Hi,
I need help with this discussion assignment.
A post of 3 to 4 paragraphs in length, and a response to one other student post. I will send you the other student post for response after the original post have been completed. The response should be a minimum of one paragraph (5 sentences). Cited references are required in APA format.
Discussion questions:
Obesity in our country is a well-known problem and it is detrimental to our health. Government initiatives have attempted to educate and reduce childhood obesity, promoting healthy eating and physical exercise through programs such as MyPlate, Let’s Move, state healthy schools grants, and for a time restrictions on what foods could be brought into the school, etc. to educate and create future healthier citizens. People have differing views of these government programs. What do you think? Should the government be involved in schools to provide access to these types of programs, or should governments stay out of influencing how children and families eat and participate or not participate in fitness activities? Who is responsible for the future health of the children of this country–parents, communities, teachers, government or a combination of these groups?
Introduction to
Nutrition
What is
going on here?
General Reference
(2,000 calorie diet)
Calories
40 Calories is low
100 Calories is moderate
400 Calories or more is high
5/20 Rule
5% DV or less is Low
20% DV or more is High
Reading Food Labels
How many calories do I need?
http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm275409.htm
http://www.cancer.org/healthy/toolsandcalculators/calculators/app/calorie-counter-calculator
Food Ingredients
http://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm094211.htm
http://www.accessdata.fda.gov/scripts/fcn/fcnNavigation.cfm?rpt=eafusListing
Meat and dairy labels
•
Natural
•
•
Grass fed
•
•
Animals are fed solely on a diet of grass or hay. These
animals have access to the outdoors.
Free range
•
•
“minimally processed” & that the meat can’t have any
artificial colors, artificial flavors, preservatives, or other
artificial ingredients in it. Animals can still get antibiotics or
growth enhancers.
Contact the producer directly for clarification.
No hormones added
•
Animals are raised without added growth hormones. By
law, poultry and pigs cannot be given hormones anyway.
USDA Certified
Organic Food Labels
100% Organic
Organic
At least 70% organic ingredients will not display the USDA seal but
may list specific organic ingredients on package front
Contains organic ingredients
At least 95% organic ingredients
Made with organic ingredients
Completely organic or made with 100% organic ingredients
Foods that contain less than 70% organic ingredients will not display
the USDA seal but may list specific organic ingredients on the
information panel of the package.
“Natural” does not equal organic
Regular
Low-Sodium
Calories
190
145
Total Fat
7g
7g
11%
11%
Saturated
4g
4g
20%
11%
Cholesterol
0 mg
0g
Sodium
830 mg 35% 530 mg 22%
Potassium
0 mg
0 mg
Total Carbs
26 g
9%
26 g
9%
Dietary Fiber
1g
4%
1g
4%
Sugars
1g
1g
Protein
4g
4g
Vitamin A
2%
0%
Vitamin C
0%
0%
Calcium
2%
0%
Iron
10%
10%
*Percent Daily Values are based on a 2000
calorie diet.
***
Classification of LDL, Total, & HDL
Cholesterol (mg/dL) &
Recommended Levels for Adults
9
Percentages of Saturated,
Polyunsaturated &Monounsaturated
Fats in Common Vegetable Oils
10
Food Allergies & Intolerance
•
•
•
•
•
Food Allergies
• 1 in every 13 children has a food allergy
• 8 foods account for 90% of all reactions
• milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish
Eosinophilic Esophagitis
• causes large numbers of eosinophils (type of white blood cell, to gather in the esophagus)
• Food allergy testing may be necessary to find the cause
Food Protein-induced Enterocolitis Syndrome
• usually triggered by cow’s milk or soy, though some cereal grains, especially rice and oat,
and other foods may cause it
• FPIES is usually resolved by the age of three
Oral Allergy Syndrome
• Birch: apple, carrot, peach, plum, cherry, pear, almond, hazelnut
• Grasses: tomato
• Ragweed: melons, zucchini, cucumber, kiwi, banana
Food Intolerances
• Lactose Intolerance (lack of adequate lactase enzyme)
• Celiac Disease (gluten from wheat, rye, barley, & possibly oats)
http://www.foodallergy.org/allergens
Food Allergy Research & Education
www.foodallergy.org
Most
common food allergies
Corn Tree Nut
FPIES
Peanut
Eosinophilic Esophagitis
Egg
Wheat
Meat
Soy
Oral Allergy Syndrome
Fish
Shellfish
Milk
Food Additive Intolerance
Foods
can trigger a latex-like allergic reaction
Banana
Fig
Melon
Potato
Kiwi
Peach
Cherry
Rye
Grape
Celery
Strawberry Wheat
Tomato
Avocado Chestnut Hazelnut
Papaya
Nectarine
Plum
Pineapple
Latex Allergy & Food
http://www.latexallergyresources.org/latex-cross-reactive-foods-fact-sheet
High
(4)
Avocado, Banana, Chestnut, Kiwi
Moderate
(7)
Apple, Carrot, Celery. Melons, Papaya, Potato, Tomato
Low/undetermined
(33)
Apricot, Cherry, Citrus fruits, Fig, Grape, Lychee, Mango, Nectarine,
Passion fruit, Peach, Pear, Persimmon, Pineapple, Strawberry,
Buckwheat, Rye, Wheat, Coconut, Hazelnut, Walnut, Castor bean,
Chick pea, Peanut, Soybean, Dill, Oregano, Sage, Peppers
(Cayenne, Sweet/bell pepper), shellfish, Sunflower seed
Food Allergies & Sensitivities
http://www.foodallergy.org/allergens
Common Allergies
Peanut
Tree nuts
Milk
Egg
Wheat
Soy
Fish
Shellfish
Related Conditions
Eosinophilic Esophagitis
Food Protein-induced Enterocolitis Syndrome
Oral Allergy Syndrome
Common pollen-food associations*
Food Intolerances
Lactose Intolerance
Celiac Disease
Nutrition &
Special Populations
Pre-pregnancy, Pregnancy, & Lactation
Iron-deficiency anemia
Folic Acid
Calcium
Mercury in fish
critical for neuro-tube development during first weeks
type and moderation are key
Toxoplasmosis
Home gardens
Litter boxes
Infants
Breastfeeding
Only water, breast milk, or formula
Medical & Environmental Considerations
“Solid”
foods
3-5 days wait between new foods
Introduce at 4-6 months
Expanding
vs. Formula
food choices
6-12 months
Finger foods
Choking hazards
• Special Considerations
– No honey
– Water quality & fluoride?
– Dental Caries (baby bottle
tooth decay)
– Lead exposure
Toddlers & Preschoolers
•
Portion size!
•
•
•
Offer variety, often & repeatedly
•
•
•
•
•
•
•
Minimum of 3 offerings
Positive experiences
Portion size, 1 TBSP per year in age
Balance across the week, not the meal
Milk & Juice
•
•
Ages 2-3 need approx. ½ to 2/3 an adult serving
≥ age 4, portions are similar to adults
Limit juice
After age 2, transition to low-fat or skim milk
Choking risks
No to:
•
•
Clean Your Plate Club
No dessert unless you clean your plate
Older Children & Adolescents
Involve children
Meal planning
Food shopping & preparation
Breakfast important for health & learning
Discuss & Set an example
Learning about food groups at school
Interest in experimenting with new foods?
Food is not a punishment or reward
Mass media & food marketing awareness
Reading food labels
Decision making away from home
Young Adulthood
Personal responsibility
Balancing calories, physical activity, & life
Metabolism changes
Women
• Folic Acid, Calcium, & Iron
• Alcohol in moderation
• Serving size
•12 oz beer
•5 oz. wine
•1.5 oz spirits
• Men: ≤2 serving/day
• Women: ≤1 serving/day
•
•
•
•
Middle Adulthood & beyond
•
Generally the same as Young Adults
•
Middle age (ages 51-70)
• Increased requirements: vitamin B6,
vitamin D
•
Elderly (age 70+)
• Increased requirements: vitamin D
• Decreased requirements: energy
• Decrease iron needs in women
• Vitamin B12, Folate/Folic Acid, Calcium,
Vitamin D, Potassium, Magnesium, Fiber,
Omega-3 Fats, Water
Food Safety
Refrigerate foods within 1-2 hours
Refrigerator = 40°F
Freezer = 0°F
Cook or freeze meats within 2 days
5 days for some meats
Canned foods
High acid = 12-18 months
Low acid= 2-5 years
Discard if damaged or lid “popped”
WASH your reusable shopping bags!
Consider using 1-use bags for meats and dairy
http://www.cdc.gov/foodsafety/
Common Food-Drug Interactions
Grapefruit Juice (furanocoumarins)
Seville oranges and the pummelo???
Changes in metabolism…lower or higher than normal blood levels of the drug
Interacts with some, but not all, cholesterol-lowering statins
Other interactions: antihistamines, blood pressure drugs, thyroid replacement drugs, birth
control, stomach acid-blocking drugs, and the cough suppressant dextromethorphan
Green Leafy Vegetables
Warfarin interfere with vitamin K-dependent clotting factors
Problems arise from significantly and suddenly increasing or decreasing intake
Warfarin often used after “____ replacement” surgery
Natural Black Licorice (Glycyrrhiza)
Can deplete the body of potassium while causing an increased retention of sodium
Decrease the effectiveness of high blood pressure medicines
Salt Substitutes
Digoxin for heart failure or ACE inhibitors for high blood pressure
Tyramine-containing Foods
High blood levels of the amino acid tyramine can cause an increase in blood pressure
Monoamine oxidase inhibitors (MAOIs) which treat depression, and drugs used to treat the
symptoms of Parkinson’s disease
Examples: chocolate; aged and mature cheeses; smoked and aged/fermented meats;
hot dogs; some processed lunch meats; fermented soy products; and draft beers
http://www.webmd.com/diet/healthtool‐portion‐size‐plate
http://www.choosemyplate.gov/supertracker‐tools/daily‐food‐plans.html
https://www.supertracker.usda.gov/default.aspx
© 2014 Pearson Education, Inc.
