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 TWELFTH EDITION

Health&
Wellness

GordonEmeritus
Edlin, PhD
Professor of Genetics
University of California, Davis

Eric Golanty, PhD

Emeritus Professor of Health, Wellness, and Physical Education
Las Positas College
viii Contents

Human Papillomavirus and Anogenital AIDS and HIV 286

Warts 246 AIDS and the Immune System 286
Hepatitis B 248 The AIDS Antibody Test 287
Molluscum Contagiosum 248 Preventing HIV Infection 288
Pubic Lice 248 Preventing Infections 288
Scabies 248
Acquired Immune Deficiency Chapter 13 Cancer: Understanding risks
Syndrome (AIDS) 248 and Means of Prevention 295
Reducing the STD Epidemic in the United Understanding Cancer 296
States 251 Incidence of Various Cancers 296
Preventing STDs 251 What Is Cancer? 296
Practicing Safer Sex 251 Causes of Cancer 298
STD Communication Skills 252 Most Cancers Are Not Inherited 298
Cancer Susceptibility Genes 299
Environmental Factors That Cause Cancer 300
Part 4 Understanding and Preventing Ionizing Radiation 301
Disease 257 Infectious Microorganisms 302
Chemical Carcinogens 302
Chapter 12 reducing Infections and Building
Do Xenoestrogens Cause Cancer? 303
Immunity: Knowledge Encourages
Prevention 259 Facts About Common Cancers 304
Lung Cancer 304
Infectious Microorganisms 260
Breast Cancer 304
Bacteria in Health and Disease 260
Testicular Cancer 307
Recognizing Agents of Infectious Disease 261
Prostate Cancer 307
Fighting Infectious Diseases 264
Skin Cancer 308
Understanding Antibiotics 264
Colorectal Cancer 309
How the Body Protects Itself 266
Diet and Cancer Risk 310
Common Infectious Diseases 266
Cancer Treatments 310
Colds 266
Curing Childhood Cancers 311
Influenza 267
Cancer Vaccines 312
The 2009 Influenza Pandemic 268
Coping with Cancer 312
Avian Influenza 268
Lyme Disease 269 Chapter 14 Cardiovascular Diseases:
Mononucleosis 269 Understanding risks and Measures
Ulcers 270 of Prevention 319
Hepatitis 271 Understanding Cardiovascular Diseases 320
Emerging Infectious Diseases 272 The Heart and Blood Vessels 321
The Immune System Battles Infections 273 Defibrillators: External and Implanted 322
The Lymphatic System 274 Regulating Blood Flow 323
Immunizations 276 Atherosclerosis 324
New Vaccines 277 Diagnosis of a Heart Attack 324
Vaccination Risks 277 Cardiopulmonary Resuscitation 325
Understanding Allergies 279 Repairing Blocked Arteries 325
Contact Dermatitis 280 Stroke 328
Asthma 281 Risk Factors for Cardiovascular Disease 328
Food Allergies 281 Cholesterol 328
Recognition of “Self” 282 High Blood Pressure 331
Autoimmune Diseases 282 Cigarettes and Cardiovascular Disease 333
Organ Transplants 284 The Metabolic Syndrome 333
Blood Transfusions: ABO and Rh Factors 285 Stress 334
 Contents ix

Diet and Cardiovascular Disease 334 Stimulants 377

B Vitamins 334 Cocaine 377
Calcium 334 Amphetamines 378
Soy Products 334 Caffeine 378
Fish Oils 334 Club Drugs 378
Salt 335 Ecstasy 379
Trans Fats 335 GHB 380
Tea 335 Ketamine 380
Aspirin 335 Rohypnol 380
Alcohol 335 Depressants 380
Coffee, Tea, and Cocoa 336 Sedative and Hypnotic Drugs 381
Preventing Cardiovascular Disease 336 Opiates 381
Marijuana 381
Chapter 15 Heredity and Disease 343
Hallucinogens 382
Chromosomal Abnormalities 345
Phencyclidine (PCP) 383
Hereditary Diseases 347
Inhalants 383
Congenital Defects 348
Anabolic Steroids 384
Thalidomide 349
Reducing Drug Use 384
DES 350
Accutane 350
Chapter 17 Eliminating Tobacco Use 389
Fetal Alcohol Syndrome 351
Tobacco Use in the United States 390
Preventing Hereditary Diseases 351
What Is Tobacco? 391
Prenatal Testing 351
E-Cigarettes 392
Genetic Counseling 352
Physiological Effects of Tobacco 393
Genetic Testing 353
Smokeless Tobacco 394
Genetic Discrimination 354
Cigars 394
Treating Hereditary Diseases 354
Hookahs 394
Gene Therapy 355
Smoking and Disease 395
Embryonic Stem Cells 355
Health Effects of Tobacco Use 395
Effects of Parental Smoking on Children 395
PART 5 Explaining Drug Use and Abuse 361
Lung Cancer 395
Chapter 16 Using Drugs Responsibly 363 Heart Disease 395
What Is a Drug? 364 Bronchitis and Emphysema 396
Drug Laws 364 Tobacco Smoke’s Effects on Nonsmokers 396
How Drugs Work 365 Why People Smoke 397
Pharmacogenetics 365 Quitting Smoking 398
Unintended Harmful Effects of Drugs 366 Reducing Tobacco’s Damage to Society 398
Routes of Drug Administration 367
Effectiveness of Drugs 367 Chapter 18 Using Alcohol Responsibly 407
The Overmedicating of Americans 368 Drinking on Campus 409
Lifestyle Drugs 370 How Alcohol Affects the Body 411
Drug Company Advertising 370 Composition of Alcoholic Beverages 411
The FDA and You 371 How Alcohol Is Absorbed, Excreted,
Drug Misuse, Abuse, and Addiction 373 and Metabolized 411
Addiction 375 The Hangover 412
Physical Dependence 375 The Effects of Alcohol on Behavior 413
Tolerance 376 Sexual Behavior 413
Withdrawal 376 Other Effects of Alcohol 415
Psychological Dependence 377 Long-Term Effects 415
x Contents

Fetal Alcohol Syndrome 415 Osteopathy 450

Health Benefits of Alcohol 415 Acupuncture 450
Alcohol Abuse and Alcoholism 416 Herbal Medicine 452
The Phases of Alcoholism 416 Naturopathy 454
The Effects of Alcoholism on the Family 418 Therapeutic Massage 455
Children of Alcoholics 419 Aromatherapy 456
Seeking Help: Treatment Options 419 Biomagnetic Therapy 456
Responsible Drinking 420 Quackery 457
Choosing an Alternative Medicine 458
Part 6 Making Healthy Choices 425
Chapter 21 accidents and Injuries 463
Chapter 19 Making Decisions about
Health Care 427 Unintentional Injuries and Accidents 464
Being a Wise Healthcare Consumer 428 Reducing Your Risk of Accidents 465
Choosing a Healthcare Provider 429 Analysis of Unintentional Injury 466
Healthcare Providers 429 Motor Vehicle Safety 467
Physician Assistants 429 Seat Belts 469
Nurses 429 Motorcycle Safety 470
Emergency Medical Technicians 430 All-Terrain Vehicles 470
Physical Therapists and Occupational Powered Two-Wheelers 471
Therapists 430 Pedestrian Safety 471
Sports Medicine 430 Bicycle Safety 471
Seeing the Doctor 431 Home and Community Safety 472
Hospitals 432 Falls 472
Understanding Health Insurance 433 Poisonings 473
Fee-for-Service Plans 433 Drowning 474
Health Maintenance Organizations 433 Choking and Suffocation 474
Preferred Provider Organizations 434 Fires 475
Point-of-Service Plans 434 Firearms 476
How the Federal Government Work Safety 476
Supports Health Care 434 Sports and Recreational Injuries 477
Healthcare Costs 435 Traumatic Brain Injury and Concussion 478
Why Healthcare Costs Continue to Rise 435 First Aid and Emergencies 480
Medical Tourism 435 Taking Risks and Preventing Accidents 480
Healthcare Costs in Other Countries 436
Quality of Medical Care 436 Part 7 Overcoming Obstacles 485
Healthcare Disparities 437
Chapter 22 Understanding aging and Dying 487
Organ Transplants 438
America’s Aging Population 488
Medicalization of Human Behaviors
and Traits 438 How Long Can Human Beings Live? 490
Personalized Medicine 439 Theories of Aging 491
Cosmetic Surgery 440 Biological Clocks Regulate Aging 491
Environmental Factors Affect Aging 492
Chapter 20 Exploring alternative Medicines 445 Alzheimer’s Disease and Senile
Defining Alternative Medicine 446 Dementia 492
Alternative Medicines 447 Parkinson’s Disease 494
Ayurveda 447 Cognitive Impairment and the Right
Homeopathy 449 to Vote 495
Chiropractic 449 Osteoporosis 496
 Contents xi

Age-Related Vision Loss 497 Chapter 24 Working Toward a Healthy

Age-Related Hearing Loss 498 Environment 527
Physical Exercise May Slow Aging 498 Outdoor Air Pollution 529
Thinking About Aging 499 Smog 529
End-of-Life Decisions 499 Improving Air Quality 531
Stages of Dying 500 Carbon Dioxide, Global Warming,
Advance Directives 500 and Climate Change 532
Physician-Assisted Suicide 501 Reducing Your Carbon Footprint 534
Palliative Care 502 The Ozone Layer 535
The Hospice 502 Evaluating the Risks of Air Pollution 535
Healthy Aging Depends on a Indoor Air Pollution 536
Healthy Lifestyle 503 Radon 536
Heavy Metal Pollution 537
Chapter 23 Violence in Our Society 509 Water Pollution 538
Intimate Partner Violence 510 Drinking Water 539
Causes of Domestic Violence 511 Land Pollution 540
Maltreatment of Children 512 Pesticides 541
Social Aspects of Child Maltreatment 513 Endocrine Disruptors 542
Child Maltreatment Prevention 513 Toxic Plastics 543
Sexual Violence 514 Monitoring Environmental Chemicals 544
Rape and Sexual Assault 514 Electromagnetic and Microwave Radiation 544
Acquaintance Rape 514 Cellular Phones 545
Consequences of Acquaintance Rape 515 Noise Pollution 545
Consequences of Sexual Assault 515 How Human Population Growth Affects Us 546
Sexual Violence at American Colleges
and Universities 516 Appendix A: Health Enhancement Methods 551
What to Do After a Sexual Assault 517
Elder Abuse 518 Appendix B: Calendar of Events and Health
Firearm Violence 518 Organizations 561
Hate Crimes 519
Glossary 565
Bullying 520
Violence in America 520 Study Guide and Self-Assessment Methods 579
Coping with Anger 521
Violence Is Not Inevitable 522 Index 779
 FEATURES

Health Tips

The Two-Minute Stress Reducer 7 Boosting Immunity with Herbs 277

Reduce Stress When Sitting in Front of a Computer 19 Getting Rid of Dust Mites May Help Allergies 280
Repeating This Phrase May Improve Your Health 29 Abortion Does Not Increase Risk of Breast Cancer 304
Make Up Your Own Mantra for Changing Behaviors 36 Don’t Be Fooled by “Miraculous” Cancer Cures 311
Image Visualization Reduces Stress 39 Video Game Helps Kids Battle Cancer 312
Warning Signs of Stress 47 Infected Gums Contribute to Heart Disease 324
Worry, Worry, Worry: How to Stop Stressful Thoughts 51 Breathing Exercise to Reduce Hypertension 333
Visualization Reduces Exam Anxiety 59 Don’t Overdose on Over-the-Counter Pain Killers 368
Tips for Emotional Wellness 67 Use the Five-Year Rule for New Drugs 372
Some Tips for Dealing with Anger and Conflict 71 Smoking: Playing the Odds 391
Wiped Out? 83 Smoking and Periodontal Disease 396
Healthier Eating: One Step at a Time 97 Benefits of Quitting Smoking 398
Eat! Eat! Breakfast, That Is 99 Signs of Alcohol Poisoning 408
Estimating Your Daily Calorie Needs 100 Are You a Problem Drinker? 418
Walk the Walk 135 Whole-Body CT Scan: Unnecessary for Healthy People 435
Mindful Eating 137 Treating a Headache with Acupressure 451
Inform Yourself: Don’t Buy Worthless and Sometimes Ways to Avoid Having a Motor Vehicle Accident 468
Harmful Weight-Loss Products 140 Driving Defensively 468
Incorporate Movement into Your Daily Activities 153 Don’t Fall at Christmas 473
Weight Training Dos and Don’ts 157 Prevent Table Saw Injuries! 476
Walking in Balance 164 Steps You Can Take to Reduce the Risk of Dementia 493
Preventing Sports Injuries 168 The Surgeon General’s Recommendations for Preventing
Alcohol: The Risky Social/Sexual Lubricant 185 Osteoporosis 497
Tips for Enhancing Sexual Experience 186 Hotline for Domestic Violence Help 511
Be Good at Sexual Communication 187 How to Prevent Date Rape 515
Environmental Chemicals Affect Genital Development Preventing Sexual Assault 518
in Males 206 Dispose of All Mercury Thermometers Safely 538
Pregnancy and Childbirth: Belly-Breathing Exercise 210 Compact Fluorescent Light Bulbs Contain Mercury 538
If You Forget to Take Your Pill 223 Good Riddance to the Plastic Bag 540
Health Tips icon © Olegro/Shutterstock.

