Canada's Health System PDF

Canada’s Health System  Objectives § Explain the five principles of the Canada Health Act § Differentiate between federal and provincial health care responsibilities § Explain the funding distribution and scheme of Canada’s health system § Describe several key issues facing Canada’s health care...

Canada’s Health System  Objectives § Explain the five principles of the Canada Health Act § Differentiate between federal and provincial health care responsibilities § Explain the funding distribution and scheme of Canada’s health system § Describe several key issues facing Canada’s health care system § Distinguish between the various approaches to medicine The Canada Health Act 1947 Saskatchewan Hospitalization Act Provincial, hospital services 1957 Hospital Insurance and Diagnostic Services Act (HID) Provincial and federal, hospital and diagnostic services 1966 Medical Care Act (MCA) Provincial and federal, physician services outside hospitals 1984 Canada Health Act Provincial and federal, replaced and consolidated HIDS and MCA  The five principles of the Canada Health Act The five principles of the Canada Health Act are the foundational elements that govern the provision of healthcare services across Canada. These principles ensure that Canadians receive universal access to healthcare without direct charges.  The 5 Principles are: If the PROVINCES & TERRITORIES Public Administration fulfill the FIVE criteria … they are entitled to their full Canada Health Transfer ($) Comprehensiveness Canada Health Act AIM: to ensure that all Universality eligible residents of Canada have reasonable access to insured health services on a prepaid basis, without any Portability point of service charges Accessibility v Public Administration: All administration of health insurance plans must be carried out by a public authority on a non-profit basis. v Comprehensiveness: All necessary health services, including hospitals, physicians, and surgical dentists, must be insured. v Universality: All insured residents are entitled to the same (e.g., uniform terms) level of care and services that the plans provide. v Portability: All residents who move within Canada are entitled to coverage regardless of their location in the country. v Accessibility: All insured residents must have reasonable access to healthcare facilities and services without discrimination.  Government Responsibilities 1. Set and maintain standards of system 2. Fund delivery of care for certain groups 3. Regulate pharmaceuticals, food, and medical devices 4. Support health promotion and health research 5. Provide financial support to provinces  Government Responsibilities 1. Plans hospital, physician, and public health services 2. Manages, finances, delivers health services 3. Administers some pharmaceutical care 4. Negotiates fee schedules (payment) for providers 5. Regulates health professionals  Insured Services In- and out-patient care Primary care services Surgical-dental services Prescription medication Walk-in clinics Nursing services Equipment and supplies Diagnostic procedures Accommodation Meals  Supplemental Health Services Supplemental health services refer to healthcare services that are not typically covered by a standard public health insurance plan (such as Canada's Medicare) but are often essential for maintaining overall health and well-being. In Canada, many of these services are either covered through private health insurance plans, employer- provided benefits, or paid out-of-pocket by individuals. Supplemental Services Delivery of Health Services PRIMARY Health Services SECONDARY Health Services à Primary care and referrals àSpecialized hospital care à Basic emergency services àMental health services à Healthy baby and child visits àResidential care à Pre- and post-natal care àPalliative care àHome care Financing of Health Services PUBLIC PRIVATE 70% 30% Government (65%) Out of Pocket (15%) Other Public (5%) Private Insurance (12%) Other (3%)  Federal Government FUNDS Hospitals and Providers Taxes Subsidies FREE SERVICES Patients  Total Spending 28.3% 15.7% 15.1% Spending Per Person $1,933 $1,074 $1,032 Growth 3% 3.2% 2.2%  Choice of health practitioner Coverage is narrow and deep All residents have coverage Many services not covered Coverage within/across Canada Out of pocket payment is costly No point of service charge Poor care transitions Providers are reasonably paid Long wait times Key System Issues Pharmaceutical coverage Aging and marginalized populations Chronic diseases Health technology Rising healthcare expenditures Shortage of medical professionals Indigenous health Public vs Private Healthcare Providers Physicians Registered Nurses Nurse Practitioners Midwives Allied Health Professionals Complementary and Alternative Medicine Practitioners Regulated Practice Regulated health care providers are usually part of a corresponding professional college.  