Chapter 1-2: Community and Public Health Concepts PDF

# Chapter 1: Community and Public Health Concepts ## Learning Outcomes After completing this chapter, the student can: * Discuss historical figures and events that played a role in the evolution of public health and epidemiology. * Define what is public health. * Enumerate the applications of pub...

# Chapter 1: Community and Public Health Concepts ## Learning Outcomes After completing this chapter, the student can: * Discuss historical figures and events that played a role in the evolution of public health and epidemiology. * Define what is public health. * Enumerate the applications of public health to medical care. * Differentiate Public health from community health. * List and describe the categories of community health care. ## Early Concepts of Disease ### Hunter-Gatherers Ten thousand years ago humans were hunter-gatherers. They had a short life span, but not because of epidemics; their primary problem was just finding enough food to eat. They lived and travelled in small groups and hunted and foraged for food. Their mixed diet was probably fairly balanced and nutritionally complete. Since they lived in small groups and moved frequently, they had few problems with accumulating waste or contaminated water or food. ### Mythology, Superstition, and Religion Early explanations for the occurrence of disease focused on superstition, myths, and religion. Primitive people believed in natural spirits that were sometimes mischievous or vengeful. The Greeks believed that the god Jupiter was angry about man accepting the gift of fire. The story is long and complicated, but Zeus crammed all the diseases, sorrows, vices, and crimes that afflict humanity into a box and gave it to Epimetheus, the husband of Pandora. Mercury was very tired from carrying his burden and gave it to Epimetheus for safe keeping. Pandora wanted desperately to know what was in the box. She waited until Epimetheus was gone. She opened the box, and all of the ills of the world flew out and spread throughout the human world. ### The Agricultural Revolution The shift from the hunter-gather mode of living to an agricultural mode provided a more secure supply of food and enabled expansion of the population. However, domesticated animals provided not only food and labor; they also carried diseases that could be transmitted to humans. People also began to rely heavily on one or two crops, so their diets were often lacking in protein, minerals, and vitamins. People began living in larger groups and staying in the same place, so there was more opportunity for transmission of diseases. Garbage and waste accumulated, and rodents and insect vectors were attracted to human settlements, providing sources of disease. ### The Hippocratic Corpus For many centuries explanations for disease were based not on science, but on religion, superstition, and myth. The Hippocratic Corpus was an early attempt to think about diseases, not as punishment from the gods, but as an imbalance of man with the environment. Although it was unsophisticated by today's standards, it was an important step forward. By considering the possibility that disease was associated with environmental factors or imbalances in diet or personal behaviors, the Corpus also opened up the possibility of intervening to prevent disease or treat it. ### The Bubonic Plague (1347-1700s) Bubonic plague is an acute infectious disease caused by the bacterium _Yersinia pestis_. The bacteria live in the intestines of fleas and are transmitted to rats by flea bites. The rats, therefore, serve as a natural reservoir for the disease, and fleas are the vectors. Occasionally, an infected flea would jump to a human and introduce the bacteria when a blood meal was taken. The bacteria would then spread to the regional lymph nodes and multiply, causing dark, tender, swollen nodules (buboes), as shown below in a boy a walnut-sized swelling in the inner aspect of his upper thigh. As the infection spread, the victim would experience headache, high fever, delirium, and finally death in about 60% of cases. ### Cause of the Plague and Strategies for Prevention The cause of the plague was not known, but there were many theories. The most popular explanation was that it was caused by "miasmas," invisible vapors that emanated from swamps or cesspools and floated around in the air, where they could be inhaled. Others thought it was spread by person to person contact, or perhaps by too much sun exposure, or by intentional poisoning. The miasma theory was the most popular, however. While most believed that plague was caused by miasmas, the primary mode of transmission was actually via flea bites, and, in a sense, the real causes were increased population density and failure to dispose of garbage. Accumulations of garbage attracted rats and enabled the rat population to explode. Rats had harbored fleas and _Yersinia pestis_ for many years without major difficulty, and plague epidemics in humans didn't occur until human behaviours created environments that brought people into proximity with rats, fleas, and _Yersina pestis_. These were the real causes of the plague epidemics. ### Quarantine and Isolation The use of quarantine as a public health measure dates back to the 14th century when the Black Death ravaged Italy and the rest of Europe. Quarantine comes from the Italian _quarantena_, meaning forty-day period. Travellers and merchandise that had potentially been exposed to disease were isolated for a period of time to ensure that they weren't infected. While quarantine is one of the oldest public health measures, it is still useful today. During the SARS epidemic, Toronto quarantined individuals who had potentially been exposed by confining them to their homes until it was certain that they weren't infected. This measure was effective in controlling SARS because individuals infected with SARS were not infectious until they began to exhibit symptoms. However, quarantine is less useful for diseases like influenza, when