Self, Family, Community Chapter 1

Health and Wellnes Health: state of complete physical, mental, social, and spiritual well-being 1 Wellness: active process of adopting patterns of behavior that can lead to improved health and heightened life satisfaction 2

Figure 1.1 The wellness continuum. Wellness may be conceptualized as a continuum. At one end is terminal illness and premature death; at the other is a sense of vitality, wellness, and optimal health. Figure 1.1 The wellness continuum.

The Socioecological Model of Health and Wellness Addresses the interrelationship between individual and environment Each individual has unique set of characteristics, including genetics, age, and knowledge Environment is anything external to us: relationships with others, community resources, physical and built environment, etc. Many social determinants of health influence the options you have and the choices you make The Socioecological Model of Health and Wellness

Life expectancy has not increased as fast in the United States as in other countries Measuring differences in health outcomes between populations can reveal why gains not equally shared Demographics: statistical data about populations or groups of people Population health: health outcomes of a group of people, and the distribution of those outcomes within the group Population Health

Figure 1.3: Health Olympics 2014, life expectancy in 35 countries.

Health Disparities Result from systemic and avoidable social and economic practices and policies that create barriers for some groups Geographical disparities: Americans have greater health risks than individuals in other high-income countries Health disparities also seen between U.S. regions

Health Disparities Ethnic and racial disparities: Health improvements not shared equally among racial and ethnic groups Ethnicity: sense of identity drawn from common origins Race: ethnic groupings based on physical characteristics Ethnic and racial disparities: Socioeconomic status has perhaps most significant impact on health outcomes Socioeconomic disparities: Different ages associated with critical phases in life, when healthy and harmful environments have greater impact Age disparities:

Public Health Discipline focused on the health of populations Health promotion: actions designed to maintain a current health state or encourage a more desirable state of health Disease prevention: defensive actions to ward off specific diseases and their consequences Community Health: Activities directed toward improving the health of a whole community, or activities employing resources shared by the members of the community

The Healthy People Initiative Leading health indicators: priority public health issues to be targeted and measured Nutrition, physical activity, and obesity Maternal, infant, and child health Tobacco Substance abuse Reproductive and sexual health Mental health Injury and violence Environmental quality Clinical preventive services (such as immunizations) Access to health care Oral health Social determinants of health

Individual Choice Versus Societal Responsibility Ethical questions: Are individuals responsible for their health choices, given the powerful influence of their environment? Should individuals be held accountable for costs to society of poor health choices? Is government justified in enacting health-related laws, regulations, and policies? Should society take action to prevent people from taking risks? Is health a basic right?

The Health Belief Model All these considerations enter into your decision-making process when making health-related behavior change decisions Health behaviors influenced by: Perceived susceptibility (risk for a problem) Perceived seriousness of consequences Perceived benefits of specific action Perceived barriers to taking action

The Stages of Change Model Also called Transtheoretical Model (TTM); takes into account thinking, feelings, behaviors, relationships, and many other factors Stages of change: Precontemplation Contemplation Preparation Action Maintenance Termination Relapse, backsliding into a former health state, is the rule rather than exception

Stages of Change Model (Transtheoretical Model) Stages or steps include Precontemplation, “Not me!”; Contemplation, “Well… maybe”; Preparation, “What should I do to prepare?”; Action, “I’m doing it”; and Maintenance, “I can change!” Relapse can happen at any stage of change. It’s part of the process.

Creating a Behavior Change Plan Accept responsibility for your own health and make a commitment to change Set goals Develop action steps Identify benefits Identify positive enablers Sign a behavior change contract Create benchmarks Assess accomplishments and revise, if necessary Creating a Behavior Change Plan

Being an Informed Consumer of Health Information Develop health literacy: ability to read, understand, and act on health information Nine out of ten American adults have trouble interpreting health materials Many factors contribute to health risk: probability of exposure to a hazard that can result in negative consequences Emotional responses affect how we interpret and react to information Being an Informed Consumer of Health Information

Being an Informed Consumer of Health Information Understanding medical research studies Basic medical research, epidemiological studies, clinical studies Careful consideration of health recommendations involves asking a series of critical questions Formal study or expert opinion? If formal clinical study, randomized and double-blind? People in the study similar to you? How many participants? Published in a reputable, peer-reviewed journal?

DNA and Genes: The Basics of Heredity Nucleus of every human cell contains entire set of genetic instructions stored in deoxyribonucleic acid, or DNA Body’s instruction book Genome: complete set of DNA Within the nucleus, DNA divided into 23 pairs of chromosomes One pair of chromosome is the sex chromosomes: XX in females; XY in males DNA and Genes: The Basics of Heredity

DNA and Genes: The Basics of Heredity Most cells become specialized, taking on characteristic shapes or functions Skin, bone, nerve, muscle Process called differentiation Stem cells: unspecialized cells Present in an embryo (embryonic stem cells) Adult stem cells retained within tissues

Figure 1.5 Chromosomes, genes, and DNA.

Genetic Inheritance Mutation: change in a gene Alleles: alternate forms of same gene Some mutations harmful, some beneficial, some have no effect Mutations allow for human diversity Alternate forms of genes called alleles are responsible for traits such as eye color Alleles can be dominant or recessive Most characteristics (such as height or skin color) are determined by the interaction of multiple genes at multiple sites on different chromosomes

Figure 1.6 Dominant and recessive alleles. A single gene appears to determine whether earlobes are detached (left) or attached (right). We all have two copies (alleles) of the “earlobe” gene. The detached allele is dominant, meaning a single copy will make the earlobes appear detached (remember, if a dominant allele is present, it determines appearance). The attached allele is recessive, meaning two copies are required for the earlobes to appear attached. Think about your parents and siblings; can you figure out which alleles you have? Consider other single-gene dominant traits—do you have the ability to roll your tongue, a widow’s peak, or freckles? Or single-gene recessive traits— do you have a hitchhiker’s thumb, inability to roll your tongue, or blue eyes?

Multifactorial disorders: conditions caused by interactions among one or more genes and the environment Account for the majority of illnesses and death in the developed world Heart disease is one example Genetic Inheritance

Creating a Family Health Tree Also called a genogram or genetic pedigree Visual representation of your family’s genetic history Illustrates the patterns of health and illness within a family Pinpoints areas of special concern or risk for you

What Can You Learn From Your Health Tree? Early onset of disease is more likely to have a genetic component 1 Appearance of a disease in multiple individuals on the same side of the family is more likely to have a genetic correlation 2 Family member with multiple cancers represents a greater likelihood of genetic association 3 Presence of disease in those with good health habits is more suggestive of a genetic cause 4

Looking Ahead While reading each chapter of this text: Reflect on your current level of health Know your predispositions based upon family history Identify the behaviors that are affecting your health Assess your readiness to change, and develop a behavior change plan Think about the influences that shape your decisions Share health information with family members and friends, and find ways to make a difference in your community