Transcript Section 1

Beliefs,
Values and
Health
Chapter 2
Learning Objectives
At the end of class, you should:
– understand health and sickness
– know the determinants of health
– know the American believes and
values in the delivery of health care
– understand the promotion of health and
the prevention of disease
– develop a position on the equitable
distribution of health care
– know basic measures of health and its
utilization
Beliefs, Values and Health
• How have beliefs and values shaped
the delivery of health care in the
U.S.?
• What are the market and social
justices?
• Is there equity?
Beliefs, Values and Health
Beliefs and values in US have
remained mostly private
– not a tax financed national health care
program
For Managers and Policy Makers
1) Health of a population determines health
care utilization
– planning a health service is determined by
health trends and demographics
2) The health appraisal should determine
– education, prevention and therapies
3) Evaluating health care organizations on
contributions made to community
4) Use of justice and equity a concern
5) Measure of health status and utilization to
evaluate:
– existing programs, plan new strategies, measure
progress, discontinue a service
What Is Health ?
• Absence of illness and disease
• “ a state of physical and mental wellbeing that facilitates the achievements
of individual and societal goals”
– Society for Academic Medicine
• A return to an illness free or disease
free state after an ill spell.
What Is Health ?
• “ A complete state of physical, mental and
social well being, not just merely the
absence of disease
– WHO
• Biopsychosocial model of health
– “Social”
• positive relationships
• support network for:
– life stresses
– self-esteem
• responsible for community and population’s
well-being
– To promote, restore and maintain health
What Is Health ?
U.S. health care has followed a medical /
biomedical model
– the existence of
• illness or disease
– have a clinical diagnosis and medical
interventions
What Is Health ?
Biomedical Model
Governs the U.S. concept of health and
health care
1. The existence of an illness or disease
2. Seek and use care
3. Find relief of symptoms and discomfort
4. Diagnosis of illness and treatment of disease to
restoration
5. Once relief is obtained, the person is considered
well, even if the disease is cured or not
Therefore, clinical intervention once disease
is diagnosed.
Illness vs. Disease
• Illness
– identified by a person’s perception and
evaluation of how he/she is feeling
– people are ill when they infer a
diminished capacity to perform tasks
and roles that are expected by society
• Disease
– based on a professional evaluation
– caused by more than one single factor
• presence of tuberculosis
• poverty
• overcrowding
An Explanation of
Disease Occurrence
• Tripartite or Epidemiology Model
• 3 elements:
1) host
•the organism
•usually a human
•for host to be ill, an agent must be present
2) agent
•(ie TB, tobacco smoke, bad diet...)
•presence of tuberculosis does not assure
host will be ill
3) environment
•external to the host to enhance or reduce
disease
Tripartite or Epidemiology Model
Epidemiology Triangle
page 42, Fig 2-2
Host
Disease
Agent
Environment
Tripartite or Epidemiology Model
Risk Factors
•attributes that increase the likelihood of
developing a disease or negative health
condition
•agent: (ie tobacco smoke, poor diet)
•host: (ie genetic make up, level of fitness)
•enviro: (ie poor sanitation, low socioeconomics)
•Prevention
•to rid risk factors
Behavioral Risk Factors
• Smoking
– increases risk of:
• heart disease, stroke, lung cancer, lung disease
– by CDC
• Substance abuse
• Lack of physical exercise
• High fat diet
• Improper use of motor vehicles
• Unsafe intimate relations
• Look @ page 43, Tbl 2-1
Interventions to Counteract
Key Risk Factors
Behavior modification
– education
– personal motivation
– financial incentives
– environmental inducements
Acute, Subacute, & Chronic
Conditions
Disease classifications:
– A) acute
• relatively severe, episodic (of short duration)
and often treatable
– (ie myocardial infarct, sudden kidney
interruption)
– B) subacute
• some acute features
• postacute treatment after discharge
– (ie head trauma, ventilator)
– C) chronic
• less severe, but long and continuous
• can be controlled, but can lead to serious
– (ie asthma, diabetes, hypertension)
Holistic Health
• A growing interest
– the well-being of all aspects that make a
person whole and complete
• Holistic medicine
– treat the whole person
– spiritual is added to:
• medical, mental and social
• Lit shows that religious & spiritual
belief hs a positive impact on
overall well-being
Another Model
Wellness Model
– efforts and programs that prevent disease
and optimize the well-being
– built on 3 factors:
1) understand risk factors
– done through a health risk appraisal
» when known, interventions can take place
2) intervention
– a) behavior modifications
– b) therapeutic
» primary, secondary, tertiary prevention