BC Regulatory Colleges BC College of Nursing Professionals College of Occupational Therapists of BC BC College of Social Workers College of Opticians of BC College of Chiropractors of BC College of Optometrists of BC College of Dental Hygienists of BC College of Pharmacists of BC College of Dental Surgeons of BC College of Physical Therapists of BC College of Dental Technicians of BC College of Physicians and Surgeons of BC College of Denturists of BC College of Podiatric Surgeons of BC College of Dietitians of BC College of Psychologists of BC College of Massage Therapists of BC College of Speech and Hearing Professionals of BC College of Midwives of BC College of Chinese Medicine and Acupuncture of BC College of Naturopathic Physicians of BC Regulation sets the legal framework for professional practice and can be in the form of: 1 Certification, licensure, or registration 2 ATIONS Reserved or controlled acts REG UL 1 Certification, licensure, or registration Education Training Exam 2 Reserved or controlled acts  1 Certification, licensure, or registration 2 Reserved or controlled acts v Identify a cause of symptoms and make a diagnosis v Administer a substance (other than drugs) v Manage labour and/or delivery of a baby  1 Biomedical Model 2 Biopsychosocial Model 3 Patient-Centered Model Approach to Medicine 4 Wellness Model 5 Complementary & Alternative Medicine 6 Integrative (Holistic) Medicine 1 Biomedical BiomedicalModel Model v Focuses on physical processes, such as physiology of disease v Doesn’t consider role of mind or society in cause or treatment v Most effective for infections and injuries v Less helpful for stress-related or chronic diseases Sickness Treatment Cure 2 Biopsychosocial Model Biopsychosocial Model v Attributes disease to an interaction between: § biological (e.g., genes) § psychological (e.g., emotions) § social (e.g., family relationships) v Uncovers health history in the context of life circumstances v Provides multi-dimensional treatment concurrently § Behaviour modification, individual- and group-counseling à Popular among alcohol and drug rehabilitation programs 3 Patient-Centered Model v All components are intertwined and work together in the process of healing and/or managing a disease v Recognizes that the body and person are not identical v Key elements: § Find common ground with patient § Build on the relationship § Understand the whole person § Focus on prevention and wellness § Be realistic with health goals Stewart M, Brown JB, Weston WW, McWhinney IR, et al. Patient-centered medicine: transforming the clinical method. Thousand Oaks: Sage; 1995. 4 Wellness Model v Recognizes the importance of mind, body, and spirit v Includes taking responsibility for personal health v Creating a full and balanced lifestyle  5 Complementary & Alternative Medicine v Non-conventional therapies that focus on the whole person: physical, mental, emotional, spiritual v Common therapies: § massage therapy, chiropractic, acupuncture, naturopathy Complementary Medicine Alternative Medicine Western practices Eastern practices Eastern practices 6 Integrative (Holistic) Medicine v Basic foundation is prevention and healing v Involves a balanced, whole person-centered approach v Uses the best and most scientifically supported therapies in a coordinated approach to diagnosis and treatment Non- Conventional AND Integrative Conventional Therapies Medicine OR Therapies Health and Wellness Objectives § Define health and wellness § Describe health and wellness from a range of perspectives § Differentiate between primary, secondary, and tertiary prevention § Explain the five action areas of the Ottawa Charter § Describe each of the dimensions of wellness § Explain the illness-wellness continuum What is Health? The World Health Organization defines health as: A state of complete physical, mental, and social well- being, and not merely the absence of disease or infirmity. (WHO Constitution, 1948) Meanwhile in Canada … The Lalonde Report sought to shift priorities from treatment-oriented, after the fact medicine, to prevention. While the report acknowledged that medical care is crucial in treating diseases, it also emphasized the importance of other factors in determining overall health: - Biology - Lifestyle - Environment 1974  The Three Levels Of Prevention In Healthcare Prevention Detection Treatment Preclinical Subclinical Clinical Primary Secondary Tertiary Prevention Prevention Prevention Population Health Preventive Medicine Clinical Medicine UPSTREAM DOWNSTREAM Primary Prevention Definition An intervention implemented before there is evidence of disease or injury Intent Reduce or eliminate causative risk factors (risk reduction); preventive Target Whole population, selected groups of healthy individuals (before disease) Examples Immunizations (vaccinations), fluoride treatments Secondary Prevention Definition An intervention implemented after a disease has begun, but before symptoms Intent Early identification (through screening) and treatment; preventive Target Selected individuals, high risk patients Examples Laboratory tests, mammograms Tertiary Prevention Definition An intervention implemented after a disease or injury is established Intent Slow disease progression, minimize damage and deterioration; treatment Target Patients with disease Examples Support groups, rehabilitation programs for stroke patients Meanwhile around the World … v An International Conference was held in Ottawa, ON in 1986, in response to growing expectations for a new public health movement. v The Ottawa Charter, describes five action areas: 1. Build healthy public policy 2. Create supportive environments 3. Strengthen community action 4. Reorient health services 5.Develop personal skills Build Healthy Public Policy vGovernment policy that: - Protects