Towards an overall model April, 2013

Modeling Decisions Outcome (What are we explaining?) General (e.g., longevity) vs. specific (e.g., MI)? Incidence vs. progression or survival? (i.e., absolute or relative?)Incidence progression Outcomes or distribution of outcomes? (Individual vs. societal?) Population (Whom are we considering?) Overall average tendencies, or particular sub-groups? Local or universal? Current patterns or historical trends? Perspective (Why?) All factors or a simplified model? How distilled? Prediction vs. explanation?explanation Form (How?) Mathematical or compositional? Organic or structural? Next

Disease management behaviors Seema Nagpal, PhD thesis, 2011 Social Support Back

Family Neighborhood National Global Factors Determinants at higher level influence health at lower level ∑ Explanations: Reasons look outwards (the “Why?” questions) Analysis: Mechanisms look inwards (the “How?” questions) ∑ ∑ ∑ Health status and risk factors at lower levels aggregate to higher levels Physical Emotional Social Spiritual The Person Back

Population Incidence Individual risk categories LowHigh D RF Causes of cases vs. Population Rates Back

Elements of a ‘model’ Elements & links; is this sufficient? Magnitude & pattern of influence Layering of influences Historical: time dimension & external influences Model vs. Framework Lalonde Selye IOTF Minard Next Frank-Etches

Health Health Care Organization Human Biology Environment Lifestyle Lalonde’s Health Field Concept Back

Theory of Planned Behaviour Attitudes Subjective Norms Perceived Behavioural Control Behavioural Intention Behaviour Ajzen & Madden, (1986), Journal of Experimental Social Psychology, 22, 453

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Alarm Resistance Exhaustion Selye’s conception of generalized reaction: initial fall in performance during alarm phase followed by heightened vigilance during resistance phase, leading to precipitous fall as body becomes exhausted. Selye’s notion of optimal level of stress: too little impairs performance (‘rust out’); we operate at peak under optimal stress, but can wear out with prolonged stress. Note similar findings for anxiety. Back

Charles Joseph Minard’s 1869 diagram of Napoleon’s Russian campaign of Back

John Frank Vera Etches Back

Global influences Societal processes Individual actions Biological processes Health outcomes, e,g.: Structural Starting-Point for our Overall Model Overall mortality CVD, cancer Mental health Obesity QoL