Condom Sense 253 Recycle Anything—Safely 541

Wash Your Hands with Plain Soap! 263 Precautions for Pesticide Use 542
Clean Your Contacts Often to Prevent Eye Infections 264 Avoid Pesticide-Contaminated Fruits and Vegetables 542
Stuffy Sinuses? 267 Ways to Reduce Your Exposure to EMFs 545
xiv Features

Managing Stress

Mind–Body Harmony 4 Treating the Underlying Emotional Causes of Obesity 138

Harmony and Peace 6 Why It Is Vital to Stay HIV Free 250
Biofeedback 34 The Art of Visualization 313
Focusing Attention 35 Breaking Addictive Behaviors 418
Relaxation with Music 37 Healthcare Professionalism Versus Religious Belief—Why
Two Monks and the River 57 You Need to Know Your Healthcare Provider 429
Do It the “Write” Way 69 Giving Up Driving Is a Hard Decision 492
If a Friend Is Considering Suicide 78 Check Your Anger Level 521

Wellness Guide

Spirituality, Religion, and Health 8 How to Interpret Blood Cholesterol and Lipid
Using Your Mind to Heal Your Body 28 Measurements 331
Using Your Mind to Improve Health 38 Controversy Over Statins 332
Assessing Life Changes 48 Home Blood Pressure Monitors and Internet
Consultations to Help Patients Reduce Hypertension 333
The Powerful General and the Monk 49
Is There a Gay Gene? 347
Are You a Sodaholic? 102
Determining If You Are at Risk for Bearing a Child
Taking Care of Your Teeth and Gums 104 with Genetic Abnormalities 352
Rules for Organic Labeling 113 Saving a Life with a Life 353
Guidelines for Food Safety 114 Risk Factors for Addiction 376
Tips for Eating Healthy When Eating Out 118 Smoking and Health: Not Only Lung Cancer 390
Getting into Shape 162 Stages of the Quitting Process 399
First Aid for Sports Injuries: RICE 167 Women and Cigarette Advertising 401
Attend to Your Sexual Health 176 One Student’s DUI Experience 414 Managing Stress icon © jiris/Shutterstock; Wellness Guide icon © Nath Srikhajon/Shutterstock.

Gay (Same-Sex) Marriage – Social and Health Issues 184 How to Have a Successful Interaction with Your Physician 431
Home Pregnancy Testing 202 How Does Your Hospital Rate? 432
Boy or Girl: Should Parents Have the Right to Choose? 214 Hope Heals 439
A Comparison of Contraceptive Methods 220 Sources for Information on Alternative Medicines 448
New Treatment for Head Lice 262 Car Seat Recommendations for Children 469
Breast Self-Examination 306 Smoke Detectors Guard You from Fires 475
Testicular Cancer: Self-Exam 307 Prevent Computer-Related Injuries 476
Ways to Prevent Skin Cancer 309 College Athletes Opt for Health 479
Concussion to the Heart 326 Spice Up Your Mind 494
 Features xv

Global Wellness

Chronic Diseases in Rich and Poor Countries: Worldwide Infectious Disease Eradication
The Causes Differ 18 Programs 278
Overwork Causes Death in Japan 51 Deaths from Cardiovascular Disease Are Increasing
Depression Is Worldwide 76 Worldwide 337
The Mediterranean Diet 97 Lactose Intolerance: A Mutation That Influenced Human
Eating Disorders Are a Worldwide Concern 142 Evolution 346
Infant Mortality 212 The Global Burden from Cigarette Smoking 392
Contraceptive Availability Reduces Abortions 235 Alcohol Abuse Is a Worldwide Problem 417
HIV/AIDS Covers the Globe 249 Japan’s Aging Society 489
Travelers to Other Countries Should Obtain Can Beliefs Influence Life Span? 499
Health Information and Disease Outbreak Alerts 263 Gaia: Is the Earth Alive? 528
Ebola – A Deadly Virus Emerges 275 Wind-Based Electrical Power 534

Dollars & Health Sense

Large Corporations Profit from Products that Make Antimicrobial Products and “Superclean” Homes 265
People Sick 10 The Cost of Extending Life Among Terminally Ill
How Much Money Is a Life Worth? 12 Cancer Patients 312
Drugs for Coping with Everyday Life 74 Coronary Artery Bypass Surgery and Angina 326
Functional Foods Increase Profits 109 The Cost of Treating Cystic Fibrosis 350
Junk Food Marketing and the Childhood Marketing Alcohol to Youth 412
Obesity Epidemic 129
No More Medicare Payments for Medical Mistakes 432
Caveat Emptor: The Business of Sports Supplements 166
Global Wellness icon: © Leone_V/Shutterstock; Dollars & Health Sense icon: © LarryRains/Shutterstock.

Rising Healthcare Costs and Unhealthy Lifestyles 435

Sex Sells 188
Buying At-Home Pregnancy (and Other) Health Marketing “Miracle” Health Juices 457
Products on the Internet 203 Belief Is Stronger Than Disbelief 458
Money Needed to Fight HIV/AIDS 252 Bottled Water Battles 539
 PREFACE

It is with particular pride that we present the twelfth edition Pedagogical Features
of Health and Wellness. Publication of this edition in 2015
We have developed a number of features to help you learn
represents 33 years of continuous use of this textbook by
about health and wellness in this book.
students and instructors since the first edition appeared in
Each chapter of the book begins with a list of Learning
1982. A lot has happened to us (the authors), to book pub-
Objectives to help you focus on the most important con-
lishing, and to the world since then. We are much older,
cepts in that chapter.
books are available online in digital format, and the world
has changed in ways too numerous to mention. However,
the visions we had of health and how to achieve it are
as true today as they were 30 years ago. When we (the
authors) conceived of writing a textbook that instructors

© jiris/Shutterstock
could use to teach health, we chose to present the ratio-
nale and scientific evidence for prevention of disease and C H A PT ER 18
illness and for individual self-responsibility for fostering and
maintaining one’s health. The idea of self-responsibility
is now accepted as fundamental in health education.
Your behaviors, lifestyle, mental attitudes, and physical
activities are what lead to overall health and wellness.
Using Alcohol Resp
Medical science is making truly remarkable advances onsibly
in curing or alleviating serious conditions such as hep-
atitis C infections, some cases of cystic fibrosis, and a
Learning Objectives
number of previously untreatable cancers. However, it
1. Discuss the pre
is even more important today to take charge of your valence of drinking,
for drinking, and atti types of drinking, rea
tudes toward drinkin sons
own health. As the pandemics of heart disease, obe- students. g among college
sity, and diabetes spread around the world, as pollu- 2. Explain the effe
cts of alcohol on the
body.
tion threatens the livability of the environment and 3. Describe how alco
hol is absorbed into
this absorption rela the body and how
climate change threatens the health of the entire 4. Discuss the effe
tes to blood alcohol
concentration.
cts of alcohol on beh
planet, everyone must understand how their behav- behavior. avior, including sex
ual
iors and attitudes contribute to their personal health 5. Describe the lon
g-term effects of alco
hol overconsumption
or illness and the living things that share the Earth 6. Define alcohol abu
se, alcohol addictio
.
n, and alcoholism.
7. Explain the pha
with them. The information and guidelines that we ses of alcoholism.
8. Describe how alco
set out in previous editions of this book are no less help that is availab
hol affects one’s sign
ificant others and the
le for both the fam
applicable in today’s world. ily and the alcohol
ic.
UI/Shutterstock
Sky image: © ARZTSAM
xviii Preface

e
in muscle tissu
ral substance
Creatine , a natu can be purchase
d as a
in some cle contraction,
bat fatigue, and, required for mus but not all, stud
ies show
ase alertness, com risk of Som e,
euphoria, incre also increase the nutritional supp
leme nt.
ht enhance shor
t-
ce appetite. They . Because lementation mig
instances, redu hotic episodes that creatine supp is not
ures , and psyc g or sprinting. It
heart attack, seiz are legally con- as weight liftin
effects, amp heta min es burst activity, such s commonly in
of their harmful ed for sale in dieta
ry
endu ranc e activities. In dose rent ly
dra has been bann helpful for , creatine is appa
trolled, and ephe grams per day) i-
use (three to five s and other nutr
supplements. ain a variety of
sub- ever, because herb
gene rally cont
rance not harmful. How ted, one cann ot be sure
Energy drinks ness and endu nts are unregula
d to increase alert ine- tional suppleme such product.
stances purporte caffeine (and caffe of the purity or dose of any
increases the num -
fatigue, including herb gua- is a hormone that
and to combat phylline); the Erythropoietin ty to
as theo ng the body’s abili
like substances
such
ginseng; ginkgo; cells, thus increasi cription
ains caffe ine; taur ine;
r. ber of red blood oieti n is a pres
rana, which cont ; and lots of suga tissues. Erythrop produce
; glucuronolactone carry oxygen to se bodies cannot
creatine; carnitine stimu- n to people who
s of caffeine are medication give le undergoing canc
er
t that high dose ormance is cells, such as peop
There is no doub ent of physical perf sufficient blood
enha ncem
latory; caffeine rino, 2013).
(Schubert & Asto
moderate at best

Muscle Enlargers and amino acid

dietary
TERMS
s include protein an
Muscle enlarger steroids, and hum
ogenic anabolic male
supplements, andr e is made of steroids: synthetic
androgenic anabolic
cle tissu
Although new mus and strength
growth hormone. certain amino acid
s will not increase muscle size
prot ein or hormones used to cle tissue
protein, ingesting cles grow in resp
onse
ral subs tance in skeletal mus
cle tissue. Mus creatine: a natu h can also be
produce new mus uming a balanced
diet
contraction, whic
to work, not food
. Anyone cons
acids to meet
the required for muscle leme nt
ein and amino ry supp
suff icien t prot builders purchased as a dieta ase strength
obtains of exercise; body tances used to incre
demands of near
ly any kind
iderable strength
are ergogenic aids: subs
cons
or athletes who
need to build
and endurance incre ases the number
one that
exceptions. oste rone and erythropoietin: a horm body ’s ability to
thus increasing the
(test
bolic steroids
Androgenic ana build muscle stren
gth in of red blood cells,
es) are used to ion for carry oxygen to tissu es
similar substanc only by prescript rring
. They are legal one: a naturally occu
women and men (“an dro” ) is a “prohor- human growth horm
Androstenedione Prior
medical reasons.
erted in the body
to testosterone. pituitary hormone
mone” that is conv could
lar substances
nedione and simi ,
to 2005, androste diet ary supp lements. However
lly as
be purchased lega

Key Terms are defined on or near the page on which

they are introduced as well as in the glossary at the end
of the book.

13
ition of Health
Chapter One The Defin

© Skip Nall/Photodisc/Ge
and Stroke
ity Health 21. Heart Disease
1. Access to Qual 22. HIV
Service
Table 1.2
and
th 23. Immunizations
tries 2. Adolescent Heal
Developed Coun Infectious Diseases

tty Images
Care Spending in
Per Capita Medical
osis,
3. Arthritis, Osteopor 24. Injury and Viole
nce
U.S. Dollars
Per capita spending in and Chro nic Back
Prevention
Country 8,508 Conditions Bisexual,
United States and 25. Lesbian, Gay,
5,669 4. Blood Disorders and Transgender
Health
Norway
5,643 Blood Safety t, and
Switzerland 26. Maternal, Infan
4,552 5. Cancer Child Health
Canada Disease
4,495 6. Chronic Kidney 27. Medical Product
Safety
Germany ding
France
4,118 7. Dementias, Inclu 28. Mental Health
and
3,925 Alzheimer’s Disease Mental Disorders
Sweden
3,800 8. Diabetes ition and Weight
Australia ndar y 29. Nutr
United Kingdom
3,405 9. Disability and Seco Status
3,213 Conditions Occupational Safet
y and
Japan le 30.
Italy
3,012 10. Early and Midd Health
2,239 Childhood Older Adults
Israel 31.
977 11. Educational and 32. Oral Health
Mexico
eration and Devel
opment (OECD). Community-Based ity and
Source: Organisation
for Economic Co-op http://dx.doi.
Programs 33. Physical Activ
tors. Retrieved from
Glance: OECD Indica Fitness
(2013). Health at a l Heal th
org/10.1787/healt
h_glance-2013-en 12. Environmenta Prep ared ness
and 34.
13. Family Planning
Sexual Health 35. Public Health
uding Infrastructure
prevention, incl
wellness/disease pre- 14. Food Safety ases
and individual type 2 diabetes 36. Respiratory Dise
n and obesity and 15. Genomics ted
smoking cessatio s emp loyers and com
munities
th 37. Sexually Transmit
also help 16. Glob al Heal
vention. The law prog ram s. ted Diseases
ngthen wellness 17. Healthcare-As
socia
institute and stre 38. Sleep Heal th
Infections ants of
ication 39. Social Determin
18. Health Commun Health
Quality
0 19. Health-Related
Healthy People 202
tanc e Abus e
g 40. Subs
c- of Life and Well-Bein
issues health obje r 41. Tobacco Use
U.S. government 20. Hearing and Othe
Each decade, the which is Healthy
Peo-
icatio n 42. Visio n and Hearing
for the nati on, the latest of n goa ls of Sensory Commun
tive s ). The mai
People.gov, 2014 Disorders
ple 2020 (Healthy individuals of all
ages
2020 are (1) to help and (2) to
Healthy People qua lity of life,
improve their the U.S. Figure 1.3
live longer and ng segments of
disparities amo thy People 2020 and Human Services Office of
eliminate health es by gender, race
or eth- Topic Areas for Heal U.S. Department of
Health
uding differenc ic loca- Source: Modified from 2020. Washington
, DC.
population, incl y, geog raph and Health Promo
tion. Healthy People
s2020/default.aspx
cati on or income, disabilit Disease Prevention v/2020/topicsobjective
nicity, edu /healthypeople.go
ntat ion. Retrieved from http:/
orie ols,
tion, or sexual that families, scho
Epigrams enliven each chapter with thought-provoking Healthy People
2020 recognizes
munities, states,
and national orga
niza-
more is insuffici
ent if
worksites, com healthfully. This
means sing people to walk s.
food. Also, advi parks or sidewalk
(and often humorous) quotations about health. tions must help
indi vidu als live
that not only are individuals
thei r com mun ities are not safe or lack
nearly 1,50 0 spec ific
healthy life- 2020 consists of 1.3),
asked to make
soun d Healthy People
into 42 topi c areas (Figure
d on es grouped
The only way to keep style choices base health objectiv ples of specific
goals are
dge but also ific goal. Exam
your health is to
eat health knowle each with a spec
t, ities strive to s as
what you don’t wan that commun on, the following: ber of new cancer case
edu cati the num
t prov ide qua lity • Cancer: Reduce death caused by
drink what you don’ , and tran sportation; the illne ss, disability, and
you’d sing well as
like, and do what
hou
g social and
health-promotin cancer. s: Promote the hea
lth
rather not. ments; and Secondary Condition
physical environ • Disability and ent secondary
condi-
Mark Twain qua lity med ical disabilities, prev
acce ss to
g of people with ariti es between peo
ple with
ple, info rmin inat e disp
care. For exam tions, and elim population.
e five servings of
fresh bilities in the U.S.
healthy to consum and without disa illnesses.
people that it is is insufficient if
their com- uce foodborne
tables each day lthy • Food Safety: Red
fruit s and vege ces of hea
other sour
have stores or
munity does not
 Preface xix

