Public Health
what we, as a society, do collectively to assure the conditions for people to be healthy:
- context
- populations
- health promotion vs. disease cure
creating the context in which everyone has the opportunity to be healthy
Social Determinants of Health
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Health Disparity
Differences in key determinants of health and health outcomes that adversely affect marginalized or excluded groups; differences in health outcomes that "ought not be
Oppression
Not having a choice
Knowledge vs Behavior Change
Knowledge DOES NOT equal behavior change
Health Behavior Theory
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Health Behavior Theory: Community-level
change theories rather than explanatory theories
Self-Efficacy Constructs
1. Master experience
2. Vicarious experience
3. Verbal persuasion
4. Somatic and emotional states
Social-Ecological Model in Public Health
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Health inequity
differences in health status or in the distribution of health determinants between different population groups
- differential opportunity to be healthy
Fallacy
the idea and belief in a hierarchy of human value
- many consciously believe and uphold it
- others have internalized it and unconsciously perpetuate it within our selves and our communities
Health consequences of inequality
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Racism
- results from false belief in a hierarchy of human value
- social construct - not a biological one
- multiple levels: institutionalized, personally mediated, internalized
- root of socioeconomic disparity
- significant cost to society
- everyone's respon
Institutionalized Racism
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Framework
- inequitable social and economic (neighborhood-level)
- environmental and institutionalized (racism)
- individual levels: adverse social and physical environment (differential access to goods, care, resources), individual behaviors and disease risk facto
Health equity
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Human rights
- the Universal Declaration of Human Rights
- Adopted by the UN in 1948
- 30 articles
- rights to which all people are inherently entitled
- includes right to a standard of living adequate for health and well-being
- US focus: civil and political rights
-
Human rights principles
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Social justice
- principal/philosophy on which public health was based
- equity and fairness
- all groups and individuals are equally entitled to important rights, such as health protection and minimal standards of income
- shared responsibility and communal wellbeing
-
Principles of Market Justice
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Principles of Social Justice
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Health
the state of complete mental, physical, emotional and social wellbeing; not just the absence of disease or illness
- WHO declared that everyone has the right to enjoyment of the highest attainable standard of physical and mental health
Culture of Health - definition
a culture in which good health and well-being flourish across geographic, demographic, and social sectors
RWJ Culture of Health Action Framework - 3 core elements
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Culture of health - 4 action areas
1. Making health a shared value
2. fostering cross-sector collaboration to improve wellbeing
3. creating healthier, more equitable communities
4. strengthening the integration of health systems and services
Community - definition
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Community health
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Community driven
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Community-based solutions
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Social-Ecological Model - Behavioral Determinants
Cognitive Factors (aka personal factors)
- knowledge
- expectations
- attitudes
Environmental Factors
- social norms
- access in community
- influence on others (ability to change own environment)
Behavioral Factors
- skills
- practice
- self-efficiency
Social Cognitive Theory - the gist
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Social Cognitive Theory - Origins
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Social Cognitive Theory - Constructs
1. self-efficacy
2. observational learning (modeling)
3. expectations
4. expectancies
5. behavioral capability
6. reinforcement
7. locus of control
Self-efficacy - definition
- personal perception of ability to do something new
- people will only try to do what they think they can do, and won't try what they think they can't do
Observational learning/modeling - definition
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Expectations - definition
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Expectancies - definition
- the values the person places on the outcomes (expectations): good/bad, positive/negative, useful/useless, healthy/unhealthy
- emotional arousal: the fear we may feel in certain situations or when engaging in certain behaviors (fear can support positive/
Behavioral capability - definition
- having knowledge of and skills to perform a behavior
- before doing something you have to know: what it is you're going to do, how to do it
Reinforcement - definition
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Locus of control - definition
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Internal locus of control
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External locus of control
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Bullying Intervention
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Social Capital Theory - gist
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Social Capital Origins
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Social Capital Constructs
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Bonding relationships
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Bridging relationships
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Linking relationships
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SisterFriends
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Building Social Capital
