1. Living Well: Promoting Healthy Behavior Change
Chapter 1
Living Well: Promoting Healthy Behavior Change
Welcome to Chapter 1.
In this chapter, we hope to cover the basics about health, such as what health is and why health is important.

2. Objectives
Discuss health in terms of its dimensions and historical, current, and future perspectives.
Explain the importance of a healthy lifestyle in preventing premature disease and promoting wellness.
Discuss the health status of Americans and the importance of Healthy People 2010 and other national initiatives to promote health.
Evaluate the role of gender in disparities in health status, research, and risk.
Specifically, we will cover the dimensions of health, Healthy People 2010, health disparities, and global issues.

3. Objectives (cont.)
Explain the importance of a global perspective on health and the health challenges faced by people of various racial and cultural backgrounds.
Examine your role in protecting global health through adoption of a green lifestyle.
Evaluate sources of health information, particularly the Internet, to determine reliability.
Focus on current risk behaviors, what factors influence your behavior, and how risk behaviors impact your current and future health.
Assess behavior-change techniques and apply them to your own lifestyle.
Find reliable health information and understand how to change your own health behaviors.

4. Activity Break
Before we begin, let’s do a quick activity. In the next 1 to 2 minutes, please write down in your own words what health is.
After 2 minutes, we will regroup.
After 2 minutes, flash the lights or call for students’ attention and have them regroup.
Please note that it is important to get the students engaged in activities the first day so they are ready to be active learners and participants throughout the semester. Always give very specific directions with time limits and prearranged signals such as flipping the lights or a simple “Hey, everyone.”

5. Health and Wellness What is health? What is wellness?
Health is the ever-changing process of achieving individual potential in the physical, emotional, social, mental, spiritual, and environmental dimensions.
Wellness is the achievement of the highest level of health possible in each dimension of health.

6. Top Ten Reported Impediments to Academic Performance in the Last 12 Months
As you all have mentioned in your definition of health, the dimensions of health interact with our health status, either positively or negatively.
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7. Health Through the Years
1800s: Health was associated with poor hygiene and unsanitary conditions.
Medical Model
Episodic care
1900s: Health was associated with an individual’s interaction with the social and physical environment.
Ecological or Public Health Model
Prevention
Health and health care have shifted their focus throughout the years.
1800s: Focused on infectious disease
Medical Model: Health status was based on the individual and a biological or diseased organ perspective.
Episodic care: Sought treatment for injury or illness
In this era, what was the leading cause of death?
Infectious Disease
And what was the average life span in 1900?
47 years
1900s: Focused on chronic disease
Ecological or Public Health Model – Viewed diseases and health outcomes as a result of: air and water pollution, working conditions, substance abuse, stress, diet, lifestyle, and access to health care for both individuals and entire populations
Prevention – Identified risk factors to reduce risk of injury or illness
And now what is our leading cause of death?
Chronic Disease and, as your book highlights in Table 1.2 on page 16, cardiovascular disease.

8. Health Through the Years (cont.)
1947: World Health Organization (WHO) defined health as
“the state of complete physical, mental, and social well-being, not just the absence of disease or infirmity.”
1960–1970: Comprehensive Ecological or Public Health Model adds these dimensions:
Physical
Social
Mental and emotional
Environmental and occupational
Spiritual
Intellectual dimensions
Our way of thinking about health has definitely changed in past 100 years and will continue to change and expand.
But even though we are living twice as long, we now focus on the quality of life.
The WHO has expanded its definition of health.
The Public Health Model covers what we term the six dimensions of health.

9. ABC News Video: It’s a Green Revolution
Discussion Questions
Does Earth Day still have the same impact now as when it was first established? Or has the significance been lost among everyday “ecofriendliness”?
What effect may global warming be having on your community? What steps has the community taken to address the issue? What should do you think should be done?
How do you make people realize the effect their actions have on the world and convince them to change their habits for the good of the community?

10. Public health achievements have changed the approach to health care and the American culture.
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11. The Evolution Toward Wellness
Health is “a quality of life, involving social, emotional, mental, spiritual, and biological fitness on the part of the individual, which results from adaptations to the environment.”
—René Dubos
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12. Dimensions of Health and Wellness
Physical health: body size and functioning
Social health: interpersonal network and successful interaction with others
Intellectual health: ability to think clearly and make responsible decisions
Emotional health: ability to express emotions and maintain a level of self-confidence
Environmental and planetary health: appreciation of one’s external environment
Spiritual health: have a sense of meaning and purpose in one’s life

13. The Dimensions of Health
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14. New Directions for Health
Healthy People 2010
Goal 1: Increase quality and years of healthy life.
Goal 2: Eliminate health disparities.
Health disparities are defined as one group (gender, race, ethnicity, community) having a higher disposition for an illness.
New focus on wellness, health promotion and disease prevention
Healthy People 2010 is a set of health objectives for the nation to achieve in the first decade of this century. It can be used by many different people, states, communities, professional organizations, and others to help them develop programs to improve health. There are two overall goals with 28 focus areas.
Goal 1: Focus on the quality of life, not just the number years.
Goal 2: Eliminate health disparities. By 2060, non-Hispanic whites, currently about 70 percent of the population, will be less than 50 percent. Does that mean the health disparities will continue? Well, Healthy People 2010 is trying to advance its national goal to eliminate health disparities.

15. What Factors Contribute to Health Disparities?
Having no or inadequate health insurance
Racism and other “-isms” that reduce opportunities or cause discrimination
Inadequate transportation
Lifestyle behaviors (e.g., smoking)
Cultural influences
Diet
Lack of exercise
Obesity and overweight
What factors do you think contribute to health disparities? 15

16. Contributors to Health Disparities (cont.)
Sexual behaviors
Stress
Mental health issues
Systemic barriers
Access to health care
Poverty
Environmental factors

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19. Increased Focus on Health Promotion
Health promotion combines educational, organizational, procedural, social, financial, and environmental supports to reduce risk factors and promote healthy lifestyles.
In order to achieve the primary goal of Healthy People 2010, the focus in public health policy must change to promotion and prevention.

