Chapter 16

Top 10 Public Health AchievementsTop 10 Public Health Achievementsin the 20th Centuryin the 20th Century1. Vaccinations2. Motor vehicle safety3. Safer workplaces4. Control of infectious disease5. Decline in deaths from coronary heart disease and stroke6. Healthier mothers and babies7. Safer and healthier foods 8. Family planning9. Fluoridation of drinking water 10. Recognition of tobacco use as a health hazard

Challenges to WellnessChallenges to WellnessObesity epidemic

According to the Centers for Disease Control and Prevention (CDC), in 2004 approximately 34% of U.S. adults over age 20 were obese (CDC 2008).

Obesity increases the risks of developing certain chronic diseases such as hypertension, cardiovascular disease, and diabetes.

Reemergence of infectious diseases Rise of antibiotic-resistant bacteriaMore global travelers, both humans and animalsCrowded living conditions

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Challenges to Wellness: Access to Challenges to Wellness: Access to Health InsuranceHealth InsuranceNearly 46.5 million nonelderly Americans

didn’t have health insurance in 2006. Low-income people are at the highest risk of

being uninsured. The uninsured are more likely to be

hospitalized for medical conditions that could have been avoided if proper medical care had been received initially.

The uninsured don’t receive basic preventive care such as Pap smears, mammograms, annual physicals, or blood glucose screenings.

Six Dimensions of WellnessSix Dimensions of WellnessDeveloped by Bill Hettler, cofounder and

president of the board of directors of the National Wellness Institute: PhysicalIntellectualEmotionalSocialSpiritualOccupational

Reaching and Maintaining Reaching and Maintaining WellnessWellnessFind your current health status and identify

areas you want to change or improve.Behavior change models help understand

why it’s hard to change behavior:Transtheoretical modelSelf-efficacy and social cognitive theoryHealth belief modelLocus of control

Set realistic goals.

Transtheoretical ModelTranstheoretical ModelFocuses on the decision-making process. Stages of changeBehavior change is not a one-step process. Other concepts include processes of change

and decision balance.

Stages of ChangePrecontemplationContemplationPreparationActionMaintenance

Self-EfficacySelf-EfficacyRefers to people’s belief in their ability to

succeed in specific situations.People with high self-efficacy believe they

can master difficult tasks and don’t avoid those kinds of challenges.

It’s vital to changing or adopting a health behavior because it helps determine your confidence in your ability to change.

Social Cognitive TheoryDeveloped by psychologist Albert Bandura.People behave in a certain way because of

interaction among personal factors, behavior, and the existing environment.

Helps explain behavior change.Helps explain how people develop and

maintain behavioral patterns.Helps in designing interventions.

Five PrinciplesFive Principlesof Social Cognitive Theoryof Social Cognitive Theory1. People learn from watching others.2. Learning is an internal process that may or

may not change behavior.3. Behaviors are targeted toward specific

goals.4. Behavior eventually becomes self-regulated.5. Reinforcement and punishment have both

direct and indirect effects.

Health Belief ModelHealth Belief ModelPeople will engage in a health-related action if

1. they have an interest in health matters (health motivation),

2. they think they are susceptible to a particular illness (perceived vulnerability),

3. they think the benefits of the treatment outweigh the barriers to it (perceived barriers and benefits), and

4. they think a particular illness could be severe (perceived seriousness).

Locus of ControlLocus of ControlLocus of control is an important aspect of

personality that depends on your view about the main causes of events.

External control: Belief that outside circumstances guide behaviorLack confidence to obtain or overcome health

habitsInternal control:

Belief that personal decisions affect actionsMore confident in your ability to change a

behavior

How to Set Realistic GoalsHow to Set Realistic GoalsSet small goals to help you achieve your

overall goal.Write down your goal.Make your goals specific and measurable. Write down when and where you’ll try to

change your behavior.Reward yourself whenever you reach a goal. Find social support.