Models of Health Flashcards
What is a model
A “model” is a perspective, or a way of looking at things.
WHO’s definition for health?
“health is more than the absence of disease or infirmity [which means illness or disability], but is a complete state of mental, physical, and social well-being.”
Other ‘dimensions of wellness’ to add to WHO’s health definition?
- Emotional wellness
- Environmental or planetary wellness
- Spiritual wellness
What is health (described as a process rather than a state)
the process of doing your best most of the time to mobilize your resources to cope with the challenges of life.
What was the main message in A New Perspective on the Health of Canadians?
many of the leading causes of death and disability at that time were associated with known, preventable risk factors: motor vehicle crashes, heart disease, lung cancer, suicide.
What model was created from the insight provided by A New Perspective on the Health of Canadians
Risk factor model
The risk factor model brought what two strong approaches to health
- At the population level, targeting interventions to groups at high risk of disease. For example, knowing that alcohol-related car crashes are especially common among young adult males could produce changes in licensing, law enforcement, or social marketing aimed at that group (social marketing is discussed in a separate unit by the same name).
- At the individual level, raising awareness of the connection between health behaviours and health outcomes, and giving knowledge and skills that will help people to change their risky or unhealthy behaviours.
Your definition of health will influence what two things?
- The scope of things you would include in “health promotion”
- The way you would approach an issue e.g., detect disease, prevent disease, or promote wellness.
Medical model/risk factor model of health vs. “holistic model” and the “wellness model”?
Medical model/risk factor model: “health” to be the absence of signs or symptoms of disease
Wellness model: health as MORE THAN the absence of disease, but a complete state of mental, physical, and social (and emotional, environmental, and spiritual) well-being
What does the holistic model/wellness model challenge an individual to?
- Become aware of the connections between health behaviour and health outcomes
- Exercise more conscious control of their thoughts and behaviours
- Pursue higher level of wellness
What is fitness? Physical fitness?
- A capacity
- the capacity to meet the demands of sport, work, and life safely and efficiently without undue fatigue
What are the 4 components of fitness
- Stamina - endurance, aerobic fitness
- Suppleness - flexibility
- Strength - muscular endurance
- Slimness - body composition
What is exercise
A process that leads to fitness
“A planned, structured, repetitive program of physical activity intended to develop or maintain one of more components of fitness”
What is activity
A process involving any voluntary movement (unlike exercise, which requires intent to develop fitness)
What is active living
A way of life in which meaningful and satisfying physical activity becomes an integral part of everyday living
From CFLRI survey, % of Canadians at least moderately active?
Bit below 50%
Where is the % of canadians least moderately active in? Highest in?
- Lowest in Martitime Canada
- Highest in BC
From the CFLRI survey, which gender is more likely to be active
Men
How does activity and age relate
Activity declines with age except men 65+ as active as men 45-64
In 2003 what percentage was the goal to increase physical activity? Results?
- Increase lvls by 10% by 2010
- Yukon, NWT, Nunavut no process
- Manitoba within 1%
- All other regions within 3%
In the CFLRI survey that sample canadian children and youth, which provinces did children take the least amount of steps
Atlantic provinces
In the CFLRI survey that sample canadian children and youth, which gender took more steps
Boys (~1,300 more)
In the CFLRI survey that sample canadian children and youth, how did age and number of steps relate
- # of steps decreases with increasing age
In the CFLRI survey that sample canadian children and youth, how did # of steps and household income relate?
- children in highest income households take more steps than lowest income
In the CFLRI survey that sample canadian children and youth, how did education lvl of parent and # steps relate?
- Year 5: no relationship
- Year 1-4: there was a relationship
In the CFLRI survey that sample canadian children and youth, how did patently activity level and # of steps taken by child relate?
- Year 3-5: no association
- Year 1-2: Yes differences
In the CFLRI survey that sample canadian children and youth, how did children how participate in organized physical activity and # of steps relate
- children who participate in organized physical activity took more steps than those who don’t (~1500 more)
When are children aged 6-10 most active
Lunchtime
When are adolescents and older teenagers most active
3-5pm
Which days are children and youth (6-19) more active?
Weekdays
Which days are adults more active?