Case Study
Javier is a fitness enthusiast who runs 5 to 10 miles daily, lifts weights 3 to 4 times
per week, and constantly talks about his quest for the perfect body. He criticizes
anyone who puts butter on bread or who eats any kind of fast food. He worries
constantly about his food intake and the “fuel” that supplies his body with energy.
Discussion Questions:
• Do you consider Javier to be a healthy person?
• How would you assess Javier’s dietary behavior?
• What things, if any, bother you about Javier?
• What problems cause you the most difficulty when you try to eat more
healthful foods?
• Are these problems that you noted in your family too, or are they unique to
your current situation as a student?
Nutrition Resources
Nutri-facts: Nutrition information on almost six thousand different foods
National Nutrient Database for Standard Reference
http://www.foodinsight.org/Resources/Detail.aspx?topic=Animal_Antibiotics_and_Food_Safety_What_you_Should_Know
The Science of Energy Balance: Calorie Intake & Physical Activity (grades 7-8)
http://chemistry.beloit.edu/Fats/index.html
Raising Safe & Healthy Animals as Part of Our Food Supply
http://www.nutrition.gov/
The Fuss About Fats in Our Diet
Http://fnic.nal.usda.gov/
USDA Nutrition
http://www.foodinsight.org/Content/5438/FINAL%20WIF%208-22-12.pdf
Food and Nutrition Information Center
http://www.mayoclinic.com/health/free-range/MY01559
Understanding Common Food Ingredients
http://ndb.nal.usda.gov/ndb/search/list
Free range and other meat and poultry terms
http://www.nutri-facts.com/
http://science.education.nih.gov/supplements/nih4/energy/default.htm
Inside Life Science Article: The Big, Fat World of Lipids
http://publications.nigms.nih.gov/chemhealth/eat.htm
Programs and Campaigns
http://www.cdc.gov/nccdphp/DNPAO/programs/index.html
Protein Synthesis
Nutrition Science & the Olympics:
http://btc.montana.edu/olympics/nutrition/default.htm
Nutritional Interventions to Promote Post-Exercise Muscle Protein Synthesis
http://nutricore.com.br/app/webroot/img/bibliotecas/Nutritional%20Interventions%20to%20Promote.pdf
Introduction to Protein Synthesis:http://www.youtube.com/watch?v=YxLdBNAxqKg
Social Marketing Resources
Training and Professional Development
http://chemistry.beloit.edu/Fats/index.html
Reading Food Labels
http://www.nutrition.gov/
The Fuss About Fats in Our Diet
Http://fnic.nal.usda.gov/
USDA Nutrition
http://www.cdc.gov/foodsafety/
http://healthymeals.nal.usda.gov/professional-career-resources/online-training/continuing-education
Food and Nutrition Information Center
http://www.cdc.gov/nutrition/professionals/training/index.html
Food Safety
http://www.cdc.gov/nccdphp/DNPAO/socialmarketing/training.html
http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm275409.htm
How many calories do I need?
http://www.cancer.org/healthy/toolsandcalculators/calculators/app/calorie-counter-calculator
Food Ingredients
Nutri-facts (Nutrition information on almost six thousand different foods)
http://www.cdc.gov/nccdphp/DNPAO/socialmarketing/training.html
Training and Professional Development
http://www.cdc.gov/nccdphp/DNPAO/programs/index.html
Social Marketing Resources
http://publications.nigms.nih.gov/chemhealth/eat.htm
Programs and Campaigns
http://science.education.nih.gov/supplements/nih4/energy/default.htm
Inside Life Science Article: The Big, Fat World of Lipids
http://www.foodinsight.org/Content/5438/FINAL%20WIF%208-22-12.pdf
The Science of Energy Balance: Calorie Intake and Physical Activity (grades 7-8)
http://www.mayoclinic.com/health/free-range/MY01559
Understanding Common Food Ingredients
http://ndb.nal.usda.gov/ndb/search/list
Free range and other meat and poultry terms
http://www.nutri-facts.com/
National Nutrient Database for Standard Reference
http://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm094211.htm
http://www.accessdata.fda.gov/scripts/fcn/fcnNavigation.cfm?rpt=eafusListing
http://www.cdc.gov/nutrition/professionals/training/index.html
Raising Safe & Healthy Animals as Part of Our Food Supply
http://www.foodinsight.org/Resources/Detail.aspx?topic=Animal_Antibiotics_and_Food_Safety_What_you_Should_Know
Common food or water-borne pathogens (Australia)
WVDHHR Food and Water borne Diseases
https://www.coursera.org/course/nutritionforhealth
Child Nutrition and Cooking 2.0
https://www.coursera.org/course/nutrition
Nutrition and Physical Activity for Health
http://www.cdc.gov/nceh/vsp/training/videos/transcripts/water.pdf
Nutrition for Health Promotion & Disease Prevention
http://www.azdhs.gov/phs/oids/epi/disease/waterborne/list.htm
CDC Vessel Sanitation Program
http://www.dhhr.wv.gov/oeps/disease/fnw/pages/default.aspx
AZ DHS Water-borne Diseases
http://ideas.health.vic.gov.au/bluebook/food-water.asp
https://www.coursera.org/course/childnutrition
Nutrition, Health, & Lifestyle: Issues & Insights
https://www.coursera.org/course/lifenutr
Introduction to
Physical Activity
How much PA should adults get?
How much PA should children get?
What Are the Health Benefits of Regular PA?
PA vs. Exercise vs. Fitness
Why Is Core Strength Training Important?
2008 Physical Activity Guidelines for Americans [PDF
Version – 8.49 MB]
Definitions
Physical Activity
Exercise
Physical fitness:
Moderate-intensity aerobic activity
Vigorous-intensity aerobic activity
Obstacles to Physical Activity
Common Barriers to Physical Activity
Fitness-Related Injuries
Overtraining is the most frequent cause of injury
◦ Traumatic injuries
◦ Overuse injuries
Runner’s knee, Shin splints, Plantar fasciitis
◦ Active in varying environments
Prevention
◦ Footwear/Clothing
◦ Protective equipment
◦ Hydration
Treatment
◦ R.I.C.E
http://espn.go.com/highschool/rise/news/story?i
d=4083099
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a2.
htm
Female Athletes & ACL
2-8 times more likely to injure the ACL
◦ Nerve/Muscular factors?
◦ Physical build?
◦ Hormones?
Focus on the strength, endurance & power of the muscles
that protect the knee, and the athlete’s balance and
coordination
http://www.health.harvard.edu/blog/the-gendergap-in-sports-injuries-201512038708
http://www.nlm.nih.gov/medlineplus/magazine/issues/summer08/articles/summer08pg24-26.html
http://mydoctor.kaiserpermanente.org/ncal/mdo/presentation/articles/articlepage.jsp?article=regions/ncal/article_163506.xml
http://www.sportsmed.org/uploadedFiles/Content/Patient/Sports_Tips/ST%20ACL%20Injury%2008.pdf
Warm up & Cool down
Consistency
Preparation
Listen to your body!
10% Rule
Balanced
Flexibility
Use common sense
Restart after an illness
Air Quality
Weather
Hydration
Exercise & Physical Activity: Your Everyday Guide
Baby Boomers & Beyond
http://orthoinfo.aaos.org/topic.cfm?topic=A00100
Common Health Conditions
Osteoarthritis
◦ Balanced fitness program
◦ Limit excessive joint stress
Low Back Pain
◦ Daily stretching
◦ Reintroduce activity slowly
◦ Back & core muscles
◦ Skill development (safe lifting)
Osteoporosis
◦ Weight-bearing activities
◦ Strength training
Joint Replacement
◦ Limit repeated stress
◦ Consider alternative activity options
◦ Seek advise
Children & Adolescents
◦ Youth Physical Activity
Guidelines
◦ Presidential Youth Fitness
Program
◦ We Can! (Children’s Activity
& Nutrition)
◦ Let’s Move!
◦ BAM! Body and Mind
Adults
◦ President’s Challenge Adult
Fitness Test
◦ Eat Healthy, Be Active
Community Workshops
Elderly
◦ Go4Life
Special Populations
◦ National Center on Health,
Physical Activity, and
Disability
◦ National Diabetes Education
Program
◦ NIHSeniorHealth:Benefits of
Exercise
◦ Women’s Health .gov
General Websites
◦ CA Dept. of Health
◦ U.S. Dept of Health &
Human Services
◦ Ontario Ministry of Health
Physical Activity Resources
Medline Plus: Sports Injuries
◦ http://www.nlm.nih.gov/medlineplus/sportsinjuries.html
MayoClinic: How to prevent training injuries
◦ http://www.mayoclinic.com/health/overuseinjury/MY01092/METHOD=print
American Academy of Orthopedic Surgeons
◦ Return To Play
http://orthoinfo.aaos.org/topic.cfm?topic=A00365
◦ Sports Injuries & Prevention
http://orthoinfo.aaos.org/menus/sports.cfm
Concussion Toolkit (Children’s Healthcare of Atlanta)
◦ http://www.gcep.org/files/Spring_2012/Concussion%20Tool
kit%20Handout.pdf
Injury-specific Information
Non-dairy calcium options
◦ http://www.unh.edu/dining/nutrition/pdf/calciumnondairy.pdf
◦ http://www.health.gov/dietaryguidelines/dga2005/document/
html/appendixb.htm
◦ (milk nutrients info for comparisons)
http://www.healthyeating.org/milk-dairy/nutrients-in-milkcheese-yogurt/nutrients-in-milk.aspx#milk_table
Weight-bearing PA
◦ Walking, jogging….
