Population Health: Upstream Thinking & Disparities

• Population health refers to the health outcomes of a group of individuals, including how these outcomes are distributed within the group.

Factors Impacting Health

• Healthy behaviors and habits have the greatest impact on health
• The United States spends 88% of its healthcare dollars on medical services, only 4% on healthy behaviors, and 8% on other areas.

Upstream Thinking

• The focus is on interventions that promote health or prevent illness, rather than treating illness after it occurs.
• It involves examining the root causes of poor health to find the source of the issue.
• Patients can gain needed knowledge and prevent illness through education.
• Examples include encouraging healthier fast-food options, increasing tobacco prices, health screenings, health fairs and smoking cessation classes.

Health Disparities

• These are differences in health outcomes among groups, representing inequalities in healthcare and unequal treatment.
• Groups that tend to experience these are ethnic minorities, the elderly, those in poverty, the uninsured, children, and those with a lack of education.

Healthy People 2030

• Aims to improve the health of all Americans through science-based, 10-year national objectives.
• Uses leading health indicators to communicate high-priority health issues and actions.
• These indicators are influenced by biological, social, economic, and environmental factors.
• The overarching goals:
• To attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death.
• To eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.
• To create social, physical, and economic environments that promote attaining full potential for health and well-being for all.
• To promote healthy development, healthy behaviors, and well-being across all life stages.
• To engage leadership, key constituents, and the public across multiple sectors to take actions and design policies that improve the health and well-being of all.

Social Determinants of Health

• Include neighborhood and built environment, health and healthcare, social and community context, education, and economic stability.

Defining Health

• Health is the state of physical, mental, spiritual, and social functioning that realizes a person's potential within a developmental context.

Health Belief Model

• This describes why some people take action to prevent disease while others do not.
• Individuals who invest more in their health are more likely to make relevant behavior changes, feeling that risks outweigh benefits.
• Important patient perceptions before taking action:
• Perceived susceptibility
• Perceived severity (of disease)
• Risk factors
• Perceived benefits from health action
• Perceived barriers
• Cues to action (symptoms, media information)
• Self-efficacy

Transtheoretical Model of Change

• Used to determine a patient's willingness to change, involving stages: pre-contemplation, contemplation, preparation, action, maintenance, termination.

Self-Efficacy

• It is defined as a belief in one's ability to complete a task or meet a challenge.
• Behavioral change is more likely when perceived benefits are greater than perceived barriers.

Health Coaching

• Partnering with clients in a creative process that inspires them to maximize their personal and professional potential.

Absolute vs. Relative Risk

• Absolute risk is an individual's risk of developing a disease over time.
• Relative risk compares the risk between two groups, one with a risk factor and one without.

Modifiable Risk Factors

• Well-documented tobacco use
• Harmful alcohol use
• Unhealthy diet
• Poor oral hygiene with biofilm

Nonmodifiable Risk Factors

• Age
• Gender
• Family history
• Ethnic background

Stress Management

• An effective intervention framework for health promotion, disease prevention, & symptom management.

Impact of Physical Activity

• It is for both health promotion and disease prevention.
• Decreases risk of death from heart disease, lowers risk for cancer, diabetes, hypertension, depression, anxiety.
• Promotes healthy weight, better sleep habits, improves mood, and maintains cognitive function in the elderly.

Exercise Recommendations

• For arthritis: stretching, walking, Pilates, cycling, hand strengthening, water exercises
• For osteoporosis: walking, hiking, jogging, aerobics, weight-bearing exercises
• For depression: aerobic exercise, walking/running, lifting weights, yoga, bouncing on a trampoline

Calculating Maximum Heart Rate (MHR)

• MHR for exercise: 220 - your age
• MHR for moderate exercises: MHR x 0.64 and MHR x 0.76
• Lower range for moderate activity and the upper range for vigorous activity: MHR X 0.77 and MHR x 0.93

Importance of Sleep

• Considered an essential component of chronic disease prevention and health promotion.

Clinical Model of Health

• People wait to see a doctor until they are ill and may not seek preventative health services.

Wellness-Illness Continuum

• Wellness points to the left, and illness points to the right; prevention moves towards wellness, medicine moves towards illness.

SMART Goals

• Specific, Measurable, Attainable, Realistic, and Timely.

Exercise Recommendations for Adults

• 150 minutes of moderate exercise each week
• 75 minutes of vigorous aerobic activity a week

Effects of Exercise

• Regular physical activity results in improved bone health, cardiorespiratory and muscular fitness, cardiovascular and metabolic health biomarkers, and more favorable body composition.
• For adults and older adults, regular physical activity lowers the risk for multiple conditions, including coronary heart disease, stroke, hypertension, elevated lipids, type 2 diabetes, metabolic syndrome, breast and colon cancers, weight gain, and depression.

Care Coordination

• Deliberate organization of patient care activities between two or more participants involved in a patient's care to facilitate the appropriate delivery of healthcare services.

Social Model of Care

• Used to manage home and community-based services and NOT medical care.
• Supports activities of daily living versus skilled healthcare.

Medical Model of Care

• Coordinates medical services, provider-driven.

