Introduction To Public Health

Lecture 4

Magda Khutsishvili, Pharm B, MPH

Lecturer in the University of Georgia
School of Health Sciences
magda.khutsishvili@ug.edu.ge
• Theme: Social and Behavioral Factors in Health, Do People Choose
Their Own Health? How psychosocial factors affect health behavior.
• Reading Materials: Introduction to Public Health 5th Edition by Mary-
Jane Schneider (Author) chapter 13 and 14, pages: 193-205, 205-217
 Mortality by Infectious and Chronic diseases
In the US, by 1990s, leading causes of death were related to infectious diseases
In the early 20th century, Public Health specialists brought infectious diseases under control
by
• removing etiologic factors from environment
• developing vaccines and immunizing hosts
In the US, from 2013, chronic diseases became more significant as causes of death
Difference between causes of death in the US in
1990 and 2013
Causes of death in the US in 2000
Tobacco as a leading cause of death
• Tobacco accounts for 30 percent of all
cancer deaths and 21 percent of
cardiovascular disease deaths.
• Tobacco causes: chronic obstructive lung
disease, infant deaths due to low birth
weight, and burns due to accidental fires.
• Of the 435,000 deaths attributed to
tobacco smoking, 35,000 were caused by
second-hand smoke.
Poor diet and Physical inactivity as a second cause
of death
Poor diet and Physical inactivity
lead to obesity, which causes:
• Heart disease
• Stroke
• Several forms of cancer
• Diabetes
The number of deaths due to this
factors increased by 22 percent
from the 1990 and continues to
increase even now
Misuse of Alcohol as a third cause of death
Misuse of alcohol causes
• 35 percent to 40 percent of motor vehicle
fatalities
• chronic liver disease and cirrhosis
• Home injuries
• drowning
• 3 percent to 5 percent of cancer deaths.
Alcohol consumption by people under 21, the
legal drinking age in the US, is associated with
some health and social problems.
 Do people choose their own health?
• These 9 actual causes of death accounts for 50% of all
deaths in the US and another 50% includes Genetic
factors
• These 9 actual causes of death have a big importance
for Public Health, because they can be PREVENTED by
public health measures!
• The main question: ‘How can we persuade people to
behave in healthier ways in a democratic society,
where every step is fraught with political, economic,
and moral controversy?’
There are two approaches that the government has taken
to promote healthy behavior:
1. Education
2. Regulation.
Role of Education in Smoking Cessation

• In the US, 1964, Surgeon General’s report

called ‘Smoking and Health’ was the first
authoritative statement from the federal
government that smoking caused cancer and
other life-threatening diseases

• Result: Many people quit the smoking after

learning the information, and the prevalence
of smoking began to decline
 Role of Education in Nutrition
• In the early 20th century, Governmental Educational efforts conducted a research on
requirements for various vitamins and minerals.
• The main focus was about the prevention of cancer, cardiovascular disease and
diabetes
They emphasized on the importance on eating:
1. Less fat
2. Less salt
3. More fruits, vegetables and grains.
• The FDA (Food and Drug administration) has revised its labeling requirements to
provide consumers with the information that will allow them to follow these guidelines.
• Results: have shown success and limitations
• Evidence of dietary improvement is difficult to verify, since surveys of people’s eating
habits are unreliable.
• While the decline in heart disease is encouraging, the prevalence of obesity has
increased,
 Health Educational Programs in Schools
The main goal:
• To teach children from an early age how
to live healthy lives, providing
information about diet, exercise, the
dangers of smoking, alcohol use and
drug abuse.
Studies have shown that health
educational programs influence young
people to behave in healthier ways, for
example:
• Sex education in schools has shown
higher likelihood of using contraceptives
and condoms and as a result reduced
cases of unintended pregnancies and
sexually transmitted diseases
 Health Education By Doctors
• Health education messages,
delivered by Medical
professionals, can keep their
patients healthier if they
include a health education
component in their
treatment plans.
• public health professionals
have a big role in educating
medical providers about
health risks and health-
related behaviors.
 Regulations for promoting healthy behaviors
• Prohibition was the most ambitious attempt to regulate Americans’ behavior, which
improved their health by reducing the rate of cirrhosis of the liver.
• Prohibition-like approach, currently used to control of illegal drugs has not shown the
effectiveness.

There are laws in Public Health, about:

1. Drunk driving
2. Driving at high speeds
3. Smoking in indoor public places
4. restrictions on access to alcohol and tobacco for children and teenagers
5. Use of seat-belts and motorcycle helmets
 What influences individual behaviors and
their health?
Humans are social creatures, and their behavior is affected
by their social environment.
Public health Perspective:
• change the social environment that influences people to
behave in unhealthy ways.
Factors, which influence health
1. Demographic factors : race, gender and marital status
2. Socioeconomic status: income, education and
occupational status
3. Access to medical care services: Health insurance
Health of Minority
Population
• The health of Black Americans is poorer than
White Americans
• Hispanics are a heterogeneous group, and
their health status varies among different
subgroups.
• There are obvious health disparities among
racial and ethnic groups and reasons are:
1. Blacks have less education level than
whites
2. Blacks have less employment level than
white
• Public health interventions aim at improving
the health of minority groups include efforts
to influence their health behaviors.
Stress and Social Support affect health
• Stress, which is due to the adverse physical and
social conditions associated with lower SES,
can influence individual behavior.
• Studies have shown that absence of social
support has been related to an increase in
coronary heart disease, complications in
pregnancy and delivery, suicide, and other
unhealthy outcomes.
 Psychological Models of Health Behavior
1. Health Belief Model
2. Trans theoretical Model
3. Ecological Model

• The goal of these analyses: is to understand the most effective ways to

promote healthier behavior
 Health Belief Model

• Specifies several factors that determine whether a person is likely to change behavior
when faced with a health threat.
• These factors are
1. The extent to which the individual feels vulnerable to the threat
2. The perceived severity of the threat
3. perceived barriers to taking action to reduce the risk
4. the perceived effectiveness of taking an action to prevent or minimize the problem

• Public Health Approach: to convince people that they are vulnerable, that the threat is
severe, and that certain actions are effective preventive measures.
 Self-efficacy
Self-efficacy is: the sense of having control over life
• High self-efficacy has people who are confident
• Low self-efficacy has people who believes their life
is subject to chance
Self efficacy reduces stress
Individual’s perception of the stress can be reduced
by two factors:
1. knowledge of when the stressful event will occur
2. The ability to regulate the timing and intensity of
the even
Studies have shown that people with high self-
efficacy are more likely to engage in health-
promoting behavior than those with low self-efficacy.
What influences Self-efficacy?
Trans theoretical Model
Ecological Model of Health behavior
Thank You For Your Attention!