HC.Chapter 1: Health Communication (PDF)

# HEALTH COMMUNICATION ## Chapter - Your World, Your Health ### OBJECTIVES - By the end of this chapter, the reader will be able to: - Identify major factors affecting life expectancy and health - Explain how biological attributes of age, race, and sex are conditioned by social interpreta...

# HEALTH COMMUNICATION ## Chapter - Your World, Your Health ### OBJECTIVES - By the end of this chapter, the reader will be able to: - Identify major factors affecting life expectancy and health - Explain how biological attributes of age, race, and sex are conditioned by social interpretations - Describe the leading causes of death for all aged individuals - Diagram an ecological model for a health issue ### CONTENTS - Major Factors Affecting Health Outcomes - Socially Defined You - How to change this picture ### Major Factors Affecting Health Outcomes - A pie chart showing the risk of premature death attributed to different factors. The biggest slice of the pie is "Individual behavior" at 40%, followed by "Genetics" at 30%, "Social & environmental" at 20%, and "Health care" at 10%. - **Health Care: The 10% Solution** - Prior to the implementation of the Affordable Care Act of 2010 (ACA), the United States spent 17.1% of its gross domestic product on health care. - This was nearly twice what was spent in the United Kingdom (8.8%). - This spending was driven by greater use of: - Expensive medical technologies (e.g. computed tomography scans) - Higher healthcare and medication prices - Not more frequent doctor visits or hospital admissions. - Even though the United States spends more on health care than any other high-income country; - Americans have the lowest life expectancy at birth _A greater prevalence of chronic diseases compared to the citizens of other high-income countries - **Genetics and Health: 30%** - The human genome: - Contains about 20,500 genes - Of all these genes, 1% differ from every other human on earth - Single gene mutations are responsible for more than 10,000 disorders - Autosomal recessive genes are expressed in the homozygous state in a 25% chance and therefore have the condition - Genomics may be targeted to an individual's genome or the genome of the disease agent (e.g. a virus or a genetic form of cancer) - **Individual Behavior: 40%** - Individual behaviors, which include: - What you eat, drink, or smoke - Your sexual and reproductive activity - How fast you drive - How long you sit on the couch - So on, play a significant role in determining your longevity - Overall life expectancy increased by 6.9 years from 1960 to 2010. - For many, the choice from an unhealthy to a beneficial behavior seems out of their hands. - “Social determinants of health (SDH)” - A bar graph showing the impact of behavioral changes on life expectancy, 1960-2010. The bar graph shows the change in life expectancy for behaviors such as smoking, motor vehicles, alcohol, obesity, poisonings, firearms, and total. The results show that declines in smoking, motor vehicle fatalities, and heavy drinking increased life expectancy, while increases in obesity, poisonings, and firearm deaths decreased life expectancy. - **Social and Environmental Factors: 20%** - Social and environmental factors: - Directly affect health (such as gang membership, air pollution, or toxic exposure to lead paint) - Others work indirectly by limiting or shaping access to resources or lifestyle options - Example: A seminal meta-analysis concluded that social determinants are associated with a third of premature deaths in the United States - The World Health Organization (WHO) and the U.S. government have adopted an SDH approach in setting priorities for action. - **Healthy People 2020**, launched in 2010 by the U.S. Department of Health and Human Services, organizes SDH around five key domains: - Economic Stability - Neighborhood and Physical Environment - Education - Community and Social context - The healthcare system - A table showing the social determinants of health, broken down by five key domains: Economic stability, Neighborhood and physical environment, Education, Food, Community and social context, and Healthcare system. The table lists factors that fall within each domain and the impact of each factor on health. - May problems with low literacy (listed under the Education domain) or playgrounds (listed under Neighborhoods) be associated the literal domain of health? - The answer is... **X** - But… - Not being able to read or understand English can have a tremendous impact on taking care of oneself or of one’s family. - Access to safe playgrounds, sidewalks, and other green spaces is closely associated with risks of obesity ### Socially Defined You - There were **biological**, **social**, and **cultural** factors that provide a strong predictive contribution to health outcomes. - There are **protective factors** and **similarly problems** associated with differences in: - Sex and gender - Race and ethnicity - Age - Environment - Societal factors **Sex and Gender** - A diagram showing the difference between sex and gender. Sex is biological, while gender is culturally defined. The diagram shows the different attributes, entitlements, roles, and responsibilities associated with female, male, and transgender individuals. - **Gender nonconforming:** When children behave in ways that are discordant with their biological references (e.g., their genes, their genitalia) - **Transgender** refers to a range of behaviors associated with making this change. - Some individuals go on to have **gender reassignment surgery** and take hormones to support this change. - **Sexual orientation** refers to being sexually and romantically attracted to persons of the same or opposite sex. - Kinsey and others have described a spectrum of attraction from consistently preferring: - The opposite sex (**heterosexual**) - Members of either