Chapter 2

Introduction

  • Instructor: Joe Konen, MD, MSPH, Adjunct Faculty

  • Course Start Date: September 8, 2025

  • Overview of topics to be covered in the course:

    • American Health Beliefs & Values

    • Concepts in Health

    • Determinants of Health

    • Health Behaviors

    • Note Public Health in Week # 6

American Health Beliefs and Values

Significance for Managers and Policymakers

  • Reference: Shi & Singh, Delivering Health Care in America: A Systems Approach, 9th edition, p. 50

  • Key Insights:

    • Health status of a population significantly affects health services utilization if services are accessible.

    • Planning health services must be informed by demographic trends and initiatives to reduce disease/disability.

    • Basic understanding of health and risk appraisal should guide the development of educational and preventive initiatives.

    • Growing importance on evaluating healthcare organizations by their contributions to community and population health.

    • Managers and policymakers can utilize quantified health measures to:

    • Assess existing programs' adequacy and effectiveness.

    • Plan new interventions.

    • Measure progress and discontinue ineffective services.

Definition of Health

  • Health Definition:

    • “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” - World Health Organization

  • Introduces the Biopsychosocial Model which emphasizes the importance of:

    • Physical

    • Mental

    • Social aspects of health for a holistic view.

  • The Holistic Wellness Model also incorporates:

    • Emotional

    • Social

    • Spiritual

    • Environmental

    • Financial

    • Intellectual

    • Occupational/Vocational dimensions.

Beliefs & Values in American Culture

  • Key Concepts:

    • Invincibility vs. Susceptibility vs. Seriousness: Perspectives affecting health attitudes and behaviors.

    • Responsibility for Health: Who is accountable?

    • Individualism: Values self-reliance and autonomy, which can conflict with collective health efforts.

    • The relationship between ability and opportunity in pursuing the American Dream.

    • Sick Role: Acceptance of accommodations in various life roles for individuals who are ill.

    • Trust in Experts: Valuing scientific expertise in medicine, intertwined with religious beliefs.

    • Entrepreneurial Spirit: Advocating for free enterprise and a general skepticism towards large government involvement.

    • Equity in Health: Most individuals value health equity, recognizing that access to health is more difficult for certain populations.

Trends in Health Beliefs (2016-2020)

  • Increasing public demand for healthcare prioritization by the federal government (43%).

  • Recognition of healthcare access disparities among African-Americans, Latinos, and people with lower incomes.

  • Growing acknowledgment of health equity and equal opportunity (increased from 58% to 62%).

  • Trust in science and health professionals has risen from 66% to 74%.

  • A noted decline in prioritizing personal health in daily life (decreased from 43% to 38%).

  • 2020 Update:

    • Eer Arthur b as MC bad is 60% believe in taking action to reduce income disparities within the country.

RWJF Health Values for 2024

  • Necessary principles:

    • Health as a universal right, not a privilege.

    • Focus on: Economic inclusion, equitable healthcare access, healthy communities, dismantling structural racism, promoting health equity, community solutions, cultural practices, and comprehensive data collection.

Distributing Health Care

  • Key Questions:

    • How much healthcare production is necessary? Unlimited vs. Limited?

    • How to distribute healthcare? Equally vs. Equitably.

  • Definitions:

    • Equality: Equal support for everyone.

    • Equity: Adjusts support based on individual need without guaranteeing equal outcomes.

    • Reference: The Annie E. Casey Foundation.

Market Justice vs. Social Justice

  • Market Justice:

    • Distribution of healthcare based on personal financial capability in a free market.

  • Social Justice:

    • Firm belief that equitable healthcare distribution is a collective societal responsibility, ideally managed by the government.

Limitations of Market Justice

  • Market justice fails in the healthcare context, as it:

    • Sees humans as products or commodities,

    • Ignores fundamental human dignity and does not adequately protect societal health interests.

