PU500: Foundations in Public Health

Question 1

What is public health to Charles-Edward Armory Winslow?

Answer 1

Public health is a science and art of preventing disease, prolonging life, and promoting health through organized efforts and informed choices of society, organizations, public and private communities, and individuals.

Question 2

Without people living near public health resources, how much earlier can people die?

Answer 2

Up to 20 years earlier than people living just a short distance away.

Question 3

What type of approach does public health use? What does it focus on?

Answer 3

A population-based approach.

It focuses on societies rather than individuals within. It aims to inform educators, policymakers, community leaders, and all of whom play different roles in the health of the community.

Question 4

What type of focus does public health utilize to fix downstream issues? What would you call these initiatives in public health?

Answer 4

Public health uses an upstream focus that fixes downstream issues. The initiatives are holistic.

This aims to keep people from getting sick or injured in the first place.

Question 5

Bonus - No backside to card.

The Institute of Medicine states that the mission of public health is fulfilling society’s interest in assuring conditions in which people can be healthy.

The World Health Organization stresses that public health aims to provide maximum benefit for the largest number of people.

Answer 5

N/A

Question 6

What is the definition of health?

Answer 6

A state of complete physical, mental, and social wellbeing rather than the mere absence of disease of infirmity

Question 7

What is the definition of public health?

Answer 7

The science and art of preventing disease, prolonging life and promoting health, through the organized efforts of society.

Question 8

What is the difference between medicine and public health?

Answer 8

A clinician focuses on immediate and emergent issues, while public health focuses on many things that would prevent this issue in the future.

Public health focuses on populations, while medical care focuses on the individual patient. Health care and the public should be considered complimentary. When they work collaboratively, all people benefit.

Question 9

What are the three core areas of public health and their enablers?

Hint: 3 Ps

Answer 9

• Protection (of the health of the population) – control of infectious disease, managing environmental hazards, ensuring healthy workplace, and managing health emergencies.
• Promotion (improving the health of the population) – covers a broad range of activities that not only focus on the individual and promoting health behaviors but also improving the social determinants of health.
• Prevention (preventing health issues before they occur) – it includes activities such as vaccination and screening.

Question 10

What are the enablers of public health?

Answer 10

Enablers of public health are good governance, advocacy (to influence and to obtain support and commitment to support actions for a health goal), capacity (having an adequate and well-training public health workforce), having accurate and timely information and research.

Question 11

Bonus: Top Historical Events in Four Areas (See other side as well)

Sanitation and Environmental Health

• 500 BCE – The ancient Greeks and Romans actively practiced community sanitation measures (concrete toilets for waste collection)
• 1848 – The public health act of 1848 was established in the UK which provided a central board of health and placed responsibilities for sanitation in the hands of boroughs
• 1970 – Nixon administration established the EPA, which protects human health by safeguarding air, water, and land.

Pandemics

Epidemics or outbreaks of disease that spread far and wide, affecting the populations of multiple continents. Influenza, or the flu, has caused pandemics many times. The Spanish flu infected 500 million people across the world. Preparing for and controlling the effects of influenza will likely remain top priorities for public health.

Polio was a feared disease and killed thousands of people each year. Thousands lined up for the polio vaccine and it was introduced in 1955. An initiative to eradicate polio was launched in 1988 because of outbreaks in more than 125 countries. Today, it exists in a few countries.

In the 1980s, human immunodeficiency virus, or HIV, emerged and spread rapidly across the globe. Public health developed ways to diagnose and treat those who are infected. Worldwide, 34 million people are living with HIV. New infections are down 20% over the past 10 years, which is a sign that public health interventions are successful.

Answer 11

Preparedness and Disaster Response

The use of biological warfare to infect people and animals goes back centuries. During the siege of Kaffa in the 14th century AD, the attacking Tartar forces used plague as weapon of war by hurling plague-infected corpses into the enemy’s city. Their actions started the first stage of the Black Death (or plague) among Europeans.

