1. Unit 6 – Public Health Social Factors in Health
Chapter 13 – Do People Choose Their Own Health?

2. Leading Actual Causes of Death
Tobacco
Poor diet and physical inactivity
Alcohol consumption
Microbial agents
Toxic agents
Motor vehicles
Firearms
Sexual behavior
Illicit drug use

3. Leading Actual Causes of Death, ctd.
Account for almost half of all deaths
Most are preventable
Most are premature
Most are caused by individual behavior
Targets for public health intervention

4. Tobacco Cancer Cardiovascular disease Chronic obstructive lung disease
Infant deaths due to low birthweight
Burns
Discussed in Chapter 15

5. Poor Diet and Physical Inactivity
Obesity
Heart disease and stroke
Diabetes
Cancer
Discussed in Chapter 16

6. Misuse of Alcohol Motor vehicle fatalities
Chronic liver disease and cirrhosis
Home injuries
Drownings
Fire fatalities
Job injuries
Cancer

7. Public Health Interventions
Education
Regulation
Prohibition?

8. Education Provide information Health education in schools
Smoking is bad
Recommended dietary allowances
Health education in schools
Sex education is controversial
Physicians’ recommendations can be effective

9. Regulation Laws against murder and assault Traffic regulations
Restrictions on alcohol, drugs, and tobacco
Age restrictions on many behaviors
Sexual behavior is hard to regulate

10. Prohibition
Eighteenth Amendment which banned alcohol was effective in reducing diseases caused by alcohol
Prohibition against drugs such as heroin, marijuana, and cocaine is generally accepted

11. Unit 6 – Public Health Social Factors in Health
Chapter 14 – How Psychosocial Factors Affect Health Behavior

12. Behavior and the Social Environment
Most important predictor of health is socioeconomic status (SES)
Health gradient holds at all levels of the social scale
Health also affected by gender, marital status, race and ethnicity
In U.S., racial and ethnic minorities have poorer health than whites
Health disparities are a big concern of public health

13. Why the Effect of SES? Nutrition Sanitation
Conditions of the physical environment
Higher SES leads to more healthy behavior
Access to medical care

14. Psychological Factors
Stress
Mortality is increased after death of a spouse, loss of a job, divorce, etc.
Stress increases risk of heart disease, common cold
Daily hassles
Social support
Alameda study
Social support can buffer stress

15. Psychological Models of Health Behavior
Health belief model
I am vulnerable to the threat
The threat is serious
By taking action I can protect myself
Locus of control theory (self-efficacy)
Self-efficacy is increased by previous successful performance
Self-efficacy is increased by seeing others successfully perform, especially if model is a peer
Theories are used for programs to promote behavior change

16. Ecological Model of Health Behavior
Intrapersonal level (psychology)
Interpersonal level – family, friends, coworkers
Institutional level – school, workplace
Community level – churches, community organizations
Public policy level – government regulations

17. Example of Health Promotion Program – AIDS Prevention
AIDS prevention in San Francisco, 1980s
Target different levels of influence
Intrapersonal level
I am susceptible to infection
There is something I can do that will lessen the treat of infection
I am capable of making these changes
Interpersonal level
My peers support new behavior
Community level
Educational programs for bartenders in gay establishments
Distribution of condoms
Public policy level
Free, confidential HIV testing

18. Changing the Environment
More effective than trying to change individual behavior
Change focus from blaming the victim
Pioneered in injury control programs (see chapter 17)
Effective in tobacco control programs
Now thinking of how to apply it to improving diet and physical inactivity

19. Unit 6 – Public Health Social Factors in Health
Chapter 18 – Maternal and Child Health as a Social Problem

20. Importance of Infant and Child Health
Foundation of health throughout life
Children are most vulnerable group in society
Infant mortality rate (IMR) is an indicator of health status of population
U.S. ranks 27th internationally
IMR higher for blacks than whites – indicator of health disparity

21. History of Child Health Programs
New York City milk stations starting in 1893
U.S. Children’s Bureau beginning in 1912
Child labor regulated by U.S. beginning in 1930s
Ongoing conflicts over the role of government in protecting children
Infant mortality rate has fallen over 20th century

22. Causes of Infant Mortality in U.S.
Birth defects – leading cause overall
Prematurity and low birth weight
Was leading cause overall until recently
Still leading cause among blacks
Sudden infant death syndrome (SIDS)

23. Social Factors in Infant Mortality
Number one risk factor is poverty
Reasons why low SES increases risk
Environmental hazards
Poor nutrition
Maternal risk behaviors – smoking, alcohol, illegal drugs
Social factors – young maternal age, violence, stress, lack of social support
Lack of prenatal care

24. Prenatal Care Provides women with information Diagnose problems early
Can often link poor women with social services
Most states try to remove financial barriers
States and federal government collect data on prenatal care

25. Preventing Birth Defects
Genetic and newborn screening
FDA regulation of teratogenic drugs
Warnings against alcohol for pregnant women
Immunization of all children against rubella protects infants
Dietary supplementation with folic acid

26. Preventing Low Birth Weight
Prenatal care
Reducing adolescent pregnancy
Causes of low birth weight are not well understood
Recent increases in low birth weight due to multiple births because of reproductive technology

27. SIDS
“Back to Sleep” campaign
SIDS rate has fallen by over 50%

28. Family Planning and Adolescent Pregnancy
Adolescent pregnancy has physical and social risks for mother and child
Planned pregnancy leads to healthier outcomes
Controversy about government provision of family planning services
Sex education in schools is controversial
Federal requirement for abstinence only programs
Abstinence only education is less effective

29. Kinds of Contraception
Sterilization – most common method, but permanent
Oral contraceptives and other hormones
IUS
Barrier methods – condom, diaphragm, cervical cap
Prevents sexually transmitted disease
Used inconsistently and unreliably
Controversy over “morning after pill”

30. Government Nutrition Programs
WIC – provides vouchers for nutritious foods for pregnancy women, lactating mothers, children up to 5 – very effective
School Meals Program
Food Stamp Program
Food insecurity is still common in the U.S.

31. Children’s Health and Safety
Immunizations required before entering school
Public health efforts to vaccinate younger children
CDC tracks immunization rates
Well baby care and screenings in school
Childhood asthma is growing

32. Children’s Health and Safety, ctd.
Fluoridation of water to prevent tooth decay
Regulation of day care centers
U.S. Consumer Products Safety Commission regulates toys and children’s furniture
Public health campaigns for child safety seats, bicycle helmets
Governments also provide diagnostic, treatment, and rehabilitative services for children with special needs