Public Health and Health Behavior
Introduction to Public Health: Health Behavior
Do People Choose Their Own Health?
Public health has achieved significant victories in combating infectious diseases.
The shift from infectious diseases to chronic diseases has changed the focus in public health.
In 1990, CDC experts analyzed leading causes of death and identified underlying causes beyond diagnoses.
These underlying causes included both genetic and external factors.
The experts compiled a list of non-genetic factors called the leading actual causes of death.
In 2000, a similar analysis was conducted, confirming the initial findings.
Currently, nine leading actual causes of death are recognized by the CDC.
Nine Leading Actual Causes of Death
Tobacco:
Remains the leading actual cause of death in the United States.
Accounts for 30% of all cancer deaths and 21% of cardiovascular disease deaths.
Poor Diet and Physical Inactivity:
Second most important actual cause of death.
Overeating and inactivity lead to obesity and chronic diseases.
Dietary fat, sedentary behavior, and obesity are linked to heart disease, stroke, cancer, and diabetes.
Misuse of Alcohol:
Third actual cause of death.
Causes 35% to 40% of motor vehicle fatalities.
Linked to chronic liver disease, cirrhosis, home injuries, drowning, accidents, fire fatalities, job injuries, and 3% to 5% of cancer deaths.
Microbial Agents:
Infectious diseases.
Top three killers of the 1900s.
Significantly less significant due to public health successes.
Toxic Agents:
Evidence of successful environmental health efforts.
Firearms
Sexual Behavior
Motor Vehicle Accidents
Illicit Use of Drugs
These nine causes account for approximately 50% of all deaths in the United States.
The other half includes genetic factors.
These factors are significant because they cause premature death and impaired quality of life.
Many of these diseases are preventable through public health measures.
Microbial and toxic agents have traditionally been public health issues.
The other seven are rooted in individual behavioral choices.
Government Approaches to Promote Healthy Behavior
Two main approaches: education and regulation.
Both have had successes and failures.
Education
Informs the public about healthy and unhealthy behavior.
People adjust behavior based on new information.
Example: Many people quit smoking after learning about its adverse effects.
Early 20th century nutritional guidelines focused on combating deficiencies.
Current focus is on preventing major killers like cancer, cardiovascular diseases, and diabetes.
Emphasis on eating less fat, salt, and more fruits, vegetables, and grains.
The FDA has revised labeling requirements to provide consumers with necessary information.
Americans have responded to messages about cutting down on fat, helping to reduce heart disease rates.
Regulation
Governments regulate behavior through laws.
Acceptable when restraining people from harming others (e.g., laws against murder, assault, traffic laws).
Most states have laws concerning alcohol and tobacco use.
Laws against drunk driving and smoking in public places are justified to protect others.
Laws aimed at preventing children and teenagers from harmful behaviors are widely accepted.
Controversy arises when regulations interfere with an individual's freedom to take risks.
Examples: seat belt and motorcycle helmet laws are less accepted.
Prohibition
The most ambitious attempt to regulate behavior.
Passed in 1919 but repealed after 14 years.
Considered a failure, but recreational drugs are treated similarly.
The prohibition approach has mixed results.
War on drugs is expensive, empowers criminals, and sends people to prison for minor offenses.
Legalization of marijuana in many states reflects changing attitudes.
Influence of Social Environment on Health Behavior
Humans are social creatures, and their behavior is strongly affected by their social environment.
Unhealthy behaviors may be maintained and reinforced by the social environment.
Public health interventions should focus on or consider these social aspects.
Socioeconomic Status (SES)
The most important predictor of health.
Includes income, education, and occupational status.
Accounts for health differences by race, sex, and marital status (disparities).
Groups with the lowest SES have the highest mortality rates.
Race and Ethnicity
Profoundly affect health in the United States.
Black Americans generally have poorer health than white Americans.
Hispanics are a heterogeneous group with varying health status.
American Indians generally have poorer health indicators.
Asian Americans have better health status.
Public health interventions aim to improve the health of minority groups by understanding and modifying factors that influence health behavior.
Stress
Contributes to heart disease.
Psychological stresses can cause physiological changes, such as decreased immune response and increased atherosclerosis.
Lower socioeconomic status exposes people to greater life stress.
Daily hassles are greater at lower levels of the socioeconomic status hierarchy (e.g., car breakdown, rent issues, childcare problems).
Racial and ethnic minorities may experience racial prejudice.
Higher income and education provide resources that buffer the impact of life stressors.
Social Support
Social networks, marital status, close friends, and religious affiliations have strong associations with health.
Social support may buffer stress.
Health Belief Model
A framework for understanding health behavior and behavior change.
Assumes people act rationally.
Factors determining behavior change:
Perceived vulnerability to the threat.
Perceived severity of the threat.
Perceived barriers to taking action.
Perceived effectiveness of taking action.
Public health approach is to convince people of their vulnerability, the severity of the threat, and the effectiveness of preventive measures.
Example: COVID-19
Vulnerability: Everyone can get COVID.
Severity: COVID can be deadly.
Preventive measures: Social distancing and masking.
Effectiveness: These measures work.
Self-Efficacy
The sense of having control over one's life.
People with high self-efficacy are more likely to adopt healthy behaviors.
Learned helplessness: The numbed acceptance of a negative situation where the individual no longer tries to change the situation because they don't expect their efforts to make any difference.
Transtheoretical Model
Envisions change as a process through five stages:
Precontemplation: No intention to change behavior.
Intervention: Consciousness raising to increase awareness.
Contemplation: Aware of the benefits but also the difficulties.
Preparation: Decided to make a change and has planned concrete actions (e.g., signing up for a class).
Action: Actually modifying behavior (e.g., abstaining from smoking).
Maintenance: Maintaining healthier behavior and preventing relapse.
Ecological Models
Recognizes that individual beliefs and behaviors happen in a social context.
Looks at how the social environment supports or maintains unhealthy behaviors.
Describes five levels of influence:
Intrapersonal Level:
Knowledge, attitudes, and skills of the individual.
Interpersonal Relations:
Family, friends, and coworkers.
Families are the origin of many healthy behaviors.
Peer pressure influences risk factors like smoking and drugs.
Institutional Settings:
Schools and workplaces.
Workplace or school cafeterias may provide health conscious menus, exercise facilities may be available, and their use are encouraged. Smoking restrictions may prevail and schools and workplace provide ideal settings for public health intervention because of all these issues.
Community:
Organizations work together to promote healthy goals.
Churches are the social centers for many Black and rural communities and may provide a focal point for health related interventions.
Public Policy:
Regulations and limitations on behavior.
Most explicit and controversial measures.
Many advocates believe that public health programs should focus on changing the environment to make it easier for people to behave in healthy ways.
Environmental perspective: Public health problems are social and political issues that require collective action.
Instead of blaming smokers, for example, for lack of willpower, public opinion has shifted its focus to the tobacco industry and the enormous resources the industry has put into making their products attractive to certain populations such as young people and ethnic minorities.