In the wake of September 11th, public health workers were on the ground conducting surveillance to identify outbreaks of disease or other possible health conditions resulting from the attacks. They monitored the health of first responders, city residents, and environmental conditions to detect health threats during the cleanup after the attack.

After Hurricane Katrina in 2005, public health workers and other disaster-relief agencies tirelessly provided emergency services. Surveillance of injury and illness among people who evacuated to shelters and other places of refuge.

Prevention Through Policy

Public health works to protect and improve health, not just by responding to disease outbreaks or preparing for natural or human-made disasters, but also by implementing policies that support these efforts on a societal level.

As far back as 1500 BCE, Leviticus, the third book of the Hebrew Bible, is believed to be the first written health code in the world. The book deals with personal and community responsibilities and includes guidance regarding bodily cleanliness, sexual health behaviors, protection against contagious diseases, and isolation of lepers.

During 2000 to 20004, cigarette smoking was reported to be responsible for $193 billion dollars in annual health-related economic losses in the United States. Laws banning smoking in the workplace and other publics have been developed to encourage smokers to quit while protecting nonsmokers from the effects of second-hand smoke.

• 1/3 of U.S. adults and 17% of children and adolescents aged 2 to 19 years are obese.
• Highlighting fat, sugar, and salt content in food labeling regulations have been developed along with the promotion of physical activity in schools, workplaces, and neighborhoods.

Question 12

What are the 5 Core Sciences of Public Health?

These five core sciences can help us protect and promote the public’s health by giving public health practitioners the answers they need. Public health is better able to respond to the situation by using contributions from each of these sciences. One science alone cannot answer the questions and provide a solution; it is the application of these core sciences together.

Answer 12

Public Health Surveillance – used to monitor a public health situation.

Epidemiology – enables us to determine where diseases originate, how or why they move through populations, and how we can prevent them.

Public Health Laboratories – support public health by performing tests to confirm disease diagnoses. Laboratories also support public health by conducting research and training.

Public Health Informatics – With EHRs, this increases in importance. Informatics deals with the methods for collecting, compiling, and presenting health information. It enables us to use electronic data effectively when addressing a public health situation.

Prevention Effectiveness – is closely linked to public health policy. Prevention effectiveness studies provide important economic information for decision makes to help them choose the best option available.

Question 13

Use the 5 Public Health Core Sciences in the context of influenza.

Answer 13

Public Health Surveillance can monitor when and where cases of influenza occur each year.

Professionals can use the science of epidemiology to understand why different population choose to get vaccinated against influenza.

Public Health practitioners can use laboratory science to determine whether persons with fever and cough have influenza or a different infection.

They can use the science of informatics to receive and analyze electronic information from health care institutions (e.g., doctor’s offices and hospitals) to determine whether persons who get influenza go to see a doctor and whether they get well or die.

They can use prevention effectiveness to show that influenza vaccination campaigns that might cost $200,000 can prevent $1 million in medical costs, lost wages, and other costs.

Question 14

Briefly go over the Public Health Approach in regards to what questions are asked.

Answer 14

What is the problem? Surveillance

What is the cause? Risk Factor Identification

What works? Implementation

How do you do it? Intervention Evaluation

Question 15

What makes up the framework or concept of public health that protects and promotes the health of all people in all communities?

Answer 15

The 3 Core Functions and 10 Essential Services

Question 16

What are the 3 Core Functions?

Answer 16

Assessment (knowing what needs to be done), Policy Development (being part of the solution to get it done), and Assurance (making sure it gets done)

These must be carried out by all levels of government – federal, state, and local – for the overall public health system to function effectively.

Question 17

What are the 2 essential health services that involves the core function of assessment?

Answer 17

• Assessing and monitoring population health
• Investigate, diagnose, and address health hazards and root causes

Question 18

What are the 4 essential health services that involves the core function of policy development?

Answer 18

• Communicate effectively to inform and educate
• Strengthen and mobilize communities and partnerships
• Create, champion, and implement policies, plans, and laws
• Utilize legal and regulatory actions

Question 19

What are the 4 essential health services that involves the core function of assurance?