an infected person can spread the disease even before they begin having symptoms. Quarantine is different from isolation, which is separation of a person who has the disease; quarantine refers to the separation of an individual who has possibly been exposed to disease. ### Ideas about Health Systematic thinking about how to establish the determinants of health and disease was not suddenly invented by a single individual. It evolved over centuries. One can see sparks of insight intermittently over time. In the 1700s and 1800s one can see attempts to examine the causes of disease and the effectiveness of prevention and treatment in a systematic way. Below shows examples illustrating some of the major ideas that emerged and contributed to the evolution of how the factors associated with health and disease. ### Girolamo Fracastoro (1546) Girolamo Fracastoro was an Italian physician, poet, astronomer, and geologist, who wrote about 'disease seeds' carried by wind or direct contact. In essence, he was proposing the germ theory of disease more than 300 years before its formal articulation by Louis Pasteur and Robert Koch. ### John Graunt - The Bills of Mortality (1662) Graunt made a number of observations regarding common causes of death, higher death rates in men, seasonal variation in death rates, and the fact that some diseases had relatively constant death rates, while others varied considerably. Graunt also estimated population size and rates of population growth, and he was the first to construct a "life table" in order to address the issue of survival from the time of birth. ### Anton van Leeuwenhouk (1670s) Van Leeuwenhouk's accomplishments were preceded by those of Robert Hooke, who had published "Micrographia" in 1665. Hooke devised a compound microscope and used it to examine and describe the structure of nature on a microscopic level, including insects, feathers, and plants. In fact, it was Hooke who discovered plant cells and coined the term "cells". Anton van Leeuwenhoek of Holland was "the father of microscopy." He used these to create the first useful microscopes. Using his inventions, he was the first to see bacteria (1674), yeast, protozoa, sperm cells, and red blood cells. ### John Pringle and "Jail Fever" (1740s) John Pringle was a Scot who served as physician general to the British forces during the War of the Austrian Succession (1740-48). He proposed a number of measures aimed at improving the health of soldiers including improvements in hospital ventilation and camp sanitation, proper drainage, adequate latrines, and the avoidance of marshes. He wrote expensively on the importance of hygiene to prevent typhus or "jail fever," which was a common malady among soldiers and prisoners in jails. Pringle also coined the term 'influenza'. ### James Lind and Scurvy (1754) Scurvy is due to a deficiency in vitamin C that results in weak connective tissue and abnormally fragile capillaries that rupture easily, causing bleeding, anemia, edema, jaundice, heart failure, and death. Scurvy was a huge problem in sailors several centuries ago, because of the chronic lack of fresh fruit and vegetables during long sea voyages. James Lind, a Scottish naval surgeon, suspected that citrus fruits could prevent it based on some anecdotal observations. ### Francois Broussais & Pierre Louis (1832) Francois Broussais was a prominent Parisian physician and a strong proponent of bloodletting with leeches. He used bloodletting to treat many diseases, including cholera. It is believed that his vigorous use of bloodletting to treat victims of a cholera epidemic in Paris substantially contributed to the mortality rate. Pierre Louis was a contemporary of Broussais's who believed in using numerical methods to evaluate treatment. Louis studied bloodletting and found it ineffective, but many dismissed his conclusions. ### The Industrial Revolution The Industrial Revolution brought an explosion of development. There were new jobs, new goods, and increased trade. However, it also brought new problems to Europe. Further expansion of the population and mass migration caused explosive growth of cities. Poor workers were often housed in cramped, grossly inadequate quarters. Working conditions were difficult and exposed employees to many risks and dangers, including cramped work areas with poor ventilation, trauma from machinery, toxic exposures to heavy metals, dust, and solvents. Consequently, progress brought a whole new set of health problems that were widespread in Europe and in America. ### The Enlightenment (1700-1850) The Enlightenment was a period that saw an embrace of democracy, citizenship, reason, rationality, and the social value of intelligence (the value of information gathering). These ideas provided important underpinnings for public health. ### Ignaz Semmelweis and Oliver Wendell Holmes (1840s) Ignaz Semmelweis was a Hungarian physician who practiced in the maternity department of the Vienna General Hospital in the 1840s. Postpartum sepsis (puerperal fever) was a common occurrence and was almost invariably fatal. He required all attendants to wash hands with chlorinated water to control spread of infection. Oliver Wendell Holmes, Sr. was an American physician, professor, lecturer, and respected literary author. He received his M.D. from Harvard Medical School in 1836 and served as professor and chairman of anatomy and physiology at Dartmouth Medical School and later at Harvard Medical School. He advocated for medical reforms and was a strong proponent of the idea that doctors and nurses could carry puerperal fever from patient to patient. In 1843, he presented a paper entitled "The Contagiousness Of Puerperal Fever" at the Boston Society for Medical Improvement. ### John Snow - The Father of Epidemiology Cholera is an infectious disease that became a major threat to health during the 1800s. In the 1800s there were large epidemics of cholera in Europe and America that killed thousands of people. John Snow was a physician in London who spent several decades