HED 311 #1

INTRODUCTION

Top 8 Leading Causes of Death in the US (Most are Behavioral and Preventable)

  1. Heart Disease (Processed Foods, High Cholesterol)

  2. Cancer (Smoking, Alcohol Use, Lead Exposure)

  3. “Unintentional Injuries” (Car Accidents, caused by alcohol and cell phones)

  4. Stroke  (High Blood Pressure, Not Sleeping)

  5. Lower Respiratory Disease - COPD (Smoking)

  6. Alzheimer’s Disease (Lack of Sleep, Stress)

  7. Diabetes (High Sugar Intake)

  8. Kidney Disease (Alcohol, Not Drinking Enough Water)

These Causes are Related To:

  • Fast Food, Bad Diet, Cigarettes, Guns, Car Accidents, Alcohol, Not Exercising, Drug Use

Ways to Maintain Health:

  • Eat Fruits/Vegetables, Drink Plenty of Water, Exercise, No Alcohol/Cell Phone Use While Driving

What influences health?

  • 84% of people in the US view their health as something largely under their control and for which they have to take personal responsibility

    • EX: “People who smoke are not very smart,” “Sitting is the new smoking,” “Distance running is too hard and takes too much time,” “Commuting to work is bad for your health,” “Meat is murder,” “People who are not vaccinated and boosted for COVID are killing my grandmother.”

Structural Health

  • Processed food companies usually have more money and can pay to be a consumer’s “major options” (e.g., Food court mall options).

    • If healthier/smarter options are not readily available to people, they are not likely to go.

  • “In health terms, your zip code matters more than your genetic code.”

Public Opinion

  • GUNS: Public Opinion is divided when it comes to the 2nd Amendment. How will we create policies that protect people’s rights but keep people alive?

What Do We Mean By Health Outcome?

  • Mental health, diet/exercise and metabolic health, cardiovascular health, cancer, sexual health, substance use/abuse, access to health care, infant and early childhood health, healthy aging, education/health literacy.

HEALTH PROMOTION

What Is It?

  • Efforts to understand the causes and trajectories of wellness and illness at the population level

    • Programs to prevent and treat emphasize the prevention of health problems, programs to facilitate wellness, and policies to maximize wellness and minimize illness in whole populations (ex. Apple Watches to motivate steps).

Understanding, Prediction, and Prevention/Promotion

  • UNDERSTANDING: We need to show that our potential predictor is related to the health outcome we want to prevent at one point in time (ex. Alcohol advertising related to how much alcohol someone drinks?).

  • PREDICTION: We need to show that our potential predictor predicts the health outcome over time, even when we account for earlier levels of the outcome.

  • PREVENTION: We need to show that, if we design a program or policy to affect our predictor, it will influence the health outcome through the predictor (ex. Restaurants now have to show the calories of their products).

    • Ultimately, health follows money.

    • EX: cigarette taxes to prevent/reduce smoking, banning large sodas to reduce obesity, mandating masks and vaccines to combat the spread of COVID-19, fruits and vegetables in school lunches to improve children’s health

Risk, Protection, and Promotion

  • + Risk Factor -> + Negative Health Outcome (ex. living in a community with a greater number of alcohol-selling outlets predicts greater alcohol consumption among adolescents).

  • + Protective Factor (ex. Parental supervision of adolescent activities may offset the effects of deviant friendships on youth substance use).

  • + Promotive Factor -> - Negative Health Outcome + Positive Health Outcome  (ex. Warm and trusting relationships with parents predict academic success (positively) and depressive symptoms (negatively)).

Theory Is Essential

  • Tells us how things are expected to work, and what predicts what (and why).

  • Research indicates that interventions that are based on theory work much better than those that are not.

    • The Theory of Planned Behavior: attitudes, social norms, self-efficacy -> intentions -> behavior (ex. New Year’s Resolution to work out).

What Happens When Interventions and Programs Are Not Based on Theory and Research Findings?

