1. Copyright © 2012 by The McGraw-Hill Companies, Inc. All rights reserved.McGraw-Hill/Irwin CHAPTER 3 Role in Society

2. 2 Changing Demographics  In 2006, life expectancy for the U.S. population rose to 77.7 years; with whites and women outliving blacks and men by over 5 years.  In 2011, the ‘baby boom’ generation (born between 1946 and 1964), will begin to turn 65. By 2030, it is projected that 20% of the population will be 65 or older.  In 2020, approximately 24% of the population will be under the age of 18.  In 2010, projections indicated that ethnic and racial minority groups accounted for 32% of the population compared to 20% in 1980. Hispanic are the fastest growing racial and ethnic group as they are expected to comprise 25% of the population by 2050.

3. 3 Implications of Changing Demographics  Important for professionals to reflect on their view of cultural diversity, because culture influences an individual’s health, beliefs, activities, access to care, adherence to programs, and treatment outcomes.  Cultural diversity can be defined as “differences associated with gender, race, national origin, ethnicity, social class, religion, age, and ability/disability, but it can also be extended to include differences in personality, sexual orientation, veteran status, physical appearance, marital status, and parental status” (De Sensi)

4. 4 Implications of Changing Demographics  Importance for professionals to continuously develop their cultural competency through awareness and reflection of their own values, beliefs, biases, and prejudices.  Culture – refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups.  Competency – implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

5. 5 Importance of Cultural Competency  Essential to the achievement of lifespan involvement in physical activity for all people. Thus, professionals need to:  Develop programs that incorporate the values, traditions, and customs of the cultural group.  Respect individual rights, use effective communication skills that convey respect and sensitivity, and appreciate how diversity enriches our lives.

6. 6 Wellness Movement  Health – ‘a state of complete physical, mental, and social well- being and not merely the absence of disease and infirmity (World Health Organization, 1947).  Holistic Health - focuses on the whole person and encompasses the intellectual and spiritual dimensions of health in addition to the physical, mental, and social dimensions.  Wellness – state of optimal health and well-being in which an individual’s physical, emotional, social, mental, spiritual, and environmental aspects of health are in balance.

7. Wellness Definitions PhysicalHow your body functions, freedom from disease, being active on a regular basis, following sound nutritional practices, maintaining a healthy body weight, and getting sufficient sleep. EmotionalEnhanced through acceptance of one’s feelings, appropriate expression of a wide range of emotions, and effective stress management. Social Emphasizes the development of interpersonal skills and healthy, fulfilling relationships as well as contributing to the welfare of others and one’s community. Mental Characterized by sound decision-making skills, intellectual growth, and high self-esteem. Spiritual Reflects a sense of purpose in life and living life in accordance to one’s beliefs and values. EnvironmentIncludes where an individual lives and works. Some factors include: amount of noise, level of pollution, availability of safe places to walk, and type of housing.

8. Epidemiological Shift  20 th century – gradual, epidemiologic transition from infectious to chronic diseases as the leading cause of death. YearLife ExpectancyLeading Causes of Death 190047.3 yearsInfectious diseases such as influenza, pneumonia, tuberculosis, gastrointestinal problems 195068 years*Development of antibiotics and vaccines 200677.7 yearsChronic diseases such as heart disease and cancer

9. 9 Chronic Disease in the U.S.  Chronic diseases accounts for 70% of all deaths and approximately 75% of health care costs each year.  Cardiovascular disease and cancer are the most prevalent chronic diseases AND the number one and two causes of death in the U.S., respectively.  Cardiovascular disease is related to physical inactivity, poor nutrition, obesity, and tobacco use.  1/3 of cancer deaths are related to poor nutrition, physical inactivity, overweight and obesity, and other lifestyle factors.

10. 10 Chronic Disease in the U.S.  The top modifiable (i.e., controllable, preventable) causes of death in the U.S. are tobacco use, poor diet, and physical inactivity.  Tobacco use is the leading cause of death contributing to 467,000 deaths per year.  The combination of poor diet and physical inactivity contribute to 365,000 deaths per year, rising 33% over the past decade (CDC).

11. 11 Health Goals of the Nation  Healthy People 2010  Stresses improvement of the health of the nation, with a particular emphasis on health promotion and disease prevention.  Primary Goals: Increase the quality and years of healthy life and eliminating health disparities.  Healthy People 2020: The Road Ahead  Will lead the charge for promoting health and preventing disease throughout the next decade.  Surgeon General’s Vision for a Healthy & Fit Nation  In 2010, First Lady Michelle Obama, U.S. Department of Health and Human Services Secretary Kathleen Sebelius, and U.S. Surgeon General Regina Benjamin called this report to action to help Americans lead healthier lives through better nutrition, regular physical activity, and improving communities to support healthy choices.