20. Disease Prevention
Actions or behaviors designed to keep people from getting sick
Primary prevention is to reduce risk and avoid health problems before they start.
Secondary prevention is to take action to stop risk behaviors before an actual illness.
Tertiary prevention is treatment or rehabilitation after an illness.

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22. Gender Differences and Health Status
Women live longer than men but don’t necessarily enjoy better quality of life.
Gender health disparities are possibly related to exclusion of women from many clinical trials due to reproductive or menstrual concerns.
Research on women’s health after 1990
Women’s Health Initiative (WHI) focused research on uniqueness of women’s health

23. Better Health in the Twenty-First Century
Focusing on global health issues
Expanding health concerns beyond borders in today’s global economy
Focusing on personal choices to achieve your optimum health as well as the health of those around you
Increasing cultural competency (harmonious attitudes and policies amongst a group of people, enabling work in cross-cultural situations)

24. A Focus on Global Health Issues
The health of all living things is globally interconnected, which presents new challenges
Diseases: pandemic flu, resistant TB, and MRSA (methicillin-resistant Staphylococcus aureus)
Nondiseases: food, air, and water contaminants; global warming; and chemical toxins

25. Changing Your Health Behaviors
Change depends on the individual.
Identify what is most important to you or what poses the most immediate threat to health.
Examples:
Diet
Relationships
Stress management
Safe sex
Drug and alcohol use
Exercise
Tobacco use

26. When we think about what affects our health, we probably think of these actions.
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27. Factors that Influence Behavior Change
Predisposing factors
Knowledge, beliefs, and attitudes based on life experiences, as well as gender, age, race, and socioeconomic background
Enabling factors
Skills and abilities, available resources; can be positive or negative
Reinforcing factors
Presence or absence of support, encouragement or discouragement from those around you

28. Factors that Influence Behavior-Change Decisions
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30. Beliefs and Attitudes
Belief is an appraisal of the relationship between subject, action, or idea.
Attitude is a stable set of beliefs, feelings, and behavioral tendencies regarding something.
Health Belief Model (HBM) is a model developed to show how beliefs affect behavior change.

31. Common Barriers to Behavior Change
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32. The Path to Behavior Change
Self-efficacy is a belief that one is capable of achieving certain goals.
External versus internal locus of control
External: belief that someone or something else controls a situation
Internal: belief in power over one’s actions
Significant others as change agents
Family
Friends and significant others (social support)

33. Motivation and Readiness to Change
Why do so many good intentions fail?
According to Dr. J. Prochaska and Dr. C. DiClemente, it is because less than 20 percent of us are prepared to take action.
Their Transtheoretical Model of Health Behavior Change (Stages of Change model) proposes a series of stages that lead to change.

34. Transtheoretical Model of Health Behavior Change
Precontemplation: no current intention of changing
Contemplation: recognize a problem
Preparation: close to taking action
Action: plans are made for behavior change
Maintenance: action plan in place; potential for relapses
Termination: new behavior is now in place

35. Choosing a Behavior-Change Strategy
Select a technique or combination of techniques that is best suited to you.
Shaping: Start slowly, keep steps small and achievable, be able to change the plan if it is not working, and be committed.
Visualization: Prepare for the event with mental practice of the planned action.
Modeling: Learn behaviors through observing others performing that behavior.

36. Choosing a Behavior-Change Strategy (cont.)
Control the situation: Put yourself in a situation that will positively influence your behaviors.
Reinforce: Promote behavior by providing a reward upon completion of the behavior.
Change self-talk: Improve your self-image to encourage the behavior change.

37. ABC News Video: Stroke of Insight
Discussion Questions
Why did it take a traumatic event to change Dr. Jill Bolte Taylor’s perception of the world? What are other, less traumatic, ways to pursue behavior change?
How did her life experience before her stroke affect the way she perceived the event? Do you think other stroke victims have similar experiences?
Discuss ways in which life-changing events can be seen as either positive or negative.

38. Changing Your Behavior
Self-assessment: Identify situations, or antecedents, that cue a behavior and act to modify them, and thus affect consequences.
Analyzing personal behavior: Determine the specific behavior you want to change.
Decision making: Be prepared to make decisions for positive change.
Setting realistic goals: Keep goals challenging but also attainable.
Assessment: Assess how healthy you are according to the dimensions of health by using the survey on pages 29 to 34.
Behavior evaluation: Try to get at the root of your problem. If you are stressed out, what is making you stressed? Is it time management, or the lack of; or is it relationship or communication issues?
Behavior selection: Remember to select only one behavior. If you want to lose weight, focus on diet or nutrition. If you chose exercise, it is all right to eat better, however, your intervention should focus on exercise.
Contract: Sometimes writing goals down makes them a reality, so use the Behavioral Change Contract to help you commit to change.
Always remember: Life is about 10 percent of what happens to you and 90 percent of how you react, so you might have to change your course of action at the beginning, middle, or the end. But stay with it! 38

39. Activity Break: Behavioral Change
Take out a sheet of paper.
What one behavior would you like to change?
What is your long-term goal?
What obstacles will you encounter?
What strategies will you use to overcome those obstacles?
What resources do you have?
What rewards will you use to motivate yourself?
This should be about a 5-minute activity.
Give suggestions as you walk the students through the questions.

40. Example of a Completed Behavior-Change Contract
Here is an example contract.
You might want to use this as an assignment or as a running theme throughout the course.
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