Answer 19

• Enable equitable access
• Build a diverse and skilled workforce
• Improve and innovate through evaluation, research, and quality improvement
• Build and maintain a strong organizational infrastructure for public health

Question 20

Bonus: Essential Services at play with Tobacco Use Prevention

Assessment
- Monitor health status: Monitor smoking use among segments of the population, such as the youth.
- Diagnose and investigate health problems: Investigate risk factors associated with tobacco use.

Policy Development
- Inform, educate, and empower people about health concerns: Place public service announcements on television regarding the dangers of smoking.
- Mobilize community partnerships: Work with advocacy groups to develop antismoking interventions that will work in a specific community.
- Develop policies and plans: Passage of Proposition 99 (the cigarette tax to fund antismoking campaigns); smoke-free workplaces, apartment complexes, and other shared spaces.

Assurance
- Enforce laws and regulations: Enforcement of policies and laws, such as placement of cigarette vending machines.
- Link people to needed personal health services: Address potential barriers related to culture and the language of materials, or staff serving special population groups. In California, ads in the tobacco control media campaign were broadcast in Spanish and Mandarin as well as English.
- Assure a competent public health and personal health care workforce: Ensure a knowledgeable workforce is in place to develop and implement the antismoking campaign.

Answer 20

N/A

Question 21

How do nongovernmental organizations (NGOs) play a key role in public health?

Answer 21

NGOs serve many different purposes from advocacy or education to emergency relief and economic development. General types include:

• Professional membership organization, such as the American Public Health Organization
• Organization with specific focus like the American Cancer Society
• Citizen groups like Americans for Nonsmokers’ Rights
• Foundations that support health projects and work at the policy level, like CARE, which fights global poverty, and the Bill and Melinda Gates Foundation, which funds public health projects around the world.

Question 22

When did the greatest improvement to life expectancy occur? And by how many years?

Also. due to mainly what?

Answer 22

In the first half of the 20th century where the U.S. and Europe increased by an average of 20 years.

Universal availability of clean water and rapid declines in infectious diseases, to include broad economic growth, rising living standards, and improved nutritional status.

Question 23

Explain how the 5-tier health impact pyramid dynamics work (2)?

Answer 23

Bottom to Top of Pyramid: Socioeconomic factors, changing the context to make individual’s default decisions healthy, long-lasting protective interventions, clinical interventions, and counseling and education.

From bottom to top, the efforts at the bottom have the most impact on populations but may be more controversial, particularly if the public does not see such intervention as falling within the government’s appropriate sphere of action.

From top to bottom, these efforts require more individual effort. The top portion of the pyramid will reach less people but is more adaptable by single individuals.

Question 24

What is socioeconomic factors referred as and forms the basic foundation of society?

Answer 24

The social determinants of health (SDOH)

Question 25

What tier of the health impact pyramid deals with representing interventions that change the environmental context to make healthy options the default choice, regardless of education, income, service provision, or other societal factors?

Answer 25

The second tier of the pyramid - Changing the Context to Encourage Healthy Decisions The defining characteristic of this tier of intervention is that individuals would have to expend significant effort not to benefit from them.

Question 26

What are some examples of second tier?

Answer 26

Other contextual changes that create healthier defaults include clean water, air, and food; improvements in road and vehicle design; elimination of lead and asbestos exposures; and iodization of salt. Strategies to create healthier environmental contexts also include designing communities to promote increased physical activity; enacting policies that encourage public transit, bicycling, and walking instead of driving; designing buildings to promote stair use; passing smoke-free laws; and taxing tobacco, alcohol, and unhealthy foods such as soda and other sugar-sweetened beverages.

Question 27

For the third level of the pyramid, what does it represent?

Answer 27

The third level of the pyramid represents 1-time or infrequent protective interventions that do not require ongoing clinical care; these generally have less impact than interventions represented by the bottom 2 tiers because they necessitate reaching people as individuals rather than collectively.

Question 28

What are some examples of the third tier of the health impact pyramid?