  • The “Just Say No To Drugs” program doesn’t work, it is not grounded in theories of adolescent behavior or in research findings about what predicts adolescent substance use.

  • People protested against COVID-19 lockdowns and vaccine mandates because they did not want to be told what to do. 

COVID Mandates VS. Self-Determination Theory

  • Self-determination theory posits 3 basic human needs: autonomy, relatedness, and competence.

    • Mandates take away people’s autonomy and lockdowns isolate people. Lockdowns also forced people to stop working, removing their sense of competence. 

Did We Exchange COVID Deaths for Drug Overdose Deaths and Suicides?

  • No, overdose deaths swelled after lockdown. 5 years later, there are still higher rates of anxiety and depression in the young adult age group. 

  • To prevent alcohol abuse, we should not only target people who are at the greatest risk of outcome. The reason lies in the difference between individual-level risk and population-level risk.

    • For example, although 20% of people have the highest individual-level risk of alcohol abuse, 80% of people in the population-level risk because they make up most of the population. 

The Perils of One-Size-Fits-All Approaches

  • Different people and groups often need different types of interventions and policies. For example, people at the lowest risk need very different interventions than people at the highest risk do. If the same exact approach is used for everyone, people will lose interest.

 INTRO TO EPIDEMIOLOGY

What Is Epidemiology?

  • Assesses the burden of disease within a population. As part of this effort, a number of indices have been proposed: Years of Life Lost (YLL) = Average Life Expectancy – Age of Premature Death

    • Life expectancy numbers used are generally 80 for men and 82.5 for women.

  • Years Lost to Disability (YLD) = number of years a person has suffered with a given health problem (cancer, diabetes, back pain, et cetera). 

Years of Life Lost and Years Lost to Disability

  • To extrapolate these numbers to the population level, we would multiply the average YLL or YLD by the number of people affected by a given condition. 

  • For example, the average age of death from breast cancer among African American women is 62, and 6,540 Black women died from breast cancer in 2019. 

    • So the YLL for African American women due to breast cancer would be: YLL = (82.5 - 62)*6,540 = 20.5*6,540 = 134,070

  • For example, the average age of onset for low back pain is about 50. Let’s assume that the average person lives until age 81, this means an average of 31 years lost to low back pain per person. The IASP estimates that 577 million people suffer from low back pain.

    • So the YLD for this condition would be computed as: YLD = (81 - 50)*577,000,000 = 31*577,000,000 = 17,887,000,000

Disability - Adjusted Life Years (Daly’s)

  • Disability-Adjusted Life Years (DALY’s) = YLL + YLD

  • For example, the average time from diagnosis to death from breast cancer is 6 years. 

    • So the YLD for breast cancer among African American women - counting only those who died from the disease in 2019 - is: YLD = 6*6,540 = 39,240

    • Then we compute the DALY for breast cancer by adding the YLL and YLD: DALY = 134,070 + 39,240 = 173,310

Disability Weights

  • Not all diseases or conditions are equally disabling. For example, being paralyzed would have a greater impact on quality of life than back pain would.

    • The World Health Organization developed a system for weighting health conditions: AIDS (.50), Depressive episodes (.60), Alcoholism (.18), Osteoarthritis (.16), and muscle sprain (.01). 

Quality of Life Indices

  • The government uses “quality of life” to determine how to prioritize people for potential interventions. For example, a 12-year-old receiving a kidney transplant over a 75-year-old because they have more life expectancy. 

    • Health-Related Quality of Life Weight (Q) - reflects the quality of life expected during a given year of age.

    • Residual Life Expectancy (L) - the number of years someone is expected to live beyond the current year of life. 

    • Discount Rate (r) - the extent to which one’s life expectancy is expected to decrease based on current health conditions.

  • These numbers are used to calculate a quality-adjusted life expectancy (QALE) - or how many more quality years of life someone has left. We can also examine how many quality of years of life are likely to be gained through an intervention or policy.

  • Finally, we can calculate the number of DALYs saved through an intervention. The earlier the intervention is delivered, the more DALYs can be saved.