Taking Charge of Your Health

Chapter 1

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 • Wellness as a Health Goal

• Health: the overall condition of body or mind and the

presence or absence of illness or injury
• Wellness: optimal health and vitality, encompassing
all the dimensions of well-being
Depends on conscious decisions that affect risk factors

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 • Dimensions of Wellness

• Nine interrelated dimensions of wellness interact

continuously
• Making changes in one dimension often affects
others

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 • Figure 1.1 The Wellness Continuum
The concept of wellness includes vitality in nine interrelated dimensions:
physical, emotional, intellectual, interpersonal, cultural, spiritual,
environmental, financial, and occupational. All contribute to wellness.
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 PHYSICAL WELLNESS
Eating well
Exercising
Avoiding harmful habits
Recognizing symptoms of disease
Getting regular checkups
Avoiding injuries
SPIRITUAL WELLNESS
Capacity for love
Compassion
Forgiveness
Altruism
Joy and fulfillment
Caring for others
Sense of meaning and purpose
Sense of belonging to something
greater than oneself
OCCUPATIONAL WELLNESS
Enjoying what you do
Feeling valued by your manager
Building satisfying relationships
with coworkers
Taking advantage of opportunities
to learn and be challenged
• Figure 1.2 Qualities and Behaviors Associated with
the Dimensions of Wellness
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EMOTIONAL WELLNESS INTELLECTUAL WELLNESS
Optimism Openness to new ideas
Trust Capacity to question
Self-esteem Ability to think critically
Self-acceptance Motivation to master new skills
Self-confidence Sense of humor
Ability to understand and accept one’s Creativity
feelings Curiosity
Ability to share feelings with others Lifelong learning
CULTURAL WELLNESS INTERPERSONAL WELLNESS
Creating relationships with those who are Communication skills
different from you Capacity for intimacy
Maintaining and valuing your own cultural Ability to establish and maintain satisfying
identity relationships
Avoiding stereotyping based on race, Ability to cultivate a support system of
ethnicity, gender, religion, or sexual friends and family
orientation
ENVIRONMENTAL WELLNESS
FINANCIAL WELLNESS
Having abundant, clean natural resources
Having a basic understanding of how
Maintaining sustainable development
money works
Recycling whenever possible
Living within one’s means
Reducing pollution and waste
Avoiding debt, especially for unnecessary
items
Saving for the future and for emergencies
 • New Opportunities for Taking
Charge
• Wellness is a fairly new concept
• Morbidity and mortality rates from common
infectious diseases were much higher 150 years ago
• Life expectancy has nearly doubled
Still, most Americans will experience some sort of
impaired life
Chronic disease: a disease that develops and continues
over a long period
• Each of us can take responsibility for our lifestyle
choices

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 • Figure 1.3 Public Health, Life Expectancy, and Quality of
Life
Public health achievements during the 20th century are credited with adding more than 25 years to life
expectancy for Americans, greatly improving quality of life, and dramatically reducing deaths from
infectious diseases. Public health improvements continue into the 21st century, including greater
roadway safety and a steep decline in childhood lead poisoning. In 2013, the government mandated that
all Americans be covered by health insurance, a protection already long established in most other
industrialized countries.
SOURCES: Kochanek, K.D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4); Centers for Disease Control
and Prevention. 2011. Ten great public health achievements—United States, 2001–2010. MMWR 60(19): 619–623; Centers for
Disease Control and Prevention. 1999. Ten great public health achievements—United States, 1900–1999. MMWR 48(50): 1141.

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 • Figure 1.4 Quantity of Life Versus Quality of
Life
Years of healthy life as a proportion of life expectancy in the U.S. population.
SOURCE: Kochanek, K. D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4). National Center for
Health Statistics. 2012. Healthy People 2010 Final Review. Hyattsville, MD: National Center for Health Statistics.