sex (**bisexual**) - The same sex (**homosexual**) - A table showing the conditions that affect men and women, emphasizing the disparity in health outcomes. - On average, women live longer than men, but they also experience more days of illness or disability. - Snow noted that the XY genotype is a necessary (but not sufficient) condition for the risk of hemophilia, prostate cancer, and testicular cancer. - Being born XX was associated with a greater risk of breast and ovarian cancer, and all maternal causes of death. - Virtually every human society expects boys and men to take risks and demonstrate courage or “manhood.” - Resulting in the higher rates of fatalities due to hunting accidents, local fights, warfare, or even car crashes. - Women and girls too often fall victim to the ugly side of the same expectations, resulting in domestic violence, rape, conflict, and trafficking. - Women also are more subject to culturally sanctioned traditions of bodily mutilation, limits on property ownership, or freedom of movement, which are upheld by both men and women in their societies. - **Femicide** - There are many societies where the perceived need and desire for males leads to parents killing female infants at birth, either by neglect or force. - When and where ultrasound technology became widely available, abortion replaced infanticide by allowing so-inclined parents to detect and abort a female fetus. - **Sexual Orientation and Health** - The sexual orientation variables were analyzed against selected: - Health behaviors - Health status indicators - Access to health care - Access to health care: - Lesbian, gay, or bisexual were insured and participated in basic healthcare options in about the same proportion as their self-identified heterosexual counterparts. - Health behaviors: - Gay or lesbian were more likely to engage in smoking and drinking than their heterosexual counterparts - They report intimate partner violence compared to heterosexual adults - The rate of new human immunodeficiency virus (HIV) diagnoses among MSM in the United States is 44 times that of other men. - LGBT distinguishes them from their heterosexual counterparts is being the target of hate crimes - A list of variables comprising how sex and gender influence health risks: - Chromosomes - Gender identification - Sexual orientation - Sexual behavior - Societal reactions to your gender identity - Behavior all **Race and Ethnicity** - Many social scientists assert that race is not based in biology but constructed by society (migration, mixing, mingling). - For example, skin color is a 19th-century approach to defining race. - Humans living near the equator developed darker skin tones (to protect against the harmful effects of too much exposure), whereas those in northern climates developed lighter hues and are more efficient at synthesizing vitamin D from sunlight. - When many people share cultural traits, such as: - Language - Appearance - Food - Religion - Dress - Meaningful symbols - Have a common ancestral homeland - They may be considered to have an **ethnic identity.** - Although race may not be clearly defined biologically, it is very real socially. - Society may allocate valued resources based on this construct. - Ethnicity tends to work through the transmission of cultural learning from one generation to another. - Race and ethnicity can strongly affect health outcomes through the media of culture and society, including selection of mates from within only specific groups. - A bar graph showing the population by race and Hispanic origin (percent of total population), 2012 and 2060. **Age** - Descending order of interest topic of students: - Stress reduction - Nutrition - Helping others in distress - Sleep difficulties - Depression and anxiety - Physical activity - Lagging only slightly behind was information pertaining to sexual assault or violence prevention, sexually transmitted diseases (STDs), and suicide prevention. - Runners-up included tobacco use, pregnancy prevention, and cold/flu/sore throats. - A table displaying the results from the National College Health Assessment, 2015—Undergraduates, which shows the percentage of students who have ever received information on specific topics and the percentage of students who are interested in receiving information on specific topics. - Nearly one third of all traffic fatalities involve alcohol-impaired drivers, and drugs other than alcohol (legal and illegal) are involved in 16% of motor vehicle crashes. - According to **SAMHSA**, approximately 30% of 18- to 25-year-olds with mental health disorders had a co-occurring substance abuse disorder. - In the United States, 1.2 million drank alcohol and 703,759 used marijuana on an almost daily or daily basis in 2015. - A bar graph showing substance use by college students, broken down by different types of substances: alcohol, any illicit drug use, marijuana, hallucinogens, prescription-type pain relievers, cocaine, stimulants, inhalants, methamphetamine, and heroin. **The Environment** - According to the WHO, environmental factors account for 24% of the global disease burden and 23% of all deaths. - Mosquito-borne illness such as Zika virus - Childhood asthma - Flooding, tornadoes, or other “natural” disasters - A graphic showing the CDC’s Environmental Public Health Tracking on **CHILDHOOD LEAD POISONING**. - Approximately 500,000 U.S. children aged 1-5 years have blood lead levels greater than 5 micrograms of lead per deciliter of blood. - The major sources of lead exposure in the U.S. are lead-based paint and lead-contaminated dust found in and around homes and buildings built before 1978. - An infographic displaying **OTHER SOURCES OF LEAD INCLUDE**. - Hobbies that include the use of lead, such as hunting. fishing, making stained-glass windows, target shooting - Work that includes the use of lead, such as recycling or making car batteries, painting, radiator