Measurement of Health

  • Common Physical Health Measures (Source: Shi & Singh, 9th edition pp. 75-81):

    • Incidence: Number of new cases of a disease during a specific period divided by the population at risk.

    • Prevalence: Total number of existing cases at a specific point in time over a specified population.

    • Crude Death Rate: Total deaths in a year divided by total population.

    • Infant Mortality Rate: Deaths from birth to one year of age in a year divided by the number of live births.

    • Fertility Rate: Live births in a year divided by women aged 15-44.

Measures of Health Care Utilization

  • Access to Primary Care Services: Percentage of the population that visited a primary care provider within the year.

  • Utilization of Specific Inpatient Services: Number of inpatient days for specific services divided by the population size.

  • Average Daily Census: Total inpatient days over a specified period divided by the number of days.

  • Occupancy Rate: Average daily census divided by total beds in the facility.

  • Average Length of Stay: Total inpatient days during a period divided by total patients served during the same period.

Quality of Life

  • Quality of life indicators:

    • Overview of life satisfaction before and after healthcare encounters.

  • Measuring Quality of Life:

    • Often factored into cost-effectiveness in evaluating interventions.

  • Value of a Statistical Life (VSL): Estimated between $1 million and $10 million, as per FEMA’s estimate in 2025 at $13.6 million.

Risk Factors and Disease

  • Risk Factors: Elements that increase disease likelihood, categorized as:

    • Host: Individuals at risk due to genetic, immunologic, fitness levels, and behaviors.

    • Agent: Factors causing the disease (bacteria, viruses, chemicals, dietary excesses/deficiencies).

    • Environment: Conditions exposing the host to agents.

Common Disease Burdens

  • Top 10 Causes of Death in U.S. Adults (August 2025):

    1. Heart disease

    2. Cancer

    3. Accidents/unintentional injuries

    4. Stroke (Cerebrovascular diseases)

    5. Chronic lower respiratory diseases

    6. Alzheimer's disease

    7. Diabetes

    8. Kidney disease

    9. Chronic liver disease and cirrhosis

    10. Suicide (notably different from COVID-19 in 2024)

Chronic Conditions in Youth

  • Chronic physical and mental health conditions among U.S. youth are on the rise, requiring attention, as highlighted by multiple studies and reports, including JAMA articles published in 2025.

Preventative Strategies

  • Primary Prevention: Activities aimed at reducing disease probability (e.g., smoking cessation).

  • Secondary Prevention: Early disease detection and intervention (e.g., health screenings).

  • Tertiary Prevention: Preventing complications of chronic conditions (e.g., medication like anticoagulants for atrial fibrillation).

Acute, Subacute, and Chronic Conditions Defined

  • Acute Conditions: Sudden onset, treatable, and typically short-lived.

  • Subacute Conditions: Less severe continuation of acute illness; may be silent.

  • Chronic Conditions: Long-lasting and generally not reversible, leading to potential chronic problems.

Determinants of Health

  • Health Determinants: Major influences on well-being, divided into:

    • Modifiable: Factors that can be changed (e.g., lifestyle).

    • Non-modifiable: Inherent factors (e.g., genetics).

    • Circumstantial: Environmental influences.

Health Disparities and Social Determinants

  • Health disparities are affected by access to care, which covers only 20% of the variance in health outcomes, with other factors crucial in explaining disparity.

Healthy People 2030 Goals (CDC)

  • Goals articulated to improve the health status of the population holistically, including enhancing health equity and promoting well-being throughout life stages.

Health Behavior Models

  • Relevant Models for Health Promotion include:

    • Health Belief Model

    • Stages of Change

    • Locus of Control

  • Perceived Barriers to Change: Factors influencing the likelihood of action to improve health based on susceptibility and seriousness of disease perceived by individuals.

Behavioral Concepts in Patient Compliance

  • Discussion of adherence versus compliance vs. persistence.

    • Compliance: Passive action without understanding.

    • Adherence: Proactive, value-driven action to improve health.

    • Persistence: Continuation of positive health behaviors over time.