39
Communica tions Maintain Wellness
Chapter Two Mind–Body
arly sensi-
ns are particul
es. The sex orga thera-
sexual respons mind. Most sex
to ima ges generated in the alization
tive and image visu
on techniques
n Reduces Stress pists use relaxati eriences. Tension
Image Visualizatio to help clients imp
rove thei r sexu al exp
n rea-
a story and is usually the mai
is telling yourself al performance ations.
Image visualization An attorney in related to sexu red sexual sens
es in your mind’s eye. eriencing the desi r mental pow-
“seeing” the imag on once in a while during son for not exp n to use you
image visualizati your life, begi ance
Los Angeles uses k. She closes the door In all areas of improve perform
tes of her lunch brea ance health and
the first few minu shoe s, and sits on the floor
with ers more to enh
s off her n
to her office, take eyes and takes a few in daily tasks. ion of suggestio
wall. She closes her is ano ther app licat
her back against a Guided imagery ve stress.
she imagines . . . ng and to relie
deep breaths. Then a meadow that lth and well-bei ge is cre-
ding at the edge of to promote hea in which the ima
. . . that she is stan is shining and aliz atio n,
wildflowers. The sun Unlike image visu , another’s verb
al sug-
is filled with golden re. On the far side
of in guided imagery sical
sant temp eratu ated by oneself, a particular phy
the air is a very plea elf slowly walk- e you to create pres-
gestions help guid
hers
lowering blood
She imag ines
the meadow is a hill. on a path that has as redu cing stre ss,
dow toward the hill gery experi-
ing acro
been worn down
ss the mea
by previous walks
through the flow
to walk on a gent
ers.
ly
response such
sure, or reducing
pain. Often, a guid ed ima
esting that you
take a Health Tips in every chapter enable students to make
the hill, she begins the guide sugg yness” by
When she reaches s, she hears the ence begins with day’s usual “bus
winding path towa
rd the top. As she
m.
walk
Alon g the side of the few moments to
settle from the
ing you r eyes , and taking immediate changes to their behavior.
sounds of birds and
a nearby strea comfortably, clos ges of
flowers, and a few sitting or lying e may suggest ima
es, small trees, a few ths. Then the guid ntain
path she sees bush the hill, where there some deep brea as beside a mou
reaches the top of eful locale, such
stones. Finally, she . Ther e’s a clear ing in the trees, you being in a peac guid e will describe in
tall trees The
is a lovely stand of ’s a fallen log. She
sits
am or at an isolated beach. peac eful and
the clearing there stre ind you how
and on one side of ing through the scene and rem guided to
ys the warm sun filter great detail the ns you may be
on the log and enjo closes her eyes and
rests. . In the mountai d and to
tall trees . She serene you feel s flyin g over hea
branches of the so she opens her meadow or bird ing in a
it’s time to return, see flowers in a d of water flow
After a few minutes, to a very large, the imagined soun
s across the clearing be soothed by imagine the wat
er carry-
eyes, rises, and walk the top of the boul
-
ht be guided to
oth, whit e boul der. She looks on her. She stream. You mig At the beac h you may
smo
mess age written just for ries and tension. hear
der and there ’s a priva te
ns to walk down the ing away your wor on your skin and
and then begi e the warm sun retreats
reads the message ds of the birds be guided to sens re. As the water
, still hearing the soun es coming asho ion, or
path to the meadow sun. Eventually the sound of wav r wor ry, tens
still feeling the warm ies away some
of you
and the stream, and retraces her path
through the to the sea it carr guide will sugg
est that
she reaches the mea dow , minutes, your ed
then . . . pain. After a few e and you are guid
golden flowers, and on the rest of her e your serene plac rn, your
and emb arks it is time to leav t. As you retu
. . . she opens her eyes al environmen
back to your norm rela xed and good you
feel and
work day. you how move
guide reminds ng with you as you
to carry that feeli
encourages you
of your day.
through the rest
king, or
smoking, drin
sports; change urges to
performance in trol compulsive
rs; and help con
rapies
Virtual Reality The
ng beh avio , we all day-
eati in our lives
time or another es
gamble. At one l mov ie,” fant asizing our hop uries that distractio
n is a
“interna riences wn for many cent
dream or run an we visu alize expe It has been kno That is why med
itation,
s. Dur ing such fantasies ge bod y tment for pain. s the
and fear
. Image visualiza
tion can chan very effective trea othe r met hods that focu
and create feelings at, breathing rate
, pro-
hypnotherapy,
prayer, and or other
d flow, heartbe other than pain
temperature, bloo y proc esse s regulated d’s atte ntio n on something
bod min
ones, and other
duction of horm
to
by the brain. with athl etes
sts who wor k
Mos t psy cho logi ge visualization
.
phy sica l perf ormance use ima ng, and TERMS
improve tennis, golf, skii
inner games of -
The so-called tion. Baseball play ns to create
d on ima ge visu aliza g verbal suggestio
skating are base and visualization guided imagery: usin relaxation, and
p use relaxation images that produce
ers in a batt ing slum
. Basketball play
ers use one’s own mental redu ce stress
es getting hits nly feelings of harm ony, and
to “see” themselv throws going clea imag es to promote
to “see” their free : use of men tal
the technique image visualization
hoo p. sex ual ge behaviors
through the
atio n also can imp rove healing and chan
Ima ge visu aliz ual arou sal beg
ins in
enjoyme nt. Sex e the
resp ons es and or fears can stifl
negative thoughts
the mind, and

Chapter Twelve Reduc

ing Infections and Building Immunity: Know
ledge Encourages Preve
ntion 275
Ebola – A Deadly
Virus Emerges
Ebola is a deadly virus thousands of anim
named for a small als in Africa over the
Peoples’ Republic river in the certain species of years showed that
of Congo where it bats normally carry only
by Western scientists was first detected being harmed by the ebola virus with
in 1976. Since the it. out
remote village in initial discovery in After becoming infec
the Congo, it has a ted with ebola, a pers
in villages in the Cong resu rface d numerous times symptoms within on may develop
o as well as in othe a few days or as long
in sub-Saharan Afric r remote locations in a few instances as 21 days or more
a. Each outbreak was . The symptoms are
confined to a smal contained by bein infections–fever, head similar to most viral
l region where peop g ache, and body pain
in or out. That all chan le could not easily diarrhea follow. As . Vomiting and
ged in 2014 when move of 2014, there were
son showed up in a single infected per- treating ebola; patie no specific medicine
a populated area nts received supp s for
became infected of West Africa. Man ily fluids to replace ortive therapy, prim
and the epidemic y people the body fluids that ar-
Sierra Leone, Guin quickly spread throu from failure of the were lost. Death occu
ea, and Liberia. By gh kidneys, liver, or loss rs
spread into Mali. Beca the end of 2014, it fluids of an ebola of blood. All body
use the disease erup had patient
where people lived ted in urban areas tears, sweat, and seme carry infectious viruses including
in close contact and n. Caring for ebola
ebola infections spre moved about freel hazardous as evid patients is extremely
y, enced by the high
Current topics are highlighted in boxes to give a com-
ad rapidly in West rate of healthcare
Ebola viruses are Africa. deaths in West Afric worker
among the smallest a. A number of infec
particle contains viruses. Each virus who were flown to ted doctors and nurs
only seven genes specially outfitted es
whose genetic infor U.S. hospitals were
plete perspective in your study of health and wellness. tion is carried in a
duce seven proteins
tiny RNA molecule.
that allow the virus
The seven genes
ma-
pro-
cessfully treated and
5000 ebola deaths
recovered. By the
were recorded in
end of 2014, more
suc-
than
cells, penetrate the to attach to human Several anti-ebola West Africa.
Global Wellness boxes explore health and wellness virus particles. Ebol
orrhagic viruses beca
cells, replicate the
a belongs to a class
RNA, and produce
of viruses called hem
new development. Thes
healthcare workers
drugs and at least
e first will be used
two vaccines are in
to protect and treat
use they cause infec - who are at high risk
topics as they affect different countries and cultures. producing extensive
varies widely but
bleeding. The deat
averages more than
ted cells to rupture
h rate from ebola
with infected patie
safe and effective,
nts. When drugs and
they then will be used
because of close cont
a vaccine are foun
act
d to be
Ebola was first trans 50% of people infec susceptible populatio to treat and vaccinate
mitted to people ted. ns. Authorities hope
came in contact with when people ate epidemic under cont to bring the ebola
fruit bats in Africa. or rol by 2015–2016.
reservoir for ebol The bats serve as virus has migrated However, now that
a but are not harm a from extreme rural the
ed by the virus. Testi outbreaks will likely regions to massive
ng of occur from time to cities,
time.

stage called plas

ma cells) synthesi
specific kind of ze vast amounts
antibody that atta of one
pathogens in the ches to all of the TERMS
body. Once the specific
nized and inactiva antibodies hav
ted them, other e recog-
the job of destruct white blood cells antibodies: proteins
ion. To produce finish that recognize and
in large amounts the correct anti viruses, bacteria, and inactivate
takes about a bodies other organisms and
tion, which is why week after an stances that enter toxic sub-
other quicker-acti infec- the body
defense mechan ng immune syst antigens: foreign
isms are also nee em proteins on infectiou
The B cells and ded. that stimulate an s organisms
T cells interact antibody response
complex ways to among themselv
produce a full-fled es in B cells: cells of the
Small molecules ged immune response immune system that
called cytokine . antibodies produce
of the B cells and s coordinate the
T cells. Many of activities cell-mediated imm
such as interfero the natural cyto unity: the response
ns and interleu kines, infections of T cells to
tions of the imm kins , that regulate func
une system are - cytokines: small mol
by biotechnolog now also manufac
y companies. Som tured ecules that coordina
used in the trea e of these prod activities of B cells te the
tment of cancer ucts are and T cells
which the func and other diseases humoral immunit
tions of the imm in y: the response of
T cells are also une system are infections B cells to
divided into diffe impaired.
ing to their spec rent classes acco lymph nodes: nod
ific functions. Help rd- ules spaced along
proliferation of er T cells increase vessels that trap infec the lymphatic
B cells, killer T the tious organisms or
and other path cells destroy canc particles foreign
ogenic organism er cells
retard the grow s, and suppressor
th of other imm T cells lymphatic system:
class of T cells calle une system cells. A a system of vessels
d CD4 cells are special trap foreign organism in the body that
the diagnosis and important indicato s and particles; the
development of rs in system is part of the immune
CD4 cells in the AIDS. When the lymphatic system
blood falls, a pers level of T cells: cells of the
susceptible to on becomes extr immune system that
infection by man emely organisms that infec attack foreign
isms, causing one y different mic t the body
of the more than roorgan-
diseases that char two dozen infe
acterize AIDS. ctious
xx Preface

Wellness Guides offer tips, techniques, and steps toward

a healthy lifestyle and self-responsibility. Chapter Twenty-One
Accidents and Injuries
479
College Athletes
Opt for Health
Most college stud Association (the gove
ents (and their fami rning body for colle
college education lies) expect their oped rules to mini giate sports) deve
to provide knowledg mize head injuries. l-
will facilitate attai e and skills that during, and after For example, befo
ning a satisfying job football season, prac re,
Students do not expe and a healthy futur tackling to the grou tices that involve
ct to graduate from e. nd and/or full-speed live
injury that causes college with a brain limited to two per blocking are to be
cognitive, emotiona week. Also, to avoid
will persist throughou l, and health defic coaches to return pressure from footb
t life. Unfortunately its that a player with a susp all
U.S. college students , many of the 500,0 activity sooner than ected concussion
who are active in 00 is medically responsib to
are at risk of brain intercollegiate athle nel should be hired le, medical person-
injury from a conc tics and paid for by the
ing in their sports. ussion while parti instead of the athle student health servi
A concussion is a cipat- tic department. Furth ce
injury (TBI) caused type of traumatic should make publ ermore, schools
by a bump, blow, brain ic their protocols
lision that causes or jolt from a fall or ing concussions and for diagnosing and
the head and brain a col- should conform to manag-
abruptly. Concussio to move back and American Academy guidelines set by
ns are usually not forth of Neurology and the
can result in serio life-threatening, but of Sports Medicine the American Colle
us intellectual impa they . Although originally ge
toms of concussio irment. Common football, the data focused on safety
n are difficulty think symp- on the prevalence in
irritability, anxiety, ing clearly, headache head trauma amo of concussions and
and sleep disturban , ng college athletes other
concussion recover ce. Most people with should be given to indicate that atten
quickly; however, a other concussion-pr tion
toms that persist. others may have symp accompanying table one sports (see the
Also, sustaining one - ).
likelihood of othe concussion increases
rs. the
In 2014, athletes from
major universities
College Players Asso formed the National
ciation to protect their Collegiate Athletes
progress, and well- health, academic ’ Concussion Rate
being from concussio Sport s by Sport
Among the NCPA’s ns and other injuries.
goals are to minimize Women’s ice hock Concussion Rate per 1,000
brain trauma and to college athletes’ risks ey Athletic Expos ures
prevent players from for Men’s spring footb 0.91
sports-related med having to pay for their all
ical expenses. They 0.54
leges from revoking also want to prohibit Men’s ice hockey
an injured player’s col-
and enforce uniform scho larship and establish Women’s soccer 0.41
safety guidelines in
ous injuries and avoid all sports to prevent Men’s football 0.41
able deaths (NCPA seri-
As an anonymous , 2014). Men’s soccer 0.37
football player post
“This isn’t about getti ed on Reddit (2014): Men’s lacrosse 0.28
ng paid. What it is
of us will have num about is protection 0.25
erous injuries throu . Many Women’s lacrosse
A group of those playe ghout our playing
rs will continue to careers. Men’s wrestling 0.25
injuries long after feel the effects of thos
their playing days e Women’s basketball 0.25
some sort of medical are over. The goal
protection if we need is to have Men’s basketball 0.22
from injuries susta surgeries stemming
ined while playing Softball 0.16
Prompted by conc for our university.”
ern for athletes’ long Baseball 0.14
the Pac-12, Ivy Leag -term health,
ue, and the Natio 0.09
nal Collegiate Athle Source: Data from
tic Hootman, J. M., et
injuries from 15 sports al. (2007). Epidemiolo
. Journal of Athletic gy of collegiate
Training, 42, 311–3
19.