the health of individuals and communities - Makes healthier choices the easier choices vThis is often accomplished through legislative, regulatory, organizational, and/or taxation-based strategies. vExamples: - Seat belt laws - Smoking restrictions - Workplace safety regulations Create Supportive Environments vAim is to modify and/or enhance the environment where people live, work, learn, and play. vIncrease the ability of people to make healthy choices while in these settings. vExamples: - Healthy workspaces - Introduce restricting junk food ads - Establishing walking paths Strengthen Community Action v Collective efforts or actions of the community to improve their general health. vExamples: Fun runs to promote physical activity Community kitchens to support good nutrition Support organizations - non-profit or volunteer-based groups that provide a variety of services and resources to support individuals and communities (eg. Heart and Stroke Foundation, The Salvation Army) Reorient Health Services vEncourages a holistic approach that strengthens protective factors (factors that help to reduce the likelihood of developing diseases) and reduces risk factors. vExamples: Training physicians in prevention measures Establishing health educator roles Improve access for diverse populations - Diverse populations - groups of people who differ in various characteristics that can include; race, culture, language, socioeconomic, etc. Develop Personal Skills vThis focuses on personal and social development vAccomplished through information, education, and life skills training to make positive choices vExamples: - Online education - Pamphlets and other materials - Health management classes Health Promotion Health Promotion is the process of enabling people to increase control over, and to improve, their health. v Includes planned combination of educational and environmental supports that encourage actions and/or living conditions that are conducive to the health of individuals and groups EDUCATIONAL ENVIRONMENTAL Teaching, training, Organizational, regulatory, counseling, consulting, and economic, and political communicating to foster interventions that interact positive health behaviours with behaviour Effective health promotion results in a healthy population. Health Health Promotion Improving health is … not just the responsibility of the health sector. What other groups or sectors play a role in health? In what ways? Give examples. Take some time Work with a friend What is Wellness? What is Wellness? ¡Purposeful, enjoyable living; a deliberate lifestyle choice characterized by personal responsibility and optimal enhancement of physical, mental, and spiritual health ¡It is an approach to health that focuses on balancing the many dimensions of a person’s life through increasing the adoption of health-enhancing conditions and behaviours rather than attempting to minimize conditions of illness. Social Wellness v Encourages a collectivist view where people: - Contribute to society and help others - Value interdependence between self and environment - Seek ways to enhance relationships - Celebrate personal friendships - Build healthy communities v Refers to ones ability to: - Interact with others - Adapt to social situations - Communicate appropriately Occupational Wellness v Occupation is consistent with values, interests, and beliefs v You want to be able to contribute your unique gifts, skills, and talents v Involves finding enrichment through work/vocation v We want to ensure our work is meaningful and rewarding v We should thrive to achieve balance of work and life commitments Physical Wellness v This is met through participating in regular activity (e.g., walking, running, cycling, swimming) v Also includes: - Making healthy food choices - Maintaining a healthy body weight - Getting a sufficient amount of sleep - Avoiding harmful substances (e.g., tobacco) - Seeking medical attention when needed Emotional Wellness v Being positive and enthusiastic about oneself and life v Awareness and acceptance of feelings; yours and others v Express and manage feelings in appropriate ways v Cope effectively with personal and professional stress Spiritual Wellness v Identifying our basic purpose in life v Helping ourselves and others achieve our potential v Learning to experience love, joy, peace, fulfillment v This may involve a connection to a formal religion or faith Intellectual Wellness v Ability to think and learn from life experience v Capacity to question and evaluate information v Pursuing intellectual and creative challenges v Openness to new ideas Illness-Wellness Continuum  Illness-Wellness Continuum The Illness-Wellness Continuum encourages a shift from a disease-centered approach (focused on managing illness) to a wellness-centered approach (focused on promoting health and preventing illness). It highlights that health is dynamic, and individuals can move back and forth along the continuum based on their lifestyle choices and interventions. The goal in healthcare is not just to treat diseases but to promote habits that lead to high-level wellness and long-term well-being.  