Weekdays and weekends showed same activity levels
In the survey regarding occupational versus leisure time activity, which income group were more likely to be classified and less likely inactive
Highest income category
What leisure time activity was reported most commonly?
Walking
During the survey comparing leisure time activity levels of blue-collar, white-collar, and professional employed Australians, which group was least active
Blue-collars were 50% more likely to be classified as insufficiently active
- did NOT appear blue-collar did less activity cause of insufficient time
Two main factors of the observed associations among leisure time activity, occupation, and education
Attitudes and values
Which ethnic group were more likely to be active and least likely to be active?
- South Asian or East Asian less likely to be active
- Aboriginals more likely to be active
- Immigrants less likely to be active and more likely to be inactive
What does the Obesity unit aims to do?
Lay the foundation to consider a broad multi-pronged strategy to combat overweight and obesity at the societal level
Physical examination data from the National Health and Nutrition Examination Survey indicates what age-adjusted prevalence of obesity ____?
Increased from 22.9% in 1988 thru 1994 to 30.5% in 1999 thru 2000
The rising prevalence of obesity will also increase what?
- Inc rates of diabetes, hypertension, cancer, heart disease, osteoarthritis, and other chronic diseases
- inc health care costs
What happens when faced with inadequate resources to pay for necessary care for obesity
- Consumers concentrate on symptomatic care while neglecting disease prevention and risk factor control
What happens when you fail to stay current with indicated preventative services and failure to control disease risk factors
Spiral of unnecessary illness, health care costs, and disability—all widening the gap between the need for health care and the resources available to pay for it
What emotions do individuals who chronic disease and disabilities associated with obesity experience
Anxiety and depression
End result of researching molecular biology of obesity
Develop better understanding of what leads a proportion of the population to become obese in an environment that requires almost no PA and provides calories in accordance with desire
End result of researching genetics and behavior
Help us understand why some individuals who were once obese are able to achieve sustained weight loss whereas most others fail at this goal
Is obesity epidemic primarily due to an increase in the consumption of calories or a decline in physical activity?
Unknown however fundamentally result of energy imbalance: more calories consumed than burned
Does walking or jogging contribute more to cardiovascular fitness
Contribute equally
What are the three factors associated with sustained, substantial weight loss?
- Adequate physical activity
- Avoidance of calorie-dense foods that are high in fat and simple carbs
- Use of multiple strategies to reinforce the maintenance of the desired physical activity and nutritional patterns
How do we create environments that make it possible and rewarding for individuals to avoid obesity in the first place and maintain weight loss if they were obese at one time
- ensure communities allow people to move around by foot or bike
- make low-calorie dense foods available at prices
- provide foods and drinks that meet nutritional goals in schools
- ensure students have adequate levels of P.E.
- develop and implement programs that market the benefits and pleasures of physical activity and low-calorie foods to offset the financed and highly sophisticated campaigns of the food, alcohol, spectator sport, and entertainment industries
What factors appear to be driving obesity epidemic among youth
Electronics, marketing, and diminishing opportunities for physical activity
Which gender is more obese in Canada? USA?
- Canada: no real difference
- USA: women more likely to be obese
Are overweight and obesity levels among children higher in Southern Europe or Northern Europe. Why?
- Higher in Southern Europe
- Trend away from traditional “Mediterranean diet” and increased consumption of processed food
How to identify abdominal obesity
Measure waist circumference
What is the BMI for adults table?
BMI < 18.5 Underweight
BMI 18.5-24.9 Normal Range
BMI 25-29.9 Pre-obese
BMI >30 Obese
What does the pre-obese category refer to
Overweight
Three categories of obesity?
BMI 30-34.9 Class I
BMI 35-39.9 Class II
BMI >40 Class III
Asian populations in a lower “action point” of BMI >23 should apply in assessing weight and health status, why?
given evidence of their vulnerability to heightened risk for related chronic diseases at lower BMI levels.
Major south of energy intake for Australian youths?