studying cholera in a systematic way. He is most often credited with solving an outbreak of cholera that occurred in London in 1854. In retrospect, Snow made several important contributions to the development of epidemiologic thinking: * He proposed a new hypothesis for how cholera was transmitted. * He tested this hypothesis systematically by making comparisons between groups of people. * He provided evidence for an association between drinking from the Broad St. well and getting cholera. * He argued for an intervention which prevented additional cases (removal of the pump handle). ### The Sanitary Idea (1850-1875) In 1842 Sir Edwin Chadwick, a social reformer, published a report entitled the 'Report into the Sanitary Conditions of the Labouring Population of Great Britain' proving that life expectancy was much lower in towns than in the countryside. Chadwick was instrumental in creating a central public health administration that paved the way for drainage, sewers, garbage disposal, regulation of housing, and regulations regarding nuisances and offensive trades. This "sanitary idea" resulted in remarkable improvements in health and well-being. ### Louis Pasteur (late 1800) Louis Pasteur was a French biologist and chemist who made enormous contributions to germ theory, to prevention of food spoilage, and to the control of disease. In 1853 Pasteur began studying fermentation in wine and beer and rapidly concluded that microorganisms were responsible. He also discovered that microbes in milk could be killed by heating to about 130 degrees Fahrenheit, a process which is now known as 'pasteurization'. He discovered that some microorganisms require oxygen (aerobic organisms), while others reproduce in the absence of oxygen (anaerobic). Pasteur pioneered the idea of artificially generating weakened microorganisms as vaccines. Edward Jenner's work had demonstrated the principle with the naturally occurring cowpox, which could be used to vaccinate against smallpox. Pasteur was able to artificially weaken strains of anthrax and cholera in order to generate vaccines. It was, in fact, Pasteur who coined the term 'vaccine' in honor of Jenner's discovery. ## What is Public Health? Public health is "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals." (WHO, 1988) In 1920 Charles-Edward A. Winslow defined public health as "the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health." While most would include mental health as an important aspect of public health today, Winslow's definition is still relevant. Health is dependent on a complex interplay among an array of genetic, environmental, and lifestyle factors. As a result, public health is built on expertise and skills from many areas, including biology, environmental and earth science, sociology, psychology, government, medicine, statistics, communication, and many others. This complexity makes it difficult for the general public to understand exactly what public health is and what it does. The life of a person who develops severe heart disease might be prolonged by a dramatic and very expensive medical procedure such as heart surgery. However, public health is about interventions that prevent disease from occurring, so the benefits tend to be less obvious. In addition, prevention of disease both prolongs life and improves the quality of life. In a sense, public health is the heart disease that never developed, the epidemic that didn't happen, the outbreak of foodborne illness that never occurred, the child that would have developed asthma, but didn't. Public health is the disaster that didn't happen. The strategy employed by public health is to: * Identify and define health problems. * Identify the determinants, i.e., the factors associated with the problem ("risk factors"; deterrents). * Develop & test interventions to control or prevent the problem. * Assess the effectiveness of interventions. Some major achievements of public health during the 20th century; * Vaccination to reduce epidemic diseases * Eradication of smallpox * Improved motor vehicle safety * Safer workplaces * Control of infectious diseases * Decline in death from cardiovascular disease * Improvements in maternal and child health * Family planning * Fluoridation of drinking water * Reductions in prevalence of tobacco use The overall vision is to promote greater health and well-being in a sustainable way, while strengthening integrated public health services and reducing inequalities. In order to achieve this vision, the public health approach involves working with other sectors to address the wider determinants of health, and with health professionals: primary health care professionals can play a key role in preventing illness and promoting health, as outlined in the Alma Ata declaration. Across the WHO European Region, the main challenges facing public health in the twenty-first century include: * Economic crisis; * Widening inequalities; * Ageing population; * Increasing levels of chronic disease; * Migration and urbanization; and * Environmental damage and climate change. ## Public health programs Most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of aging and other physical and mental health conditions, although public health generally receives significantly less government funding compared with medicine. The World Health Organization (WHO) identifies core functions of public health programs including: * Providing leadership on matters critical to health and engaging in partnerships where joint action is needed; * Shaping a research agenda and stimulating the generation, translation and dissemination of valuable knowledge; * Setting norms and standards and promoting and monitoring their implementation; * Articulating ethical and evidence-based policy options; * Monitoring the health situation and assessing health trends. In particular, public health surveillance programs can: * Serve as an early warning system for impending public health emergencies; * Document the impact of an intervention, or track progress towards specified