Illness-Wellness Continuum Disease Poor Health Neutral Good Health Optimal Health Multiple Symptoms, drug No symptoms, Good nutrition, 100% body medications, poor therapy, surgery, inconsistent diet, regular exercise, function, quality of life, losing normal sporadic exercise, wellness continuous body function is body function health not a education, close to development, limited priority full body function wellness lifestyle  HEALTH WELLNESS vA passive state of vA dynamic process of homeostasis or balance of continually moving toward body and mind ones potential for optimal functioning vA state of being; concerned with the treatment of vA balanced lifestyle; a practical diseases way of achieving health vFocuses primarily on vAlso focuses on occupational, mental, physical, and social intellectual, spiritual, and wellbeing emotional wellbeing Determinants of Health Lecture 3 Instructor: Dr. Colin Francis Objectives § Describe the major types (e.g., levels) of health determinants § Provide examples of health determinants at each level § Differentiate between equity and equality as they pertain to health § Describe the social gradient effect on health § Identify key strategies to enhance health determinants Jason’s Story "Why is Jason in the hospital? Because he has a bad infection in his leg. But why does he have an infection? Because he has a cut on his leg and it got infected. But why does he have a cut on his leg? Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on. But why was he playing in a junk yard? Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them. But why does he live in that neighbourhood? Because his parents can't afford a nicer place to live. But why can't his parents afford a nicer place to live? Because his Dad is unemployed and his Mom is sick. But why is his Dad unemployed? Because he doesn't have much education and he can't find a job. But why...?" Determinants of Health v The determinants of health are the wide set of forces and systems that shape our daily lives. v The conditions in which people are born, grow, work, live, and age, influence or determine health. Determinants of Health Social and Physical Individual Public Policy Economic Environment Individual Factors Biology and Genetics Personal Behaviours 18+ Inherited Conditions Age Diet and Nutrition Physical Activity Family History Sex Substance Use Hand Washing Social and Economic Factors Income Education Employment Early Life Experiences Food Insecurity Housing Social Support Health Services Gender Race Immigration Status Disability Physical Environment Factors Natural Environment Built Environment Hazardous Substances Community Design Drinking Water Public Safety Public Policy Factors v Rules and regulations at the local, provincial, and/or federal government level that impact living conditions Income and Wealth Family Benefits and Social Availability of Affordable Distribution Assistance Housing What is the Problem? § What are the key § What are the individual, biological or social, economic, pathophysiological environmental, and features that present political, factors that put within a person and people at risk or protect cause them to be them from illness? unhealthy? What is the Solution? § Initiatives carried out by § The various ways other people or institutions societal sectors (policy, (physicians, nurses, education, engineering) hospitals, community can work to advance health workers) whose people’s health. primary job is to improve people’s health. Summary of The Determinants of Health: Dahlgren and Whitehead model Source: Canadian Medical Association The lower you are in the socio-economic status hierarchy the worse your health, the higher you are, the better your health. - Michael Marmot  100 HEALTH 0 Low SOCIO-ECONOMIC STATUS High There is a step-wise gradient in health; each step up the socio-economic ladder brings an increase in overall health Source: Adapted from Making Partners: Intersectoral Action for Health, 1988 Proceedings and outcome of a WHO Joint Working Group on Intersectoral Action for Health, The Netherlands  The concept of equality and equity can be applied to health status to illustrate how The Concept of healthcare and resources should be Equality vs Equity distributed based on individual needs rather than assuming everyone starts from the same point. Equality means providing everyone with the same resources or support, regardless of their specific individual needs. Equity means providing resources based on individual needs, so that everyone has the opportunity to achieve the same outcome. Taking Action 1. Adopt a framework for social inclusion 2. Promote full employment, job security, etc. 3. Protect universal access to our health system 4. Protect Canada’s high-quality public education system 5. Ensure all Canadians have adequate food and housing 6. Ensure basic minimum wages and levels of social assistance  Thought for the day … Stop thinking of health as something we get in hospitals and doctors’ offices but instead as something that starts in our families, in our schools and workplaces, in our playgrounds and parks, and in the air we breathe and the water we drink. The more you see the problem of health this way, the more opportunities you have to improve it. - Robert Wood Johnson Foundation Measurement of Health Lecture 4 Instructor: Dr. Colin Francis Objectives § Define epidemiology and its common measures § Distinguish between descriptive and analytic epidemiology § Identify basic study designs used in epidemiology § Interpret various frequency measures § Describe Canada’s health from an epidemiologic