◦ Sports
◦ Dancing
Additional Resources
◦ National Osteoporosis Foundation (http://www.nof.org/)
◦ Clinician’s Guide
http://www.nof.org/files/nof/public/content/resource/913/fi
les/580.pdf
Bone Health
Instant Recess: 5-Minute Physical Activity Break
◦ http://www.youtube.com/watch?v=tMuZ0_-Y7n4
10-Minute Physical Activity Break
◦
◦
◦
◦
NOLA http://www.youtube.com/watch?v=6_d3zKJAjIU
Hip Hop http://www.youtube.com/watch?v=pPp4DrKSgHM
Reggae http://www.youtube.com/watch?v=7s8MO2qvWGo
Soccer http://www.youtube.com/watch?v=mO1GJlOQg6E
Zenergy Instant Recess Break
◦ http://www.youtube.com/watch?v=9k44fS83_s4
◦ http://diet-fitness.healthguru.com/topic/fitness/home-gym
Leslie Sansone “Walk away the pounds” Facebook page….
◦ http://club.walkathome.com/
◦ https://www.facebook.com/LeslieSansone/app_269601699719501
15-minute breaks
◦ http://www.youtube.com/watch?v=qa2IWYs3ags
◦ http://www.youtube.com/watch?v=-EEughTIdlQ
30-minute breaks
◦ http://www.youtube.com/watch?v=NUieo6Mc9EA
◦ http://www.youtube.com/watch?v=7QMgcG7m9sY
45+ minute breaks
◦ http://www.youtube.com/watch?v=-rnB9rDRrCM
◦ http://www.youtube.com/watch?v=CoN_rvyeG0Y
◦ http://www.youtube.com/watch?v=lNc2_7MH7ao
Physical Activity Breaks
Personal Health
HLTA 1100
Version 3 from: https://www.canyons.edu/Offices/DistanceLearning/OER/Documents/Health%20Science%20100%20V3.pdf
(Some images and data updated May 2019)
2
Acknowledgements
We would like to extend appreciation to the following people and
organizations for allowing this textbook to be created:
California Community Colleges Chancellor’s Office
Chancellor Diane Van Hook
Santa Clarita Community College District
College of the Canyons Distance Learning Office
Compiled by
Garrett Rieck, MA, ACSM-CPT
&
Justin Lundin, MA
Special Thank You to OER staff
Alexa Johnson, Mitchell Norhiro, & Trudi Radtke
for helping with formatting, editing, readability, and aesthetics.
&
COC Kinesiology Department for making it all possible.
Cover Photo: Cougar Field PIO COC
The contents of this textbook were developed under the Title V grant from the Department
of Education (Award #P031S140092). However, those contents do not necessarily represent
the policy of the Department of Education, and you should not assume endorsement by the
Federal Government.
Unless otherwise noted, the content in this textbook is licensed under CC BY 4.0
3
Table of Contents
Acknowledgements ………………………………………………………………………………………………………………………… 2
CHAPTER 1: Introduction to Health ……………………………………………………………………………………………. 6
Section 1.1 Definition and Concepts of Health …………………………………………………………………………………….. 6
Section 1.2 Narrow Perspectives of Health ………………………………………………………………………………………….. 6
Section 1.3 Broader Perspectives of Health …………………………………………………………………………………………. 6
Section 1.4 The Six Dimensions of Health …………………………………………………………………………………………….. 7
Section 1.5 Life Expectancy at Birth ………………………………………………………………………………………………………. 8
Section 1.6 Leading Causes of Death ……………………………………………………………………………………………………… 8
Section 1.7 About Determinants of Health …………………………………………………………………………………………… 8
Section 1.8 Health Disparities ……………………………………………………………………………………………………………….. 11
Section 1.9 Risk Factors and Levels of Disease Prevention …………………………………………………………….. 13
Section 1.10 Levels of Disease Prevention …………………………………………………………………………………………. 14
Section 1.11 Behavior Change and Goal Setting ………………………………………………………………………………… 15
Section 1.12 SMART Goal Setting …………………………………………………………………………………………………………. 17
CHAPTER 2: Psychological Health …………………………………………………………………………………………….. 19
Section 2.1 Physiological Needs ……………………………………………………………………………………………………………. 20
Section 2.2 Safety Needs ………………………………………………………………………………………………………………………… 20
Section 2.3 Social Belonging ………………………………………………………………………………………………………………….. 20
Section 2.4 Esteem …………………………………………………………………………………………………………………………………… 21
Section 2.5 Self-Actualization………………………………………………………………………………………………………………… 21
Section 2.6 Self-Transcendence ……………………………………………………………………………………………………………. 22
Section 2.7 Mental Health ………………………………………………………………………………………………………………………. 22
Section 2.8 Emotional Health ………………………………………………………………………………………………………………… 23
Section 2.9 Spiritual Health …………………………………………………………………………………………………………………… 24
Section 2.10 Social Health ……………………………………………………………………………………………………………………… 24
Section 2.11 Factors That Influence Psychological Well-Being ……………………………………………………… 24
Section 2.12 Developing and protecting individual attributes ………………………………………………………. 27
Section 2.13 Supporting families and communities …………………………………………………………………………. 27
Section 2.14 Supporting vulnerable groups in society …………………………………………………………………….. 28
Section 2.15 Mental Illness ……………………………………………………………………………………………………………………. 28
Section 2.16 Mood Disorders ………………………………………………………………………………………………………………… 29
Section 2.17 Depression …………………………………………………………………………………………………………………………. 29
Section 2.18 Dysthymic Disorder …………………………………………………………………………………………………………. 29
Section 2.19 Bipolar Disorder ……………………………………………………………………………………………………………….. 30
Section 2.20 The Causes of Depression (depressive disorders)…………………………………………………….. 30
Section 2.21 Treating depression…………………………………………………………………………………………………………. 30
Section 2.22 Coping with Depression ………………………………………………………………………………………………….. 31
Section 2.23 Anxiety Disorders …………………………………………………………………………………………………………….. 31
Section 2.24 The Stigma of Mental Illness ………………………………………………………………………………………….. 42
CHAPTER 3: Stress Management ……………………………………………………………………………………………….. 45
Section 3.1 Chronic Stress ……………………………………………………………………………………………………………………… 45
Section 3.2 The Effects of Stress on the Body…………………………………………………………………………………….. 45
Section 3.3 Stress and the Brain …………………………………………………………………………………………………………… 45
Section 3.4 Your Bodies Response to Stress ………………………………………………………………………………………. 47
Section 3.5 General Adaptation Syndrome…………………………………………………………………………………………. 47
4
Section 3.6 Distress may be destructive to health…………………………………………………………………………….. 49
Section 3.7 Eustress ………………………………………………………………………………………………………………………………… 49
Section 3.8 Burnout and Stress Related Illness …………………………………………………………………………………. 49
Section 3.9 Common Causes of Stress …………………………………………………………………………………………………. 51
Section 3.10 Common signs and symptoms of stress ………………………………………………………………………. 52
Section 3.11 Do women react to stress differently than men?……………………………………………………….. 52
Section 3.12 Can Stress Affect My Health?………………………………………………………………………………………….. 52
Section 3.13 The Effect of Stress on the Immune System ……………………………………………………………….. 52
Section 3.14 Does stress cause ulcers? NO …………………………………………………………………………………………. 53
Section 3.15 Post-traumatic stress disorder (PTSD)………………………………………………………………………… 53
Section 3.16 Stress is in the Eye of the Beholder ………………………………………………………………………………. 54
Section 3.17 Managing Stress ……………………………………………………………………………………………………………….. 56
Section 3.18 Coping with Stress ……………………………………………………………………………………………………………. 58
Section 3.19 Exercise and Stress ………………………………………………………………………………………………………….. 58
Section 3.20 Meditation and Health …………………………………………………………………………………………………….. 59
Section 3.21 Relaxation Techniques ……………………………………………………………………………………………………. 60
Section 3.22 Resilience …………………………………………………………………………………………………………………………… 65
CHAPTER 4: Relationships and Communication …………………………………………………………………….. 68
Section 4.1 Theories of Love………………………………………………………………………………………………………………….. 68
Section 4.2 THEORIES OF MATE SELECTION ……………………………………………………………………………………. 72
Section 4.3 Marriage ……………………………………………………………………………………………………………………………….. 77
Section 4.4 Cohabitation ………………………………………………………………………………………………………………………… 78
Section 4.5 Marrieds and Non-Marrieds …………………………………………………………………………………………….. 79
CHAPTER 5: Gender and Sexuality ……………………………………………………………………………………………. 92
Section 5.1 Sexual Scripts ………………………………………………………………………………………………………………………. 92
Section 5.2 Genital Development………………………………………………………………………………………………………….. 93
Section 5.3 The Importance of Sexuality …………………………………………………………………………………………….. 94
Section 5.4 Sexual Anatomy …………………………………………………………………………………………………………………… 95
Section 5.5 The Sexual Response ………………………………………………………………………………………………………….. 96
Section 5.6 The Sexual Experience ………………………………………………………………………………………………………. 99
Section 5.7 Sex and Gender …………………………………………………………………………………………………………………. 100
Section 5.6 Sexuality …………………………………………………………………………………………………………………………….. 102
CHAPTER 6: Sexual Health………………………………………………………………………………………………………… 106
Section 6.1 Sexual Health …………………………………………………………………………………………………………………….. 106
Section 6.2 Sexuality …………………………………………………………………………………………………………………………….. 106
Section 6.3 Public Health Approach to Sexual Health ……………………………………………………………………. 106
Section 6.4 Stigma …………………………………………………………………………………………………………………………………. 106
Section 6.5 Sexual Dysfunction…………………………………………………………………………………………………………… 106
Section 6.6 Sexual Frequency……………………………………………………………………………………………………………… 107
Section 6.7 Sex and Health ………………………………………………………………………………………………………………….. 107
Section 6.8 Sexual Happiness ……………………………………………………………………………………………………………… 107
Section 6.9 Sexual Bias and Misconceptions……………………………………………………………………………………. 107
Section 6.10 Reproductive Health ……………………………………………………………………………………………………… 108
CHAPTER 7: Infectious diseases and Sexually Transmitted Infections (STI’s)…………………. 131
Section 7.1 Introduction ………………………………………………………………………………………………………………………. 131
Section 7.2 What are infectious diseases? ……………………………………………………………………………………….. 131
Section 7.3 Symptoms and signs of infection ………………………………………………………………………………….. 132
Section 7.4 What causes infectious diseases? …………………………………………………………………………………. 132
Section 7.5 Direct person-to-person transmission of pathogens………………………………………………… 133
Section 7.6 Indirect person-to-person transmission of pathogens …………………………………………….. 134
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Section 7.7 Animal-to-human transmission of pathogens ……………………………………………………………. 136