Many retired prof

essional football
brain damage. players have seri
The National Foot ous a concussion, brai
other sports orga ball League (NFL n damage from
nizations now ) and late over time. headers may accu
head injuries in stress the need A professional mu-
sports. In 2010, to reduce soccer player may
the NFL placed a post thousands of hea execute
every team’s lock er in ders in practice
er room warning Studies of professi and games over
long-term effects players of the poss onal soccer play a career.
of concussions ible exhibit signs of ers show that som
to set up a fund . In 2013, the NFL brain injury, loss e do
to pay for concussi agreed on both. Because of cognitive func
lems of approxi on-related health of the growing tion,
mately 18,000 prob- brain damage from concern over long
original fund of retired NFL play headers, it is reco -term
$765 million was ers. The dren younger than mmended that
ficient, and a cour later found to be age 14 who play chil-
t ordered that mor insuf- allowed to use soccer should not
to compensate e money be set their heads to be
past and future aside any time. intercept a socc
health problem NFL players who er ball at
s from repeated suffer
Recently, attentio concussions.
n has turned to
also suffer conc soccer players
ussions; these may who TERMS
to-head collision occur from falls
s, being hit by a , head-
monly, by repeated kicked ball, or, mor
“headers” (using e com- concussion: a blow
the ball in orde the head to inte to the head that caus
r to score or pass rcept temporary loss of es injury,
header may not ). Although an indi consciousness, and
cause any obse vidual period of amnesia possibly a
rvable problem
such as
upon awakening
35
Communications Maint ain Wellness
Chapter Two Mind–Body

you can choose to

feet. This shows that on
the bottoms of your cious awareness)
(also called your cons
focus your attention discomfort from your
Focusing Attention what you want to:
your feet, signa ls of
ories of a nice time you
thousands to-do list, or mem
that you could read body, worries, your n is being aware of
what
A wise teacher said as good as a special. Meditatio
itation, but none is had with someone ment basis and shift
ing
of books about med notice the sensation of on a moment-to-mo
do this: Righ t now , your mind is doing to, for example, to
your
demonstration. So, insides of the enes s if you wish of
feet touching the es the focus of your awar or an image. Instead
the bottoms of your caused by the nerv soun d or pray er,
s. That sensation is breathing, a repeating and pulled this way and that by the
bottoms of your shoe your brain that your
feet ed
your feet signa ling your mind being push itation allows you
to notice that your
in the bottoms of signa ling has been going on of your life, med to shift
shoes. That busyness gly so—and
are touching your page, but you were —perhaps distressin e,
e been reading this mind is overly busy facilitates feeling stabl
the entire time you’v tion was focused to something that
ed because your atten your mental process
unlikely to have notic aps on other thou
ghts— and adaptive.
read ing— or perh in control, flexible,
on what you were ge the focu s of your attention to
d to chan
until you were aske

Table 2.3
Hypnosis
t Happens During anything that he or
she wants.
Myths About Wha
r hypnosis you lose
control of your mind
and the hypnotist
can make you do
or make you do some
thing against your
will or beliefs. A hypn
hypnotist selects
people from the audie
otized
nce Managing Stress boxes give you practical strategies
Myth: While unde control your mind ypnosis. The stage OK to do them.
a hypnotist cannot self-h it is
for coping with stress.
in movi es, hypn osis is mind s that
Fact: Despite what
is portrayed Ultimately, all use they agree in
their to
ized” at any time. on the stage beca if you do not agree
to become “unhypnot le do funny things can control your mind
person can decide of the act. Peop
desire to be helpe d. No one
otized and be part use of trust and a
who want to be hypn suggestions beca do not
follows a therapist’s you wake up you
Similarly, a person around you. When
of what is happening
cooperate voluntarily
. us and are unaware
g aslee p. You become unconscio d. is like focus ed attention in
like fallin hypnotize osis
Myth: Hypnosis is you while you were feel very aware. Hypn and choose to
going on around cts report that they touch with reality
remember what was hypnotized subje you are always in
do not lose consc
iousness, and most deep meditation,
Fact: In hypnosis you of others. Just as with
hts to the exclusion
you are awar e of specific thoug peop le’s mind s.
which e up.”
tative state or “wak they can control other special powers shou
ld be
remain in the medi which explains why e who claim to have
ic or occult powers, g suggestions. Thos
have special psych are skillful at givin self-hypnosis.
Myth: Hypnotists rs of observation and that all hypnosis is
trained their powe Always remember
Fact: Hypnotists have es and shou ld not be trusted.
n motiv ly enter
avoided because
they harbor hidde e can be hypnotize
d. ge intelligence usual
or of low intelligenc le with above avera on the
with “weak minds” do in all abilities. Peop or are terrified by
what is happening
Myth: Only people that ability as they People laugh, cry, adopting the
ugh people vary in in a movie theater. of hypnosis and, by
be hypnotized, altho ider what happens egoers are in a state s. Witness
Fact: Everyone can other s. Cons the scree n. Most movi ol of their mind
a state of hypnosis
more easily than
powe rfully are, in reality, light on es. Neve rthele ss, everyone is in contr osis is self-h ypnosis.
es that affect them
so by the imag all hypn
to be manipulated emphasizing that
screen. But the imag allow their emotions Again, it is worth
r,” have agreed to turned on abruptly.
role of “moviegoe or if the lights are
“unhy pnot izing” if someone yells “fire” harm ful beha viors. ng a wide range of symptoms.
the sudden tive in improving
health or be very useful in treati sts
not useful or effec profession als, may clinical psychologi
Myth: Hypnosis is by trained health Many physicians and
it is called when used peutic technique. ing, alcoholism, and
hypnotherapy as apy as a valid thera panic attacks, smok
Fact: Hypnosis, or approved hypnother lems such as pain,
, the Amer ican Medical Association emot ional , and behavioral prob
In 1957 of physi cal,
to treat a wide range
use hypnotherapy
disorder.
posttraumatic stress
medi-
e people think,
trary to what som over
and healing. Con giving up control
take time to deve
lop a
n is not a cult, religion, or out thou ghts
tatio ed out” with
sicians have to much isn’t being “zon
everything. Phy ing to take as one’s mind. It itation is focusing
ents and be will Inst ead , med
rapport with pati er all que stio ns and make sure or used to esca
pe reality.
y to answ -
time as necessar g hypnotized. Mod
fortable with bein age of
the patient is com w for this in an
tice does not allo Time is money
ern medical prac Cha pter 19). TERMS
HMOs (see
managed care and
ical practice. produced
in modern med awareness on a self-
Meditation: Focusing d, or
”) or an external soun
inner sound (“mantra n attentiveness to
Meditation thin g to lesse
spiritual image, or one’s brea
g relig ious and external stimuli
a long-standin n, and
Meditation is trance inductio
sed awareness, health
practice of focu used to prom ote
is increasingly
relaxation that
 Preface xxi

ing and Preve nting Disease

Part Four Understand al—in
350 -counter, or illeg
iption, over-the nant.
g any drug—prescr they become preg
en exp erie ncing “mornin r to prot ect a fetus should
nant wom orde
of choice for preg be extremely safe
and
was thought to not act
sickness.” The drug als, where it did DES
in pregnant anim DES thetic hormone
had been tested 1960s, the syn ent mis-
In the 1950s and ed to help prev
as a teratogen. any woman who ol) was prescrib the
ever , thal idom ide is not safe for al deve l- (diethylstilbestr tifie d as a teratogen until
How es with norm not iden before
lidomide interfer carriage. DES was en who took DES
is pregnant. Tha s and legs of a fetus and Man y dau ghters of wom had abn or-
bones of the arm 1970 s. ed that they
opment of the Between nancy discover
abnormalities. or during preg n they tried to
developmental drug ctive organs whe
causes other tera toge nic effects of the ities in their reprodu a high er risk
whe n the pe mal rs also have
1956 and 1961, s of babies in Euro t. These daughte did not
gnized, thousand severe become pregnan ough the drug
were finally reco been born with nal cancer. Alth
in the world had s more of developing vagi dren of DES mot
hers, the
and elsewhere and legs . Many thousand e abn orm alities in all chil en carr y the
the arm s preg- caus t DES wom
deformities of sure how many tly great that mos e
no one knows for risk is sufficien l for reproductiv
were stillborn, but
nant women lost thei r fetu ses or gave birth
to deformed
Unit ed psyc hological burden
of their potentia
Dollars & Health Sense boxes focus on the influ-
r app rove d for sale in the prob lem s and cancer.
was neve
babies. The drug
States largely beca
use of Francis Kels
ey, a physician at
(FDA) who was
responsi-
the

A and is
ence of economic forces on individual and com-
Administration t Accutane logue of vitamin
Food and Drug concerned abou etinoin) is an ana
ble for new drug
applicat ions . She was
yed its approva
l until the
Accutane (isotr
sold as a drug calle
d Accutane that
is used to treat
severe
in lab-
munity health; for example, the marketing of
drug ’s side effects and dela ed in othe r rder s. Accu tane was tested
the were discover diso
and other skin use it caused
devastating effe
cts of
countries
the drug
had ban ned the use of thal ido- acne
orat ory anim als and labeled a tera toge n
to preg
beca
nan t mic e and worthless and sometimes dangerous supplements
countries. Most n administered
birth defects whe warning that
mide by 1961.
However, inte rest in the ther apeutic potentia
l of tha-
arch rats . The drug was finally
used during
released with the
preg nan cy. How ever, dur- and devices for weight management, fitness, and
not subsided. Rese it should not be defects
ted drugs has with congenital
lidomide and rela
has continued
and, in an iron
ic twist of fate
, thalido-
d by the FDA
ing the 1980s, hun
dreds of babies
who became preg
nant while taki
ng stress relief; direct-to-consumer advertising in the
e, Tha lom id) was approve wer e born to women som e case s, the women
mide (trade nam associated with problems. In
in 1998 for use
in treating skin lesio ns
with a strong
warning Acc utan e
may have beco
for skin
me pregnant by
accident whi le taki ng the
condi-
marketing of minimally effective and sometimes
g now comes any con- rove their skin
leprosy. The dru e the drug for the desire to imp
advising doctors
not to prescrib
it is not app rove d or for women who
drug; in others,
tion may have caus ed them to disr
egard the warning
the FDA, the gove rnm
. This
ent dangerous pharmaceuticals; and cigarette adver-
dition for which thalidomide is mma faced by
t. The lesson from points out a dile
might beco me preg
may
nan
beco me preg nant should not take
tising to encourage youths to start smoking.
that women who

They
ct to the high cost.
and Medicaid, obje
Medicare Disability that discovered the
drug
rosis scientific research
g Cystic Fib point out that the ved considerable
The Cost of Treatin that Verte x recei
ayers and
0 babies are was paid for by taxp n and hence spen
t less
d States about 30,00 c Fibrosis Associatio drug.
Each year in the Unite disease that causes severe help from the Cysti to develop the new
billion to $2 billion d by
born with cystic fibro
sis, a
inhe rited than the typical $1 in the price , as is being demande
). This nt
brea thing prob lems (Kaiser, 2012 rits a With out some adjustme nts, each patie nt receiving the
lung and an affected child inhe European governme
occu rs beca use ts the U.S. and profi t for Verte x. In the
(genetic) disease ern medical treatmen a multi-billion-dollar doing
each parent. Mod drug will produce and sale, Vertex is
defective gene from to survive to abou
t drug development
with cystic fibrosis for-profit model of fit. And patients
enable babies born pies, there still its product as it sees
Desp ite the impr oved care and thera testi ng of noth ing illegal to price to have a med icine that can save
age 40. n by gene tic are relieved
y patient; preventio and their families
is no cure for ever cost.
is the best strategy. a life, no matter the s approved for
prospective parents ation (FDA) and and other new drug
and Drug Administr and other The cost of Kalydeco which is almost alwa
ys
In 2012 the U.S. Food pean Unio n, especially cancers—
heal th prog rams in Canada, the Euro , whic h can serious diseases— men t or annu ally if the drug
the Kalydeco (ivakator) $100,000 per treat facing
oved the drug sis more than pres sing prob lem
countries appr of cystic fibro inuously, is a
in a specific subtype Vertex must be given cont tic technologies to
restore lung function with cystic fibrosis. m. With modern gene
of 100 individuals the healthcare syste l numbers of patie
nts,
patients—about 4 manufactures Kalyd
eco, drugs to treat smal
mace utica ls, the company that n twice daily ). help produce more rs will be temp ted to exploit their
Phar (take lope tic and other
,000 for a year ’s supply of pills will need indu stry and drug deve and treat ing gene
charges $300 ond to the drug . Detecting
patients who resp advantage financially economic concerns
Most cystic fibrosis rife with ethical and
des to stay alive. serious diseases are the coming years.
to take it for deca lies, and insurers, become urgent in
nts and their fami through that are going to
Many doctors, patie h pays for the drug
government, whic
including the U.S.