goals; * Monitor and clarify the epidemiology of health problems, allow priorities to be set, and inform health policy and strategies; and * Diagnose, investigate, and monitor health problems and health hazards of the community. Public health surveillance has led to the identification and prioritization of many public health issues facing the world today, including HIV/AIDS, diabetes, waterborne diseases, zoonotic diseases, and antibiotic resistance leading to the re-emergence of infectious diseases such as tuberculosis. Antibiotic resistance, also known as drug resistance. ## Applications in health care While seeking to improve population health through the implementation of specific population-level interventions, public health also contributes to medical care by identifying and assessing population needs for health care services, including: * Assessing current services and evaluating whether they are meeting the objectives of the health care system * Ascertaining requirements as expressed by health professionals, the public and other stakeholders * Identifying the most appropriate interventions * Considering the effect on resources for proposed interventions and assessing their cost-effectiveness * Supporting decision making in health care and planning health services including any necessary changes. * Informing, educating, and empowering people about health issues ## Community Health Community refers to a group of people who share a common place, experience, or interest. We often use this term for people who live in the same area: the same neighborhood, the same city or town, and even the same state or country. People may also consider themselves part of a community with others who have had similar experiences. For example, people may see themselves as part of a: * Racial or ethnic community (for example, the African-American community, the Hispanic community) * Religious community (for example, the Catholic community, the Hindu community, or the Muslim community) * Community of people with disabilities (those with visual impairments, developmental disabilities, or mental illness) Community health is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection and improvement of the health status of population groups and communities as opposed to the health of individual patients. It is a distinct field of study that may be taught within a separate school of public health or environmental health. The WHO defines community health as environmental, social, and economic resources to sustain emotional and physical well-being among people in ways that advance their aspirations and satisfy their needs in their unique environment. Medical interventions that occur in communities can be classified as three categories: primary healthcare, secondary healthcare, and tertiary healthcare. In the United States, community health is rooted within primary healthcare achievements. Primary healthcare programs aim to reduce risk factors and increase health promotion and prevention. Secondary healthcare is related to "hospital care" where acute care is administered in a hospital department setting. Tertiary healthcare refers to highly specialized care usually involving disease or disability management. ## Public Health vs Community Health Public Health includes community health. Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". It is concerned with threats to health based on population health analysis. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services, environmental health, community health, behavioral health, health economics, public policy, insurance medicine and occupational health are other important subfields. Community health is a discipline concerned with the study and improvement of the health characteristics of different communities. Community health tends to focus on geographical areas, and includes primary, secondary and tertiary healthcare. ## Categories of Community Health ### Primary healthcare and primary prevention Community based health promotion emphasizes primary prevention and population based perspective. It is the goal of community health to have individuals in a certain community improve their lifestyle or seek medical attention. Primary healthcare is provided by health professionals, specifically the ones a patient seas first that may refer them to secondary or tertiary care. Primary prevention refers to the early avoidance and identification of risk factors that may lead to certain diseases and disabilities. Community focused efforts including immunizations, classroom teaching, and awareness campaigns are all good examples of how primary prevention techniques are utilized by communities to change certain health behaviors. Prevention programs, if carefully designed and drafted, can effectively prevent problems that children and adolescents face as they grow up. Prevention programs are one of the most effective tools health professionals can use to greatly impact individual, population, and community health. ### Secondary healthcare and secondary prevention Secondary prevention refers to improvements made in a patient's lifestyle or environment after the onset of disease or disability. This sort of prevention works to make life easier for the patient, since it's too late to prevent him/her from his/her current disease or disability. An example of secondary prevention is when those with occupational low back pain are provided with strategies to stop their health status from worsening; the prospects of secondary prevention may even hold more promise than primary prevention in this case. ### Tertiary healthcare In tertiary healthcare, community health can only be affected with professional medical care involving the entire population. Patients need to be referred to specialists and undergo advanced medical treatment. ## Population Health vs. Individual Health The biggest difference between public health and medicine is that public health deals with health from the perspective of populations, while medicine deals with health from the