Section 7.8 Immune Defenses Against Infectious Diseases ………………………………………………………….. 138
Section 7.9 Risk Factors and Levels of Disease Prevention ………………………………………………………….. 147
Section 7.10 Levels of Disease Prevention ………………………………………………………………………………………. 148
Section 7.11 Sexually Transmitted Infections …………………………………………………………………………………. 149
Section 7.12 STD/STI Treatments……………………………………………………………………………………………………… 155
Section 7.13 STD/STI Prevention: How to Prevent STI’s ……………………………………………………………… 157
Section 8.1 Understanding Drug Use and Addiction ……………………………………………………………………… 161
Section 8.2 Types of Drugs ………………………………………………………………………………………………………………….. 161
Section 8.3 Prescription Drugs …………………………………………………………………………………………………………… 172
Section 8.4 Alcohol Abuse……………………………………………………………………………………………………………………. 176
Section 8.5 Tobacco………………………………………………………………………………………………………………………………. 181
Section 8.7 Drug Addiction………………………………………………………………………………………………………………….. 186
Section 8. 7 Treatment Approaches for Drug Addiction ……………………………………………………………….. 189
CHAPTER 9: Basic Nutrition and Healthy Eating …………………………………………………………………… 196
Section 9.1 Nutrition and Health ……………………………………………………………………………………………………….. 196
Section 9.2 Planning a Diet………………………………………………………………………………………………………………….. 208
Section 9.3 Popular Diets …………………………………………………………………………………………………………………….. 217
Section 9.4 Food Supplements and Food Replacements ………………………………………………………………. 222
CHAPTER 10: Weight Management …………………………………………………………………………………………. 227
Section 10.1 Assessing Body Weight and Body Composition ………………………………………………………. 230
Section 10.2 Factors Contributing to Overweight and Obesity ……………………………………………………. 233
Section 10.3 Balancing Calories and Eating Healthfully ……………………………………………………………….. 239
Section 10.4 Body Image ……………………………………………………………………………………………………………………… 246
CHAPTER 11: Physical Fitness………………………………………………………………………………………………….. 251
Section 11.1 Health Benefits Associated with Regular Physical Activity…………………………………… 251
Section 11.2 Health Related Components of Physical Fitness ……………………………………………………… 253
Section 11.3 Adding Physical Activity to Your Life ………………………………………………………………………… 256
Section 11.4 Implementing Your Fitness Plan ………………………………………………………………………………… 262
CHAPTER 12: Cardiovascular Disease, Diabetes, and Cancer ……………………………………………… 271
Section 12.1 Stroke ……………………………………………………………………………………………………………………………….. 277
Section 12.2 Metabolic Syndrome ……………………………………………………………………………………………………… 279
Section 12.3 Diabetes …………………………………………………………………………………………………………………………… 287
Section 12.4 Cancer ………………………………………………………………………………………………………………………………. 292
CHAPTER 13: Environmental Health ………………………………………………………………………………………. 305
Section 13.1 Overpopulation ………………………………………………………………………………………………………………. 306
Section 13.2 Air Pollution ……………………………………………………………………………………………………………………. 307
Section 13.3 Climate Change ………………………………………………………………………………………………………………. 308
Section 13.4 Water ……………………………………………………………………………………………………………………………….. 309
Section 13.5 Waste Management……………………………………………………………………………………………………….. 310
CHAPTER 14: Health Care Choices …………………………………………………………………………………………… 312
Section 14.1 Understanding your Health Care Choices …………………………………………………………………. 312
Section 14.3 Health Care Choices: The Affordable Health Care Act (ACA)………………………………… 319
Section 14.4 Health Insurance: Key Terms ……………………………………………………………………………………… 321
Section 14.5 Choices in Medical Care………………………………………………………………………………………………… 323
Section 14.6 Alternative Medical Practices ……………………………………………………………………………………… 327
Section 14.7 Health Disparity …………………………………………………………………………………………………………….. 332
6
CHAPTER 1: Introduction to Health
In this section, readers will learn about the nature of health, health education, health
promotion and related concepts. This will help to understand the social, psychological and
physical components of health.
Section 1.1 Definition and Concepts of Health
In the Oxford English Dictionary health is defined as: ‘the state of being free from sickness,
injury, disease, bodily conditions; something indicating good bodily condition.”
Clearly, health is not quite as simple as the definition implies. The concept of health is wide
and the way we define health also depends on individual perception, religious beliefs,
cultural values, norms, and social class. Generally, there are two different perspectives
concerning people’s own definitions of health: a narrow perspective and a broader
perspective.
Section 1.2 Narrow Perspectives of Health
People with a narrow perspective consider health as the absence of disease or disability or
biological dysfunction. According to this view (or model), to call someone unhealthy or sick
means there should be evidence of a particular illness. Social, emotional and psychological
factors are not believed to cause unhealthy conditions. This model is narrow and limits the
definition of health to the physical and physiological capabilities that are necessary to
perform routine tasks.
According to this definition, the individual is healthy if all the body parts, cells, tissues and
organ systems are functioning well and there is no apparent dysfunction of the body. Using
this model people view the human body in the same terms as a computer, or mechanical
device, when something is wrong you take it to experts who maintain it. Physicians, unlike
behavioral experts, often focus on treatment and clinical interventions with medication
rather than educational interventions to bring about behavior change.
Section 1.3 Broader Perspectives of Health
The most widely used of the broader definitions of health is that within the constitution of
the World Health Organization (WHO), which defines health as: A state of complete
physical, mental, and social well-being, and not merely the absence of disease or infirmity.
This classic definition is important, as it identifies the vital components of health.
Well-being includes the presence of positive emotions and moods (e.g., contentment,
happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with
life, fulfillment and positive functioning. In simple terms, well-being can be described as
judging life positively and feeling good. Well-being is associated with numerous health-,
job-, family-, and economically related benefits. For example, higher levels of well-being are
associated with decreased risk of disease, illness, and injury; better immune functioning;
7
speedier recovery; and increased longevity. Individuals with high levels of well-being are
more productive at work and are more likely to contribute to their communities.
Many practitioners have expanded their focus to include wellness at the positive end of the
health continuum. Wellness is being in good physical and mental health. Because mental
health and physical health are linked, problems in one area can impact the other. At the
same time, improving your physical health can also benefit your mental health, and vice
versa. It is important to make healthy choices for both your physical and mental well-being.
Remember that wellness is not just the absence of illness or stress. One can still strive for
wellness even if he/she is experiencing these challenges in life.
To more fully understand the meaning of health, it is important to understand each of its
individual components.
Section 1.4 The Six Dimensions of Health
1.4.1 Physical
Body size and functioning; recognizing the need for physical activity, healthy foods, and
adequate sleep; avoiding unhealthy habits
1.4.2 Social
Developing a sense of connection, belonging, and sustained support system; having positive
relationships
1.4.3 Intellectual
Recognizing creative abilities and finding ways to expand knowledge and skills; being
open-minded
1.4.4 Emotional
Coping effectively with life and expressing emotions in an appropriate manner
1.4.5 Spiritual
Having a sense of purpose and meaning in life; establishing peace, harmony, and balance in
our lives
1.4.6 Environmental
Occupying pleasant, healthy, and safe environments that support wellbeing; positively
impacting the quality of our surroundings (including protecting and preserving nature)
Learning about the Six Dimensions of Health can help a person choose how to make
wellness a part of everyday life. Wellness strategies are practical ways to start developing
healthy habits that can have a positive impact on physical and mental health.
8
Section 1.5 Life Expectancy at Birth
Life expectancy is a measure often used to gauge the overall health of a population. Life
expectancy at birth represents the average number of years that a group of infants would
live if the group were to experience the age-specific death rates present in the year of birth.
Differences in life expectancy among various demographic subpopulations, including racial
and ethnic groups, may reflect differences in a range of factors such as socioeconomic
status, access to medical care, and the prevalence of specific risk factors in a particular
subpopulation.
During 1975–2015, life expectancy at birth in the United States increased from 68.8 to 76.3
years for males and from 76.6 to 81.2 years for females. During this period, life expectancy
at birth for males and females was longer for white persons than for black persons. Racial
disparities in life expectancy at birth persisted for both males and females in 2015, but
continued to narrow.
Section 1.6 Leading Causes of Death
In 1975, the five leading causes of death were heart disease, cancer, stroke, unintentional
injuries, and influenza and pneumonia. In 2015, the five leading causes of death were heart
disease, cancer, chronic lower respiratory diseases, unintentional injuries, and stroke.
Throughout 1975–2015, heart disease and cancer remained the top two leading causes of
death.
Section 1.7 About Determinants of Health
The range of personal, social, economic, and environmental factors that influence health
status are known as determinants of health.