12. HEALTH DISPARITIES AMONG DEMOGRAPHIC GROUPS Gender  Women have a longer life expectancy than men (80.4 to 75.2 years).  30% of the gap between men and about 40% between women is attributable to cardiovascular disease and its effects. Race and Ethnicity  The death rate from heart disease for African Americans is more than 40% higher than for whites and the death rate for cancer is more than 30% higher than whites.  Hispanics have higher rates of blood pressure and are almost twice as likely to die from diabetes than non-Hispanic whites. Education and Income  Activity limitation caused by chronic disease occurs three times more frequently among people whose income is low compared with those people with higher incomes.  The overall death rate for adults with less than 12 years of education is more than twice the death rate for those with 13 or more years of education. Disability  Persons with disabilities have fewer rates of vitality, lower rates of physical activity, and higher rates of obesity compared with persons without disabilities. Geographic Location  Rural populations are less likely to exercise regularly and experience higher rates of heart disease, cancer, diabetes, and injury-related deaths than people living in urban areas. Sexual Orientation  Gay men experience health issues, such as HIV/AIDS, substance abuse, depression and suicide at a higher rate than their heterosexual peers. For more information pertaining to disparities, see the www.cdc.gov or www.healthypeople.govwww.cdc.govwww.healthypeople.gov

13. 13 Overweight & Obesity in Adults  National Health and Nutrition Examination Survey (NHANES) – tracks the prevalence of overweight youths and adults.  Adult Overweight & Obesity in 2005-2006 (estimated)  67% were overweight or obese  34.3% were obese  6% extremely obese  These numbers signify a dramatic increase from the 1970s when 47.7% of adults were overweight or obese; 14.6% of these adults were obese.

14. 14 Overweight & Obesity in Youths  Youth Obesity in 2005-2006 (estimated)  10.4% of children ages 2-5  19.6% of children ages 6-11  18.1% of adolescents ages 12-19  The biggest and most concerning change that has occurred with children’s and adolescents’ weight is that in 2003-2004 the results were based on overweight; however, the numbers reported above demonstrate a significant increase in obese children and adolescents.  80% of overweight and obese children and adolescents are becoming overweight and obese adults.

15. 15 Health Care Costs Health care expenditures rose from $1.2 trillion in 1999 to $2.3 trillion in 2008 and are expected to reach $4.5 trillion in 2019.  Cardiovascular disease = $368.4 billion in 2004  Obesity – $92.6 billion in 2002  Physical inactivity - $76 billion in 2000

16. Recommendations - The Surgeon General’s Vision for a Healthy and Fit Nation Improving Our Communities Neighborhoods and communities should become actively involved in creating healthier environments. The availability of supermarkets, outdoor recreational facilities and the limitation of advertisements of less healthy foods and beverages are all examples of ways to create a healthier living environment. Healthy Choices and Healthy Home Environments Change starts with the individual choices Americans make each day for themselves, their families and those around them. Reducing the consumption of sodas and juices with added sugars; eating more fruits, vegetables and whole grains; limiting television time; and being more physically active help us achieve and maintain a healthy lifestyle. Creating Healthy Child Care Settings It is estimated that more than 12 million children ages 0-6 receive some form of child care on a regular basis from someone other than their parents. Parents should talk with their child care providers about changes to promote their children’s health. Creating Healthy Schools To help students develop life-long health habits, schools should provide appealing healthy food options including fresh fruit and vegetables, whole grains, water and low-fat beverages. School systems should also require nutrition standards and daily physical education for students. Creating Healthy Work Sites Employers can implement wellness programs that promote healthy eating in cafeterias, encourage physical activity through group classes and create incentives for employees to participate. Mobilizing Medical Communities Medical care providers must make it a priority to teach their patients about the importance of good health. Doctors and other health care providers are often the most trusted source of health information and are powerful role models for healthy lifestyle habits. From the Surgeon General’s Vision for a Healthy and Fit Nation (http://www.surgeongeneral.gov/library/obesityvision/index.html)http://www.surgeongeneral.gov/library/obesityvision/index.html

17. 17 Implications of the Wellness Movement What role should physical education, exercise science and sport take in promoting health and achieving national public health goals?

18. 18 Implications of the Wellness Movement  Americans show limited progress in achieving previous goals, objectives, and recommendations suggested by Healthy People and ‘Calls to Action’ from the nation’s administration.  School Physical Education  Need for strong, passionate spokespersons on behalf of PE and sport.  Must reverse the decline in the number of children participating daily in PE.  Should be an integral component of a comprehensive school health program.  Should provide the foundation for participation in physical activities throughout one’s lifespan.

19. 19 Implications of the Wellness Movement  School Settings  Offer worksite health promotion programs to the 5 million school employees.  Use the school as a community center during evening hours, on the weekend, and during the summer.  Offer more physical activity programs for older adults.  Increase worksite health promotion programs, for employees at all levels, that include fitness, recreational activities, and health promotion programs.  Continue to offer programs at commercial fitness clubs and community programs for individuals of all ages.

20. 20 Physical Activity & Fitness Movement  Although men and women of all ages are participating in fitness and sport activities more than ever before, available data show that many children and adults are leading sedentary lives.  The Surgeon General’s Vision for a Health & Fit Nation (2010), Physical Activity Guidelines for Americans (2008), and American College of Sports Medicine Physical Activity and Public Health Guidelines (2008) provide recommendations for youths and adults in relation to physical activity.

