Lecture 1b: Health, Public Health, Health Behavior & Illness

Health, Public Health, Health Behavior & Illness

Understanding Health Behavior

The course HLTH366 aims to:

  1. Understand the science of health behavior.
  2. Explore how social and behavioral science theories and public health concepts and methods can be applied to the health-illness experience.
  3. Explore how these theories and concepts can be applied to public health interventions.
  4. Promote an appreciation for the role of social and behavioral sciences in public health.

Defining Health

World Health Organization (WHO) Definition (1946)

Health is defined as "…the state of complete physical, social, and spiritual well-being, not simply the absence of illness…"

Critique of the WHO Definition

Marks et al. critique the WHO definition as idealistic and redefine health as:

"…a state of well-being with physical, cultural, psychosocial, economic and spiritual attributes, not simply the absence of illness…"

Social Construction of Health

Health is described and explained in various discourses that are socially constructed. Concepts of health vary across time and place and have historically been linked with ideas of wholeness, naturalness, and balance (e.g., ancient Chinese and Hippocratic traditions).

Diverse Groups of Elders: Definitions of Health

Damron-Rodriguez, J et al. (2005) Definitions of Health Among Diverse Groups of Elders: Implications for Health Promotion.

  • Physical Domain:
    • Somatic
    • Absence of illness
    • Absence of symptoms
    • Bodily functioning
    • Physical Activity
    • Daily living
    • Walk, dance, etc.
  • Social Domain:
    • Social Interaction
    • Family connectedness
    • Support
  • Psychological Domain:
    • Positive attitude
    • Gratitude
    • Creativity
  • Spiritual Domain:
    • Leisure Activity
    • Hobby
    • Music/art
    • Religion
    • Humanitarian beliefs
    • Positive spirit
Primary Domain/Aspect by Ethnic Group
  • African-American: Physical: absence of illness or symptoms
  • Eastern European: Physical: activity and functional ability
  • Hispanic-American: Physical: do not have to go to the doctor
  • Chinese-American: Psychological-spiritual: “positive spirit,” “good heart”

Illness

Definition of Illness

Illness is the patient’s subjective experience of physical or mental states, whether based on some underlying disease pathology or not. It is socially constructed and highly controversial.

Health-Illness Continuum

A continuum exists between public health, disease, health, and illness.

Medicalization

Definition of Medicalization

Medicalization is when nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders (Conrad & Leiter, 2004).

Influencing Factors of the Rise of Medicalization
  1. Factors setting the context
  2. Direct factors:
    • Supply
    • Demand
    • Tolerance
  3. Medical markets
Costs of Medicalization

Estimating the costs of medicalization. Conrad, P, Mackie, T, & Mehrotra, A (2010).

Issues with costs in millions:

  • Anxiety Disorder
  • Behavioral disorders
  • Body Image
  • Erectile Dysfunction
  • Infertility
  • Male pattern baldness
  • Menopause
  • Normal pregnancy
  • Normal sadness
  • Obesity
  • Sleep disorders
  • Substance abuse

Disease

Definition of Disease

Disease refers to abnormalities in the structure and function of organs and body systems, as defined by biomedicine. Doctors diagnose and treat disease, which is not dispersed equally among the population.

Factors Influencing Health

Interplay of Factors

Individual Biology + Behavior + Exposure interact with Opportunity leading to Prevention.

Control Over Health

Factors that keep us from having control over our health include access, knowledge, education, insurance, genetics, and environment.

Public Health

Definition of "Public"

"Open to or concerning the people as a whole."

  • Includes everyone.
  • Population = everyone.
  • Subpopulation: How do we choose?
Focus on High-Risk Groups

Often focus on “those with the highest risk,” meaning the highest likelihood that something negative will occur. "Those with the highest risk" is a shifting concept and depends largely on the health issue being examined (e.g., childhood obesity, HIV, TB, suicide).

Examples
  • HIV rates in the US
  • TB cases by Age/ Race
  • Suicide Methodology
Terms Related to “At-Risk”
  • Vulnerable populations: May have high levels of risk factors and/or low levels of protective factors.
  • Risk behaviors: Behaviors that increase the probability that a negative outcome will occur.
  • Risk factors: Any factors that increase the probability that a negative outcome will occur.
  • Protective factors: Any factors that decrease the probability that a negative outcome will occur.
Public Health Definition

Public health encompasses activities that society undertakes to assure the conditions in which people can be healthy. These include organized community efforts to prevent, identify, and counter threats to the health of the public (Turnock, 2011).

Ten Great Public Health Achievements -- United States, 1900-1999
  1. Vaccination
  2. Motor-vehicle safety
  3. Safer workplaces
  4. Control of infectious diseases
  5. Decline in deaths from coronary heart disease and stroke
  6. Safer and healthier foods
  7. Healthier mothers and babies
  8. Family planning
  9. Fluoridation of drinking water
  10. Recognition of tobacco use as a health hazard
Core Areas of Public Health

Anthropology, Communication, Economics, Political Science, Psychology, Sociology, Social and Behavioral Sciences, Environmental Health, Health Policy, Epidemiology, and Biostatistics.

Definition of "Behavioral" and "Social"
  • "Behavioral" refers to overt actions, underlying psychological processes (cognition, emotion, temperament, and motivation), and biobehavioral interactions.
  • "Social" encompasses sociocultural, socioeconomic, and sociodemographic status, biosocial interactions, levels of social context from small groups to complex cultural systems, and societal influences.
Behavioral Sciences/Health Education

Specialists use specific methods, skills, and program strategies to help promote:

  • Healthier lifestyles
  • More efficient use of services
  • Self-care practices
  • Active participation in behaviors affecting health

Health Behavior

Examples of Health Condition and Behavior
  • Chlamydia: Regular testing and condom use
  • Unplanned pregnancy: Using effective birth control consistently and correctly
  • Depression: Journaling destructive thoughts and triggers
  • COPD: Reduced number of cigarettes smoked a day
  • Obesity: Increasing number of physically active minutes per day.

Health Promotion

Definition of Health Promotion

"…the process of enabling people to increase control over, and to improve their health…"

Theory vs. Law

Theory Definition

Theories are our ways of understanding how or why. We all have theories about how things are related in life – folk theories or informal theories.

Why Do We Have Theories About Health Behaviors?
  1. We acknowledge that health behaviors influence health.
  2. We want to be able to identify the most important reasons why people have health behaviors.
  3. We want to be able to develop interventions that help to change the reasons.
Common Health Behavior Theories/Models
  • Theory of planned behavior
  • Health belief model
  • Stages of change theory
  • Social cognitive theory
  • Diffusion of innovations etc…

Lecture Key Terms

  • Health
  • Illness
  • Disease
  • Socially constructed
  • Health promotion
  • Public
  • Protective factors
  • Vulnerable populations
  • Theory
  • Behavior
  • Population
  • Subpopulation
  • Risk behaviors
  • Risk factors