Answer 28

Historic examples include immunization, which prevents 2.5 million deaths per year among children globally. Another example is colonoscopy, which can significantly reduce colon cancer and is only needed every 5 to 10 years for most people. Smoking cessation programs increase quit rates; life expectancy among men who quit at age 35 is almost 7 years longer than for those who continue to smoke. Male circumcision, a minor outpatient surgical procedure, can decrease female-to-male HIV transmission by as much as 60%. Scale-up could potentially prevent millions of HIV infections in sub-Saharan Africa. A single dose of azithromycin or ivermectin can reduce the prevalence of onchocerciasis, a major cause of blindness.

Question 29

What does the fourth tier of the health impact pyramid represent?

Answer 29

The fourth level of the pyramid represents ongoing clinical interventions, of which interventions to prevent cardiovascular disease have the greatest potential health impact.

Question 30

What is the issues surrounding the fourth tier?

Answer 30

Lack of access, unpredictable adherence, and imperfect effectiveness. At least a third of patients do not take medications as advised, and nonadherence cannot be predicted from socioeconomic or demographic characteristics. This goal is more likely to be attained if electronic record keeping is implemented along with changes in both financial incentives and physician practices to proactively support preventive care and control of chronic diseases.

Question 31

Why is tier 5, counseling and educational interventions, perceived as the essence of public health action but is generally the least effective type of intervention?

Answer 31

The need to urge behavioral change is symptomatic of failure to establish contexts in which healthy choices are default actions (Tier 2). For example, counterbalances to our obesogenic environment include exhortations to increase physical activity and improve diet, which have little or no effect. More than one third of US adults, or 72 million people, were obese in 2006, a dramatic increase over 1980. Two thirds of these individuals were counseled by a health care provider to lose weight, yet daily calorie and fat intake continues to rise. Counseling, either within or outside the clinical context, is generally less effective than other interventions; successfully inducing individual behavioral change is the exception rather than the rule. Nevertheless, educational interventions are often the only ones available, and when applied consistently and repeatedly may have considerable impact. An example of a successful evidence-based educational intervention is trained peer counselors advising men who have sex with men about reducing HIV risk.

Question 32

Public health promotes and protects the health of people in the communities where they _, _, _, and _.

Answer 32

Live, learn, work, and play.

Question 33

How many additional years in life expectancy did public health add opposed to medicine?

Answer 33

25 years for public health, and 5 years for clinical medicine.

Question 34

What are some of the differences of Public health and Clinical Medicine?

Answer 34

- Public health focuses on the entire population while Medicine emphasizes diagnosis and treatment of the individual. - Public health focuses on UPSTREAM healthcare while not ignoring downstream healthcare. Medicine focuses on DOWNSTREAM healthcare. - Public health intervenes through public policy, the environment, community, and individual. Medicine intervenes through medical care, medications, and surgical procedures.

Question 35

What are the four levels of prevention within Public Health?

Answer 35

- Primordial – prevention of risk factors occurring (must go UPSTREAM far enough) - Primary – prevention of disease/illness occurring. - Secondary – reduce the impact of disease. - Tertiary – soften the impact of chronic illness.

Question 36

What are the five categories of the determinates of health? They influence the health of individuals and communities.

Answer 36

Behavioral Choices – directly impact health by affecting risk of injury, illness, or disease. Examples include diet, physical activity, hand washing, seatbelt use, alcohol use, and preventative behaviors such as vaccination, screenings, etc. Biology and Genetics – affect the likelihood of developing certain diseases like age, sex (different risk factors), inherited conditions, BRCA1 and BRCA2 gene, family history of heart disease. Social and Physical Environment (sometimes believed these are the only determinates) -- Social determinates: availability of resources to meet daily needs; social norms and attitudes; exposure to crime, violence, and social disorder; social support and social interactions; socioeconomic conditions; quality schools; availability of transportation; residential segregation. -- Physical determinates: natural environment; availability of clean water and air; exposure to toxic substances; built environment; worksites, schools, and recreation settings; housing, homes, and neighborhoods; physical barriers, aesthetic elements. Health Services – access to service and the quality of services. It is not just about having a facility close, but can you get there, can you take time off work to go to the hospital (will you lose wages), is the doctor too booked. Policy - laws and regulations influence individual behavior choices, social norms, and the environment. Examples: taxes on tobacco sales, motor vehicle safety standards, seatbelt laws and speed limits, laws preventing toxic waste dumping.