Carbs
What is Resting Energy Expenditure
- Nrg expended by body in resting state to maintain itself & digest food
- made up of Basal Metabolic Rate and Thermic Effect on Food
What is Basal Metabolic Rate
Nrg expended in rested & fasted state
What is Thermic Effect of Food
Nrg used in digesting food (~10% of Total Nrg Expenditure)
What is Activity Energy Expenditure
- Nrg expended by body in movement, & is only aspect of nrg expenditure that is under conscious control
- makes up 20-40% of Total Nrg Expenditure, depending on activity lvl
What is Total Daily Nrg Expenditure
- Nrg expended by individual in 1 day
- made up of Resting Nrg Expenditure and Activity Nrg Expenditure
Since obesity is not primarily a medical problem and can’t be controlled by primarily medical approaches, what is it controlled by and what approaches are essential
- obesity anchored in society and culture
- structural approaches essential
Why are environmental and policy solutions called passive solutions
They achieve objectives for the good of society and people in it w/out requiring individual behaviour change and perhaps even w/out knowledge of individual
Why are passive strategies more successful than those requiring decision making
they do not require health to be the basis of decision making and also because they help to reshape community norms …This strategy has been summarized by the phrase ‘to make healthy choices the easy choices’
3 strategies proposed by Milio?
- General • Development of an intersectoral, national policy on obesity control • Educate government agency leadership about the inadvertent impacts of their policies on eating and physical activity
- Physical activity related • Long-term planning of towns and city centers to promote walking and cycling • Measures to slow or ban traffic in some areas • Remove sales tax on the purchase of exercise equipment • Change building codes to increase the use of stairways • Develop adequate safety guidelines and liability legislation for sports equipment and exercise or recreational facilities • Protect open spaces through zoning and land-use policies • Give incentives to employers who provide for physical activity breaks or release time
- Food and eating related • Label the fat and caloric content of foods in restaurants and take-out establishments • Setting and enforcing guidelines for the fat content of school and hospital meals • “Silent” alteration of the content of restaurant foods or processed foods through gradual changes in food processing or food preparation • Banning some types of food advertising on television • Regulation of television commercials in children’s programming • Requiring nutrient content information as a part of food advertisements • Use price supports to promote or discourage consumption of certain foods • Levy taxes on certain foods and use the revenues to support other health promotion activities
What is a campaign
a connected series of operations designed to bring about a particular result
Health communication campaigns have what qualities
- Are goal oriented
- Attempt to inform, persuade, or motivate change
- Are aimed at well-defined, large audiences [efforts aimed at small groups are probably more properly called ‘projects’]
- Occur during a given time period
- Involve an organized set of communication activities
To understand health communication campaigns we should look at what six elements
- Target group(s)
- Central messages
- Strategy
- Tactics
- Outcomes (results)
- Costs (and ideally cost/benefit analysis)
Examine Let’s Talk campaign:
- Target group(s)
- Central messages
- Strategy
- Tactics
- Outcomes (results)
- Costs (and ideally cost/benefit analysis)
- Target groups
• Primary = Canadians with mental illness
• Secondary target = employers (Education & awareness on prevalence_
2. Central Messages • It is not your fault • Do not be afraid of being judged • There is help available • “Just be open” This may be a bit too many messages. Maybe it is easier to maintain focus and have impact with one or two key messages.
3. Strategy: Four Pillars • Workplace mental health • Research • Community care and access • Anti-stigma
4. Tactics • Spokesperson Clara Hughes, six-time Olympic medalist (speed skating & cycling), who had depression • Workshops for senior managers • Provide statistics • Raise money • Partnerships: support to hospitals and agencies • e.g., Royal Ottawa Hospital telepsychiatry • Fellowships and grants for research • Bus stand billboards • Company publications • Online newsletters • Television • Website: bell.ca/letstalk • Post your smile next to Sarah’s
- Outcomes: Bell launched the Bell Let’s Talk mental health initiative in September 2010 with an initial commitment of $50 million over 5 years. In addition, they donated 5 cents for every call or text made by Bell customer on annual “Let’s Talk” Day
• $3.3 million resulting from Bell Let’s Talk Day 2011
• $3.9 million from 2012
• $4.8 million from 2013
Examine Bob & Martin campaign:
- Target group(s)
- Central messages
- Strategy
- Tactics
- Outcomes (results)
- Costs (and ideally cost/benefit analysis)
- Target: Smokers age 40-54
- Central messages
• Quitting smoking may be difficult, but it is possible and it is worth it.