repair. - Drinking water contaminated with lead - Folk medicines and remedies, such as azarcon and greta. - A simplified infographic showing **PREVENTION** strategies for **CHILDHOOD LEAD POISONING**. - Ask a doctor to test your child if you are concerned about his or her exposure to lead. - Damp-mop floors, damp-wipe surfaces, and frequently wash your child’s hands, pacifiers, and toys to reduce exposure. - Avoid using folk remedies (such as azarcon, greta, and pay-loo-ah) and cosmetics (such as kohl and alkohl) that contain lead. - Although the environment affects everyone, the risk of exposure to poor quality environments or having access to safe and salubrious spaces is largely a matter of how society allocates resources. - **Example:** - A map showing the life expectancy at birth by county of the DC metro area. - **Example:** - People living at one end of the so-called “Red Line" or "Yellow Line" have six to seven more years of life expectancy than those at the opposite end of the “Blue Line” or living in the center of town. - The economic, educational, and resource availability associated with a place can be found in cities around the country. - Growing up on the proverbial wrong side of the tracks not only is a matter of status, but it also is associated with health disparities. ### How to Change This Picture - Health problems arise from multiple sources (i.e., individual biology, family life, community resources), solutions can also be developed on multiple levels. - **The Ecological Model** - Social scientists use an **ecological model** to begin identifying the roots of problems and potential points of intervention. - A diagram showing the social-ecological model, made up of concentric circles representing individual, relationship, community, and societal levels. - The basic idea in using an ecological model is to look at the **outer layers** of a problem and work on solutions to these. - **New policies and structural interventions** will be more sustainable over time than **individualized interventions.** - **Example:** Take water contaminated by lead or other pollutants: - Cleaning up the water supply will be more sustainable over time than handing out bottled water to individuals. - Bottled drinking water should be viewed as a short-term, emergency intervention. - A diagram showing the **ecological model for childhood obesity**, which includes individual level, household level, and community level. - Health communication strategies can be organized in terms of their relative utility within each level of the ecological model. - Some approaches are more effective at influencing the outer layers (the policymakers who develop regulations or implement programs that provide resources to communities and individuals). - Other processes are more effective midway by influencing community dynamics. - Others work by facilitating individual behavior change. - **Points of Intervention** - Health communicators work through a causal analysis to determine the modifiable factors existing at each level of an ecological model. - **Example:** Of students turning to drugs or alcohol to relieve stress: - Go beyond simple interdiction of on-campus drug use or drinking. - Search for modifiable causes of the stress. - A process to do this is **root cause analysis.** - Root cause analysis is a technique from engineering used to analyze what went wrong in a disaster. - Root cause analysis has found its way into healthcare settings, particularly in eliminating intravenous line infections, mistakes in drug delivery, and similar human errors. - It can also be used to **prevent disasters**, such as: - Young adult suicide - Drug overdose - **The People and Places Framework** - "The people and places model of social change" framework has been developed to diagram the processes of communication in terms of its potential impact within an ecological model by Maibach, Abroms, and Marosits. - The people and places framework (PPF) asks, "What about the people, and what about the places, needs to be happening for all to be healthy?" - Forces that affect people at the individual, social network, or community/population level are referred to as **“people fields of influence. ” ** - Forces that are linked to a higher administrative level (state, nation, world) are referred to as **“place fields of influence.”** - PPF suggests that **business-to-business approaches and policy (legislative, corporate) advocacy** mainly affect place fields of influence. - **Social marketing and health communication** promote voluntary behavior change based on information, motivation, and self-efficacy, among other psychological processes, and are more effective at changing people fields. - **A health communicator** can use this information to develop an overarching intervention strategy that will target the desired ecological level(s). - A table showing the **People and Places Framework**, broken down by level of aggregation, ranging from **individual** to **distal-level**, and showing the **attributes of people** and **attributes of places**. ### Conclusion - Health communication can: - Inform policies and regulations contributing to social determinants - Educate, motivate, and persuade individuals to choose healthier behaviors - Assist individuals to access health care, interact with healthcare providers, and follow healthcare instructions - Work with healthcare providers to be better communicators. - In the **19th century**, public health had enormous impact on population health through infection control. - The **20th century** brought the power of technology and medicine to improve health through medical treatment. - At the outset of the **21st century**, health communication – which affects individual knowledge, behaviors, and collective policies – has the power to bring the next major changes in our health and our world. # THANK YOU FOR YOUR ATTENTION!