Question 37

What is the importance of determinates?

Answer 37

All determinates work together and prevention requires understanding factors that affect or determine disease. Changing health determinates can directly impact health status.

Question 38

How is the Socio-Ecological Model of Health organized?

Answer 38

Circles within circles. Policy/Systems -> Community/Environment -> Institutional/Organizational -> Interpersonal -> Individual (Reciprocating Factors)

Question 39

What is a health disparity?

Answer 39

They are differences in health status between segments of the population that are related to social or demographic factors such as race, gender, income, or geographic region.

Question 40

T/F A health disparity tells us the root cause and how to fix the difference in health status.

Answer 40

False. You will have the root cause but not necessarily the path to correct the issue. It is an indicator of a difference only. Remember: a disparity tells us there is a difference but not the primary cause of the difference. That is when you go UPSTREAM and look for causation.

Question 41

What are the primary sources of health disparities?

Answer 41

Income - One of the most persistent differences in health status is related to income. People with lower socioeconomic status experience poorer health than those with higher socioeconomic status. More people in the higher income brackets had excellent or very good health while more of those within low-income brackets had fair or poor health. Race/ethnicity - In the U.S., there are dramatic health disparities between racial and ethnic groups. Example: Prevalence of asthma among children. Non-Hispanic blacks tend to have more asthma than any other race/ethnicity. Age - This plays a factor in health disparities. Example: Colon Cancer Geographic Location - Studies have found that geographic location can influence health disparities. Example: Obesity in Adults

Question 42

What are some root causes to health disparities?

Answer 42

- Income inequality – one of the greatest causes of disparity. - Neighborhood Segregation – another big root cause. - Different access to quality education – thee most critical components of overall health, not because you become smarter, but the path of education you have greater opportunity and then more health options.

Question 43

Bonus - Information and Review Determinants & Disparities - Individual health and behavior are affected by multiple levels of influence. - If determinants that influence health and behavior differ systematically (by race, income, age, or another demographic factor), disparities may result. Summary - Health is determined by the 5 determinants of health, one of which is health behavior. - Health behavior is further influenced by the levels of the 5 levels of the social ecological model. - These influences can create health disparities in health status between groups. - An upstream approach allows us to investigate and address the CAUSE of the disparity. (the last thing we want to jump to conclusions for the disparity because if we do, we may create the wrong intervention.)

Answer 43

N/A

Question 44

Unit 7 Start - INDIVIDUAL BEHAVIOR AND BEHAVIOR CHANGE What can guide the development and refinement of intervention efforts?

Answer 44

Theories and models of human behavior.

Question 44

What emphasizes that learning a new, complex pattern of behavior, like changing from a sedentary to an active lifestyle, normally requires modifying many of the small behaviors that compose an overall complex behavior?

Answer 44

Learning theories

Question 45

When it comes to learning theories and principles of behavior modification, what is a good example involving the goal of walking continuously for 30 minutes daily?

Answer 45

It can be learned by first breaking it down into smaller segments (e.g., walking for 10 minutes daily). Behaviors that are steps toward a final goal need to be reinforced and established first, with rewards given for partial accomplishment if necessary. Incremental increases, such as adding 5 minutes to the daily walking each week, are then made as the complex pattern of behaviors is “shaped” toward the targeted goal.

Question 46

What is a complication to the change process where newth patterns of physical activity behavior must replace or compete with?

Answer 46

Former patterns of inactive behaviors that are often satisfying (e.g., watching television), habitual behaviors (e.g., parking close to the door), or behaviors cued by the environment (e.g., the presence of an elevator).

Question 47

What describes the consequences that motivate individuals either to continue or discontinue a behavior?