Chapter Fifteen Hered

ity and Disease
Critical Thinking 357
About Health
1. A friend who
is about 25 year
that she is preg s old has just lear
nant. The wom ned susceptibility gen
and likes to part an smokes ciga es increase risk
y on weekends. rettes , they do not mak
Based on what cancer inevitab e
have learned abou you le (see Chapter
t the causes of should be informe 13). If you agre
in this chapter con genital defects d, how should rela e they
, make a list of and what support tives be notified
dietary, and lifes all the behavio should be offe
tyle changes you ral, hand, should rela red? On the othe
to your friend to would recomm tives not be told r
help ensure that end certainty they since there is no
healthy child. Disc she gives birth will develop pan
uss the rationale to a there is no esta creatic cancer
recommendatio for each of you blished rule or and
ns. r should be info law that says rela
2. Abortion is rmed of harmful tives
one of the mos a relative’s DNA mutations foun
American soci t controversial ? d in
ety. At one end issues in
of the spectrum 4. A few years
views are people ago, the U.S. mili
who think that of personnel to hav tary ordered all
be prohibited for all abortions shou e a blood sample service
any reason wha ld DNA of each indi taken so that the
life of the pregnan tsoever, even if vidual’s cells coul
t woman is in jeop the the pattern plac d be analyzed and
extreme are peo ardy. At the othe ed on file, much
ple who believe r of fingerprints as the FBI keep
woman should that each pregnan of criminals and s files
have complete t the military wan others. The reas
soever she cho freedom to do ts each person’s on
oses with resp what- DNA analyzed
ect to her preg that remains can is so
because it is her nan cy be positively iden
body. Evaluate person dies in tified in case that
abortion and pres these two view a future conflict
ent your own s of to give a blood . One soldier refu
detail as possible. views in as muc sample in violatio sed
Substantiate each h and was ordered n of a direct orde
3. Are scientis of your views. to stand before r
ts obliged to info soldier argued that a court martial.
results of their rm nonscientis he had no assu The
research that mig ts of rance that his DNA
ht bear on susc information wou
bility to a serious epti- ld be kept private
disease? Here is used for purposes and would not
A scientist is stud an example. of discriminati be
Chapters conclude with Critical Thinking About who have died
trying to discover
ying the DNA
from cancer of
from patients
the pancreas. She
ment in other way
a. Do you thin
s.
k the military
on or to his detr
i-

any genes that is is just ified in wanting

Health—a set of questions that present controver- in the developm
the DNA of man
ent of the dise
may be involved
ase. She finds
that
each person’s DNA
b. In wha t way
on file?
s mig ht the DNA
y patients with used to the detr info rma tion be
sial or thought-provoking situations and ask you carry mutations
cers. One such
that are known
mutation is BRC
pancreatic can
to cause other
cer
can-
military or afte
iment of the sold
r his release from
ier either in the
A2, which is a c. Discuss the military service?
established risk pros and cons
to examine your opinions and explore your biases. in women. Sho
factor for breast
uld the scientis
and ovarian canc
well-
er
profile of ever
file in a federal
y person in the
of having the
United States
DNA
pancreatic canc t inform relative agency so that on
er patients of her s of any person coul
can be tested for discovery so they be pos itiv ely d
iden tifie d by
BRCA2? Even thou authorities, gove law enfo rcem ent
gh most cancer rnment agencies
nizations, shou , or other orga
ld the need aris -
e.

Chapter Summa
ry and Highlights
Chapter Summar
y
The hereditary
information in following this
tained in long, chai every human bein amazing accompl
nlike molecules g is con- DNA sequence ishment, the com
of DNA, in turn of DNA. The mol s of some viruses, plete
, are packaged ecules and animals wer bacteria, yeast,
of which come into 46 chromos e obtained. This plants,
from each pare omes, 23 the cost of sequ became possible
needed to constru nt. All of the info encing DNA drop because
ct a human bein rmation process became ped dramatically
3 billion pairs g is con tained in about automated and as the
of four different cost of sequenci computerized.
and T. Every hum chemical letters: ng all of the DNA Today, the
an trait, from skin A, G, C, thousand dollars. in a person is only
sity for athletic color to the prop a few
and intellectual en- Because of thes
massive “Book ability, is contained in e advances in sequ
of Life.” In the 1990 this olution has occu encing DNA, a rev-
decipher the exac s, scientists deci rred in our und
t sequence of the ded to (genetic) diseases erst anding of inhe
3 billion elements rited
UI/Shutterstock

one person’s DNA . A defect in a

. The U.S. governm in a genetic disease single gene can
and established ent funded the such as sickle cause
the Human Gen idea dystrophy, cyst cell anemia, mus
sequencing a com ome Project. The ic fibrosis, hem cular
goal of oph
Sky image: © ARZTSAM

plete human gen others. Genetic ilia, and thousands

2003 when the ome was reached defects can be of
entire sequenc in parents, and new identified in pros
The cost of this e was published genetic and repr pective
project was $2.7 online. help prevent the oductive technolo
billion. In the defective genes gies
years children. Diseases from being passed on
such as cancer, to
heart disease, diab
etes,
xxii Preface

End-of-chapter material includes Chapter Summary and

Highlights (a brief review of the chapter), For Your Health
(new self-evaluation exercises), References, Suggested
Readings, and Recommended Websites where you can find
additional health information.

hy Relationships
Part Three Building Healt
216

for rea-
inducing labor
About Health the practice of
Critical Thinking disagreed with that Chapter Nine Understand
eless believed ing Pregnancy
son, the hospita
l’s nce, he neverth and Parenthood
muttered Dr. John sons of convenie d to nigh ts and making wise cho 217
1. “Hmmmm,” d over the hos
pi- t wrong, compare ices about med
icine, as he pore if something wen l was not fully
staffed, such as episioto ical intervention
s,
new chief of med John son ’s curi os- n the hos pita my and pain man • Approximat
ing statistics. Dr. weekends whe less risky for the • Childbirth is agement. ely 20% of Am
erican married
tal’s recent birth data showing a
wide were financially divided into thre are infertile. Som couples
were piqued by weekday births stage starts with e stages. The
first e of these cou
ity and concern ction among the the
the beginning
of cally assisted to ples can be med
i-
rates of labor indu hospital. thing to change until the cervix labo r and lasts become pregnan
variation in the ital: Dr. Smi th, 7%;
Should Dr. John
son do any
what
is fully dilated.
The second stag may occur with t; pregnancy also
ners at the hosp hospital? If so, the birth of the e is in vitro fertiliza
medical practitio 45%; and Dr. Has
t- practices at the baby. The third insemination. tion or artificia
; Dr. Tompkins, labor induction of the placenta stage is the deli
very l
Dr. Anderson, 12% nati onal rate not, why not? . • Adoption is
Dr. John son knew that the U.S. should he do? If and smoking are
dan- • The period afte
r childbirth may
an alternative
for couples. Chil
ings , 74% .
managed prio r to this drugs, alcohol, involve breastfe be adopted thro dren can
the hospital he 2. We know that gine that you are ing and resumpt ed- ugh a private
was 20%, and at loping fetus. Ima ion of sexual acti agency, in an inde or public adoptio
rate was 12%. gerous to a deve nt.
vities. pendent or priv n
assignment the checked the hos- er in a restaura international ado ate adoption, or
ch, Dr. Johnson working as a serv a customer who
was ption. an
Following a hun determine the
days you say or do if
rized records to a. What would
pital’s compute ital for the prev
i- a glass of wine? For Your Health
births at the hosp pregnant ordered a custome r who was
and times of the Dr. Tom kins had you say or do if
He discovered that b. What would ? Perhaps not now
ous four months. period, king a cigarette but some day you
ken d deli very during that time pregnant was smo : Peop le hav e been ing a parent. Use
the “Parenthood
may consider beco
m-
only one wee d deliveries and
only this point of view and Me” questio (Exercise 9.1, pag
s had no weeken 3. Comment on s. Nowadays, the nnaire e 000) to help clar
and Dr. Hasting thousands of year for possibly beco ify your motivat
having babies for icalized with birth
ing ming a parent. ions
two after 2 A.M. the medical reco
rds fur- is way too med
stiga ted entire process s, ane sthesia, fetal
Dr. Johnson inve
tings had note
d in l delivery room References
ed that Dr. Has classes, hospita labor induction,
cesareans,
ther and discover rds that the wom
en epis ioto my, American Coll
’ medical reco monitoring, bottlefeeding. ege of Obstetr
several patients n for reasons
of per- male infants, and icians and Gyn
labo r indu ctio circumcision of (2011). Exercis
e during pregnan ecologists.
had requested h Dr. John son personally http://www.acog cy. Retrieved from it heading? Curr
ent Opinions in Obst
nce. Althoug .org/~/media/For ogy, 22, 482–486. etrics and Gynecol-
sonal convenie pdf?dmc=1&ts=2 %20Patients/faq
0120322T13182386 119. Swan, S. H. (200
Carroli, G., & Mig 28 8). Environmen
nini, L. (2009, Janu relation to repr tal phthalate exp
ary 21). Episioto oductive outcome osure in
more vaginal birth. Coch my for
healthy child. The
ry and Highlights
rane Database of endpoints in hum s and other hea
give birth to a lth
Chapter Summa nancy Issue 1. Art. No.: Systematic Reviews ans. Environmenta
couples want to n a healthy preg CD000081. doi: , 177–186. l Research, 108
learn abou t how to maintai ome will CD000081.pub2 10.1002/14651858 ,
y couples e likely the outc . U.S. Central Inte
Chapter Summar an being process, the mor Food and Nutritio lligence Agency.
life to a new hum and the birthing (2011). Country
nant and giving experi- involved.
n Board, Institute son: Infant mor compari-
Becoming preg and rewarding be joyful for all
Dietary Referenc of Medicine. (200 tality rate. Wor
t awe-inspiring lives for-
e Intakes (DRIs) 4). January 21, 2015 ld Fact Book. Retr
ieved
is one of the mos ges peop les’ tional Academ . Washington, DC:
Na- from https://w
s in life. Beco ming parents chan e to beco me edu/~/media/File
ies. Retrieved
from http://www. pub lica tion s/th
e-w orld -fac t-bo
ww.cia.gov/libra
ry/
ence plan and striv Highlights childbirth are imp
ortant iom. ok/ ran kor der
many couples ionally pregnancy, and
s/Activity File
s/Nutrition/DRIs/ 2091rank.html /
ever. Whereas pregnant unintent • Conception, to Summary Table
others become s. The decision Tables 1–4.pdf 5_ Yonkers, K. A.,
pregnant, many of pare nt. Peo- life experience Kuczkowski, K. Vigod, S., & Ros
repa red to take on
the role
nt and meaningful psyc hological and phy
si- M. (2010). A revi
ew of obstetric pathophysiology s, L. E. (2011). Diag
nosis,
are unp be a pare requ ires in the new mill , and managem
and
erta in or who do not wish to beco me a parent
d can hav e pare nts pre- ennium: Where anesthesia
ders in pregnan ent of mood diso
ple who are unc contra- so every chil we are and whe t and postpartum r-
lable methods of cal preparation re is women. Obstetric
of the many avai ive and Gynecology,
should use one s with a prospect pared to meet its
needs. 117, 961–977. s
ng pregnancy risk s of the embryo
ception. Discussi ship. Hav- wed by cleavage
ertaken early in a relation • Fert ilization is follo About the sixt
h day
partner should
be und
t and understanding. es into the uterus. g Suggested Readin
on can fost er trus
a as it mov
the embryo imp
lants in the linin gs
ing such a discussi nant and have after fertilization, the Boston Women’s
les who desi re to become preg repr o- the nex t 266 days or so Health Book Coll
Some coup ern for ective. (2011). Our
one part ner is infertile. Mod of the uterus, and
ks of preg nan cy a baby ourselves: Pregnanc bodies,
child may find that y infer- . After 40 wee y and birth. New Murkoff, H., & Maz
it possible for man fetus develops A comprehensi York: Touchstone el, S. (2008). Wha
gies now make ances ve, accessible, . t to expect when
ductive technolo use of circumst is born. nutri- expectant mothers up-to-date boo expecting. New York you’re
have a child. Beca nancy such as good . k for : Workman Pub
lishing. This pop
tile couples to still ies and young
children habits during preg l lar guide to preg u-
man y bab • Hea lthy cise and physica nancy covers ever
beyond their con
trol,
Ado ptio n by persons seek ing pren atal care, exer te to a natal period, from y aspect of the
pre-
without pare nts. tion , con tribu developmental
find themselves lenges of parentin
g tional well-being stages to nutrition
take on the chal activity, and emo .
and coup les eage r to
and new hope. nancy. ciga-
Recommended
children new lives cially
successful preg hol, and smoking Websites
gives orphaned nancy are espe • Taking drugs,
consuming alco or American Academy
its during preg e fetal damage
Good health hab is responsible nancy can caus of Fam
ily Physicians
nan t mother-to-be rettes during preg amn ioce ntesis or cho- Provides informa
UI/Shutterstock

The preg cco as tion on a vari Motherisk Program

important. her unb orn child’s. All toba birth defe cts. Tests, such e to dete rmi ne to pregnancy, chil ety of topics
related at the Hospital for
and labl dbirth, and cari
for two lives, hers hol should be stop
ped pling, are avai ng for a newborn Toronto, Canada Sick Children,
sumption of alco rionic villus sam .
smoking and con an is trying to beco
me cts are present. American Academy Up-to-date info
whether birth defe
Sky image: © ARZTSAM

attend- rmation on the

cy and when a wom ult- be achieved by of Ped
iatrics development. risk of medicati
during pregnan ld be take n without cons • Opt ima l childbirth can ensuring emo-
Information abo
ut immunizatio
ons on fetal
icines shou
e to many aration classes,
UI/Shutterstock

pregnant. No med and exp osur

ing chil dbir th prep th, and and child safety. ns, childhood illne
sses, Parenthood.com
a phy sicia n. Many medicines deve lopm en- for the mot her during childbir
ing cause tional support Tons of informa
environment can nant KidsHealth tion about beco
chemicals in the of a fetus. Preg ming pregnant,
Sky image: © ARZTSAM

and /or bod y and parenthood. pregnancy,

brain Provides doctor-
tal defects in the approved hea
children, from lth information ParentsPlace.com
before birth to about
adolescence. Lots of informa
tion about preg
week-by-week nancy, includin
pregnancy guid g a detailed
e.