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Fundamental Principles of Social Network Theory
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Health Belief Model - gist
personal beliefe or perceptions influence health behavior
Health Belief Theory - origins
- researchers at US public health service wanted to see why so many people weren't taking advantage of the free or low cost TB screenings
- conducted study to identify factors that determined whether or not a person wanted to be screened for TB
- Research
Health Belief Model - Constructs
- perceived seriousness
- perceived susceptibility
- perceived benefits of change
- perceived barriers to change (modifying variables, cues to action, self-efficacy)
- perceived seriousness + perceived susceptibility = perceived threat
- perceived threat
Perceived Seriousness
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Perceived susceptibility
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Perceived Threat
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Perceived Benefits and Barriers to Change
- benefits: personal opinion or perception of the value or usefulness of a new behavior in decreasing the risk of developing of disease
- barriers: personal opinion of the obstacles in the way of adopting a new behavior (most predictive construct of behav
Modifying Variables
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Cues to Action
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Health Belief Theory - Application
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Transtheoretical Model/stages of change - gist
behavior change is a process that occurs in stages
Transtheoretical Model/stages of change - origins
- research conducted in the early 1980s sought to find out how treatment of addictive behaviors occurred, as it worked successfully through therapeutic treatments and through self-change
- reveled 10 common process that are used as people progress through
Transtheoretical Model Constructs
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Stages of Change
behavior change occurs in five steps:
1. pre-contemplation
2. contemplation
3. preparation
4. action
5. maintenance
Pre-Contemplation stage
- time up to six months before a person starts thinking about change
- no thoughts about changing behavior because the person: may be uninformed or under-informed and doesn't know there is a behavior that needs to be changed, may have tried before and it
Contemplation stage
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Preparation stage
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Action stage
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Maintenance stage
- begins six months after action stage began and generally lasts for six months
- most difficult of all stages, because it's the stage in which a person works to avoid relapsing back to old behavior
- in order for change to be successful/maintained, the n
Processes of Change
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Cognitive Processes, explained
- consciousness raising: obtaining information about self and the problem behavior (pre-contemplation)
- dramatic relief or emotional arousal: expressing feelings about, or reacting emotionally to the behavior in question (pre-contemplation, contemplation
Behavioral Processes, explained
#NAME?
Transtheoretical Model/Stages of Change - Application
- effect of ergonomics-based educational intervention based on transtheoretical model in adopting correct body posture among operating room nurses
- in class application, once you became aware of your sitting position, what did you do (most people changed
Life Course Theory - the gist
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Principles of Life Course Theory
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Principles of Life Course Theory - life span development
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Principles of Life Course Theory - agency
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Principles of Life Course Theory - time and place
- individual life course is embedded and shaped by the historical times and places they experience over a lifetime
- today's experiences and exposures influence tomorrow's health
Principles of Life Course Theory - timing
- developmental antecedents and consequences of life transitions, events, and behavioral patterns vary according to their timing in a person's life
- health trajectories are particularly affected during critical or sensitive periods
- 0-5 years of age is
Principles of Life Course Theory - linked lives
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Life Course Theory - Application
- unequal opportunity race (Video)
- immigrant paradox
- how racism harms pregnant women (constant stress = constant fight or flight response --> harms woman and baby, increases risk for preterm birth)
Weathering
cumulative effect of chronic stress and discrimination
Theory - definition
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Model - definition
- a model is a composite, a mixture of ideas or concepts taken from any number of theories used together
- helps us understand a particular problem in a particular setting (intrapersonal vs. interpersonal vs. community-level)
Nine Facts About Facts
1. less is always more
2. use complementary-not competing data
3. context is kind
4. specific examples matter
5. don't let numbers be forgettable
6. break down big numbers
7. the value in a number is in its values
8. imagine why someone might cry foul? --
7 lessons on Language and Framing of SDOH
1. traditional phrasing of social determinant language consistently tested poorly in every phase of research
2. priming audiences about the connection with messages they already believe makes the concept more credible
3. use one strong and compelling fact
Six Ways to Talk about SDOH
1. health starts-long before illness-in our homes, schools and jobs
2. all Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background
3. your neighborh
Why did PH need to reframe its messaging on SDOH?
- finding a way to translate SDOH so that it made sense to people who may not have been exposed to them before, to colleagues in the PH field, to policy makers
- to find a way to talk about the topic in a way that was easy to understand, which it wasn't b