Answer 47

Reinforcement

Question 48

What are most behaviors, including physical activity, are learned and maintained under fairly complex schedules of __________ and anticipated future __________.

Answer 48

Reinforcement and rewards. Future rewards or incentives may include physical consequences (e.g., looking better), extrin￾sic rewards (e.g., receiving praise and encouragement from others, receiving a T-shirt), and intrinsic rewards (e.g., experiencing a feeling of accomplishment or gratification from attaining a personal milestone).

Question 49

What is important to note about praise, encouragement, and other extrinsic rewards when it comes to helping people adopt positive lifestyle behaviors?

Answer 49

Such external reinforcement many not be reliable in sustaining long-term change.

Question 50

What are the four critical areas within the health belief model that are perceived by an individual to induce behavioral change?

Answer 50

- severity of potential illness - person's susceptibility to that illness - benefits of taking a preventative action - barriers to taking that action

Question 50

What does the health belief model incorporate like leaving a written reminder to oneself to walk as important elements in eliciting or maintaining patterns of behavior?

Answer 50

Cues to action

Question 51

What model stipulates that a person's health-related behavior depends on the person's perception of four critical areas?

Answer 51

Health Belief Model

Question 52

What model has conceptualized behavior change as a five-step process or continuum related to a person's readiness to change?

Answer 52

Transtheoretical model

Question 53

What was added to the health belief model, like a person's confidence in his or her ability to successfully perform an action, which, perhaps allows the model to better account for habitual behaviors, such as a physically active lifestyle?

Answer 53

The construct of self-efficacy

Question 54

What are the five-steps within the continuum of the transtheoretical model?

Answer 54

Precontemplation, contemplation, preparation, action, and maintenance.

Question 55

What is interesting about the progress within the transtheoretical model of change?

Answer 55

People are thought to progress these stages at varying rates, often moving back and forth along the continuum a number of times before attaining the goal of maintenance. Therefore, the stages of change are better described as spiraling or cyclical rather than linear.

Question 56

For the transtheoretical model of change, what is important to remember about the processes of change and the stage someone is in?

Answer 56

These processes can be different depending on the individual and is highly dependent on which stage they are in. Efficient self-change thus depends on doing the right thing (processes) at the right time (stage). Therefore, tailoring interventions to match a person's readiness or stage of change is essential. For example, for people who are not yet contemplating becoming more active, encourag￾ing a step-by-step movement along the continuum of change may be more effective than encouraging them to move directly into action.

Question 56

What model of change focuses on anticipates problems with adherence?

Answer 56

Relapse Prevention Model For example, factors that contribute to relapse include negative emotional or physiologic states, limited coping skills, social pressure, interpersonal conflict, limited social support, low motivation, high-risk situations for relapse and developing appropriate solutions.

Question 56

Distinguishing between what, in the relapse prevention model, is thought to improve adherence to behavioral change?

Answer 56

Helping people distinguish between a lapse (e.g., a few days of not participating in their planned activity) and a relapse (e.g., an extended period of not participating)

Question 56

What states that individual performance of a given behavior is primarily determined by a person's intention to perform that behavior?

Answer 56

The theory of reasoned action.

Question 57

Within the theory of reasoned action, the intention to perform such behavior is determined by what two major factors?

Answer 57

- The person's attitude toward the behavior (i.e., beliefs about the outcomes of the behavior and the value of these outcomes) - The influence of the person's social environment or subjective norm (i.e., beliefs about what other people think the person should do, as well as the person's motivation to comply with the opinions of others)

Question 57

What theory of behavior change adds to the theory of reasoned action in which the concept of perceived control over the opportunities, resources, and skills necessary to perform a behavior?

Answer 57

The theory of planned behavior. (very similar to the theory of self-efficacy) A person's perception of his or her ability to perform the behavior. Perceived behavioral control over opportunities, resources, and skills necessary to perform a behavior is believed to be a critical aspect of behavior change processes.

Question 57

What does social learning theory, later changed to social cognitive theory (SCT), propose?