The text also includes appendixes on relaxation exercises • Chapter 16 includes new coverage on changes in
and stress management techniques (including guides for marijuana laws.
yoga and t’ai chi). • Chapter 17 includes new coverage on e-cigarettes.
A workbook has been included at the end of the text • Chapter 19 includes new coverage and a more detailed
to provide you with self-assessments and activities to discussion of the Affordable Care Act (ACA).
explore your own health. • Chapter 24 includes expanded coverage of the
Below are some examples of topics that are new predicted health effects of climate change.
to this edition or have been expanded upon from prior • Updated Chapter Summary and Highlights sections,
editions: at the end of each chapter, highlight key points and
• Chapter 2 provides an expanded discussion of spiri- emphasize the essential health message in each
tuality and health. chapter.
• Chapter 8 includes new coverage on the right to marry • New For Your Health sections are included at the end
for gay couples as well as updated information on the of each chapter, featuring self-evaluation exercises
LGBT community and gender identity. that ask readers to look at their own health and fit-
• Chapter 12 includes new information on ebola and ness lifestyle.
worldwide efforts on controlling infectious diseases.

A Note of Thanks
Throughout all of the editions of Health and Wellness, many
people have contributed support and guidance. This book
has benefited greatly from their comments, opinions,
thoughtful critiques, expert knowledge, and constructive
suggestions. We are most appreciative for their partici-
pation in this project. We also want to thank our editors
(past and present) and all of the people at Jones & Bartlett
Learning for their unflagging support of this textbook over
the years.
Reviewers
Lawrence E. Acker, PhD, MHA, Harris-Stowe State
University
Pat Alsader, Planned Parenthood of West Central Illinois
David Anspaugh, Memphis State University
Catherine G. Ansuini, Buffalo State College
Jennifer Austin, PhD, ATC, NH LAT, Colby-Sawyer College
Judy B. Baker, East Carolina University
Cynthia Bartok, Nutrition and Exercise Science
Department, Bastyr University
N. K. Bhagavan, University of Hawaii Medical School
Nancy J. Binkin, Centers for Disease Control and Preven-
tion, Atlanta
David Birch, Indiana University
Barbara Brehm-Curtis, Smith College
Tyrone R. Burkett, LSW, Professor, The Pennsylvania
State University
Donald Calitri, Eastern Kentucky University
Barbara Coombs, San Francisco City College
Linda Chaput, W. H. Freeman, New York
Dorothy Coltrin, De Anza College
Geoffrey Cooper, Harvard Medical School
Nicholas J. DiCicco, EdD, Camden County College
Judy Drolet, Southern Illinois University at Carbondale
Philip Duryea, University of New Mexico
Seymour Eiseman, California State
University–Northridge
Carol Ellison, Berkeley, California
Marlene Henry Fletcher, Mental Health Services Depart-
ment, Central Texas College
Marianne Frauenknecht, Western Michigan University
Laura Fox Fudacz, Ivy Tech Community College of
Indiana
Nicole Gegel, Illinois State University
Katherine Gieg, Health and Sport Sciences Department,
Missouri Baptist University
Preface xxiii
Mai Goldsmith, Southern Illinois University at
Edwardsville
Wretha G. Goodpaster, MSRS, Imaging Sciences
Department, Morehead State University
Catherine M. Headley, Judson College
Allan C. Henderson, California State University–Long
Beach
Meg Henning, MA, PhD, Keene State
Sherry Hineman, University of California–San Diego
Leo Hollister, Stanford Medical Center
Stanley Inkelis, Harbor General Hospital
John Janowiak, PhD, Appalachian State University,
Curriculum and Instruction Department
William Kane, University of New Mexico
Mark Kittleson, Southern Illinois University at
Carbondale
Tim Knickelbein, Normandale Community College
Dawn Larsen, Mankato State University
C. H. “Pete” LeRoy, New Mexico Highlands University
Karen M. Lew, Med., ATC, LAT, Kinesiology and Sport
Sciences Department, University of Miami
Will Lotter, University of California–Davis
Beverly Saxton Mahoney, The Pennsylvania State
University
Mary Martin, University of California–San Francisco
Sharon Mathis, Benedictine College
Patricia L. McDiarmid, EdD, Springfield College
Marion Micke, Illinois State University
Peter J. Morano, Central Connecticut State University
Richard P. Morris, Rollins College
Linda J. Mukina Felker, PhD, Edinboro University of
Pennsylvania
Debra J. C. Murray, University of North Carolina at
Chapel Hill
Anne Nadakavukaren, Illinois State University
Ann Neilson, PhD, College of Saint Rose
Marion Nestle, New York University
Roberta Ogletree, Southern Illinois University at
Carbondale
Larry Olsen, The Pennsylvania State University
Elizabeth O'Neill, Central Connecticut State University
David Phelps, Oregon State University
Richard Plant, South Middlesex Community College
Bruce Ragon, Indiana University
Kerry J. Redican, Virginia Technical University
Dwayne Reed, Buck Institute for Research on Aging
Janet Reis, University of Illinois at Urbana–Champaign
Russell E. Robinson, PhD, Shippensburg University
xxiv Preface
Brian Luke Seaward, Paramount Wellness Institute
Sam Singer, University of California–Santa Cruz
Susan Spreecher, Illinois State University
Chris Stratford, RN, BS, EMT, University of Utah
David R. Stronck, California State University–East Bay
John Struthers, Planned Parenthood of Sacramento
County
Michael Teague, University of Iowa
Amy Thompson, Mississippi State University
Eric Triffin, MPH, Southern Connecticut State
University
Tony N. Trunfio, State University of New York–Cortland
George L. Walker, PhD, Health & Human Performance
Department, Cumberland University
Aleida Whittaker-Gordon, RD, MPH, MBA, California
State Polytechnic University–Pomona
Bryan Williams, University of Arkansas
Malinda Williams, MS, ACSM-HFI, NSCA-CPT*D,
University of Oklahoma
Carol Wilson, University of Nevada at Las Vegas
Richard Wilson, Western Kentucky University
Doris D. Yates, PhD, Hospitality, Recreation, and Tourism
Department, California State University, East Bay
Acknowledgments
This book could not have been published without the
efforts of the staff at Jones & Bartlett Learning and
the Health Science team: Cathy Esperti, Kayla Dos
Santos, Dan Stone, Julie Bolduc, Amy Rathburn, and
Sara Peterson. We would also like to thank Brian Luke
Seaward, PhD, Paramount Wellness Institute; James
Walsh; Esther M. Weekes; Martin Schulz; Shae Bearden;
Rocky Young; Bharti Temkin; Laura Jones-Swann, MEd,
LCDC, Texas Tech University; and Scott O. Roberts, PhD,
FAACVPR, Texas Tech University. To all, we express our
appreciation.
 PART ONE

© Skynesher/iStockphoto.com

Achieving Wellness
Chapter 1
The Definition of Health
Chapter 2
Mind–Body Communications Maintain Wellness
Chapter 3
Managing Stress: Restoring Mind–Body Harmony
Chapter 4
Sky image: © ARZTSAMUI/Shutterstock

Mental Health
© maridav/123RF

Health Dollars & Health Global Managing Wellness

Tips
The Two-Minute Stress Reducer
Reduce Stress When Sitting
in Front of a Computer
Sense
Large Corporations Profit from
Products that Make People Sick
How Much Money is
a Life Worth?
Wellness Stress Guide
Chronic Diseases in Rich Mind–Body Harmony Spirituality, Religion,
and Poor Countries: Harmony and Peace and Health
The Causes Differ
© jiris/Shutterstock

CHAPTER 1

The Definition of Health

Learning Objectives
1. Describe the medical and wellness models of health.
2. List the key points of the World Health Organization
definition of health.
3. List and describe the six dimensions of wellness.
4. List the three health behaviors responsible for most of the
actual causes of death.
5. Define lifestyle disease.
6. Identify the goals of Healthy People 2020.
7. List and describe the major health issues of college students.
8. Describe the Health Belief Model, Transtheoretical Model, and
Theory of Reasoned Action/Theory of Planned Behavior.
Sky image: © ARZTSAMUI/Shutterstock
4 Part One Achieving Wellness
Most people usually think of health as the absence of
disease. But what about someone who has a relatively
harmless genetic disorder, such as an extra toe? Is this
individual less healthy than a person with the usual
number of toes? Different perhaps, but not necessarily
less healthy.
It is true that not feeling sick is one important aspect
of health. Just as important, however, is having a sense of
optimum well-being—a state
The health of a people of physical, mental, emo-
is really the foundation tional, social, and spiritual
wellness. In this view health
upon which all their
can be obtained by living in
happiness and all
harmony with yourself and
their powers as a state
with your social and physi-
depend. cal environments. You foster
Benjamin Disraeli your own health and well-
being when you take respon-
sibility for avoiding harmful behaviors (e.g., not smoking
cigarettes), limiting your exposure to health risks (e.g.,
not drinking alcohol and driving; limiting the consump-
tion of junk food), and by undertaking healthy behaviors
and practices such as consuming nutritious food, exer-
cising regularly, attending to your mental well-being,
Mind–Body Harmony
When you are well and healthy, your body systems
function harmoniously. If one of your organs is not
functioning properly, however, the other organs may not be
able to function correctly either, and you may become ill. Thus,
disease may be regarded as the disruption of physical and
mental harmony.
The Yin–Yang Symbol
This symbol represents the harmonious balance of forces in nature
and in people. The white and dark dots show that there is always
some yin in a person’s yang component and vice versa. The goal in life
and nature, according to the traditional Asian view, is to maintain a
harmonious balance between yin and yang forces.
and supporting actions that contribute to the health and
well-being of your community (e.g., limiting pollution and
reducing violence).
In this chapter we discuss the definition of health,
how modern lifestyles contribute to an enormous degree
of chronic illness throughout the world, and how adopting
healthy living habits can help people maintain wellness.
Throughout this book, we show you ways to maximize
your health by understanding how your mind and body
function, how to limit exposure to pollution and toxic sub-
stances, how to make informed decisions about health
and health care, how to be responsible for your actions and
behaviors, and how social, economic, and political forces
affect your ability to lead a healthy life. Learning to be
responsible for the degree of health and vitality you want
while you are young helps to ensure lifelong wellness and
the capacity to cope with sickness when it does occur.
Models of Health
Scientists and health educators have developed two main
ways to define health: the medical model, and the well-
ness, or holistic, model.
Many Asian philosophies embody an idea of mind–body
harmony. This idea is based on a universal energy called chi
(qi), which must be distributed harmoniously throughout
the mind–body to attain and maintain health. Harmony is
expressed as a balance of forces called yin and yang. Yin and
yang represent the opposing and complementary aspects of
the universal chi that is present in everything, including our
bodies. Yang forces are characterized as light, positive, creative,
full of movement, and having the nature of heaven. Yin forces
are characterized as dark, negative, quiet, receptive, and having
the nature of earth.
In Asian philosophies and medicine, body and mind are
regarded as inseparable. Yin and yang apply to both mental
and physical processes. When yin and yang forces are in bal-
ance in an individual, a state of harmony exists and the person
experiences health and wellness. However, if either yin or yang
forces come to predominate in a person, a state of disharmony
is produced and disease may result.
Treatment of disease is designed to reestablish harmony of
the mind and body. The balance of yin and yang forces must be
restored so that health returns.
T’ai chi ch’uan and qigong (pronounced jê-kung) are two
Chinese mind–body methods that are being practiced by
more and more North Americans to help maintain health and
harmony. These exercises are especially useful for older per-
sons whose bodies can no longer manage vigorous exercise.
People who practice qigong experience lower blood pressure,
improved circulation, and enhanced immune system functions.