perspective of individuals. In medicine, the patient is the individual person. In public health, the patient is the entire community. Medical professionals diagnose our individual health problems by listening to us describe our symptoms and performing necessary medical tests. Public health professionals diagnose community health problems using scientific research and disease surveillance systems. Public health professionals use two important indicators to measure population health: disease prevalence and disease incidence. Disease prevalence is the number of individuals within a population who have a particular disease at a given time. Disease incidence is the number of new cases of a particular disease within a population in a given time period. Prevalence tells us how widespread the disease is, while incidence tells us about the risk of contracting a particular disease. ## Prevention vs. Treatment & Care Another key difference between public health and medicine is that medicine emphasizes disease treatment and care, while public health emphasizes disease prevention and health promotion. This is not to say that medical professionals don't employ disease prevention strategies. In fact, this is a very important part of their work. For example, doctors often help their patients quit smoking to help prevent them from getting lung cancer. However, the primary goal of medicine is to provide treatment and medical care for individuals who have already developed a disease. The primary goal of public health is to prevent disease and promote health at the population level. Public health professionals employ many different disease prevention strategies, such as health education, community vaccination, sanitation initiatives, and health policy. Health policy is a particularly important tool for achieving public health goals because policies can reach a wide range of people. For example, many U.S. states have adopted policies that ban smoking in restaurants. These policies can help prevent lung cancer by reducing exposure to second-hand smoke. ## Community Organization Community organization covers a series of activities at the community level aimed at bringing about desired improvement in the social well-being of individuals, groups and neighborhoods. It is being often used synonymous to community work, community development and community mobilization. It can represent both community-based organizations, operating as civil society non-profits, and also as a function of organizing within communities defined by geographical location, shared work space, and/or shared experience or concerns. # Chapter 2: Human Behavior and Health ## Learning Outcomes After completing this chapter, the student can: * Describe the determinants of health * List examples of social and physical determinants of health * Discuss the impact of human behavior to health ## The determinants of health Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact. The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health fall under several broad categories: * **Policymaking** * **Social factors** * **Health services** * **Individual behavior** * **Biology and genetics** It is the interrelationships among these factors that determine individual and population health. Because of this, interventions that target multiple determinants of health are most likely to be effective. Determinants of health reach beyond the boundaries of traditional health care and public health sectors. Sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health. ### 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 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 * 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 neighbourhoods * Exposure to toxic substances and other physical hazards * Physical barriers, especially for people with disabilities * Aesthetic elements, such as good lighting, trees, or benches ### Health Services Both access to health services and the quality of health services can impact health. 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 ### 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 than 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 ### Human Behavior Human behavior is the responses of individuals or groups of humans to internal and external stimuli. It refers to the array of every physical action and observable emotion associated with individuals, as well as the human race. While specific traits of one's personality and temperament may be more consistent, other behaviors will change as one moves from birth through adulthood. In addition to being dictated by age and genetics, behavior, driven in part by thoughts and feelings, is an insight into individual psyche, revealing among other things attitudes and values. Social behavior, a subset of human behavior, study the considerable influence of social interaction and culture. Additional influences include ethics, encircling, authority, rapport, hypnosis, persuasion and coercion. ### Health Behavior Health Behavior is any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health, whether or not such behavior is objectively effective towards that end. It is possible to argue that almost every behavior or activity by an individual has an impact on health status. In this context, it is useful to distinguish between behaviors which are purposefully adopted to promote or protect health, and those which may be adopted regardless of consequences to health. Health behaviors are distinguished from risk behaviors which are defined separately as behaviors associated with increased susceptibility to a specific cause of ill-health. Health behaviors and risk behaviors are often related in clusters in a more complex pattern of behaviors referred to as lifestyles ### Lifestyle Lifestyle is the interests, opinions, behaviors, and behavioral orientations of an individual, group, or culture. The term was introduced by Austrian psychologist Alfred Adler with the meaning of "a person's basic character as established early in childhood. Lifestyle