1. Self, Family, and Community

2. Self, Family, and Community
LEARNING OBJECTIVES
Demonstrate a basic understanding of common health terminology.
Discuss health issues and concerns in a diverse and multicultural society.
Discuss helpful strategies for health-related behavior change.
Explain how factors such as family health history or genetics can influence a person’s patterns of health and illness.

3. Health and Wellness
Health: state of complete physical, mental, social, and spiritual well-being
Not merely the absence of disease and infirmity
Wellness: active process of adopting patterns of behavior that can lead to improved health and heightened life satisfaction

4. Figure 1.1 The wellness continuum.
Wellness encompasses multiple dimension including: Physical, Emotional, Intellectual, Spiritual, Social, Environmental, and Occupational Domains
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.
Source: Adapted from “Definition of Health Promotion,” by M. P. O’Donnell, American Journal of Health Promotion, 1 (5), premier issue, 1986.

5. The Socioecological Model of Health and Wellness
Addresses 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.
The complex external factors that influence an individual’s and populations’ health are known as the social determinants of health.

6. The Socioecological Model of Health and Wellness
Many social determinants of health influence the options you have and the choices you make

7. Population Health
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

8. 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

9. Figure 1.3 Health Olympics 2014, life expectancy in 35 countries.
Source: Population Health Forum, by School of Public Health, University of Washington, (based on Human Development Report 2015, by United Nations Development Program, Table 1,

10. 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
Socioeconomic disparities:
Socioeconomic status has perhaps most significant impact on health outcomes (Low SES = higher disparities)
Age disparities:
Different ages associated with critical phases (childhood, adolescence) in life, when healthy and harmful environments have greater impact

11. 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
Initiatives must balance needs and rights of individuals against needs and rights of other members of the population.

12. Community Health
Activities directed toward improving the health of a whole community, or activities employing resources shared by the members of the community
Public Health Service, led by Surgeon General and Centers for Disease Control and Prevention (CDC)
State and local government programs
Nongovernmental organizations
*Understanding population trends enables improved planning for community health programs.

13. The Healthy People Initiative (Healthy People 2020)
Leading health indicators(determinants): 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

14. 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?

15. Health-Related Behavior Choices (Lifestyle Choices)
Your individual health-behavior impact your health.
Areas where individuals have most control over managing their health
Choices concerning physical, mental, emotional, spiritual, social well-being

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

17. 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

18. Creating a Behavior Change Plan
Accept responsibility for your own health and make a commitment to change
Set goals (see methods of “SMART” goal writing, p.13, text)
Develop action steps
Identify benefits
Identify positive enablers
Sign a behavior change contract
Create benchmarks
Assess accomplishments and revise, if necessary

19. 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

20. 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?

21. DNA and Genes: The Basis of Heredity
Nucleus of every human cell contains entire set of genetic instructions stored in deoxyribonucleic acid (DNA)
Body’s instruction book
DNA consists of long strands (see example, Slide 22) of paired nucleotides arranged in a double helix—a kind of spiraling ladder
Within the nucleus, DNA divided into 23 pairs of chromosomes(tightly coiled molecule of DNA)
A karyotype is an ordered display of one individual’s 23 pairs of chromosomes
One pair of chromosome is the sex chromosomes: XX in females; XY in males.
A gene is a series of paired nucleotides at a certain location on a chromosome that codes for a certain protein
Genome: complete set of DNA

22. DNA and Genes: The Basis 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

23. 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

24. Genetic Inheritance
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

25. 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?

26. Genetic Inheritance
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

27. Figure 1.8 Relative contribution of environment and genetics.
Genetic and environmental contributions for some common diseases and incidents can be conceptualized as a continuum, from single gene disorders and chromosomal disorders all the way to injury and poisoning. Notice that there is no clear distinguishing line between environment and genetics because the precise roles of each are not always clear.
Source: Adapted from Figure 12.1: Relative contribution of environment and genetic factors in some common disorders, in ABC of Clinical Genetics by Helen Kingston, 3rd edition, 2002, London: BMJ Publishing Group.

28. 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

29. Figure 1.9 A family health tree.
What conclusions can you draw from this tree? Perhaps the grandfather’s obesity played a role in his heart attack at age 50. Perhaps the uncle would have survived the motor vehicle crash if seat belt laws had been in place in 1964.

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

31. 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

32. Review How are health and wellness defined?
What factors influence a person’s health?
What health-related trends are occurring in our society?
What is health-related behavior change?
What challenges do we face in changing our health behavior?
How do genes affect your health?