The Medical Model of Health
The medical model of health’s main tenet is that health
is the absence of one or more of the “five Ds”—death, dis-
ease, discomfort, disability, and dissatisfaction. In other
words, if you are not sick, disabled, or clinically depressed,
you are defined as healthy. The medical model relies
almost exclusively on biological explanations of disease
and illness and is interpreted in terms of malfunction of
organs, cells, and other biological systems (e.g., liver dis-
ease, heart disease, or osteoporosis). In the medical model,
the absence of health is determined by the presence of
observable or measurable symptoms. In times of sickness
the restoration of health is accomplished by successfully
treating the underlying cause of the disease. If that is not
possible, then the goal is to alleviate symptoms.
Within the medical model, the health of a population
is measured in terms of vital statistics, which are data
on the degree of illness (morbidity) and the numbers of
deaths (mortality) in a given population. Vital statistics
include the following:
Incidence: the number of new cases of disease of
illness during a particular time period, generally
expressed per 100,000 population. Example: The
annual incidence of chlamydia infection among U.S.
college student is about 1,000/100,000.
Prevalence: the total number of people in a commu-
nity, country, or other group with a particular health
status. Example: The prevalence of high blood pres-
sure among U.S. adults is about 50 million.
These statistical measurements allow comparisons
between populations and also within the same popula-
tion over time.
The medical model tends not to deal with social fac-
tors that affect health and only with difficulty integrates
mental and behavioral issues that do not derive from dis-
eased organs. In the medical model, health is restored by
curing a disease or by restoring function to a damaged
body part. Furthermore, the medical model rarely consid-
ers psychological and social factors in the cause, diagno-
sis, treatment, and prevention of illness and disease.
© aricvyhmeister/Shutterstock
A healthy lifestyle depends on exercise.
Chapter One The Definition of Health 5
The reliance on biological interpretations of illness
has contributed greatly to the success of the medical
model. Anyone who has been cured of a serious infec-
tion by taking antibiotics or undergone a lifesaving surgi-
cal procedure can attest to that. On the other hand, that
same reliance on biological thinking has not furthered
understanding of health and illness in terms of psycho-
logical and social factors, nor has it been very success-
ful in encouraging healthy lifestyles, reducing unhealthy
behaviors, and fostering a healthy environment.
For example, overweight and obesity, which are a
worldwide pandemic, are caused in most instances by
overconsumption of low-nutrient food and by too little
physical activity. Rather than addressing personal living
habits and social conditions, the response of the medical
model to overweight and obesity is to treat patients with
drugs, surgery, or both to alter the biological aspects of the
condition. In fact, surgically tying off most of the stomach
in obese individuals is one of the fastest-growing surgical
procedures in the United States.
The Wellness Model of Health
If freedom from sickness isn’t all there is to health, then
what else is involved? The World Health Organization
(WHO) employs a wellness definition of health, as fol-
lows: health is “a state of complete physical, mental, and
social well-being and not merely the absence of disease
and infirmity.” This definition is so broad and covers so
much that some people find it meaningless. Its universal-
ity, however, is exactly right. People’s lives, and therefore
TERMS
chi: a Chinese term referring to the balance of energy
in the
T E body
RMS
health: state of sound physical, mental, and social
well-being
incidence: the number of new cases of a particular
disease
medical model: interprets health in terms of the
absence of disease and disability
morbidity: the number of persons in a population
who are ill
mortality: death rate; number of deaths per unit of
population (e.g., per 100, 10,000, or 1,000,000) in a
specific region, age range, or other group
prevalence: the number of people within a population
with a particular disease
vital statistics: numerical data relating to birth, death,
disease, marriage, and health
6 Part One Achieving Wellness
their health, are affected by every aspect of life: envi-
ronmental influences such as climate; the availability of
nutritious food, comfortable shelter, clean air to breathe,
and pure water to drink; and other people, including
family, lovers, employers, coworkers, friends, and associ-
ates of various kinds.
The WHO definition of health recognizes the inter-
relatedness of the physical, psychological, emotional,
social, spiritual, and environmental factors that contrib-
ute to the overall quality of a person’s life. All parts of the
mind, body, and environment are interdependent. The Old
English root of our word health (hal, meaning sound or
whole) implies that there is more to health than freedom
from sickness.
Jesse Williams (1939), one of the founders of modern
health education, echoes the WHO definition by describ-
ing health as
that condition of the individual that makes possible
the highest enjoyment of life, the greatest constructive
work, and that shows itself in the best service to the
world. . . . Health as freedom from disease is a standard
of mediocrity; health as a quality of life is a standard
of inspiration and increasing achievement.
Health is not static; it is a dynamic process that takes into
account all the decisions we make daily, such as which
foods we eat, the amount of exercise we get, whether we
Harmony and Peace
Many Native American cultures and tribes incorporate
the idea of harmonious interactions with nature, animals,
and other people in their religions.
Reprinted with permission from The Sacred Pipe: Black Elk’s Account of
the Seven Rites
Reprinted with of the Oglala
permission Sioux,
from Theby Joseph
Sacred Pipe:Epes Brown.
Black
Elk’s Account
1953, 1989ofby
University the University
Oklahoma Press. of Oklahoma Press.
drink alcohol before driving, wear seat belts, or smoke cig-
arettes. Every choice we make potentially affects health
and wellness. Sometimes the social and physical environ-
ments present obstacles to making healthful choices. For
example, a person may know not to eat fatty, fast food
every day, but this kind of food may be easier to obtain
than healthier alternatives. Wellness includes recogniz-
ing that some social influences are not healthy and find-
ing healthier alternatives. It also includes taking actions
to make the social and physical environments healthier
for all.
Health is not something suddenly achieved at a spe-
cific time, like getting a college degree. Rather, health
is a process—indeed, a way of life—through which you
develop and encourage every aspect of your body, mind,
and spirit to interrelate harmoniously as much of the time
as possible. Health means (1) being free from symptoms of
disease and pain as much as possible; (2) being active, able
to do what you want and what you must at the appropri-
ate time; and (3) being in good spirits and feeling emo-
tionally healthy most of the time.
The wellness model emphasizes self-healing, the pro-
motion of health, and the prevention of illness rather than
solely the treatment of symptoms of disease. Consider,
for example, how the wellness model views the head-
ache. About 80% to 90% of American adults experience at
The first peace,
which is the most important,
is that which comes from
within the souls of men when they
realize their relationship,
© Photos.com
their oneness, with the universe
and all its powers,
and when they realize that
at the center of the universe dwells
Wakan-Tanka, and that
this center is really everywhere,
it is within each of us.
This is the real peace, and the others are
but reflections of this.
The second peace is that which is
made between two individuals,
and the third is that
which is made between two nations.
But above all you should
understand that there can never be peace
between nations until there is
first known that true peace which . . .
is within the souls of men.
Copyright
Black
of the©Seven Rites of the Oglala Sioux, by Joseph Epes Brown. Copyright © 1953, 1989 Elk
by the
The Sacred Pipe

least one headache each year.
You can observe a lot
Although a headache can be
just by watching.
the result of brain injury or
Yogi Berra the symptom of another ill-
ness, more often it is caused
by emotional stress that produces a tightening of the
muscles in the head and neck. These contracting muscles
increase the blood pressure in the head, thereby causing
the pain of headache.
The medical model advocates relieving a headache
by taking aspirin or some other drug that can alter the
physiological mechanisms that produce the pain. In con-
trast, the wellness approach advocates determining the
source of the tensions—worry, anger, or frustration—and
then attempting to reduce or eliminate it.
Identifying and eliminating the sources of tension
and anxiety in your life is the surest way to prevent
headaches. Some people have learned to use “having
a headache” as a means of avoiding unpleasant situa-
tions, such as school or work obligations. As children
they may have observed their parents coping with ten-
sion and stress by “getting a headache,” and so they too
learned that “having a headache” can be used to avoid
anxiety-provoking experiences. Have you developed
such an avoidance mechanism?
Dimensions of Health and Wellness
The wellness model of health has six dimensions of
health and wellness: emotional, intellectual, spiritual,
occupational, social, and physical:
1. Emotional wellness requires understanding emo-
tions and coping with problems that arise in every-
day life. A person with emotional wellness is able to
maintain a sense of humor, recognize feelings and
appropriately express them, strive to meet emo-
tional needs, and take responsibility for his or her
behavior.
2. Intellectual wellness involves having a mind open
to new ideas and concepts. If you are intellectually
healthy, you seek new experiences and challenges.
A person with intellectual wellness is able to com-
municate effectively in speaking and in writing, see
more than one side of an issue, keep abreast of global
issues, and exhibit good time-management skills.
3. Spiritual wellness is the state of harmony with your-
self and others. It is the ability to balance inner needs
with the demands of the rest of the world. A person
with spiritual wellness is able to examine personal
values and beliefs, search for meanings that help
explain the purpose of life, have a clear understand-
ing of right and wrong, and appreciate natural forces
in the universe.
4. Occupational wellness is being able to enjoy what you
are doing to earn a living and contribute to society,
whether it be going to college or working as a secretary,
Chapter One The Definition of Health 7
The Two-Minute Stress Reducer
Stressed out?
Be still.
And take a
D
E
E
P
Breath.
Center Yourself
Focus your attention inward. Allow thoughts, ideas, and
sensations to pass through your mind without reacting to
any of them. You will notice them pass out of your mind,
only to be replaced by new thoughts and sensations.
Continue to breathe deeply and slowly and watch the
passing of the thoughts that stress you.
Empty Your Mind
Acknowledge that you have preconceived ideas and
ingrained habits of perceiving. Know that you can empty
your mind of distressing thoughts and replace them with
ones that create inner harmony.
Ground Yourself
Feel the sensation of your body touching the earth. Place
your feet (or your bottom if you are sitting, or your entire
body if you are lying down) firmly on the earth. Let your
awareness come to your point of contact with the earth,
and feel gravity connecting you to Mother Earth and
stabilizing you.
Connect
Allow yourself to feel your physical and spiritual
connection with all living things. Remind yourself that
with every breath you are reestablishing your connection
with all of nature.
TERMS
TERMS
emotional wellness: understanding emotions and
knowing how to cope with problems that arise in
everyday life and how to manage stress
intellectual wellness: having a mind open to new
ideas and concepts
occupational wellness: enjoyment of what you are
doing to earn a living and contribute to society
spiritual wellness: state of balance and harmony with
yourself and others
wellness model: encompasses the physiological,
mental, emotional, social, spiritual, and environmental
aspects of health
8 Part One Achieving Wellness
doctor, construction manager, or accountant. In a job,
it means having skills such as critical thinking, prob-
lem solving, and communicating well. A person with
occupational wellness is able to feel a sense of accom-
plishment in his or her work, balance work and other
aspects of life, find satisfaction in being creative and
innovative, and seek challenges at work.
5. Social wellness refers to the ability to perform social
roles effectively, comfortably, and without harm-
ing others. A person with social wellness is able
to develop positive relationships with loved ones,
develop relationships with friends, enjoy being with
others, and effectively communicate with others who
may be different.
6. Physical wellness is a healthy body maintained by
eating right, exercising regularly, avoiding harmful
habits, making informed and responsible decisions
about health, seeking medical care when needed, and
participating in activities that help prevent illness.
A person with physical wellness is able to exercise
regularly and select a well-balanced diet; participate
in safe, responsible sexual behavior; make informed
choices about medicinal use and medical care; and
maintain a positive, health-promoting lifestyle.
Spirituality, Religion, and Health
Many people believe that spirituality—finding
meaning, hope, comfort, and inner peace through
religion, a connection with Nature, or some force larger
than oneself—plays a role in health and illness. Spiritual
experiences tend to engender feelings of compassion and
empathy; peace of mind; relatedness and communion
with a force, power, or set of values larger than oneself;
and harmony with the environment. These feelings are
believed to be a cornerstone of health because they rep-
resent a balance between the inner and outer aspects of
human experience. For some, the spiritual dimension of
life is embodied in the practice of a specific religion. For
others, the spiritual dimension is nonreligious and simply
part of a personal philosophy. Many practices can help
people experience the spiritual realms of existence—
prayer, meditation, yoga, musical and artistic endeavors,
and helping others are but a few common ones.
Becoming more spiritually aware, regardless of the
chosen path, can lead to a healthier life. Being in touch
with your spiritual feelings helps you handle life’s ups and
downs with understanding and compassion for yourself and
others. You become open to love in the highest sense of
its meaning, which is acceptance and tolerance. You begin
to love yourself despite your problems and hang-ups. You
love your family and friends when relations are strained.
You see beauty and harmony in more and more aspects
of living. And occasionally—however fleetingly—you may
experience the truly wondrous feeling of being completely
and joyfully alive.
Because wellness is dynamic and continuous, no
dimension of wellness functions in isolation. When you
have a high level of wellness or optimal health, all dimen-
sions are integrated and functioning together. The person’s
environment (including work, school, family, community)
and his or her physical, emotional, intellectual, occupa-
tional, spiritual, and social dimensions of wellness are in
tune with one another to produce harmony.
Lifestyle Diseases
In the early part of the twentieth century, infectious
diseases—those caused by bacteria, viruses, and other
parasites—were the leading causes of death because
modern public health methods and modern drugs, such
as antibiotics, were not available. In 1918, millions of
people around the world died from influenza, the cause
of which was unknown at that time, but is now known
to be a virus.
Today, the leading causes of death in the United
States and much of the industrialized world are not due
to infections but to “lifestyle diseases” (Table 1.1). These
diseases, such as heart disease and cancer, mostly result
from people’s behaviors and the ways in which they live.
Heart disease, for example, results primarily from
poor diet, cigarette smoking, lack of exercise, high levels of
stress, high blood pressure, and high levels of blood cho-
lesterol. Cancer is associated with poor nutrition, smoking
cigarettes, and exposure to hazardous substances in the
environment. An unhealthy lifestyle is also at the root of
many instances of lung disease (from cigarette smoking)
and type 2 diabetes and kidney disease (from overweight).
Table 1.1
Ten Leading Causes of Death in the United States for All
Ages, All Races, and Both Sexes, 1900 and 2013
1900 2013
1. Tuberculosis Heart disease
2. Pneumonia Cancer
3. Diarrhea and Chronic lower respiratory diseases
enteritis (e.g., emphysema/bronchitis)
4. Heart disease Stroke/disease of brain blood vessels
5. Liver disease Accidents
6. Injuries Alzheimer’s disease
7. Stroke Diabetes (mostly type 2)
8. Bronchitis Flu and pneumonia
9. Cancer Kidney disease
10. Diphtheria Suicide
Source: Data from Centers for Disease Control and Prevention, National Center
for Health Statistics, NCHS Data Brief, Mortality in the United States, 2013,
Number 178, December 2014. Retrieved February 5, 2015 from http://www.cdc.
gov/nchs/data/databriefs/db178.htm
 Chapter One The Definition of Health 9