3) adequate public health and social services
Therapeutic Preventions
1) Primary
– activities to decrease or restrain the problem or
develop that a disease will occur
• (ie smoking cessation to prevent lung dis)
• (ie handwashing to decrease spread of infection)
2) Secondary
– early detection and treatment of disease
– to block progression of disease or injury
• (ie pap smears, mammograms, prostate exam)
3) Tertiary
– rehabilitation and monitoring to prevent further
injury or complications
• (ie turn bed-bound patients)
Public Health
• To fulfill “society’s interest in
assuring conditions in which
people can be healthy”
• by IOM
• Deals with broad societal concerns
promoting optimum health for the
society as a whole
• A health-related service to minimize
risk factors to prevent, control and
contain disease
Public Health
• The science and art of preventing
disease,
– prolonging life, and
– promoting health and efficiency through
• organized community effort
• Seeks to apply
– current knowledge of health and disease
in ways
• that will have the maximum impact
– on a pop’s health status
Public Health Roles
1) Prevention
2) Health Promotion
3) Health Protection {new}
• Due to 20th century industrialization
– Environmental Protection Agency (EPA)
– Occupational Safety and Health
Administration (OSHA)
– Bioterrorism, Homeland Security Act 2002:
• the use of chemical, biological & nuclear agents
to harm populations
• training, Civil Defense, countermeasures &
cooperation between interagency groups
– (ie anthrax, small pox)
Medicine versus Public Health
• Medicine
– focuses on the individual patient
– biological causes of disease with treatment
– treat disease and recover health
• Public Health
– focuses on the populations
– identify environment, social & behavior then
• develop population-based interventions
– prevent disease and promote health through
influence
– provides education to pass laws
– disseminate information
Medicine versus Public Health
• Medicine
– Physicians, nurses, dentists, therapists,
social workers, psychologists,
nutritionists, health educators,
pharmacists, laboratory, administration
• Public Hlth
– same as above, but also includes:
– sanitarians, epidemiologists,
statisticians, hygienists, environmental
health specialists, food/drug inspectors,
toxicologists, and economists
Environmental Health
• Aims to prevent the spread of disease
through:
– water, air & food
• 1900s Top 3 killers:
– pneumonia, tuberculosis, diarrhea
• 1999 Top 3 killers:
– heart disease, cancer, lung disease
• New Challenges in 20th century
– hazards of chemicals, asbestos, industrial waste,
infectious waste, radiation
Quality of Life
• Overall satisfaction with life during and
following a person’s encounter with the
health care delivery sys
• An indicator of how satisfied a person
was with the experiences while receiving
health care
– comfort, respect, privacy, security, autonomy
– A person’s overall satisfaction with life
and self-perceptions of health, especially
after a medical intervention
– Goal:
• have a positive effect on an individual ability to
function, meet obligations, feeling of self-worth
Determinants of Health
Factors that influence an individual and a
population’s health:
– A person’s genetic make up
• 20% of premature deaths
– Individual Behaviors
• 50% of premature deaths
– Medical Practice
• 10%
– The Social and Environment
• 20%
Blum’s Force Field & Well-being
Paradigms of Health
Force Fields:
– Environment
• Physical, social, cultural, and economic factors
– Lifestyle
• Behaviors, attitudes toward health
– Heredity
• Current health and lifestyle practices are likely to
impact future generations
– Medical care
• Health care delivery system
– (access, availability of service)
Blum’s Force Field & Well-being
Paradigms of Health
All forces must be considered simultaneously
when addressing the health status of an
individual or population
Blum v. Centers for Disease Control (CDC)
Models
• Blum:
– looks at overall well-being
– environment is the main contributor
• look @ page 50, Fig 2-4
• CDC:
– lks at causes leading to premature death
– lifestyle main contributor
American’s Beliefs and Values
1) The advancement of science
• helped to create the medical model
2) A champion of capitalism
• an economic good
3) Entrepreneurial spirit and self
determination
4) A concern for the underprivileged
• poor, elderly, disabled
5) Free enterprise and distrust of
government
The Equitable Distribution
of Health
We have scarce resources.
1) How much health care should be
produced?
2) How should health care be
distributed?
• Distribution creates inequalities
• Need justice / fairness
Theories of
Equitable Distribution
2 Contrasting Principles:
– Market Justice
• The Economic Good
– Social Justice
• A Social Good
Market Justice
“The Economic Good”
Fair distribution of health care to the
market forces in a free economy
– Medical services distributed on the basis
of people’s willingness and ability to pay.