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 • Table 1.1 Leading Causes of Death in the US, 2013
NUMBER OF % OF TOTAL
RANK CAUSE OF DEATH DEATHS DEATHS LIFESTYLE FACTORS
1 Heart disease 614,348 23.4 Diet; inactivity; smoking; alcohol
2 Cancer 591,699 22.5 Diet; inactivity; smoking; alcohol
3 Chronic lower respiratory diseases 147,101 5.6 Smoking
4 Unintentional injuries (accidents) 136,053 5.2 Inactivity; smoking; alcohol
5 Stroke 133,103 5.1 Diet; inactivity; smoking; alcohol
6 Alzheimer’s disease 93,541 3.6 n/a
7 Diabetes mellitus 76,488 2.9 Diet; inactivity; smoking
8 Influenza and pneumonia 55,227 2.1 Diet; inactivity; smoking; alcohol
9 Kidney disease 48,146 1.8 Smoking
10 Intentional self-harm (suicide) 42,773 1.6 Alcohol
11 Septicemia (systemic blood infection) 38,940 1.5 Alcohol
12 Chronic liver disease and cirrhosis 38,170 1.5 Alcohol
13 Hypertension (high blood pressure) 30,221 1.2 Diet; inactivity; smoking; alcohol
14 Parkinson’s disease 26,150 1.0 n/a
15 Lung inflammation due solids/liquids 18,792 0.7 Alcohol
Other All other causes 535,666 20.0 n/a
Total All causes 2,626,418 100.0 n/a

©McGraw-Hill Education. SOURCE: Kochanek, K. D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4).
 • Table 1.2 Key Contributors to Deaths among
Americans

ESTIMATED NUMBER OF PERCENTAGE OF TOTAL

CONTRIBUTOR
DEATHS PER YEAR DEATHS PER YEAR
Tobacco 480,000 18.3
Diet/activity patterns (obesity) 400,000 15.2
Alcohol consumption 90,000 3.4
Microbial agents 80,000 3.0
Firearms 30,000 1.1
Illicit drug use 25,000+ 1.0
Motor vehicles 20,000 0.8
Sexual behavior 15,000 0.6

SOURCES: Kochanek, K. D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4), National Research Council, Institute of Medicine. 2015.
Measuring the Risks and Causes of Premature Death: Summary of Workshops. Washington, DC: National Academies Press; Stahre, M., et al. 2014. Contribution
of excessive alcohol consumption to deaths and years of potential life lost in the United States. Preventing Chronic Disease: Research, Practice, and Policy 11:
130293; U.S. Department of Health and Human Services. 2014. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
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 • Table 1.3 Leading Causes of Death among Americans
Aged 15–24, 2014

CAUSE OF DEATH, RANKED NUMBER OF DEATHS PERCENTAGE OF TOTAL DEATHS

#1, Unintentional injuries (accidents): 11,836 41.1
Unintentional injury: motor vehicle 6,959 24.2
All other unintentional injuries 4,877 16.9
#2, Suicide 5,079 17.6
#3, Homicide 4,144 14.4
#4, Cancer 1,569 5.4
#5, Heart disease 1,199 4.2
All Causes 28,791 100.0

©McGraw-Hill Education. SOURCE: Kochanek, K. D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4).
 • Promoting National Health

• Health promotion: the process of enabling people to

increase control over their health and its
determinants
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)

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 • The Affordable Care Act
• ACA was signed into law in 2010
Requires most people to obtain health insurance

Regulations expand coverage, limit costs, and guarantee

care for certain services

Health exchanges facilitate the purchase of insurance

Those below income requirements are eligible for federal

help

Students benefit in specific ways, such as with the ability

to stay on their parents’ plans until 26 years old
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 • The Healthy People Initiative

• Healthy People 2020 objectives:

Eliminate preventable disease, disability, injury, and
premature death

Achieve health equity, eliminate disparities, and improve the

health of all groups

Create social and physical environments that promote good

health for all

Promote healthy development and behaviors

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 • Table 1.4 Progress toward Healthy People 2020 Targets
BASELINE MOST RECENT TARGET PROGRESS
HEALTH MEASURE (2008) (2013–2014) (BY 2020) TOWARD GOAL
Increase proportion of people with health 83.2% 86.7% 100.0% Significant
insurance progress
Help adults with hypertension get blood Significant
pressure under control 43.7% 48.9% 61.2% progress

Reduce proportion of obese adults 33.9% 37.7% 30.5% Getting worse

Reduce proportion of adults who drank 27.1% 26.9% 24.4% Insignificant

excessively in past 30 days progress
Increase proportion of adults who meet federal 18.2% 21.3% 20.1% Target met
guidelines for exercise
Significant
Reduce proportion of adults who use cigarettes 20.6% 17.0% 12.0%
progress

©McGraw-Hill Education. SOURCE: U.S. Department of Health and Human Services. Healthy People 2020 data search (https://www.healthypeople.gov/2020/data-search/Search-the-Data).
 • Health Issues for Diverse
Populations
• Health disparities are linked to social, economic,
and/or environmental disadvantage
• Other differences are biological and cultural
Sex and gender
Race and ethnicity
Income and education
Disability
Geographic location
Sexual orientation and gender identity