• It is important to develop a quit plan. - Strategy (the big plan)
I don’t know what the strategy was. - Tactics (the specifics)
• Eight 30 sec television ads
• Call-to-action to contacts: 1-800 O-Canada; gosmokefree.ca
• Website where Bob & Martin made journal entries
• Other advertising (billboards, print, mail to physicians) Text of one TV spot in which Bob thinks about quitting
• “I know. It’s tough to be a smoker these days…
• I’m outside and it’s minus 20. No problem - I like winter.
• My breath stinks? I’ve got mouthwash.
• Food’s got no taste? No problem - I use salt.
• I’m getting sick of this. That’s the problem.” Sample daily quitting message
• “What makes you reach for a cigarette?
• In addition to physical cravings, many people smoke in response to certain emotions….
• We all feel these things, but we can choose how we respond. What else could you do with your emotions instead of smoking? What else could you do to feel pleasure when you quit? Just think about it for now and we’ll talk more about this in future messages.” Strategic alliance with Reader’s Digest
• Subscribers got Health Canada’s self-help guide to quitting
• Those who had requested smoking cessation info got letter
• Doctors got letter (poly-bagged with Reader’s Digest), informing them of Health Canada’s cessation resources and encouraging them to use/distribute them to patients - Outcomes
• 30,000+ calls to the toll-free number
• 90,000 users have created profiles to receive support through an electronic version of “On the Road to Quitting”
• 33,000+ registrations for e-quit, which sends free daily quitting messages • Thoughts about quitting increased throughout the campaign by almost 10%
• 23% of those that saw the ad said that they did something as a result of seeing the ad 33
• A further 20% said that they planned on doing something because of the ad.
• Ad recall averaged 42% (range 24 to 60% for the different ads) - Costs
• Production $ 194,000
• Media placement $ 6,400,000
• Evaluative research $ 237,000
Examine VERB. It’s what you do campaign:
- Target group(s)
- Central messages
- Strategy
- Tactics
- Outcomes (results)
- Costs (and ideally cost/benefit analysis)
- Target group • Children aged 9 to 13 (“tweens”) Targeted because at this age they become more independent • Parents = secondary target, to support & encourage tweens’ participation in PA 4.2. Central messages • PA is a good way to spend time with friends • PA is fun • PA is cool They later dropped the first message because it was giving a mixed message, since socializing may connote sedentary time. They added messages on mastery & inclusiveness for older tweens
- Strategies I don’t know what the strategy was. 4.4. Tactics • TV ads on Nickelodeon, Disney Channel, etc. • Website • Text messages to kids: “Remember to have fun by being physically active” • Yellowball o 500,000 yellowballs (about 18 cm = 7 “ diameter) with campaign name and logo were passed out
o Tweens encouraged to play with ball with their friends, then blog about its whereabouts. o View photos of Hillary Duff with her yellowball and read her blog about getting physically active
Other advertising: radio, theatres, billboards, print (e.g., in Sports Illustrated for Kids, Teen People) • Website, whose interactive components included o ability to create virtual character identities and blog about their physical fitness activities o virtual “playground” that included jokes and games for kids to explore - Outcomes A random sample of children and parents were surveyed April-June 2002, before the launch of VERB. This same group of individuals surveyed again April-June 2003 • 74% of children aware of VERB • Those who were “Informed” (i.e., had heard about Yellowball) reported 34% more free-time physical activity in the week preceding survey than the “uninformed” • 21% of the balls were passed on. • Nearly 17,000 blogs were received. • One ball was passed 31 times while another ball traveled 39,940 miles. 4.6. Costs • $339 million (USD) over the five years (= $68 million per year) • Campaign ended because of funding shortfall • Difficult to calculate cost/benefit:
o If reached 21 million people, then $16/person o But, what is cost/participant-hour of PA? • Advertising production, especially for TV, is expensive.