perspective  Epidemiology Epidemiology is the study of how diseases or health-related conditions are distributed within populations and the factors that influence or determine this distribution. It focuses on understanding the patterns, causes, and effects of health and disease conditions in specific groups of people. Epidemiologists seek to identify risk factors for diseases, monitor the spread of health issues, and develop strategies for prevention, control, and treatment to improve public health outcomes. The field of epidemiology plays a critical role in public health research, policy- making, and the management of health crises, such as epidemics or pandemics. Epidemiology is concerned with the distribution and determinants of health phenomena … in populations. Epidemiology is concerned with the pattern and causes of illness and disease … in groups of people. Distribution § Person (Who?), Place (Where?), Time (When?) § Endemic, Epidemic, or Pandemic § Morbidity (disease) and/or Mortality (death) Determinants § Genetic (e.g., family history, inherited conditions) § Biologic (e.g., E. coli bacteria, Influenza A virus) § Chemical (e.g., carcinogens, toxins) § Behavioral (e.g., tobacco use, nutrition) § Social (e.g., socioeconomic status, education) Health Phenomena § Chronic disease (e.g., breast cancer, heart disease) § Infectious disease (e.g. HIV, Herpes) § Injuries (e.g., road traffic accidents, falls) § Positive health outcomes (e.g., Quality of Life) Population § Geography (e.g., Canada, British Columbia) § Age (e.g., adolescents, adults, seniors) § Gender (e.g., males, females) § Race/ethnicity (e.g., Hispanic, Asian)  Health phenomena are NOT randomly distributed in a population  Epidemiologic Transition Epidemiologic Transition describes: Infectious Chronic Disease Disease (e.g., flu, diarrhea) (e.g., heart disease) TIME 1900 2000  Epidemiologic Transition In the early 1900s, infectious diseases like the flu, diarrhea, and pneumonia were the leading causes of death. These diseases spread quickly, especially in times when sanitation and healthcare were less advanced. By the 2000s, as public health measures, antibiotics, and vaccines helped control many infectious diseases, chronic diseases such as heart disease, cancer, and diabetes became the leading causes of death. These diseases develop over time and are more linked to lifestyle factors, aging, and longer life expectancy.  1 Conduct surveillance 2 Identify risk factors Practical Applications of 3 Diagnose community health Epidemiology 4 Plan for health needs 5 Evaluate health services  Epidemiologic Approach CONFIRM DESCRIBE TEST CONTROL § Make initial § Define the § Create an § Recommend observation disease hypothesis intervention and/or policy § Confirm the § Describe § Conduct outbreak the disease studies by person, place, time § Analyze and summarize the findings The two types of epidemiology are: Descriptive § To describe the distribution of disease Epidemiology § Key variables include person, place, and time Analytic § To describe the determinants of disease Epidemiology § Key variables include agent, host, environment The aims of descriptive epidemiology are: 1. To permit evaluation of trends à monitoring known disease and identifying new disease 2. To provide a sound basis for the provision and evaluation of health services à engaging in health system planning 3. To identify problems to be studied by further analytic methods à generating hypotheses  § Who has the disease? PERSON § age, race, gender § Where is the disease? PLACE § urban or rural, within or between countries § When did the disease occur? TIME § point, secular, seasonal  Time: point, secular, seasonal Point: This refers to a single, specific point in time when a disease or outbreak occurs. Point epidemics often happen suddenly and can be traced back to a single source or event (e.g. foodborne illnesses that occur after a contaminated meal is served). Secular: Secular trends describe long-term patterns in disease occurrence over an extended period, often years or decades. These trends help identify whether the incidence of a disease is increasing, decreasing, or remaining stable. Seasonal: Seasonal trends are fluctuations in disease incidence that occur regularly at certain times of the year (e.g., winter for flu). The aim of analytic epidemiology is: 1. To investigate which factors put individuals and groups at an increased or decreased risk of a particular health outcome. OBSERVATION: Compares the frequency of illness or disease among groups with and without the risk or protective factor INTERVENTION: Evaluates the effect of reducing a risk factor or increasing a protective factor on the frequency of illness or disease Descriptive Data: Focuses Epidemiology Data Sources on describing the distribution of diseases or health conditions in populations. This data helps to observe health patterns and trends. Analytic Studies: Aimed at understanding the causes and determinants of health-related events or diseases. Descriptive Data Registers of births and deaths, adverse events Monitoring notification, and hospital or clinic records Statistical portrait of the country every five years Censuses (e.g., births, deaths, age, gender) Provide information on the use of health services, Surveys coverage of interventions, frequency of outcomes Describes characteristics