Integrated Model of Care

• Hybrid of social and medical model.
• Evolving to support holistic, patient-centered, and family-focused care.

Key Attributes of Care Coordination

• Interprofessional team
• Proactive plan of care
• Targeted set of purposeful activities
• Proactive follow-up
• Communication

Therapeutic Relationship Characteristics

• Purposeful communication
• Builds rapport and trust
• Empathetic (different than sympathetic)
• Goal-directed, patient-centered

Therapeutic Communication Techniques

• Using silence
• Accepting
• Giving recognition
• Offering self
• Giving broad openings
• Active listening
• Seeking clarification
• Placing the event in time or sequence

Factors in Effective Communication

• Listening, flexibility, silence, humor, touch, space

Barriers to Effective Communication

• Asking irrelevant personal questions
• Offering personal opinions
• Giving advice
• Giving false reassurance
• Minimizing feelings
• Changing the topic
• Asking "why" questions
• Offering value judgments
• Excessive questioning
• Responding approvingly or disapprovingly

SBAR/ISBARR

• Introduction
• Situation
• Background
• Assessment
• Request
• Recommendation

Advocacy

• Act of speaking for others to assist them to meet needs.

Health Literacy

• The degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions.
• Patient education material should be at a 6th-grade reading level.
• Low literacy skills can lead to poorer employment opportunities and outcomes, lower income, and poor health.

Indicators of Low Health Literacy

• "I forgot my glasses"
• Lots of papers folded up in purse/pocket
• Lack of follow-through
• Seldom ask questions
• Questions are basic in nature
• Difficulty explaining medical concerns, plan of care, or medications

Macronutrients

• A chemical substance that an organism must obtain in relatively large amounts.
• Examples: carbs, fats, proteins

Micronutrients

• Vitamins and minerals that are essential to the body in small amounts.
• Examples: vitamins and minerals

Basal Metabolic Rate (BMR)

• The energy needed to maintain life-sustaining activities for a specific period of time at rest.

BMI Calculation

• Weight in pounds divided by Height2 x 703

BMI Percentiles

• Underweight: less than 18.5
• Healthy weight: 18.5-24.9
• Overweight: 25.0-29.9
• Obese: 30.0 or greater

Childhood Obesity Strategies

• Intensive behavioral programs using multiple strategies
• Policy and curriculum changes that make it easier for children and adolescents to eat healthily and be physically active

Dietary Guidelines

• Consume a healthy eating pattern that includes a variety of vegetables from all subgroups, whole fruits, grains, fat-free or low-fat dairy, and a variety of protein
• Limit added sugars, saturated fats, and sodium consumed alcohol in moderation

Calories per Gram

• Carbohydrates: 4 calories per gram
• Proteins: 4 calories per gram
• Fats: 9 calories per gram

Calculating Calories from Macronutrients

• Look at the food label
• Multiply the number of grams of each macro by its corresponding calorie number (4, 4, or 9)
• To find the percentage, divide the number of calories per gram by the total calories on the label

Daily Water Intake Recommendations

• Women: 72 ounces
• Men: 104 ounces

Food Safety Guidelines

• Hand washing
• Prevent cross-contamination
• Store foods properly
• Serve foods at safe temperatures
• Chill and defrost properly
• Avoid raw milk and undercooked meat/eggs

Cardiovascular Disease (CVD) Prevention Diet

• Balanced diet with emphasis on fresh fruits and vegetables, whole grains
• Limit red meat and processed meat
• Eat a variety of fish at least 2x/week
• Limit saturated fats and avoid trans fats
• Choose fat-free or low-fat dairy products
• Limit sodium intake
• Limit nutrient-poor foods, like sugar-sweetened beverages

Cancer Prevention Diet

• Focus on plant-based food
• Fruits/vegetables: 2.5 cups every day
• Whole grains
• Limit salty foods
• Avoid sugar-sweetened drinks
• Choose fish, poultry, and beans instead of red meat
• Limit alcohol

Osteoporosis Prevention Diet

• Maximize bone mineral density (BMD) through good calcium intake in childhood
• Avoid smoking
• Adequate dietary calcium and vitamin D (dairy sources, eggs, some cereals)
• Calcium supplementation if inadequate dietary sources
• Note: Calcium recommendations vary by age

Dietary Recommendations for Hypertension

• DASH diet
• 4-5 servings of fruit daily
• 4-5 servings of vegetables daily
• 2-3 servings of low-fat dairy daily
• Consume lean meats, nuts, seeds, dried beans, and high-fiber grains

Portion Size Visuals

• For fruits and vegetables = the size of a woman's fist or baseball
• For meat = the palm of the hand or a deck of cards
• For cheese = the size of a thumb or a pair of dice

SNAP Program

• Supplemental Nutrition Assistance Program
• Monthly allotment to help low-income families buy nutritious food

WIC Program

• Supplemental Nutrition for Women, Infants, and Children
• Supplemental foods and nutrition education to low-income pregnant/postpartum women and at-risk children

Explore population health, focusing on factors impacting health and the importance of healthy behaviors. Learn about upstream thinking, which focuses on preventing illness through education and addressing root causes. Understand health disparities, which are inequalities in healthcare, and their effects on different groups.