Answer 57

Behavior change is affected by environmental influences, personal factors, and attributes of the behavior itself where each may affect or be affected by either of the other two.

Question 58

What is the central tenet of the SCT?

Answer 58

The concept of self-efficacy. A person must believe in his or her capability to perform the behavior (i.e., the person must possess self-efficacy) and must perceive an incentive to do so (i.e., the person’s positive expectations from performing the behavior must outweigh the negative expectations). Additionally, a person must value the outcomes or consequences that he or she believes will occur as a result of performing a specific behavior or action. Outcomes may be classified as having immediate benefits (e.g., feeling energized following physical activity) or long-term benefits (e.g., experiencing improvements in cardiovascular health as a result of physical activity).

Question 58

Why is self-efficacy believed to be the single most important characteristic that determines a person's behavior change in the SCT?

Answer 58

This characteristic is important because the expected outcomes are filtered through a person's expectations or perceptions of being able to perform the behavior in the first place.

Question 58

What are ways that self-efficacy can be in increased? (3)

Answer 58

- Providing clear instructions - Providing the opportunity for skill development or training - Modeling the desired behavior Caveat, models must evoke trust, admiration, and respect from the observer; models must not, however, appear to represent a level of behavior that the observer is unable to visualize attaining.

Question 59

What are different ways that social support can be effective?

Answer 59

- Be instrumental, as giving a nondriver a ride to an exercise class. - Be informational, as telling someone about a walking program in the neighborhood. - Be emotional, as in calling to see how someone is faring with a new walking program. - Be appraising, as in providing feedback and reinforcement in learning a new skill. Sources of support for physical activity include family members, friends, neighbors, co-workers, and exercise program leaders and participants.

Question 60

What is the largest criticism of most theories and models of behavior change?

Answer 60

That they emphasize individual behavior change processes and pay little attention to sociocultural and physical environmental influences on behavior. But, recently, interest has developed in ecological approaches to increasing participation in physical activity.

Question 61

What is now considered on par with the development of personal skills and reorientation of health services?

Answer 61

Ecological and sociocultural approaches to behavioral change.

Question 62

How is the concept of a health-promoting environment illustrated?

Answer 62

Physical activity could be promoted by establishing environmental supports, such as bike paths, parks, and incentives to encourage walking or bicycling to work.

Question 63

When it comes to the ecological perspectives of behavioral change using theories and models, what is the underlying theme?

Answer 63

The most effective interventions occur on multiple levels. A model that encompasses several levels of influences on health behaviors: intrapersonal factors, interpersonal and group factors, institutional factors, community factors, and public policy. Similarly, a model advanced by Simons￾Morton and colleagues (CDC 1988) has three levels (individual, organizational, and governmental) in four settings (schools, worksites, health care institu￾tions, and communities). Interventions that simulta￾neously influence these multiple levels and multiple settings may be expected to lead to greater and longer-lasting changes and maintenance of existing health-promoting habits.

Question 64

UNIT 8: SOCIAL DETERMINATES OF HEALTH What are the social determinates of health (SDOH)?

Answer 64

The conditions in the environments where people live, learn, work, and play.

Question 65

T/F SDOH contribute to wide health disparities and inequities.

Answer 65

True

Question 65

What are the 5 sub domains that the SDOH can be grouped within?

Answer 65

- Economic Stability - Education Access and Quality - Health Care Access and Quality - Neighborhood and Built Environment - Social and Community Context

Question 66

What is a health disparity?

Answer 66

They are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. For example, some groups of people are affected by HIV, viral hepatitis, STDs, and TB more than other groups of people. The occurrence of these diseases at greater levels among certain population groups more than others is often referred to as a health disparity.

Question 67

What are health inequities?

Answer 67

Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people learn, live, work, and play. Example: Racial and ethnic groups are less likely to have proper access to health resources and are typically underrepresented in the health care workforce. Example: Two people have a heart attack. One lives in a city and reaches a good hospital quickly while the other lives in a rural area where healthcare quality is poorer. Because of this inequity, there is an unequal outcome.