What was ParticipACTION
- project that produced many campaigns
- focused on promoting physical activity
What other health messages did ParicipACTION couple with physical activity message
- Heart health
• Weight management
• Healthy eating
• Positive self- and body image
What was the profession of the first director of ParticipACTION
- marketing and did marketing approach with PartcipACTION
What did the ParticipACTION brand intended to connote
- Activity
- Health
- Me
- Time to get moving
How did ParticipACTION differ from traditional ‘health education’
- traditional ‘health education designed to give people info’, ParticipACTION followed ‘health communication’ to persuade people to take action
What is the primary goal of modern social marketing and health communication campaigns
Long-term goal of changing social norms
ParticipACTION’s “two major strengths in terms of leveraging public service advertising were
(a) innovative marketing combined with an obsession for creativity
(b) a proven approach to building personal relationships with the media.”
What was ParticipACTION’s primary audience
the media
What are ParticipACTION’s 12 key elements of successful behaviour and social change initiatives
- Take advantage of what is known and has been done before 2. Start with target markets that are (most) ready for action 3. Promote a single doable behaviour, explained in simple, clear terms 4. Consider incorporating and promoting a tangible object or service to support the target behaviour 5. Understand and address perceived benefits and costs 6. Make access easy 7. Develop attention-getting and motivational messages 8. Use appropriate media and watch for and exploit opportunities for audience participation 9. Provide response mechanisms that make it easy and convenient for inspired audiences to act on recommended behaviours 10. Allocate appropriate resources for media and outreach 11. Allocate adequate resources for (formative) research 12. Track results and make adjustments
At the individual level what does hollistic model/wellness model challenge individuals to do
- become aware of connections between health behaviour n health outcomes
- learn more about this
- exercise more conscious control of their thoughts n behaviours
- pursue high lvl of wellness
nrg expenditure of obese individuals is ___ to that of lean individuals
similar
What r the 5 domains of influence in Kumanyika’s model
- International
- Nation/regional
- Community locality
- Work/School/Home
- Individual
PartcipACTION’s can be assessed by what 2 outcome measures
- awareness of campaign
- activity lvls of Canadians
participation’s success was partly cause it’s msgs were
- simple
- practical
- could be easily incorporated into daily life
Why did participACTION decline
- insufficient resources to compete in competitive market
- drop in creative quality
- loss focus that audience was media not public
Cause for global obesity epidemic
result of inc urbanization n globalization, coupled with significant changes in food environment
Obesity is the consequence of automatic n largely uncontrollable responses to an environment w/excess food availibility n aggressive n unrelenting cues that cause people to eat too much
.
Ten human characteristics exploited to make people eat too much
- Physiological response to food n to images of food
- Inborn preferences for sugar n fat
- Hardwired survival strategies
- Inability to judge caloric content
- Natural tendency to conserve nrg
- Mirror neurons
- Conditioned responses to stimuli
- Priming
- Automatic stereotype activation
- Limited cognitive capacity
- Physiological response to food n to images of food
- dopamine secreted when see food & creates craving
- exploited: vending machines
- Inborn preferences for sugar n fat
- people born w/natural preferences for sweets n fat
- exploited: placing candy at checkout
- Hardwired survival strategies
- people are wired to eat a greater variety of foods
- people respond to variety by consuming larger total quantities of food
- Inability to judge caloric content
- people cannot judge volume n portion amts
- exploited: restaurants serve too large portions
- Natural tendency to conserve nrg
- people naturally attracted to foods conveniently prepared in order to save nrg
- exploited: make foods for on the run
- Mirror neurons
- people tend to mimic behaviours of others
- exploited: modelling eating behaviors, people eat more when with others
- Conditioned responses to stimuli
- humans have tendency to respond to conditioning
- exploit: branding… people learn to buy that brand rather than product
- Priming
- priming evokes specific memories that make people more disposed to act in particular way
- exploit: in restaurants people eat faster when faster music played n vice versa
- Automatic stereotype activation
- exploit: advertisers exploit fact that we respond more favourably to images of people like us n customize marketing to reflect appearance of target group
- Limited cognitive capacity
- people can only process limited amt of info at one time, when over loaded tend to make decisions impulsively
- exploit: default options r items high in sugar n fat
how to reduce people’s overwhelming desire to eat in response to environmental cues
number n type of cues needs to b limited n regulated
- regulations addressing food cues, food availability, portion sizes, n advertising are needed