1.7.1 Determinants of Health
What makes some people healthy and others unhealthy?
How can we create a society in which everyone has a chance to live a long, healthy life?
Determinants of health are factors that contribute to a person’s current state of health.
These factors may be biological, socioeconomic, psychosocial, behavioral, or social in
nature. Scientists generally recognize five determinants of health of a population:
Healthy People 2020 is exploring these questions by:
•
Developing objectives that address the relationship between health status and
biology, individual behavior, health services, social factors, and policies.
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•
Emphasizing an ecological approach to disease prevention and health promotion. An
ecological approach focuses on both individual-level and population-level
determinants of health and interventions.
•
•
Genes and biology: for example, sex and age
Health behaviors: for example, alcohol use, injection drug use (needles),
unprotected sex, and smoking
Social environment or social characteristics: for example, discrimination, income,
and gender
Physical environment or total ecology: for example, where a person lives and
crowding conditions
Health services or medical care: for example, access to quality health care and
having or not having insurance
Other factors that could be included are culture, social status, and healthy child
development.
•
•
•
•
Determinants of health fall under several broad categories:
Policymaking
Policies at the local, state, and federal level affect individual and population health.
Increasing taxes on tobacco sales, for example, can improve population health by reducing
the number of people using tobacco products.
Some policies affect entire populations over extended periods of time while simultaneously
helping to change individual behavior. For example, the 1966 Highway Safety Act and the
National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and
regulate standards for motor vehicles and highways. This led to an increase in safety
standards for cars, including seat belts, which in turn reduced rates of injuries and deaths
from motor vehicle accidents.
Social Factors
Social determinants of health reflect the social factors and physical conditions of the
environment in which people are born, live, learn, play, work, and age. Also known as social
and physical determinants of health, they impact a wide range of health, functioning, and
quality-of-life outcomes. Examples of social determinants include:
•
•
•
•
•
•
Availability of resources to meet daily needs, such as educational and job
opportunities, living wages, or healthful foods
Social norms and attitudes, such as discrimination
Exposure to crime, violence, and social disorder, such as the presence of trash
Social support and social interactions
Exposure to mass media and emerging technologies, such as the Internet or cell
phones
Socioeconomic conditions, such as concentrated poverty
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•
•
•
•
Quality schools
Transportation options
Public safety
Residential segregation
Examples of physical determinants include:
• Natural environment, such as plants, weather, or climate change
• Built environment, such as buildings or transportation
• Worksites, schools, and recreational settings
• Housing, homes, and neighborhoods
• Exposure to toxic substances and other physical hazards
• Physical barriers, especially for people with disabilities
• Aesthetic elements, such as good lighting, trees, or benches
Poor health outcomes are often made worse by the interaction between individuals and
their social and physical environment. For example, millions of people in the United States
live in places that have unhealthy levels of ozone or other air pollutants. In counties where
ozone pollution is high, there is often a higher prevalence of asthma in both adults and
children compared with state and national averages. Poor air quality can worsen asthma
symptoms, especially in children.
Health Services
Both access to health services and the quality of health services can impact health. Healthy
People 2020 directly addresses access to health services as a topic area and incorporates
quality of health services throughout a number of topic areas.
Lack of access, or limited access, to health services greatly impacts an individual’s health
status. For example, when individuals do not have health insurance, they are less likely to
participate in preventive care and are more likely to delay medical treatment.
Barriers to accessing health services include:
• Lack of availability
• High cost
• Lack of insurance coverage
• Limited language access
These barriers to accessing health services lead to:
• Unmet health needs
• Delays in receiving appropriate care
• Inability to get preventive services
• Hospitalizations that could have been prevented
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Individual Behavior
Individual behavior also plays a role in health outcomes. For example, if an individual quits
smoking, his or her risk of developing heart disease is greatly reduced.
Many public health and health care interventions focus on changing individual behaviors
such as substance abuse, diet, and physical activity. Positive changes in individual behavior
can reduce the rates of chronic disease in this country.
Examples of individual behavior determinants of health include:
• Diet
• Physical activity
• Alcohol, cigarette, and other drug use
• Hand washing
Biology and Genetics
Some biological and genetic factors affect specific populations more than others. For
example, older adults are biologically prone to being in poorer health then adolescents due
to the physical and cognitive effects of aging.
Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a
condition that people inherit when both parents carry the gene for sickle cell. The gene is
most common in people with ancestors from West African countries, Mediterranean
countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.
Examples of biological and genetic social determinants of health include:
• Age
• Sex
• HIV status
• Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
• Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian
cancer
• Family history of heart disease
Section 1.8 Health Disparities
Although the term disparities is often interpreted to mean racial or ethnic disparities, many
dimensions of disparity exist in the United States, particularly in health. If a health outcome
is seen to a greater or lesser extent between populations, there is disparity. Race or
ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location
all contribute to an individual’s ability to achieve good health. It is important to recognize
the impact that social determinants have on health outcomes of specific populations.
Healthy People strives to improve the health of all groups.
To better understand the context of disparities, it is important to understand more about
the U.S. population. In 2008, the U.S. population was estimated at 304 million people.
12
•
•
•
•
•
In 2008, approximately 33%, or more than 100 million people, identified
themselves as belonging to a racial or ethnic minority population.
In 2008, 51%, or 154 million people, were women.
In 2008, approximately 12%, or 36 million people not living in nursing homes or
other residential care facilities, had a disability.
In 2008, an estimated 70.5 million people lived in rural areas (23% of the
population), while roughly 233.5 million people lived in urban areas (77%).
In 2002, an estimated 4% of the U.S. population ages 18 to 44 identified themselves
as lesbian, gay, bisexual, or transgender.
During the past 2 decades, one of Healthy People’s overarching goals has focused on
disparities. In Healthy People 2000, it was to reduce health disparities among Americans. In
Healthy People 2010, it was to eliminate, not just reduce, health disparities. In Healthy
People 2020, that goal expanded even further: to achieve health equity, eliminate
disparities, and improve the health of all groups.
Healthy People 2020 defines health equity as the “attainment of the highest level of health
for all people. Achieving health equity requires valuing everyone equally with focused and
ongoing societal efforts to address avoidable inequalities, historical and contemporary
injustices, and the elimination of health and health care disparities.”
Healthy People 2020 defines a health disparity as “a particular type of health difference
that is closely linked with social, economic, and/or environmental disadvantage. Health
disparities adversely affect groups of people who have systematically experienced greater
obstacles to health based on their racial or ethnic group; religion; socioeconomic status;
gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or
gender identity; geographic location; or other characteristics historically linked to
discrimination or exclusion.”
Over the years, efforts to eliminate disparities and achieve health equity have focused
primarily on diseases or illnesses and on health care services. However, the absence of
disease does not automatically equate to good health. Powerful, complex relationships exist
between health and biology, genetics, and individual behavior, and between health and
health services, socioeconomic status, the physical environment, discrimination, racism,
literacy levels, and legislative policies. These factors, which influence an individual or
population’s health, are known as determinants of health.
For all Americans, other influences on health include the availability of and access to:
• High-quality education
• Culturally sensitive health care
providers
• Nutritious food
• Health insurance
• Decent and safe housing
• Clean water and non-polluted air
• Affordable, reliable public
transportation
13
Throughout the next decade, Healthy People 2020 will assess health disparities in the U.S.
population by tracking rates of illness, death, chronic conditions, behaviors, and other
types of outcomes in relation to demographic factors including:
•
•
•
Race and ethnicity
Gender
Sexual identity and orientation
•
•
Disability status or special health
care needs
Geographic location (rural and
urban)
Section 1.9 Risk Factors and Levels of Disease Prevention
What is a Risk Factor?
Part of learning how to take charge of one’s health requires understanding risk factors for
different diseases. Risk factors are things in life that increase your chances of getting a
certain disease. Some risk factors are beyond your control. A person may be born with
them or have exposure with no fault assigned.
Some risk factors that you have little or no control over include:
•
•
•
Family history of a disease
Sex/gender — male or female
Ancestry
Some controllable risk factors include:
•
•
•
•
•
What you eat
How much physical activity you get
Whether you use tobacco
How much alcohol you drink
Whether you misuse drugs
In fact, it has been estimated that almost 35 percent of all U.S. early deaths in 2000
could have been avoided by changing just three behaviors:
•
•
•
Stopping smoking
Eating a healthy diet (for example, eating more fruits and vegetables and less red
meat)
Getting more physical activity
A person can have one risk factor for a disease or he/she can have many. The more risk
factors a person has, the more likely he/she will get the disease. For example, if people eat
healthy, exercise on a regular basis, and control blood pressure, their chances of getting
heart disease are less than those of diabetics, smokers, and sedentary people. To lower
14
your risks, take small steps toward engaging in a healthy lifestyle, and you’ll see big
rewards.
People with a family health history of chronic disease may have the most to gain from
making lifestyle changes. You can’t change your genes, but you can change behaviors that
affect your health, such as smoking, inactivity, and poor eating habits. In many cases,
making these changes can reduce your risk of disease even if the disease runs in your
family. Another change you can make is to have screening tests, such as mammograms and
colorectal cancer screening. These screening tests help detect disease early. People who
have a family health history of a chronic disease may benefit the most from screening tests
that look for risk factors or early signs of disease. Finding disease early, before symptoms
appear, can mean better health in the long run.
Section 1.10 Levels of Disease Prevention
Prevention includes a wide range of activities — known as “interventions” — aimed at
reducing risks or threats to health. You may have heard researchers and health experts talk
about three categories of prevention: primary, secondary and tertiary. What do they mean
by these terms?
Primary prevention aims to prevent disease or injury before it ever occurs. This is done by
preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe
behaviors that can lead to disease or injury, and increasing resistance to disease or injury
should exposure occur. Examples include:
•
•
•
Legislation and enforcement to ban or control the use of hazardous products (e.g.
asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike
helmets)
Education about healthy and safe habits (e.g. eating well, exercising regularly, not
smoking)
Immunization against infectious diseases.