Principles of Market Justice
• Health care is an economic good
governed by free market forces
and supply and demand
• Individuals are responsible for
their own achievements
• People make rational choices in
their decision to buy health care
products and services
Principles of Market Justice
continued...
• People consult with their physicians
who know what is best for them
• The market works best without
interference from government
Market Justice
In association with Classical Ethical Theory
– A physician is duty-bound to do whatever is
necessary to restore a patient’s health
– An individual is responsible for paying the
physician for his/her service
– The poor can be served by charity
– Ignores the societal good and people’s
responsibility to the community at large
Market Justice
In association with Libertarianism:
– Equity is achieved when resources are
distributed according to merits
– Health care distributed according to
minimal standards and financed through
willingness to pay
– Health care is not a central priority
Market Justice
• The production of health care is
determined by how much the
consumers are willing and able to
buy at the prevailing price.
• Those not able to pay have barriers
to health care
– “rationing by ability to pay”
• Focus on individual rather than a
collective responsibility for health
Social Justice
“The Good Society”
• Theory is at odds with capitalism and
market justice
• The equitable distribution of health
care is society’ responsibility
– Best when a central agency is
responsible for the production and
distribution of health care
• Health care is a social good.
– Should be collectively financed and
available to every citizen.
Principles of
Social Justice
• Health care should be based on need
rather than cost
• There is a shared responsibility for
health
– Factors outside a person’s control might
have brought on the condition
• There is an obligation to the
collective good
– The well being of the community is
superior than that of the individual
Principles of Social Justice cont...
Government rather than the market can
better decide
– Through planning how much health care
to provide and how to distribute among
all citizens
– Look @ page 59, Tbl 2-4
Community Health Assessment
• An assessment of the population at a
local or state level
• Collaboration with:
– public health agencies
– hospitals
– othr providers
• A JCAHO requirement, especially for
community not-for-profit
hospitals
Healthy People 2010
– 10 year plans
– key national health objectives
– founded on the integration of medical
care and prevention, health promotion
and education
– under the US Surgeon General’s direction
• Look at page 62, Fig 2-6
• Look at page 63, Exh 2-1
Evaluation of Health Status
Health status is an indicator of health
and well-being interpreted through:
– Morbidity
• Disease or Disability
– Mortality
• Death rate
Evaluation of Health Status
Longevity
– life expectancy
• a prediction of how long a person will live
– life expectancy at birth
» how long a newborn can expect to live
» Look at page 69, Tbl 2-5
– life expectancy at age 65
» expected remaining years of life for a 65 year old
Evaluation of Health Status
Morbidity
– At risk population
• All people in the same community or group
who can acquire a disease or a condition
– Incidence =
• number of new cases occurring / population at
risk
– Epidemic
• Large number of people who acquire a specific
disease from a common source
– Prevalence =
• Measure the total number of cases at specific
point in time / specified population
Evaluation of Health Status
• Disability
– Activities of daily living (ADL) Scale
• evaluates 7 activities of self care & mobility:
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feeding
bathing
dressing
using the toilet
transferring
grooming
walking eight feet
Evaluation of Health Status
Disability
– Instrumental activities of daily living
(IADL)
• evaluates activities necessary for independent
living:
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using phone
driving a car, traveling alone on bus, taxi
shopping
preparing meals
lt housework
taking medications
handling money
doing heavy housework
walk up/down stairs
walk 1/2 mi without assistance
Evaluation of Health Status
Mortality
– Crude Death Rate =
– Total deaths /
Total population
– Age Specific =
– number of deaths within a certain age group /
Total # of persons in that age grp
– Cause Specific =
– # of deaths from a specific disease /
Total population
– Infant Mortality =
– number of deaths from birth to one year of age /
# of live births that same year
Demographic Change
• Changes in the composition of a
population over time
• Births
– Natality
• birth rate
• measured by:
– crude birth rate =
» number of live births / total population
– Fertility
• capacity of a population to reproduce
• measured by:
– fertility rate =
» Number of live births / number of females 15-44
years old
Demographic Change
Migration
– the geographic movement of
populations between defined geographic
units and a permanent change of
address
– immigration
• in migration
– emigration
• out migration
Measures of Hlth Svc Utilization
Utilization
– the consumption of health care services
or the extent to which health care
services are used
• Crude Measure of Utilization
• Specific Measure of Utilization
• Institution-Specific Utilization