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 • Factors That Influence Wellness

• Health habits
• Heredity/family history
• Environment
• Access to health care
• Personal health behaviors
Your personal behavior can tip the balance toward
good health, even when heredity or environment is a
negative factor

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 • Reaching Wellness through
Lifestyle Management
• Behavior change: cultivating healthy behaviors and
working to overcome unhealthy ones
• Getting serious about your health:
Examine your current health habits
Choose a target behavior
Learn about your target behavior
Find help

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 • Reaching Wellness through
Lifestyle Management (2)
• Building motivation to change:
Examine the pros and cons of change
Boost self-efficacy
– Locus of control: the extent to which a person believes he or
she has control over the events of his or her life
– Internal locus of control versus external locus of control
– Visualization and self-talk
– Role models and supportive people
Identify and overcome barriers to change

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 • Reaching Wellness through
Lifestyle Management (3)
• Enhancing your readiness to change:
Transtheoretical, or “stages of change,” model

What stage are you in?

Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination

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 • Dealing with Relapse

• People seldom progress through the stages of change

in a linear way; and most make several attempts
• Plan for relapse
Forgive yourself if you have a setback
Give yourself credit for the progress you have already
made
Move on—learn from relapse and use that knowledge to
deal with setbacks in the future

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 • Figure 1.5 The Stages of Change: A Spiral
Model
The stages of change are best conceptualized as a spiral in which people cycle back
through previous stages but are farther along in the process each time they renew
their commitment.
SOURCE: Adapted from Centers for Disease Control and Prevention. n.d. PEP Guide: Personal Empowerment Plan for
Improving Eating and Increasing Physical Activity. Dallas, TX: The Cooper Institute.
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 • Developing Skills for Change:
Creating a Personalized Plan
1. Monitor your behavior and gather data
2. Analyze the data and identify patterns
3. Be “SMART” about setting goals
Specific
Measurable
Attainable
Realistic
Time-frame specific

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 • Figure 1.6 Sample Health Journal
Entries
Keep a record of your behavior and the circumstances surrounding it,
including each activity; when, where, and what you were doing; and how
you felt about it. For example, if you wanted to change your eating
habits, you would track not only what you eat, but when, where, with
whom, and so on.
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 • Developing Skills for Change:
Creating a Personalized Plan (2)
4. Devise a plan of action
Identify resources that can help
Modify your environment
Control related habits
Reward yourself
Involve the people around you
Plan for challenges
5. Make a personal contract

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 • Figure 1.7 A Sample
Behavior Change
Contract
In your behavior change contract, include a statement of your goal and your
commitment to reaching it. It should also include the date you will start; the steps
you will take the measure your progress; the strategies you plan to use to
promote change; and the date you expect to reach your final goal. Have someone
sign your contract as a witness.
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 • Putting Your Plan into Action

• Commit to making your plan work

Remember your reasons
Use all your strategies and keep track of your progress
Reward yourself for achievements
• Staying with it:
Social influences can be negative as well as supportive
Levels of motivation and commitment must be high
Choice of techniques and level of effort may need to be
reconsidered at various points
Stress can be a major obstacle
Be alert to procrastinating, rationalizing, and blaming
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 • Being Healthy for Life

• Maintaining good health is an ongoing process

Once you’ve started, don’t stop
Remember you can’t control every aspect of your health
• You can make a difference: help create an
environment that supports wellness for everyone

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 Review
• Define wellness as a health goal
• Explain two major efforts to promote national health
• List factors that influence wellness
• Explain methods for achieving wellness through
lifestyle management
• List ways to promote lifelong wellness for yourself
and your environment

©McGraw-Hill Education. All rights reserved. Authorized only for instructor use in the classroom.  No reproduction or further distribution permitted without the prior written consent of McGraw-Hill Education.
 Long image descriptions

APPENDIX A

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 • Figure 1.3 Public Health, Life Expectancy, and Quality of Life
Appendix
Important advances have been achieved in several areas:
Vaccinations for childhood diseases
Control of infectious diseases
Fluoridation of drinking water
Safer and healthier foods
Safer workplaces
Motor vehicle safety
Recognition of tobacco use as a health hazard
Family planning
Healthier mothers and babies; and in recent years
A decline in deaths from heart disease and stroke
Implementation of the Affordable Care Act

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