of a population or the issue Studies being studied; does not answer a research question  Analytic Studies Analytic studies is deviled into: – Observation Studies – Intervention Trials/Studies Analytic Data Observation Studies Ecological Relate total frequency of outcome to average level Studies of exposure by population group Cross-Sectional Collect exposure and outcome data at one point in Studies time from a random sample of study subjects Cohort Compare individuals with differences in exposure to Studies measure the occurrence of outcome over time Case Control Individuals with and without the outcome and examine Studies for differences in previous exposure Analytic Data Intervention Trials/Studies Randomized Controlled Experiments, evaluating the effect of reducing a risk factor or increasing a protective factor on the frequency of disease; answer a research question Non-Randomized Measures of Disease Frequency Count (a) § Number of new cases of a disease § 50 people with hypertension Proportion § Proportion of population with a disease (a/a+b) § 50/100 or 50% of people with hypertension  § Existing cases of disease Prevalence § Indicates the extent of a health problem § New cases of disease Incidence § Indicates the emergence of a health problem  Prevalence is the proportion of the population that has the disease at a particular time. Number of existing cases of a disease = Total number of people in population EXAMPLE: In City A, where the population is 70,000 people, there are 7,000 individuals currently living with arthritis. What is the prevalence of arthritis, per 1,000 people? = 7,000 cases / 70,000 population = 0.1 x 1,000 = 100 cases of arthritis per 1,000 people (10%)  Incidence is a measure of the occurrence of new cases of disease during a specific period of time Number of new cases of a disease = Total # of people at risk in population EXAMPLE: In City A, the population is 35,000 men and 35,000 women. There are 500 women currently living with cervical cancer and 250 who developed it in the year 2019. What is the incidence of cervical cancer, per 1,000 people, in 2019? = 250 cases / 34,500 population = 0.007 x 1,000 = 7.25 cases of cervical cancer per 1,000 people (0.7%) Each blue marble represents an existing case of disease Each blue marble is a new (incident) case being added to the existing (prevalent) pool of cases Leading causes of death in Canada, All Ages (2013) 1. Cancer 2. Heart disease Lifestyle Related 3. Stroke 4. Lower respiratory diseases 5. Accidents (unintentional injury) 6. Diabetes mellitus 7. Influenza and pneumonia 8. Alzheimer’s disease 9. Intentional self-harm 10. Kidney disease Health Behaviour Change Lecture 5 Instructor: Dr. Colin Francis Objectives § Distinguish between the factors that shape behaviour § Define and differentiate between goals and objectives § Identify and write the components of an objective § Discuss the purpose of theory in interventions § Apply a behaviour change theory to a health issue Steps in Behaviour Change 1. Choose a target health behaviour (+/-) 2. Determine what shapes it (risk or protective factors) 3. Identify desired outcome (goals and objectives) 4. Conceptually explain why it occurs (theories) 5. Design an intervention to reach desired outcome 6. Evaluate the success of the intervention activities Three groups of factors shape behaviour: Predisposing encourage or inhibit behaviour change Factors (e.g., knowledge, attitudes, self-efficacy) Enabling make decisions more convenient or more Factors challenging (e.g., skills, resources, access) include support or discouragement from the Reinforcing people and situations around us (e.g., praise, Factors rewards) Predisposing Factors Life experiences, knowledge, cultural and ethnic inheritance, and current beliefs and values  Enabling Factors Skills or abilities, physical, emotional, and mental capabilities, and resources and accessible facilities that make health decisions more convenient or difficult. Positive and negative enablers  Reinforcing Factors Support and encouragement or discouragement that come from significant others or situations in your life that reinforce a particular behaviour  Goals Objectives What will change? Who will be affected? In health behavior change, § Broad statements of long-range direction or setting clear intent goals helps guide § Used to explain the general purpose of a program interventions and the evaluation of Goal statements typically use verbs like: their success. IMPROVE INCREASE PROMOTE PREVENT REDUCE  Goals Objectives Example Statements: § To prevent the spread of influenza among residents living in long term care in Surrey, BC. § To reduce the number of new diagnoses of cardiovascular disease among employees at KPU. § To decrease the spread of HIV among youth living in Vancouver, BC.  