21. 21 Benefits of Regular Physical Activity  Reduces the risk of:  Early death, heart disease, stroke, Type 2 diabetes, high blood pressure, adverse blood lipid profile, metabolic syndrome, colon and breast cancers.  Helps prevention of weight gain.  Helps with weight loss when combined with a diet.  Increases cardiorespiratory and muscular fitness.  Prevents falls.  Reduced depression.  Better cognitive function for older adults.  Better functional health for older adults.  Helps to reduce abdominal obesity.

22. 22 Physical Activity Guidelines  Children and adolescents (ages 6-17) are recommended to engage in 60 minutes of moderate physical activity daily and vigorous physical activity three times a week and engage in muscle and bone strengthening activity 3 days a week.  Adults (aged 18-64) are recommended to engage in moderate intensity exercise (2 hours and 30 minutes a week), vigorous- intensity aerobic physical activity (75 minutes a week), or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity each week.  Adults should engage in aerobic activity, such as brisk walking or gardening, in episodes of at least 10 minutes.  Adults should also partake in muscle strengthening activities twice a week. The Surgeon General’s Vision for a Health & Fit Nation (2010), Physical Activity Guidelines for Americans (2008), and American College of Sports Medicine Physical Activity and Public Health Guidelines (2008) provide recommendations for youths and adults in relation to physical activity.

23. 23 Fitness & Physical Activity of Children & Youth Are our nation’s children and youth fit? Are they participating in sufficient physical activity to gain health benefits and reduce their risk for disease?

24. 24 2007 Youth Risk Behavior Surveillance System (YRBSS)  1 in 4 students (24.9%) did not participate in 60 or more minutes of physical activity on ANY day during the past seven days.  25% of students played video or computer games and 35.4% watched television for three or more hours a day.  15.8% of the students were at risk for becoming overweight.  61% of the students reported they exercise to lose weight or to keep from gaining weight and 41% of the students tried to manage their weight by eating less food, consuming fewer calories, or selecting foods low in fat to eat.

25. 25 Fitness & Physical Activity of Adults How many adults are physically active on a regular basis? What can be done to increase the number of adults who incorporate physical activity into their lifestyle?

26. 26 2008 National Health Interview Survey  33% of adults engage in regular physical activity during their leisure time.  Men engaged slightly more frequently than women.  Younger adults were more active than older adults.  Differences in leisure-time physical activity participation were associated with level of education, poverty, race, and ethnicity.  Higher levels of education and income were associated with greater participation by adults.  Non-Hispanic whites were more active than non-Hispanic blacks and Hispanics. For specific statistics on these examples, go to the National Health Interview Survey website: http://www.cdc.gov/nchs/nhis.htm.http://www.cdc.gov/nchs/nhis.htm

27. 27 Health Club Memberships According to the International Health, Racquet and Sports Club Association:  45.5 million people were members of a health club.  13.7 million health club members were between the ages of 18-34.  14 million health club members were between the ages of 35-54..  9.9 million health club members were aged 55 or older.  Women represent slightly more health club members than men (54% versus 46%).  51% of the members have a household income greater than $75,000; 33% have a household income greater than $100,000.  Only 9% of health club members have a household income of less than $25,000..

28. 28 SGMA Expenditure & Participation  While more than 170 million Americans are active in a fitness, team sports, recreational, or outdoor endeavor, nearly 45 million are only casually active and more than 60 million Americans are not active at all.  The two fitness machine categories which generate the most sales are treadmills ($870 million) and elliptical machines ($687 million).  Some of the top 10 fitness activities include: walking (111 million), bowling (57 million), treadmill (51.4 million), weight training (50+ million), running/jogging (44 million), fishing (41 million), bicycling (40.1 million), and stretching (36.3 million).  Among ‘core’ participants (those who participate 50 days or more a year), nearly 30% of fitness participants were 55 years of age or older.  Fitness sales (wholesale) reached 71.8 billion in 2009, which included 28.2 billion for sports apparel, 12.3 billion for athletic footwear, over 20.2 billion for sporting goods equipment, 4.2 billion for exercise equipment, and 27.3 billion in recreational transport.

29. 29 Implications of the Fitness Movement  Professionals should ‘practice what they preach’ (Corbin) by being role models and reflect a commitment to a healthy and physically active lifestyle.  School-based programs must teach students the skills for lifetime participation and foster an appreciation for the value of fitness and physical activity.  School and community physical activity programs should align with the Surgeon General’s Vision for a Healthy and Fit Nation and the Physical Activity Guidelines.  Programs for at-risk youths can increase well-being, enhance self-esteem, and teach important life skills (e.g., goal-setting, planning, and values development).

30. 30 Implications of the Fitness Movement  Professionals must understand the inequities individuals have to navigate (e.g., low socioeconomic status) to be physical active and develop effective strategies to change these inequities.  Need to expand public sector opportunities and make them available to people of all socioeconomic classes.  Culturally competent professionals are needed to design and implement programs that are sensitive to the needs and values of different population groups, such as racial and ethnic minorities, females, and the aged.