is a combination of determining intangible or tangible factors. Tangible factors relate specifically to demographic variables, i.e. an individual's demographic profile, whereas intangible factors concern the psychological aspects of an individual such as personal values, preferences, and outlooks. A rural environment has different lifestyles compared to an urban metropolis. Location is important even within an urban scope. The nature of the neighborhood in which a person resides affects the set of lifestyles available to that person due to differences between various neighborhoods' degrees of affluence and proximity to natural and cultural environments. For example, in areas within a close proximity to the sea, a surf culture or lifestyle can often be present. ### Impact of Lifestyle on Health Poor lifestyle choices, such as smoking, overuse of alcohol, poor diet, lack of physical activity and inadequate relief of chronic stress are key contributors in the development and progression of preventable chronic diseases, including obesity, type 2 diabetes mellitus, hypertension, cardiovascular disease and several types of cancer. Even though doctors encourage healthful behaviors to help prevent or manage many chronic medical conditions, many patients are inadequately prepared to either start or maintain these appropriate, healthy changes. Most patients understand the reasoning behind a healthy lifestyle even if they don't understand the disease processes that can occur when they don't maintain healthy habits. Despite an understanding of what constitutes a healthy lifestyle, many patients lack the behavioral skills they need to apply every day to sustain these good habits. ### Healthy Behaviors for a Healthier Lifestyle Daily habits like the foods you eat, the time you go to sleep and how much activity you get throughout the day have a significant influence on your health. Each of these behaviors positively or negatively affects you and dictates the overall state of your health. Developing a healthy lifestyle is about more than just focusing on habits that address a specific health problem. By devoting your time to healthy behaviors every day, you can ensure that your whole body stays as healthy as possible for as long as possible. A healthy lifestyle can affect multiple aspects of your health, including: * Your ability to maintain a healthier weight level * The aging process, including how your mental and physical health change with age * Your risk of developing chronic disease Developing healthier lifestyle habits can initiate permanent change in your life. Depending on your current wellness level, certain behaviors can reverse the onset of disease, increase your energy levels and improve your mood. ### What does it take to live a Healthy Lifestyle? Adopting a healthier lifestyle requires fundamental change to several aspects of your life. This isn't a temporary shift. To become healthier, you'll have to commit to a collection of: * Psychological Changes * Behavioral Changes * Dietary Changes You may not realize the way your everyday actions are affecting your health. The first step to making healthy lifestyle changes is identifying your current habits. Then, you can take steps to replace poor habits with more positive behaviors. Here are several aspects of your lifestyle that might be influencing your health: * **Nutrition habits:** The foods we eat have a direct influence on the health of our bodies. Instead of eating to feel full, focus on eating to increase your energy levels, benefit your digestive health and improve your overall health. * **Hydration habits:** To maintain good health you have to drink plenty of water. A daily minimum of 3 liters (14 cups) of fluid is recommended for men and 2.2 liters (9 cups) for women. Try drinking water instead of sodas or juices throughout the day. * **Physical activity:** Staying physically active can help you maintain a healthy weight and body composition, reducing the risk of weight-related medical conditions. It can also help you maintain the health of your muscles, bones and joints with age. * **Stress management:** Stress triggers a survival response that can help us in the short-term but become damaging if it persists for a prolonged period. Learning how to control stress can help you retain your mental and physical health. * **Sleeping habits:** The amount of sleep you get every night dictates your energy level, feelings of mental alertness and ability to maintain a healthy weight level. Try to get between seven and nine hours of sleep every night. * **Daily supplements:** Vitamins, nutrients and herbs are big supporters of health and wellness. Taking supplements and managing your health through detoxification and other treatment methods can encourage a healthier lifestyle. ### Health lifestyle program to address noncommunicable diseases in PH The Department of Health (DOH) launched its nationwide healthy lifestyle movement Pilipinas Go4Health which encourages Filipinos to commit to a healthy lifestyle through physical activity, proper nutrition, and the prevention or cessation of smoking and alcohol consumption. The health lifestyle program was launched to help prevent and control noncommunicable diseases (NCDs) in the country. A significant proportion of Filipino adults are exposed to NCD risks which include tobacco and alcohol use, unhealthy diets, and physical inactivity. The increase in NCDs are affecting populations of low and middle income countries like the Philippines, at a young age, reducing the productivity of the working age population and stifling economic growth. Hence, the Pilipinas Go4Health aspires to provide options for healthy living and making these options accessible to every Filipinos. Filipinos are encouraged to register in the program online through their website (www.go4health.ph) to get news and updates on activities for healthier lifestyle. Through the movement, DOH and its partners work together to promote and establish a sustainable environment for healthy living.