Goals Objectives In health behavior change, Who will do What, When, and by How Much? objectives help ensure that the § Precise steps that will lead to the program goals intervention's § Outline, in measureable terms, the changes to occur progress and success can be Objective statements typically use verbs like: tracked and measured effectively. LABEL DESCRIBE PERFORM EXPLAIN CHOOSE  Goals Objectives WHO Who is expected to change The priority population WHAT What will change The outcome to be achieved WHEN When the change will occur The conditions under which the outcome will be observed HOW MUCH How much change should occur The criterion for deciding whether the outcome was achieved  Goals Objectives When Example Statements: Who What How Much § By the end of the year, 50% of employees will report engaging in physical activity at least 3 times per week. § When asked via survey, one out of three viewers of the heart special television show will be able to explain the four principles of cardiovascular conditioning. § After viewing the video, half of participants will be able to locate their pulse and count it every time they are asked. Where appropriate, revise the following objectives: 1. After the class on objective writing, the students will know the difference between a goal and an objective. 2. The students will understand how a skinfold caliper works. 3. After completing this chapter, the students will be able to write objectives based on the four elements outlined in the chapter. 4. Given appropriate instruction, the employees will be able to accurately take blood pressure readings of fellow employees. 5. Program participants will be able to list the reasons why people do not exercise. What is Theory? v A set of interrelated concepts, definitions, and propositions that can be used to better explain and predict events or situations. v Theories provide a framework for generating testable hypotheses, and a roadmap for the design and implementation of intervention strategies. à In other words, theories help explain why people do what they do, and how we can help them change. Theories can be categorized by approach: Continuum Theories: use an approach that identifies variables that influence action and combines them into a prediction equation to predict the likelihood of a specific health outcome (e.g., Health Belief Model) Health Belief Model helps predict whether individuals will take a particular health action (such as adopting healthier behaviors) based on certain beliefs and perceptions. Concept 1 Concept 2 Outcome Theories can be categorized by approach: Stage Theories: These theories classify people into distinct categories or stages and explain how individuals progress through these stages over time. The movement from one stage to the next is influenced by various factors, which could promote or inhibit progress. (e.g., Transtheoretical Model) Stage 1 Stage 2 Stage3 Stage 4 Health Belief Model § Developed to explain and predict one-time behaviours § Assumes behaviour is rationale and that people will make health related decisions based on reason and logic § Based on the perceptions of the target audience: Susceptibility Severity Benefits Barriers  Components of the Health Belief Model Perceived Susceptibility à Perception of risk of contracting or developing a condition à People will change if they believe they are at risk Perceived Severity à Perception of seriousness of illness or leaving it untreated à Likelihood of change depends on seriousness of not changing Susceptibility Severity Threat  Components of the Health Belief Model Perceived Benefits à Perception that advised action will reduce risk or seriousness à People change when there is “something in it for them” Perceived Barriers à Perception of potential downside of health behaviour change à A negative aspect that acts as an impediment Benefits Barriers Outcome Expectancy  Components of the Health Belief Model Cues to Action à People will change when something helps them move from thinking about change to actually making a change Self-efficacy à Individual belief (or confidence) in ones ability to make and follow through on health behaviour change Susceptibility Cues to Action Threat Severity Behaviour Benefits Outcome Expectancy Barriers Self-efficacy Assess the Health Belief Model statements below and identify which components of the model each statement reflects: 1. If I do not practice safe sex, it is very likely that I will contract the HIV virus. 2. My partner would exercise with me, which would mean we could spend more time together. 3. I believe that having a heart attack would have serious implications for my life. 4. I am a low-income earner so I don’t have enough money to join a gym.  Transtheoretical Model §Developed to understand longer-term behaviour change §Recognizes common barriers within stages and different barriers between stages à change occurs in steps or stages Stages 1 - 5 Precontemplation à No intention of changing, not aware of problem à No action anticipated within the next 6 months à Aware of problem, and considering change Contemplation à Usually move to next stage within 6 months à Started taking small steps to change Preparation à Intend to change behaviour within 1 month à Modifying behaviour according to plan Action à Changes are visible to others (within 6 months) à Continuing to work at changing behaviour Maintenance à Change can take ~6 months to lifetime Interventions v Interventions are activities or strategies that permit the most effective and efficient achievement of desired outcomes. Communication Education Policy Other Strategies Strategies Strategies Strategies Communication à Route through which a health message is disseminated Strategies § Provider and patient interaction § Telephone, computer or other electronic devices § Newsletters, bulletin boards, health fairs § Billboards, direct mail, television  Education à Formal health