Health Assessment Terms Definition of Health Major Causes

Health Assessment

Terms �Definition of Health �Major Causes of Death 1900 vs. 2010 �Behavioral Pathogen �Behavioral Immunogen � 7 Healthy Behaviors �Determinants of Life Expectancy/Health

How to Define Health? ?

Word Origins �Indo-European Root: Kailo �Old English: Hale �Emphasis on vigor, strength, whole, uninjured �Health= absence of physical disease

WHO Definition �State of complete physical, psychological, and social well-being �Not merely absence of disease or infirmity �“Health Triangle”: Biopsychosocial Model

Threats to Health

1900 USA: Life Expectancy 47 �Infectious Disease �Cholera �Dysentery �Influenza �TB �Occupational Diseases �Black lung �Silicosis �Accidents

2016 USA Major Causes of Death? ?

CDC 2014 Data: Life Expectancy 78 �Heart Disease: 599, 413 �Cancer: 567, 628 �Chronic Respiratory Disease: 137, 353 �Stroke: 128, 842 �Accidents: 118, 021

Major Contributors �-tobacco ( 400, 000) �-diet and activity patterns ( 300, 000) �-alcohol (100, 000) �-microbial agents like viruses, bacteria, fungi ( 90, 000) �-toxic agents (60, 000) �-firearms (35, 000) �-sexual behavior (30, 000) �-motor vehicles ( 25, 000) �-illicit use of drugs ( 20, 000) �Iatrogenic (doctor or treatment caused)

Causes of Death Demo

Lifestyle and Behavioral Factors �Behavioral Pathogens: healthcompromising behaviors

�Behavioral Immunogens: healthenhancing behaviors

Behavioral Pathogens for Alzheimer’s ?

nine risk factors �Obesity �Smoking �Low Education �Type 2 Diabetes �Depression �High Blood Pressure �Narrowing of Carotid Artery in Neck �High levels of Homocysteine

Are certain traits linked to long life ? Carmelo Flores, b 1890

�"I was born here in the highlands, " Flores told CNN in Aymara, with his son translating into Spanish. "I was not a mischievous child. I was rather calm. I arrived as a young man in Frasquia and worked as herder and farmer. I was very happy with my wife. We never fought. I never cheated on her and we were both very happy. ” �Flores' wife lived to be over 100 years old. According to family tradition, the secret to a long life is drinking the water that flows down the Illampu Glacier, located not far from Frasquia. Their diet includes no packaged or processed foods, but locally grown plants like barley and quinoa. They hunt a local fox that lives in the

Importance of Genes no particular diet, geographical location or kind of water makes people live longer. ” People who have extreme old age have virtually nothing in common. They don't share the same religion, nutrition or exercise routine. They only have one detail in common: they have relatives who have lived a long time and children (who) also tend to live a long time, " Coles said.

Factors Influencing Life Expectancy

�**Biological/Personal: �Individual characteristics (genes) and behaviors �Social/Cultural: �Economy and society �Environmental: �What we do or don’t do

How Much of Cancer is Due to Lifestyle? � Just Bad Luck vs. Preventable Behaviors? � Song & Giovannucci (2016) �Data from Nurse’s Health Study & Health Professionals Follow-up Study ( 130, 00 subjects) �Filled out medical data/lifestyle surveys every 2 years; dietary info every 4 years �Divided subjects into two groups, based on lifestyle

�Low- Risk Group: (21% total; 12% F; 9% M) �Never smoked or not smoked for 5 yrs before start �Not drink alcohol or only moderately ( 1/day women; 2/day men) �BMI of at least 18. 5 and lower than 27. 5 �Engage in at least 75 min vigorous intensity or 150 min moderate intensity activity/week �High- Risk Group (79% Total) �Everyone else

Rates �Overall USA Cancer Rates per 100, 000 �Women: 618 �Men: 425 �Rates in Low Risk Group �Women: 463 �Men: 183

Main Outcomes & Measures �Population Attributable Risk (PAR) : Proportion of cancer cases that would not occur if all individuals adopted characteristics of low risk lifestyle �Calculated by comparing incidence & mortality of cancer between low & high risk groups �Assessed PAR at national scale by comparing low risk group with US population

PAR for Cancer Incidence

PAR for Cancer Mortality

PARS Summary �Overall, about 20 -40% of all cancer diagnoses, and about 50% of all cancer deaths can be prevented by lifestyle changes �Rates increase to 40 -70% in general population �Individual Cancers: �Lung Cancer: 70 -80% deaths avoided by low risk lifestyle �Colorectal: 30% �Bladder-40 -50% �Liver- 50 -70%

Conclusions �Lifestyle factors are important factor in cancer incidence & mortality �Certain cancers are more influenced by lifestyle factors �“Need to avoid procrastination”- induced by waiting for new cures, or idea that cancers are driven only by chance �Preventability may be higher if diet, occupational factors, infectious agents, hormone use also

Behaviors

7 Healthy Behaviors � Regular Physical Activity � Eating Breakfast � Enough Sleep ( at least 7 hrs) � Never Smoking � Moderate Alcohol Use � 3 Meals a Day � Being at or Near Normal Weight

Social Factors �Marital Status �Social Groups

Changing Behavior

“When we look at living creatures from an outward point of view, one of the first things that strike us is that they are bundles of habits” - William James

James on Habits: “Any sequence of mental action which has been frequently repeated tends to perpetuate itself; so that we find ourselves automatically prompted to think, feel, or do what we have been before accustomed to think, feel, or do, under like circumstances, without any consciously formed purpose, or anticipation of results”

Characteristics of Habits �We’re only vaguely aware of performing them �Act of performing a habit is emotionless �Repetition produces habituation �Environments tend to trigger chain of habit behaviors �Classical Conditioning: e. g. Daily Routines

Implications for Change: Make new habits “For this we must make automatic and habitual, as early as possible, as many useful actions as we can, and guard against the growing into ways that are likely to be disadvantageous to us, as we should guard against the plague. The more of the details of our daily life we can hand over to the effortless custody of automatism, the more our higher powers of mind will be set free for their own proper work. ”

Don’t Think, Just Do �Start now- don’t wait till New Years, or special date �Don’t let the old habit slip in �Arrange your environment to trigger new habit �put yourself in conditions that encourage the new way �Make new behavior incompatible with the old �Make public pledge

How long does it take to change? �Depends: � 21 days for some: drink glass of water with breakfast � 84 days, or much longer for others ( exercise)

In Class Activity �How many of the 7 health behaviors are part of your routine? �How might you make them habitual, using the techniques discussed earlier?

Log Entry #4 What is your health belief model? How do you define health? What is important to you? How can you optimize health, minimize illness?

�“We are what we repeatedly do, ” Aristotle famously proclaimed. “Excellence, then, is not an act, but a habit. ”

�Don’t have a specific goal, like to lose five pounds �choose a particular situation and then attach a particular action to it. �Example: if you always snack between meals �Replace cake with apple �Create new link between that situation and response that you perform in that situation �Repeat that over and over again until you do it automatically