Secondary prevention aims to reduce the impact of a disease or injury that has already
occurred. This is done by detecting and treating disease or injury as soon as possible to halt
or slow its progress, encouraging personal strategies to prevent re-injury or recurrence,
and implementing programs to return people to their original health and function to
prevent long-term problems.
Examples include:
•
•
•
Regular exams and screening tests to detect disease in its earliest stages (e.g.
mammograms to detect breast cancer)
Daily, low-dose aspirins and/or diet and exercise programs to prevent further heart
attacks or strokes
Suitably modified work so injured or ill workers can return safely to their jobs.
15
Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting
effects. This is done by helping people manage long-term, often-complex health problems
and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much
as possible their ability to function, their quality of life and their life expectancy. Examples
include:
•
•
•
Cardiac or stroke rehabilitation programs, chronic disease management programs
(e.g. for diabetes, arthritis, depression, etc.)
Support groups that allow members to share strategies for living well
Vocational rehabilitation programs to retrain workers for new jobs when they have
recovered as much as possible.
Section 1.11 Behavior Change and Goal Setting
Transtheoretical Model (Stages of Change)
The transtheoretical model of behavior change, developed by Prochaska and DiClemente,
assesses an individual’s readiness to implement a healthier behavior and provides insight
into the decision making process that leads to action. For many people, changing or
modifying a behavior that is unhealthy or potentially harmful can be quite challenging.
Here are the stages that lead to behavior change:
•
•
•
•
•
Precontemplation (Not Ready) – You are not intending to take action in the
foreseeable future, and can be unaware that your behavior is problematic
Contemplation (Getting Ready) – You are beginning to recognize that your behavior
is problematic, and start to look at the pros and cons of your continued actions
Preparation (Ready) – You are intending to take action in the immediate future, and
may begin taking small steps toward behavior change
Action – You are making actual changes to your problem behavior by incorporating
healthy choices/behaviors into your life
Maintenance – You have been able to sustain action for at least six months and are
working to prevent relapse into previous unhealthy behaviors
Stage 1: Precontemplation (not ready)
People at this stage do not intend to start the healthy behavior in the near future (within 6
months), and may be unaware of the need to change. People here learn more about healthy
behavior: they are encouraged to think about the pros of changing their behavior and to
feel emotions about the effects of their negative behavior on others.
Precontemplators typically underestimate the pros of changing, overestimate the cons, and
often are not aware of making such mistakes.
16
One of the most effective steps that others can help with at this stage is to encourage them
to become more mindful of their decision-making and more conscious of the multiple
benefits of changing an unhealthy behavior.
Stage 2: Contemplation (getting ready)
At this stage, participants are intending to start the healthy behavior within the next 6
months. While they are usually now more aware of the pros of changing, their cons are
about equal to their Pros. This ambivalence about changing can cause them to keep putting
off taking action. People here learn about the kind of person they could be if they changed
their behavior and learn more from people who behave in healthy ways.
Others can influence and help effectively at this stage by encouraging them to work at
reducing the cons of changing their behavior.
Stage 3: Preparation (ready)
People at this stage are ready to start taking action within the next 30 days. They take small
steps that they believe can help them make the healthy behavior a part of their lives. For
example, they tell their friends and family that they want to change their behavior.
People in this stage should be encouraged to seek support from friends they trust, tell
people about their plan to change the way they act, and think about how they would feel if
they behaved in a healthier way. Their number one concern is: when they act, will they fail?
They learn that the better prepared they are, the more likely they are to keep progressing.
Stage 4: Action (current action)
People at this stage have changed their behavior within the last 6 months and need to work
hard to keep moving ahead. These participants need to learn how to strengthen their
commitments to change and to fight urges to slip back. People in this stage progress by
being taught techniques for keeping up their commitments such as substituting activities
related to the unhealthy behavior with positive ones, rewarding themselves for taking
steps toward changing, and avoiding people and situations that tempt them to behave in
unhealthy ways.
Stage 5: Maintenance (monitoring)
People at this stage changed their behavior more than 6 months ago. It is important for
people in this stage to be aware of situations that may tempt them to slip back into doing
the unhealthy behavior—particularly stressful situations. It is recommended that people in
this stage seek support from and talk with people whom they trust, spend time with people
who behave in healthy ways, and remember to engage in healthy activities to cope with
stress instead of relying on unhealthy behavior.
Relapse (recycling): Relapse in the TTM specifically applies to individuals who
successfully quit smoking or using drugs or alcohol, only to resume these unhealthy
17
behaviors. Individuals who attempt to quit highly addictive behaviors such as drug, alcohol,
and tobacco use are at particularly high risk of a relapse. Achieving a long-term behavior
change often requires ongoing support from family members, a health coach, a physician,
or another motivational source. Supportive literature and other resources can also be
helpful to avoid a relapse from happening.
Section 1.12 SMART Goal Setting
Figure 1. SMART Acronym
Have you ever said to yourself that you need to “eat healthier” or “exercise more” to
improve your overall health? How well did that work for you? In most cases, probably not
very well. That’s because these statements are too vague and do not give us any direction
for what truly needs to be done to achieve such goals. To have a better chance at being
successful, try using the SMART acronym for setting your goals (S= Specific, M=
Measurable, A=Attainable, R= Realistic, T= Time-oriented):
Specific – Create a goal that has a focused and clear path for what you actually need to do.
Examples:
•
•
•
I will drink 8 ounces of water 3 times per day
I will walk briskly for 30 minutes, 5 times per week
I will reduce my soda intake to no more than 2 cans of soda per week
Do you see how that is more helpful than just saying you will eat healthier or exercise
more? It gives you direction.
Measurable – This enables you to track your progress, and ties in with the “specific”
component. The above examples all have actual numbers associated with the behavior
change that let you know whether or not it has been met.
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Attainable – Make sure that your goal is within your capabilities and not too far out of
reach. For example, if you have not been physically active for a number of years, it would
be highly unlikely that you would be able to achieve a goal of running a marathon within
the next month.
Realistic – Try to ensure that your goal is something you will be able to continue doing and
incorporate as part of your regular routine/lifestyle. For example, if you made a goal to
kayak 2 times each week, but don’t have the financial resources to purchase or rent the
equipment, no way to transport it, or are not close enough to a body of water in which to
partake in kayaking, then this is not going to be feasible.
Time-oriented – Give yourself a target date or deadline in which the goal needs to be met.
This will keep you on track and motivated to reach the goal, while also evaluating your
progress.
References
Behavior Change and Goal Setting
https://courses.lumenlearning.com/suny-monroecc-hed110/chapter/three-levels-ofhealth-promotiondisease-prevention/ CC BY SA
Centers for Disease Control
https://www.cdc.gov/nchs/data/hus/hus16.pdf%23019 CC BY SA
Contemporary Health Issues
http://hlth21fall2012.wikispaces.com/home CC BY SA
Healthy People
https://www.healthypeople.gov CC BY SA
Transtheoretical Model
https://en.wikipedia.org/wiki/Transtheoretical_model CC BY SA
19
CHAPTER 2: Psychological Health
Figure 2. Maslow’s Motivation Model
Maslow’s hierarchy of needs is a theory in psychology proposed by Abraham Maslow in his
1943 paper “A Theory of Human Motivation” in Psychological Review. Maslow used the
terms “physiological”, “safety”, “belonging” and “love”, “esteem”, “self-actualization”, and
“self-transcendence” to describe the pattern that human motivations generally move
through. The goal of Maslow’s Theory is to attain the sixth level of stage: self-transcendent
needs.
Maslow’s hierarchy of needs is often portrayed in the shape of a pyramid with the largest,
most fundamental needs at the bottom and the need for self-actualization and selftranscendence at the top.
The most fundamental and basic four layers of the pyramid contain what Maslow called
“deficiency needs” or “d-needs”: esteem, friendship and love, security, and physical needs.
If these “deficiency needs” are not met – with the exception of the most fundamental
(physiological) need – there may not be a physical indication, but the individual will feel
anxious and tense. Maslow’s theory suggests that the most basic level of needs must be met
before the individual will strongly desire (or focus motivation upon) the secondary or
higher level needs.
The human brain is a complex system and has parallel processes running at the same time,
thus many different motivations from various levels of Maslow’s hierarchy can occur at the
same time. Maslow spoke clearly about these levels and their satisfaction in terms such as
“relative”, “general”, and “primarily”. Instead of stating that the individual focuses on a
certain need at any given time, Maslow stated that a certain need “dominates” the human
organism. Thus Maslow acknowledged the likelihood that the different levels of motivation
could occur at any time in the human mind, but he focused on identifying the basic types of
motivation and the order in which they should be met.
20
Section 2.1 Physiological Needs
Physiological needs are the physical requirements for human survival. If these
requirements are not met, the human body cannot function properly and will ultimately
fail. Physiological needs are thought to be the most important; they should be met first.
Air, water, and food are metabolic requirements for survival in all animals, including
humans. Clothing and shelter provide necessary protection from the elements. While
maintaining an adequate birth rate shapes the intensity of the human sexual instinct, sexual
competition may also shape said instinct.
Section 2.2 Safety Needs
Once a person’s physiological needs are relatively satisfied, his/her safety needs take
precedence and dominate behavior. In the absence of physical safety – due to war, natural
disaster, family violence, childhood abuse, etc. – people may (re-)experience post-traumatic
stress disorder or transgenerational trauma. In the absence of economic safety – due to
economic crisis and lack of work opportunities – these safety needs manifest themselves in
ways such as a preference for job security, grievance procedures for protecting the
individual from unilateral authority, savings accounts, insurance policies, disability
accommodations, etc. This level is more likely to be found in children as they generally
have a greater need to feel safe.
Safety and Security needs include:
•
•
•
•
Personal security
Financial security
Health and well-being
Safety net against accidents/illness and their adverse impacts
Section 2.3 Social Belonging
After physiological and safety needs are fulfilled, the third level of human needs is
interpersonal and involves feelings of belongingness. This need is especially strong in
childhood and it can override the need for safety as witnessed in children who cling to
abusive parents. Deficiencies within this level of Maslow’s hierarchy – due to hospitalism,
neglect, shunning, ostracism, etc. – can adversely affect the individual’s ability to form and
maintain emotionally significant relationships in general, such as:
•
•
•
Friendships
Intimacy
Family
According to Maslow, humans need to feel a sense of belonging and acceptance among their
social groups, regardless whether these groups are large or small. For example, some large
21
social groups may include clubs, co-workers, religious groups, professional organizations,
sports teams, and gangs. Some examples of small social connections include family
members, intimate partners, mentors, colleagues, and confidants. Humans need to love and
be loved – both sexually and non-sexually – by others. Many people become susceptible to
loneliness, social anxiety, and clinical depression in the absence of this love or belonging
element. This need for belonging may overcome the physiological and security needs,
depending on the strength of the peer pressure.
Section 2.4 Esteem
All humans have a need to feel respected; this includes the need to have self-esteem and
self-respect. Esteem presents the typical human desire to be accepted and valued by others.
People often engage in a profession or hobby to gain recognition. These activities give the
person a sense of contribution or value. Low self-esteem or an inferiority complex may
result from imbalances during this level in the hierarchy. People with low self-esteem often
need respect from others; they may feel the need to seek fame or glory. However, fame or
glory will not help the person to build their self-esteem until they accept who they are
internally. Psychological imbalances such as depression can hinder the person from
obtaining a higher level of self-esteem or self-respect. Most people have a need for stable
self-respect and self-esteem. Maslow noted two versions of esteem needs: a “lower”
version and a “higher” version. The “lower” version of esteem is the need for respect from
others. This may include a need for status, recognition, fame, prestige, and attention. The
“higher” version manifests itself as the need for self-respect. For example, the person may
have a need for strength, competence, mastery, self-confidence, independence, and
freedom. This “higher” version takes precedence over the “lower” version because it relies
on an inner competence established through experience. Deprivation of these needs may
lead to an inferiority complex, weakness, and helplessness.
Maslow states that while he originally thought the needs of humans had strict guidelines,
the “hierarchies are interrelated rather than sharply separated”. This means that esteem
and the subsequent levels are not strictly separated; instead, the levels are closely related.
Section 2.5 Self-Actualization
“What a man can be, he must be.”[ This quotation forms the basis of the perceived need for
self-actualization. This level of need refers to what a person’s full potential is and the
realization of that potential. Maslow describes this level as the desire to accomplish
everything that one can, to become the most that one can be. Individuals may perceive or
focus on this need very specifically. For example, one individual may have the strong desire
to become an ideal parent. In another, the desire may be expressed athletically. For others,
it may be expressed in paintings, pictures, or inventions. As previously mentioned, Maslow
believed that to understand this level of need, the person must not only achieve the
previous needs, but master them.
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Section 2.6 Self-Transcendence
In his later years, Abraham Maslow explored a further dimension of needs, while criticizing
his own vision on self-actualization. The self only finds its actualization in giving itself to
some higher goal outside oneself, in altruism and spirituality, which is essentially the desire
to reach infinite. “Transcendence refers to the very highest and most inclusive or holistic
levels of human consciousness, behaving and relating, as ends rather than means, to
oneself, to significant others, to human beings in general, to other species, to nature, and to
the cosmos” (Farther Reaches of Human Nature, New York 1971, p. 269).
Section 2.7 Mental Health
According to the World Health Organization (WHO), mental health includes “subjective
wellbeing, perceived self-efficacy, autonomy, competence, inter-generational dependence,
and self-actualization of one’s intellectual and emotional potential, among others.” The
WHO further states that the well-being of an individual is encompassed in the realization of
their abilities, coping with normal stresses of life, productive work and contribution to
their community. Cultural differences, subjective assessments, and competing professional
theories all affect how “mental health” is defined. A widely accepted definition of health by
mental health specialists is psychoanalyst Sigmund Freud’s definition: the capacity “to
work and to love”.
Mental Health Issues Are Prevalent Among College Students
Mental health issues are a leading impediment to academic success among college students.
Untreated mental illness in the college student population — including depression, anxiety
and eating disorders — is associated with lower GPA and higher probability of dropping
out of school. Treatment is effective and available yet because of an unnecessary shame
surrounding these issues, mental health is not discussed and too many students are
suffering in silence
•
•
•
An estimated 26 percent of Americans ages 18 and older – or about 1 in 4 adults
– live with a diagnosable mental health disorder.
Half of all serious adult psychiatric illnesses – including major depression,
anxiety disorders, and substance abuse – start by 14 years of age. Three-fourths
of them are present by 25 years of age.
Compared to older adults, the 18-24 year old age group shows the lowest rate of
help-seeking.
Mental Health Issues Impact Students’ Ability To Succeed:
•
Almost one third of all college students report having felt so depressed that they
had trouble functioning.
23
•
•
Mental health issues in the college student population, such as depression,
anxiety, and eating disorders, are associated with lower GPA and higher
probability of dropping out of college.
More than 80 percent of college students felt overwhelmed by all they had to do
in the past year and 45 percent have felt things were hopeless.
Mental health issues can be deadly:
•
•
•
•
Suicide is the 2nd leading cause of death among college students, claiming the
lives of 1,100 students each year.
67% of college students tell a friend they are feeling suicidal before telling
anyone else.
More than half of college students have had suicidal thoughts and 1 in 10
students seriously consider attempting suicide. Half of students who have
suicidal thoughts never seek counseling or treatment.
80-90% of college students who die by suicide were not receiving help from
their college counseling centers
Section 2.8 Emotional Health
Emotional well-being is a term that has been used increasingly in recent decades. The
implications of decreased emotional well-being are related to mental health concerns such
as stress, depression, and anxiety. These in turn can contribute to physical ill-health such as
digestive disorders, sleep disturbances, and general lack of energy.[1] The profile of a
person prone to emotional distress is usually someone with low self-esteem, pessimistic,
very self-critical, etc. and people who need to constantly assert themselves through their
behavior. They also tend to be afraid, overly worried about the future, and focused on the
past.
On the positive side, enhanced emotional well-being is seen to contribute to upward spirals
in increasing coping ability, self-esteem, performance and productivity at work, and even
longevity. Thoughts determine feelings, and thoughts are nothing more than firings of
neurons. And those feelings that thoughts generate make the body release extremely
addicting substances like adrenaline and cortisol. Like with any other addiction, the need to
continually feed off these addicting substances tends to make the body think and feel in a
certain way. When someone decides to disengage from these emotional addictions, he/she
must learn to think differently.
Emotions and feelings are part of every step a person takes. A person must learn how to
manage himself/herself in order to reach the maximum potential in all aspects of life. Good
emotional health leads to better physical health, prevents diseases, and makes it possible to
enjoy life and be happier. In this way you can become a “medicine person” through mirror
neurons, those that lead to empathy and fire to imitate the emotions of others. Mirror
neurons are what make you feel good when you’re with someone who is positive, cheerful
24
and motivational. At the other extreme are the so-called “toxic people”, who make others
around them feel bad.
Section 2.9 Spiritual Health
The spiritual dimension is understood to imply a phenomenon that is not material in
nature, but belongs to the realm of ideas, beliefs, values and ethics that have arisen in the
minds and conscience of human beings, particularly ennobling ideas. Ennobling ideas have
given rise to health ideals, which have led to a practical strategy for Health for All that aims
at attaining a goal that has both a material and non-material component. If the material
component of the strategy can be provided to people, the non-material or spiritual one is
something that has to arise within people and communities in keeping with their social and
cultural patterns. The spiritual dimension plays a great role in motivating people’s
achievement in all aspects of life. [7]
Section 2.10 Social Health
The capacity for an individual to develop and flourish is deeply influenced by immediate
social surroundings – including their opportunity to engage positively with family
members, friends or colleagues, and earn a living for themselves and their families – and
also by the socioeconomic circumstances in which said individual find himself/herself.
Restricted or lost opportunities to gain an education and income are especially pertinent
socio-economic factors.
Psychoneuroimmunology is defined as the examination of the interactions among
psychological, behavioral, and social factors with immunological and neuroendocrine
outcomes. It is now well established that psychological factors, especially chronic stress,
can lead to impairments in immune system function in both the young and older adults. In
several studies of older adults, those who are providing care for a relative with dementia
report high levels of stress and exhibit significant impairments in immune system
functioning when compared with non-caregivers. Stress-induced changes in the immune
system may affect a number of outcomes, including slowing the wound healing process and
increasing susceptibility to infections.
Section 2.11 Factors That Influence Psychological Well-Being
Infancy and Early Childhood
There is a strong body of evidence to show the importance of attachment by neonates to
their mothers or other primary caregivers for subsequent social and emotional
development. Separation from the primary caregiver – due for example to parental absence
or rejection – leads to anxiety, stress and insecurity. Post-natal depression among new
mothers can likewise contribute to sub-optimal attachment and development. Parents who
have difficulties in bonding, have limited skills or exhibit negative attitudes place their
children at increased risk of exposure to stress and behavioral problems. Other important
25
risks to physical and cognitive development in infancy and early childhood include
maltreatment and neglect (by parents and other caregivers), malnutrition and infectious or
parasitic diseases.
Individual attributes and behaviors
These relate to a person’s innate and learned ability to deal with thoughts and feelings and
to manage him/herself in daily life (’emotional intelligence’). It is also the capacity to deal
with the social world around by partaking in social activities, taking responsibilities or
respecting the views of others (‘social intelligence’). An individual’s mental health state can
also be influenced by genetic and biological factors; that is, determinants that persons are
born or endowed with, including chromosomal abnormalities (e.g. Down’s syndrome) and
intellectual disability caused by prenatal exposure to alcohol or oxygen deprivation at
birth.
Social and economic circumstances
The capacity for people to develop and flourish is deeply influenced by their immediate
social surroundings – including their opportunity to engage positively with family
members, friends or colleagues, and earn a living for themselves and their families – and
also by the socioeconomic circumstances in which they find themselves. Restricted or lost
opportunities to gain an education and income are especially pertinent socio-economic
factors.
Environmental factors
The wider sociocultural and geopolitical environment in which people live can also affect
an individual’s, household’s or community’s mental health status, including levels of access
to basic commodities and services (water, essential health services, the rule of law),
exposure to predominating cultural beliefs, attitudes or practices, as well as by social and
economic policies formed at the national level; for example, the on-going global financial
crisis is expected to have significant mental health consequences, including increased rates
of suicide and harmful alcohol use. Discrimination, social or gender inequality and conflict
are examples of adverse structural determinants of mental well-being.
Personality
Personality measures turn out to be good predictors of your health, your sexual
promiscuity, your likelihood of divorce, how happy you typically are—even your taste in
paintings. Personality is a much better predictor of these things than social class or age.
The origin of these differences is in part innate. That is to say, when people are adopted at
birth and brought up by new families, their personalities are more similar to their blood
relatives than to the ones they grew up with. The differences begin to emerge early in life
and are surprisingly stable across the decades. This is not to say that people cannot change,
but major change is the exception rather than the rule. Personality differences tend to
manifest themselves through the quick, gut-feeling, intuitive, and emotional systems of the
26
human mind. The slower, rational, deliberate systems show less variation in output from
person to person. Deliberate rational strategies can be used to over-ride intuitive patterns
of response, and this is how people wishing to change their personalities or feelings have to
go about it.
So what are the major ways personalities can differ? The dominant approach is to think of
the space of possible personalities as being defined by a number of dimensions. Each
person can be given a location in the space by their scores on all the different dimensions.
Virtually all theories agree on two of the main dimensions, though they differ on how many
additional ones they recognize.
Five factors
•
•
•
•
Openness to experience: (inventive/curious vs. consistent/cautious). Appreciation
for art, emotion, adventure, unusual ideas, curiosity, and variety of experience.
Openness reflects the degree of intellectual curiosity, creativity and a preference for
novelty and variety a person has. It is also described as the extent to which a person
is imaginative or independent and depicts a personal preference for a variety of
activities over a strict routine. High openness can be perceived as unpredictability
or lack of focus. Moreover, individuals with high openness are said to pursue selfactualization specifically by seeking out in tense, euphoric experiences. Conversely,
those with low openness seek to gain fulfillment through perseverance and are
characterized as pragmatic and data-driven—sometimes even perceived to be
dogmatic and closed-minded. Some disagreement remains about how to interpret
and contextualize the openness factor.
Conscientiousness: (efficient/organized vs. easy-going/careless). A tendency to be
organized and dependable, show self-discipline, act dutifully, aim for achievement,
and prefer planned rather than spontaneous behavior. High conscientiousness is
often perceived as stubbornness and obsession. Low conscientiousness is associated
with flexibility and spontaneity, but can also appear as sloppiness and lack of
reliability.
Extraversion: (outgoing/energetic vs. solitary/reserved). Energy, positive emotions,
surgency, assertiveness, sociability and the tendency to seek stimulation in the
company of others, and talkativeness. High extraversion is often perceived as
attention-seeking, and domineering. Low extraversion causes a reserved, reflective
personality, which can be perceived as aloof or self-absorbed.
Agreeableness: (friendly/compassionate vs. challenging/detached). A tendency to
be compassionate and cooperative rather than suspicious and antagonistic towards
others. It is also a measure of one’s trusting and helpful nature, and whether a
person is generally well-tempered or not. High agreeableness is often seen as naive
or submissive. Low agreeableness personalities are often competitive or challenging
people, which can be seen as argumentativeness or untrustworthiness.
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•
Neuroticism: (sensitive/nervous vs. secure/confident). The tendency to experience
unpleasant emotions easily, such as anger, anxiety, depression, and vulnerability.
Neuroticism also refers to the degree of emotional stability and impulse control and
is sometimes referred to by its low pole, “emotional stability”. A high need for
stability manifests itself as a stable and calm personality, but can be seen as
uninspiring and unconcerned. A low need for stability causes a reactive and
excitable personality, often very dynamic individuals, but they can be perceived as
unstable or insecure.
Assess yourself! This is an interactive version of the IPIP Big-Five Factor Markers, a
measure of the big five personality traits: Big 5 Personality Test
Section 2.12 Developing and protecting individual attributes
At its core, mental health and well-being rests on the capacity of individuals to manage
their thoughts, feelings and behavior, as well as their interactions with others. It is essential
that these core attributes of self-control, resilience and confidence be allowed to develop
and solidify in the formative stages of life, so that individuals are equipped to deal with the
complex choices and potential adversities they will face as they grow older.
Alcohol, tobacco and drug use pose risks to mental and physical health, particularly among
pregnant women and adolescents. Raising awareness about the health risks of substance
use can be accompanied by implementation of a number of proven strategies for reducing
their use, including fiscal measures (namely, increased excise taxes) and regulatory
instruments (such as comprehensive restrictions on advertising, minimum age of use and
restrictions on smoking in public places).
Maintaining a healthy diet and regular physical exercise are also protective factors for
mental health and can be considered as part of a holistic approach to health promotion and
protection in the population.
Section 2.13 Supporting families and communities
Individual-level mental health and well-being is strongly mediated by the immediate social
context in which people live, work and carry out their day-to-day activities. The focus of
family- and community-level attention is therefore to foster living and working conditions
that enable psychosocial development (particularly among vulnerable persons) and
promote positive interactions within and between families and social groups. Certain
mental health promotion and protection strategies are targeted at specific groups,
including: home-based interventions for socioeconomically disadvantaged families and for
children with a mentally ill parent; prevention of intimate partner violence; school-based
interventions for children and adolescents exhibiting emotional or behavioral problems;
work-based interventions for adults looking for employment or struggling to cope at work;
community-based interventions aimed at enhanced social participation of older adults; and
psychosocial support for persons affected by conflict or disaster.
28
Section 2.14 Supporting vulnerable groups in society
At the level of social and environmental determinants, key predictors of – and also
consequences of – mental ill-health include lack of access to basic amenities and services,
social exclusion, discrimination and exposure to violence, conflict or disasters. State-wide
policy instruments that can address these failings and contribute towards social equality,
inclusion and security include: anti-discrimination laws and campaigns; social protection
for the poor; and elaboration of peaceful relations within and across national or ethnic
boundaries.
Section 2.15 Mental Illness
We have all had some exposure to mental illness, but do we really understand it or know
what it is? Many of our preconceptions are incorrect. A mental illness can be defined as a
health condition that changes a person’s thinking, feelings, or behavior (or all three) and
that causes the person distress and difficulty in functioning. As with many diseases, mental
illness is severe in some cases and mild in others. Individuals who have a mental illness
don’t necessarily look like they are sick, especially if their illness is mild. Other individuals
may show more explicit symptoms such as confusion, agitation, or withdrawal.
Even if you or a family member has not experienced mental illness directly, it is very likely
that you have known someone who has. Estimates are that at least one in four people is
affected by mental illness either directly or indirectly.
Consider the following statistics to get an idea of just how widespread the effects of mental
illness are in society:
•
•
•
•
•
•
According to recent estimates, approximately 20 percent of Americans, or about one
in five people over the age of 18, suffer from a diagnosable mental disorder in a
given year.
Four of the 10 leading causes of disability—major depression, bipolar disorder,
schizophrenia, and obsessive-compulsive disorder—are mental illnesses.
About 3 percent of the population have more than one mental illness at a time.
About 5 percent of adults are affected so seriously by mental illness that it interferes
with their ability to function in society. These severe and persistent mental illnesses
include schizophrenia, bipolar disorder, other severe forms of depression, panic
disorder, and obsessive-compulsive disorder.
Approximately 20 percent of doctors’ appointments are related to anxiety disorders
such as panic attacks. Eight million people have depression each year.
Two million Americans have schizophrenia disorders, and 300,000 new cases are
diagnosed each year.
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Section 2.16 Mood Disorders
Major mood disorders are depression, bipolar disorder, and dysthymic disorder. Like
anxiety, depression might seem like something that everyone experiences at some point,
and it is true that most people feel sad or “blue” at times in their lives. A true depressive
episode, however, is more than just feeling sad for a short period. It is a long-term,
debilitating illness that usually needs treatment to cure. And bipolar disorder is
characterized by dramatic shifts in energy and mood, often affecting the individual’s ability
to carry out day-to-day tasks. Bipolar disorder used to be called manic depression because
of the way that people would swing between manic and depressive episodes.
Section 2.17 Depression
Depression, or depressive disorders, is a leading cause of disability in the United States as
well as worldwide. It affects an estimated 9.5 percent of American adults in a given year.
Nearly twice as many women as men have depression. Depression is more than just being
in a bad mood or feeling sad. Everyone experiences these feelings on occasion, but that
does not constitute depression. Depression is actually not a single disease; there are three
main types of depressive disorders. They are major depressive disorder, dysthymia, and
bipolar disorder (manic-depression).
While some of the symptoms of depression are common during a passing “blue mood,”
major depressive disorder is diagnosed when a person has five or mo…