MILIO’s

FRAMEWORK FOR PREVENTION

GROUP 1 (BAULO, BAUTISTA JR., BAYABAO, BOHARI, BOLOTO, CAIRODEN
A., CAIRODEN J., CALANDADA, CALAUTO, CALI, CAMAMA)
WHO IS
NA NCY MILIO?
Nancy Rosalia Milio, Ph.D., FAPHA, FAAN is
Professor Emeritus of Nursing and Professor
Emeritus of Health Policy and Administration,
School of Public Health, University of North
Carolina at Chapel Hill. She is a leader in public
health policy and education, who originated the
notion of healthy public policy which addresses
the effects of all areas of public policy on health
and has been adopted internationally, including
the World Health Organization.
OVERVIEW OF MILIO’S FRA MEW ORK
FOR PREV ENTION
• Milio (1976) proposed that health deficits often result from an imbalance
between a population’s health needs and its health sustaining resources.
• She stated that diseases associated with excess occurred in affluent societies
(obesity) and diseases that result from inadequacies in food, shelter and water
afflict the poor. Therefore, poor people in affluent societies experience the least
desirable cambination of factors.
• Personal and societal resoures affect the range of health promoting or health
damaging choices available to individuals. Personal resources include the
individual’s awareness, knowledge, and health beliefs. Money and time are also
personal resources.
• She proposed that most human beings make the easiest choices available to
them most of the time. Health promoting choices must be more readily available
and less costly than health damaging options for individuals to gain health.
• This theory is broader than the HBM, it includes economic, political, and
environmental health determinants rather than just the individual’s perceptions.
• This theory encourages the nurse to understand health behaviors in the context
of their societal milieu.
DEFINITION OF MILIO’S FRA MEW ORK
FOR PREV ENTION
• A framework for prevention that
includes concepts of community-
oriented, population-focused care.
• Milio’s framework described
sometimes neglected role of
community health nursing to
examine the determinants of a
community’s health and attempt to
influence those determinants
through public policy.
• Milio stated that behavioral
patterns of the populations- and
individuals who make up
population- are a result of habitual
selection from limoted choices.
• She challenged the common notion
that a main determinant for
unhealthnful behavioral choice is
lack of knowledge.
 MILIO’s
PROPOSITIONS
1. Population Health
results from deprivation
and excess of critical
health resources.
• E.g., Individuals and families living in poverty have poorer health status
compared with middle and upper class individuals and families.
2. Behaviors of populations result from
selection from limited choices; these arise
from actual and perceived options
available a well as beliefs and expectations
resulting from socialization, education and
experience.
• E.g., Positive and Negative lifestyle choices (example: smoking, alcohol use,
safe sex practices, regular exercise, diet/nutrition, seatbelt use) are strongly
dependent on culture, socioeconomic status, and educational level.
2. Behaviors of populations result from
selection from limited choices; these arise
from actual and perceived options
available a well as beliefs and expectations
resulting from socialization, education and
experience.
• E.g., Positive and Negative lifestyle choices (example: smoking, alcohol use,
safe sex practices, regular exercise, diet/nutrition, seatbelt use) are strongly
dependent on culture, socioeconomic status, and educational level.
3. Organizational decisions and policies
(both governmental and
nongovernmental) dictate many of the
options available to individuals and
populations, and influence choices.
• E.g., Health insurance coverage and availability are largely determined and
financed by federal and state governments (like Medicare and Medicaid) and
employers (like private insurance): the source and funding of insurance very
strongly influence health provider choices and services.
4. Individual choices related to health-
promoting or health-damaging behaviors
is influenced by efforts to maximize valued
resources.
• E.g., Choices and behaviors of individuals are strongly influenced by desires,
values, and beliefs. For example, the use of barrier protection during sex by
adolescents is often dependent on peer pressure and the need for acceptance,
love, and belonging.
5. Alteration in patterns of behavior
resulting from decision making of
significant number of people in a
population can result in social change.
• E.g., Some behaviors such as tobacco use have become difficult to maintain in
many settings or situations in response to organizational and public policy
mandates.
6. Without concurrent availability of
alternative health-promoting options for
investment of personal resources, health
education will be largely ineffective in
changing behavior patterns.
• E.g., Addressing persistent health problems (like overweight and obesity) is
hindered because most people are very aware of what causes the problem, but
are reluctant to make reluctant lifestyle changes to prevent or reverse the
condition. Often “new” information (like a new diet) or resources (like a new
medication) can assist in attracting attention and directing positive behavior
changes.
 MILIO’S PROPOSITIONS OF
FRA MEW ORK FOR PREV ENTION
1. Population Health results from deprivation and excess of critical health resources.
2. Behaviors of populations result from selection from limited choices; these arise from actual
and perceived options available a well as beliefs and expectations resulting from
socialization, education and experience.
3. Organizational decisions and policies (both governmental and nongovernmental) dictate
many of the options available to individuals and populations, and influence choices.
4. Individual choices related to health-promoting or health-damaging behaviors is influenced by
efforts to maximize valued resources.
5. Alteration in patterns of behavior resulting from decision making of significant number of
people in a population can result in social change.
6. Without concurrent availability of alternative health-promoting options for investment of
personal resources, health education will be largely ineffective in changing behavior patterns.
Personal Behavior patterns are not simply “free” choices of
“lifestyle” that are isolated from their personal and economic
context. Lifestyles are patterns of choices made from available
alternatives according to people’s socioeconomic
circumstances and how easily they are able to choose some
over others.
Thank s!
ALL RIGHTS RESERVED 2023