In some instances, suicide and accidents are from stress

© Cora Reed/Shutterstock
or drug and alcohol use.
A major characteristic of many lifestyle diseases is
that they are chronic diseases that persist for years or life.
Chronic diseases lower the quality of life of the affected
person and usually shorten the life span. A chronic
disease also tends to affect a patient’s family and is costly
to the healthcare system. About 70% of total annual U.S.
health expenditures of $2.4 trillion is for chronic condi-
tions. About half that amount is spent on medical care
for diseases that are largely preventable, such as heart
disease, many cancers, high blood pressure, and type 2
diabetes (American Public Health Association, 2012).
When a person dies, the cause of death is generally
identified in terms of the organ system(s) that failed and
resulted in the person’s death, for example, heart disease,
cirrhosis of the liver, cancer of the lung. This may not,
Many alternative medical practices, such as chiropractic, massage, and
however, identify the root causes of that death. For exam-
acupuncture, are now considered legitimate medical treatments and are
ple, saying someone died of lung cancer does not tell us often covered by insurance.
that the actual cause of death was smoking. When deaths
are examined for their actual causes and not simply what
is reported on death certificates, the results show that
smoke contribute substantially to deaths caused by can-
approximately half of the 2.6 million deaths in the United
cer of all kinds, heart disease, high blood pressure, stroke,
States each year are due to lifestyle factors (Figure 1.1).
bronchitis, chronic obstructive pulmonary disease (COPD),
Leading the list of life-shortening behaviors is poor
pneumonia, low birth weight, and burns from fires. The
diet. Low consumption of fruits, vegetables, nuts, and
enormous toll on life and health exacted by tobacco use
seeds and high consumption of salt and sugar contribute
is the reason that health agencies, doctors, and govern-
to 680,000 American deaths annually. Next to poor diet is
ments overwhelmingly recommend avoiding tobacco use.
tobacco use, which is responsible for more than 446,000
Low-to-no physical activity is responsible for 234,000
American deaths per year. Smoking cigarettes and cigars,
deaths, principally from heart disease, high blood
chewing tobacco, and being exposed to second-hand
pressure, stroke, and diabetes. Alcohol abuse accounts
for nearly 48,000 deaths each year from alcohol toxicity,
motor vehicle and pedestrian accidents, and homicides.
Poor diet (680,000) In contrast, only 25,000 deaths annually are attributable
Tobacco use (466,000) to the use of illegal drugs. Unsafe sex is responsible for
20,000 deaths from AIDS and other diseases.
Low physical activity (234,000)
Environmental factors also cause fatalities. For exam-
Alcohol abuse (88,000) TERMS
ple, exposure to toxic agents in the workplace and else-
Infections (77,000) where accounts for about 55,000 deaths per year. Firearms
Cause

Toxic agents (55,000) used in homicides, suicides, and accidental shootings are
responsible for 31,000 deaths. Motor vehicle accidents
Motor vehicle accidents (33,700)
cause nearly 40,000 deaths.
Firearms (31,600)
Illegal drug use (25,000)
Risky sexual behavior (15,000) TERMS

0 1 2 4 6 8 10 15 20 chronic disease: a disease that persists for years or

even a lifetime
Percentage of Total Deaths
physical wellness: maintaining a healthy body by
n Figure 1.1
eating right, exercising regularly, avoiding harmful
Number of Preventable Deaths in the United States in 2010
habits, and making informed, responsible decisions
Estimates of the annual number of deaths are in parenethesis. The
data include actual numbers (firearm deaths) and calculated risks about your health
(tobacco deaths). More than 1 million deaths are caused by lifestyles and
social wellness: ability to perform social roles
behaviors—all these deaths are preventable.
effectively, comfortably, and without harming others
Source: Data from U.S. Burden of Disease Collaborators. (2013). The state of U.S. health,
1990–2010. Journal of the American Medical Association, 310, 591–608.
10 Part One Achieving Wellness
Large Corporations Profit from
Products that Make People Sick
Heart disease, stroke, lung cancer, colon cancer,
type 2 diabetes, and chronic obstructive pulmonary disease
account for nearly half of all deaths in the United States.
These diseases are caused in large part by unhealthy lifestyle
choices: eating poorly, smoking cigarettes, being overweight,
and not exercising. Unfortunately, many large corporations
profit from individuals’ unhealthy lifestyles—indeed, some
encourage unhealthy behavior as the basis of their business.
The tobacco industry is the prime example of profiting
financially from harming others. No other industry makes a
product that, when used as directed, causes disease and death.
Knowing that long-term smokers (i.e., their best customers)
tend to begin smoking as teens, the tobacco industry uses
sophisticated marketing methods to lure young people to
smoke and to get them hooked. The tobacco industry is a
friend to no one.
Whereas it is not as obvious as with tobacco, some food
companies, for example, also profit from harming their
customers. A typical serving of fast food (e.g., burger, fries, and
a soft drink or shake) contains around 1,000 calories, about
half or more of most individuals’ energy requirement for one
day. Approximately one-third to one-half of those calories are
Type 2 Diabetes as a Lifestyle Disease
Diabetes is a disease in which the amount of sugar in the
blood increases to unhealthy levels as a result of malfunc-
tions in the body’s sugar-regulating system. Diabetes can
cause blindness, blood vessel problems, kidney failure,
heart damage, and death. There are two forms of diabetes:
Type 1 (insulin-dependent). The pancreas (a digestive
organ) is diseased and is unable to manufacture the
hormone insulin, which regulates the level of sugar
in the blood. Medical treatment involves frequent
injections of insulin.
Type 2 (non-insulin-dependent). Too much fat in
the blood (generally from being overweight) causes
body cells to resist the actions of insulin (insulin
resistance). This causes blood levels of sugar to rise.
Over time, insulin-producing cells in the pancreas
become damaged and produce less insulin. Treat-
ment includes increasing exercise, decreasing the
consumption of calories to produce weight (fat)
loss, and possibly injections of insulin or drugs that
decrease insulin resistance.
Evidence that type 2 diabetes is a disease of lifestyle
comes from studies of populations that have dramatically
altered their lifestyle over a brief time span. For example,
Yemenite Jews who emigrated to Israel in 1949 had one of
the lowest rates of type 2 diabetes in the world—less than 1
case per 1,000 individuals. Thirty years later, the same popu-
lation, now adapted to a Western lifestyle in Israel, had a rate
of almost 12 cases of type 2 diabetes per 1,000 individuals.
from fat, a prime contributor to heart and blood vessel disease.
Fast food also contains large amounts of cholesterol and salt,
which also contribute to heart and blood vessel disease. This is
why a steady diet of fast food can lead to weight problems and
associated illnesses like type 2 diabetes.
Some of America’s largest corporations are in the business
of supplying consumers with less-than-healthy amounts
of sugar. The sugar is contained in packaged foods (from
ketchup to breakfast cereals), snack foods, fast food, and
sugar-sweetened beverages, such as sodas, energy drinks, and
sports drinks. Sugar-sweetened beverages alone deliver 36%
of the added sugar that Americans consume, contributing to
the risk of heart disease and type 2 diabetes. And, unlike other
products to which sugar is added, sugar-sweetened beverages
have no nutritional value; they can readily be replaced by
healthy beverages such as water and low-fat milk. Efforts to
limit the damage to health from added sugar in food include
taxing sugar-sweetened beverages in order to lessen con-
sumption, particularly among youth, and encouraging food
companies to voluntarily reduce the amount of sugar added
to their products.
You need not wait for the actions of government and indus-
try to better your health. You can start today by resisting efforts
of others to profit from distributing ill health and by adopting
healthy living habits.
Another example is the prevalence of type 2 diabe-
tes among the Pima Indians of the southwestern United
States. Traditionally, these Native Americans lived
mostly on maize, beans, wild game, and vegetables. They
were active, lean, and strong. Because forced relocation
removed them from their traditional environment, today
many Pimas have adopted living habits characteristic of
most Americans, and hence many are overweight and
about 40% have type 2 diabetes, the highest incidence in
the world.
Currently, about 26 million Americans are affected
with type 2 diabetes and millions more have prediabetes,
a risk factor for developing diabetes in 10 years. Diabetes
is strongly associated with being overweight: For every
20% increase in weight gain, the chance of diabetes dou-
bles. As a consequence of the epidemic of overweight and
obesity in the United States, diabetes has become a major
health problem.
Diabetes is a problem not only in the United States
but also around the world. In 2000, the global number
of people with diabetes was about 171 million (2.5% of
the world’s population). In 2013, about 347 million people
worldwide had diabetes (about 7.3% of the world’s popula-
tion). By the year 2025 the number of people with diabetes
is expected to be more than 450 million.
Research has conclusively shown that eating
healthfully and regularly engaging in a moderate phys-
ical activity can reverse and prevent type 2 diabetes
(American Diabetes Association, 2013). This is the reason

that everyone is encouraged to learn more about healthy
eating and the value of moderate physical activity.
Whereas each individual is responsible for her or
his lifestyle decisions, scientists and health profession-
Percentage of Students Who Are Nearsighted
als know that many lifestyle diseases, including type 2
diabetes, require community-wide efforts to help indi-
viduals make healthy choices (Katz, 2009). For example,
institutions can insist that vending machines contain
healthy foods instead of junk food. Stairwells can be
made visually attractive and have music or video to
encourage walking instead of riding elevators. Munici-
palities can ensure that subdivisions have sidewalks and
many parks. Rather than being at a centralized location,
food service can be located at the periphery of large insti-
tutions to encourage walking.
Many health insurers and employers have begun
to offer financial incentives to employees to make
healthy changes in their lifestyles. Some companies give
employees time off to exercise during work hours and
financial rewards for losing weight. Some companies
also penalize and even fire employees who violate no-
smoking rules. In a 2008 poll, 91% of American employ-
ers believed that they could reduce their healthcare
costs by getting employees to adopt healthier lifestyles
(Mello & Rosenthal, 2008).
Nearsightedness
Another dramatic example of how modern lifestyles affect
health concerns vision. Many children and a majority of
adults in modern societies wear glasses or contact lenses
to correct for nearsightedness (myopia). When our ances-
tors had to forage and hunt for food, acute vision was
probably essential to survival and, of course, corrective
lenses were unknown. During early development, a child’s
eye adapts to the visual information the eyes receive from
the environment. Looking at distant objects tends to pro-
duce normal vision or eyes that are slightly farsighted.
Today, almost all children watch TV and computer screens
for many hours a day and also read books, magazines, and
newspapers—all of which require close-up vision. These
activities tend to cause myopia in many children.
The influence of modern lifestyles on vision was
documented by measuring the vision of young people in
rural China compared with the vision of Chinese students
in Hong Kong (Seppa, 2013). Most of the young people in
the rural environment had normal vision or were slightly
farsighted (Figure 1.2). In contrast, most of the Chinese
students in Hong Kong were nearsighted, many to a
considerable degree. Thus, if one considers 20/20 vision
desirable, our modern lifestyle, which involves much
close-up vision, is likely to affect eye development and
may produce myopia. Until we understand more about
the environmental and genetic cues that affect visual
development, children should be encouraged to spend
time outdoors, where their eyes are more likely to focus
on distant objects.
Chapter One The Definition of Health 11
100
90
80
70
60
50
40
30
20
10
0
Hong Kong Rural China
Region
n Figure 1.2
Comparison of visual acuity of 18- to 28-year-old students in Hong Kong
with youths in rural areas of China. Most of the rural youths have normal
vision, whereas most of the Hong Kong students are myopic.
Source: Data from J. Wallman. (1994). Nature and nurture of myopia. Nature, 371,
201–202.
The U.S. Medical Care System
In the United States, the medical model of health, focus-
ing as it does on symptoms and disease, has given rise
to an enormous, complex, and expensive industry. Most
of the resources of the medical industry are devoted to
treating people who are already sick. Very little effort is
made to prevent illness and disease or to encourage self-
responsibility for health. Although, in reality, the system
we all pay for and use is one of sickness care, it is called
a healthcare system.
There is little doubt that the U.S. medical care sys-
tem can deliver high-quality sickness care. However, it
produces less health for Americans than do the anal-
ogous care systems in nearly all other high-income
countries, including Canada, Australia, Japan, Sweden,
France, and the United Kingdom. Compared to those
countries, the United States has higher rates of chronic
disease and early death among adults and higher rates
of untimely death and injuries among adolescents and
small children, and larger percentages of people with
obesity, type 2 diabetes, heart disease, chronic lung dis-
ease, and arthritis (Woolf & Aron, 2013). Reasons for the
United States’ poor health rankings are lack of access
to, and deficiencies in, the medical care system; high
rates of unhealthy behaviors, such as excess calorie
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN