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Beliefs, Values and Health


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Title: Beliefs, Values and Health

Beliefs, Values and Health
  • Chapter 2

Learning Objectives
  • At the end of class, you should
  • understand health and sickness
  • know the determinants of health
  • know the American believes and values in the
    delivery of health care
  • understand the promotion of health and the
    prevention of disease
  • develop a position on the equitable distribution
    of health care
  • know basic measures of health and its

Beliefs, Values and Health
  • How have beliefs and values shaped the delivery
    of health care in the U.S.?
  • What are the market and social justices?
  • Is there equity?

Beliefs, Values and Health
  • Beliefs and values in US have remained mostly
  • not a tax financed national health care program

For Managers and Policy Makers
  • 1) Health of a population determines health
    care utilization
  • planning a health service is determined by health
    trends and demographics
  • 2) The health appraisal should determine
  • education, prevention and therapies
  • 3) Evaluating health care organizations on
    contributions made to community
  • 4) Use of justice and equity a concern
  • 5) Measure of health status and utilization to
  • existing programs, plan new strategies, measure
    progress, discontinue a service

What Is Health ?
  • Absence of illness and disease
  • a state of physical and mental well-being that
    facilitates the achievements of individual and
    societal goals
  • Society for Academic Medicine
  • A return to an illness free or disease free
    state after an ill spell.

What Is Health ?
  • A complete state of physical, mental and social
    well being, not just merely the absence of
  • WHO
  • Biopsychosocial model of health
  • Social
  • positive relationships
  • support network for
  • life stresses
  • self-esteem
  • responsible for community and populations
  • To promote, restore and maintain health

What Is Health ?
  • U.S. health care has followed a medical /
    biomedical model
  • the existence of
  • illness or disease
  • have a clinical diagnosis and medical

What Is Health ?
  • Biomedical Model
  • Governs the U.S. concept of health and health
  • 1. The existence of an illness or disease
  • 2. Seek and use care
  • 3. Find relief of symptoms and discomfort
  • 4. Diagnosis of illness and treatment of disease
    to restoration
  • 5. Once relief is obtained, the person is
    considered well, even if the disease is cured or
  • Therefore, clinical intervention once disease is

Illness vs. Disease
  • Illness
  • identified by a persons perception and
    evaluation of how he/she is feeling
  • people are ill when they infer a diminished
    capacity to perform tasks and roles that are
    expected by society
  • Disease
  • based on a professional evaluation
  • caused by more than one single factor
  • presence of tuberculosis
  • poverty
  • overcrowding

An Explanation of Disease Occurrence
  • Tripartite or Epidemiology Model
  • 3 elements
  • 1) host
  • the organism
  • usually a human
  • for host to be ill, an agent must be present
  • 2) agent
  • (ie TB, tobacco smoke, bad diet...)
  • presence of tuberculosis does not assure
    host will be ill
  • 3) environment
  • external to the host to enhance or reduce disease

Tripartite or Epidemiology Model
Epidemiology Triangle page 42, Fig 2-2
Tripartite or Epidemiology Model
  • Risk Factors
  • attributes that increase the likelihood of
    developing a disease or negative health
  • agent (ie tobacco smoke, poor diet)
  • host (ie genetic make up, level of fitness)
  • enviro (ie poor sanitation, low socioeconomics)
  • Prevention
  • to rid risk factors

Behavioral Risk Factors
  • Smoking
  • increases risk of
  • heart disease, stroke, lung cancer, lung disease
  • by CDC
  • Substance abuse
  • Lack of physical exercise
  • High fat diet
  • Improper use of motor vehicles
  • Unsafe intimate relations
  • Look _at_ page 43, Tbl 2-1

Interventions to Counteract Key Risk Factors
  • Behavior modification
  • education
  • personal motivation
  • financial incentives
  • environmental inducements

Acute, Subacute, Chronic Conditions
  • Disease classifications
  • A) acute
  • relatively severe, episodic (of short duration)
    and often treatable
  • (ie myocardial infarct, sudden kidney
  • B) subacute
  • some acute features
  • postacute treatment after discharge
  • (ie head trauma, ventilator)
  • C) chronic
  • less severe, but long and continuous
  • can be controlled, but can lead to serious
  • (ie asthma, diabetes, hypertension)

Holistic Health
  • A growing interest
  • the well-being of all aspects that make a person
    whole and complete
  • Holistic medicine
  • treat the whole person
  • spiritual is added to
  • medical, mental and social
  • Lit shows that religious spiritual belief hs
    a positive impact on overall well-being

Another Model
  • Wellness Model
  • efforts and programs that prevent disease and
    optimize the well-being
  • built on 3 factors
  • 1) understand risk factors
  • done through a health risk appraisal
  • when known, interventions can take place
  • 2) intervention
  • a) behavior modifications
  • b) therapeutic
  • primary, secondary, tertiary prevention
  • 3) adequate public health and social services

Therapeutic Preventions
  • 1) Primary
  • activities to decrease or restrain the problem or
    develop that a disease will occur
  • (ie smoking cessation to prevent lung dis)
  • (ie handwashing to decrease spread of infection)
  • 2) Secondary
  • early detection and treatment of disease
  • to block progression of disease or injury
  • (ie pap smears, mammograms, prostate exam)
  • 3) Tertiary
  • rehabilitation and monitoring to prevent further
    injury or complications
  • (ie turn bed-bound patients)

Public Health
  • To fulfill societys interest in assuring
    conditions in which people can be healthy
  • by IOM
  • Deals with broad societal concerns promoting
    optimum health for the society as a whole
  • A health-related service to minimize risk
    factors to prevent, control and contain disease

Public Health
  • The science and art of preventing disease,
  • prolonging life, and
  • promoting health and efficiency through
  • organized community effort
  • Seeks to apply
  • current knowledge of health and disease in ways
  • that will have the maximum impact
  • on a pops health status

Public Health Roles
  • 1) Prevention
  • 2) Health Promotion
  • 3) Health Protection new
  • Due to 20th century industrialization
  • Environmental Protection Agency (EPA)
  • Occupational Safety and Health Administration
  • Bioterrorism, Homeland Security Act 2002
  • the use of chemical, biological nuclear agents
    to harm populations
  • training, Civil Defense, countermeasures
    cooperation between interagency groups
  • (ie anthrax, small pox)

Medicine versus Public Health
  • Medicine
  • focuses on the individual patient
  • biological causes of disease with treatment
  • treat disease and recover health
  • Public Health
  • focuses on the populations
  • identify environment, social behavior then
  • develop population-based interventions
  • prevent disease and promote health through
  • provides education to pass laws
  • disseminate information

Medicine versus Public Health
  • Medicine
  • Physicians, nurses, dentists, therapists, social
    workers, psychologists, nutritionists, health
    educators, pharmacists, laboratory,
  • Public Hlth
  • same as above, but also includes
  • sanitarians, epidemiologists, statisticians,
    hygienists, environmental health specialists,
    food/drug inspectors, toxicologists, and

Environmental Health
  • Aims to prevent the spread of disease through
  • water, air food
  • 1900s Top 3 killers
  • pneumonia, tuberculosis, diarrhea
  • 1999 Top 3 killers
  • heart disease, cancer, lung disease
  • New Challenges in 20th century
  • hazards of chemicals, asbestos, industrial waste,
    infectious waste, radiation

Quality of Life
  • Overall satisfaction with life during and
    following a persons encounter with the health
    care delivery sys
  • An indicator of how satisfied a person was with
    the experiences while receiving health care
  • comfort, respect, privacy, security, autonomy
  • A persons overall satisfaction with life and
    self-perceptions of health, especially after a
    medical intervention
  • Goal
  • have a positive effect on an individual ability
    to function, meet obligations, feeling of

Determinants of Health
  • Factors that influence an individual and a
    populations health
  • A persons genetic make up
  • 20 of premature deaths
  • Individual Behaviors
  • 50 of premature deaths
  • Medical Practice
  • 10
  • The Social and Environment
  • 20

Blums Force Field Well-being Paradigms of
  • Force Fields
  • Environment
  • Physical, social, cultural, and economic factors
  • Lifestyle
  • Behaviors, attitudes toward health
  • Heredity
  • Current health and lifestyle practices are likely
    to impact future generations
  • Medical care
  • Health care delivery system
  • (access, availability of service)

Blums Force Field Well-being Paradigms of
  • All forces must be considered simultaneously when
    addressing the health status of an individual or
  • Blum v. Centers for Disease Control (CDC) Models
  • Blum
  • looks at overall well-being
  • environment is the main contributor
  • look _at_ page 50, Fig 2-4
  • CDC
  • lks at causes leading to premature death
  • lifestyle main contributor

Americans Beliefs and Values
  • 1) The advancement of science
  • helped to create the medical model
  • 2) A champion of capitalism
  • an economic good
  • 3) Entrepreneurial spirit and self
  • 4) A concern for the underprivileged
  • poor, elderly, disabled
  • 5) Free enterprise and distrust of government

The Equitable Distribution of Health
  • We have scarce resources.
  • 1) How much health care should be produced?
  • 2) How should health care be distributed?
  • Distribution creates inequalities
  • Need justice / fairness

Theories of Equitable Distribution
  • 2 Contrasting Principles
  • Market Justice
  • The Economic Good
  • Social Justice
  • A Social Good

Market JusticeThe Economic Good
  • Fair distribution of health care to the market
    forces in a free economy
  • Medical services distributed on the basis of
    peoples willingness and ability to pay.

Principles of Market Justice
  • Health care is an economic good governed by free
    market forces and supply and demand
  • Individuals are responsible for their own
  • People make rational choices in their decision
    to buy health care products and services

Principles of Market Justice continued...
  • People consult with their physicians who know
    what is best for them
  • The market works best without interference from

Market Justice
  • In association with Classical Ethical Theory
  • A physician is duty-bound to do whatever is
    necessary to restore a patients health
  • An individual is responsible for paying the
    physician for his/her service
  • The poor can be served by charity
  • Ignores the societal good and peoples
    responsibility to the community at large

Market Justice
  • In association with Libertarianism
  • Equity is achieved when resources are
    distributed according to merits
  • Health care distributed according to minimal
    standards and financed through willingness to
  • Health care is not a central priority

Market Justice
  • The production of health care is determined by
    how much the consumers are willing and able to
    buy at the prevailing price.
  • Those not able to pay have barriers to health
  • rationing by ability to pay
  • Focus on individual rather than a collective
    responsibility for health

Social JusticeThe Good Society
  • Theory is at odds with capitalism and market
  • The equitable distribution of health care is
    society responsibility
  • Best when a central agency is responsible for the
    production and distribution of health care
  • Health care is a social good.
  • Should be collectively financed and available to
    every citizen.

Principles of Social Justice
  • Health care should be based on need rather than
  • There is a shared responsibility for health
  • Factors outside a persons control might have
    brought on the condition
  • There is an obligation to the collective good
  • The well being of the community is superior
    than that of the individual

Principles of Social Justice cont...
  • Government rather than the market can better
  • Through planning how much health care to provide
    and how to distribute among all citizens
  • Look _at_ page 59, Tbl 2-4

Community Health Assessment
  • An assessment of the population at a local or
    state level
  • Collaboration with
  • public health agencies
  • hospitals
  • othr providers
  • A JCAHO requirement, especially for community
    not-for-profit hospitals

Healthy People 2010
  • 10 year plans
  • key national health objectives
  • founded on the integration of medical care and
    prevention, health promotion and education
  • under the US Surgeon Generals direction
  • Look at page 62, Fig 2-6
  • Look at page 63, Exh 2-1

Evaluation of Health Status
  • Health status is an indicator of health and
    well-being interpreted through
  • Morbidity
  • Disease or Disability
  • Mortality
  • Death rate

Evaluation of Health Status
  • Longevity
  • life expectancy
  • a prediction of how long a person will live
  • life expectancy at birth
  • how long a newborn can expect to live
  • Look at page 69, Tbl 2-5
  • life expectancy at age 65
  • expected remaining years of life for a 65 year

Evaluation of Health Status
  • Morbidity
  • At risk population
  • All people in the same community or group who can
    acquire a disease or a condition
  • Incidence
  • number of new cases occurring / population at
  • Epidemic
  • Large number of people who acquire a specific
    disease from a common source
  • Prevalence
  • Measure the total number of cases at specific
    point in time / specified population

Evaluation of Health Status
  • Disability
  • Activities of daily living (ADL) Scale
  • evaluates 7 activities of self care mobility
  • feeding
  • bathing
  • dressing
  • using the toilet
  • transferring
  • grooming
  • walking eight feet

Evaluation of Health Status
  • Disability
  • Instrumental activities of daily living (IADL)
  • evaluates activities necessary for independent
  • using phone
  • driving a car, traveling alone on bus, taxi
  • shopping
  • preparing meals
  • lt housework
  • taking medications
  • handling money
  • doing heavy housework
  • walk up/down stairs
  • walk 1/2 mi without assistance

Evaluation of Health Status
  • Mortality
  • Crude Death Rate
  • Total deaths /
  • Total population
  • Age Specific
  • number of deaths within a certain age group /
  • Total of persons in that age grp
  • Cause Specific
  • of deaths from a specific disease /
  • Total population
  • Infant Mortality
  • number of deaths from birth to one year of age /
  • of live births that same year

Demographic Change
  • Changes in the composition of a population over
  • Births
  • Natality
  • birth rate
  • measured by
  • crude birth rate
  • number of live births / total population
  • Fertility
  • capacity of a population to reproduce
  • measured by
  • fertility rate
  • Number of live births / number of females 15-44
    years old

Demographic Change
  • Migration
  • the geographic movement of populations between
    defined geographic units and a permanent change
    of address
  • immigration
  • in migration
  • emigration
  • out migration

Measures of Hlth Svc Utilization
  • Utilization
  • the consumption of health care services or the
    extent to which health care services are used
  • Crude Measure of Utilization
  • Specific Measure of Utilization
  • Institution-Specific Utilization