure

• weight

• genotypic sex

you should ask this question about every possible combination of lifestyle choices

“How does blank affect blank?”

Determinants of health, including lifestyle choices, occur in a social context, in two directions

• your choices affect other people / society

• your choices are affected by other people / society

Your choices affect other people / society

Your choice to smoke pollutes the air and affects the health of others.

Your choices are affected by other people / society

What you can choose to buy in a food store or restaurant is affected by what those businesses bought or prepared to sell to you.

Primary Intervention

prevents health disorder

Secondary Intervention

cures existing health disorder

Tertiary Intervention

permits better function with incurable disorder

Macro

executed by society

Personal

an individual's behaviour

Micro

one that is executed and affects people at a sub-individual (organs or tissues) or microscopic (cellular or molecular) level

Macro & Primary

• bicycle paths

• laws against tobacco ads

• health insurance programs

• vaccination programs supporting manufacture and distribution of vaccines

• programs supporting production and sales of healthy foods

Macro & Secondary

• hospitals

• health insurance programs

• programs supporting research into curative treatments such as cancer surgery or antibiotics for bacterial infection

Macro & Tertiary

• hospitals

• health insurance programs

• accessibility programs; wheelchair ramps; closed captions on videos

• exercise programs for people with osteoarthrosis

• palliative care programs for terminally ill people

• programs to produce and distribute prosthetic limbs

Personal & Primary

• riding a bicycle

• (not) smoking tobacco

• going to get a vaccine

• eating "healthy" foods

Personal & Secondary

• going to see a physician when you have a curable illness; taking the cure prescribed

Personal & Tertiary

• doing rehab exercises for osteoarthrosis

• learning sign language when hearing impaired

• taking medicine to relieve pain when terminally ill

• wearing a prosthetic limb

Micro & Primary

• a vaccine (the actual formula or serum itself)

• healthy foods themselves

Micro & Secondary

• antibiotics that cure bacterial infections

• surgery that cures cancer

Micro & Tertiary

• medicines such as analgesics (pain relievers)

• a prosthetic limb

Some interventions can be justifiably classified into more than one of these nine cells.

For example, bicycle paths are a social intervention - the government builds them. But they can prevent some disease, cure some disease, and help some people with incurable disorders to get around more easily, so they can be considered all three of primary, secondary, and tertiary.

Federal government concluded that while investing in "health care" is necessary, and humane, and civilized, it is far from the

best "bang for the buck" in promoting health.

The most cost-effective health interventions are

primary-macro - like building bike paths, and educating children - these are true "health promotion" efforts as opposed to "disease care". 

Topology

A branch of mathematics that studies shapes and their equivalence.

Simple torus

The surface created by revolving a small circle around in a bigger circle in a direction orthogonal to its plane, so that the surface creates a 3-dimensional ring of sorts. 

Solid torus

Includes the space inside the surface that defines the simple torus. 

We can think of the donut (originally spelled and derived from dough-knot) as a solid torus -

It includes its surface, and also the cooked dough inside that surface; but it does not include the air outside its external surface. 

The surface of the donut in its hole is part of it, but the air in the hole is

not part of the donut - it is outside of it.

A torus can have more than

one hole passing through it (and such shapes are not topologically equivalent). 

How many tori does our body have?

7

Our gut, or alimentary tract, is a hole that passes through our bodies from

mouth to anus.

What is the space inside through the mouth and anus called?

Lumen

Is the lumen part of our body?

No.

The surface of the gut's lumen, as viewed from inside the gut, is an

external surface of our body.

For as long as the food remains in the lumen of the gut, it is not inside our body -

it has to cross the surface of the gut to get inside our body, a process we call digestion and absorption

The other six holes that go right through us all relate to

our noses.

The nose includes 2 nostrils that connect to the lumen of our alimentary tract in our pharynx (throat), and each of four portals of entry into

two naso-lacrimal ducts that conduct tears from the external surface of our eyes into the lumina of our nostrils.

Anything inside the lumina of these holes / passages that go through us is

outside of our body.

The surface of our body that is facing the lumen (called a luminal surface) is an

external body surface. 

We have multiple other orifices that lead to

dead-end indentations called invaginations of our surfaces.

Invaginations

Dead-end indentations

cul-de-sacs

don't go through us to connect to any part of our surface other than the orifice they came in.

The space formed between the surfaces of such a dead-end invagination can also be called its.

lumen.

There is only one portal of entry or exit into or out of such a

dead-end lumen.