education courses, seminars, etc. Strategies § Audiovisual - charts, pictures, slides, educational TV § Print - handouts, worksheets, pamphlets, study guides § Teaching – case studies, debates, discussion, panels § Other – field trips, museums, health centres  Policy à Mandated or regulated health activities, actions, etc. Strategies § Laws, ordinances, policies, position statements, regulations, formal or informal rules § Seat-belt laws § Alcohol taxation § Non-smoking spaces  Other Strategies § Social or organizational activities § support groups, buddy systems, contracts § exercise facility at work, healthy food in vending machines § Incentives and disincentives § monetary, benefits, extra vacation time § penalties, fines  Nutrition Lecture 6 Instructor: Dr. Colin Francis Objectives § Explain the role of macro- and micronutrients in health § Define the functions and food sources of macronutrients § Critically examine Canada’s Food Guide § Interpret the components of food labels Nutrition is the science of how the body uses food, concentrating on two basic attributes: Energy § calories, amount of heat produced when food is metabolized Nutrients § chemical substances used to build, maintain, repair tissues  Energy How many calories per gram do the energy-yielding nutrients contain?: Carbohydrates: 4 calories/g Protein: 4 calories/g Fat: 9 calories/g Calorie requirements per day, females and males, ages 19-30: 2350 3000 2100 2700 1900 Active Active Low Active 2500 Low Active Sedentary Sedentary  Nutrients Essential nutrients are compounds that the body cannot produce or cannot produce in sufficient quantity. These nutrients must be obtained through diet, as they are vital for the body to function properly and maintain health. There are six classes: Water Carbohydrates Protein Fat Vitamins Minerals  Nutrients Food provides two distinct groups of nutrients: § Nutrients the body needs in greater amounts Macronutrients § e.g., water, carbohydrates, protein, and fat Micronutrients § Nutrients the body needs in lesser amounts § e.g., vitamins and minerals Mouth: Teeth and tongue break food apart (mechanical digestion); and salivary amylase enzymes start to break down complex carbohydrates (chemical digestion). Stomach: Secretes gastric juices (enzymes, hydrochloric acid, mucus) to break down protein; contents become a thick liquid (chyme) and pass into small intestine. Small Intestine: Pancreatic juices and enzymes, along with bile are released into the small intestine; digestion of carbohydrates, proteins, fats continues; absorption occurs. Large Intestine: Indigestible waste (such as fibre), dead cells, and bacteria move into the large intestine where water is reabsorbed; feces are formed and excreted via the anus. Water vBetween 50-70% of the body is water. v Humans need water for various reasons, including to: Digest food: dissolves nutrients to pass from intestine to bloodstream Carry waste: rids the body of waste products through urination Regulate temperature: cools skin with perspiration that evaporates Other: send electrical messages, lubricate joints, etc. v Humans do not store water, so replacement is key. v Water is lost in: (1) breath and perspiration (850-1,200mL) (2) urine (600-1,600mL) (3) feces (50-200mL) Current recommendations, for an average healthy adult: Women – 9 cups Men – 12 cups FOOD SOURCES: juice, milk, soups, popsicles, fruits, vegetables, etc.  Carbohydrates vSugar compounds that are classified based on the number and type of sugar units present. v There are two main categories of carbohydrates: SIMPLE COMPLEX 1 or 2 units of sugar 3 or more units of sugar FOOD SOURCES: bread, pasta, rice, cereal, fruits, vegetables, milk, nuts, table sugar (sucrose).  SIMPLE Carbohydrates Monosaccharides Disaccharides 1 unit of sugar 2 units of sugar Glucose Sucrose Fructose Lactose Galactose Maltose Simple carbohydrates include: § Sugar found naturally in foods and beverages Natural Sugars § e.g., lactose in milk, fructose in fruit Added Sugars § Sugars added to foods and beverages during processing § e.g., in cookies, cakes, soda, energy and sports drinks Recommended that ≤10% of total daily calories are from added sugar  COMPLEX Carbohydrates Polysaccharides 3 or more units of sugar Starches Fibre  § Primary form of complex carbohydrates from diet Starches § Stored as glycogen in liver and muscle cells § e.g., grains, vegetables, beans, and nuts Most nutritious form are whole grains: Bran: Fibre-filled outer layer of the edible grain; contains B vitamins and minerals Endosperm: Carbohydrate middle layer, with some protein, vitamins, minerals Germ: Nutrient-packed core with B vitamins, vitamin E, healthy fats  § Non-digestible; does NOT provide any energy for the body Fibre § Average healthy adult needs ~25-40 grams of fibre per day § Occurs naturally in plant foods (e.g., stems, seeds, leaves) Two types of fibre: Soluble: dissolves in H2O; helps lower glucose levels and blood cholesterol Food sources include oatmeal, nuts, beans, lentils, apples, blueberries, etc. Insoluble: does not dissolve in H2O; promotes regularity, prevents constipation Food sources include wheat, whole wheat bread, brown rice, legumes, carrots, etc.  Carbohydrates The key functions of carbohydrates in the body are: - provide the body with energy - promote digestive health - influence heart health and diabetes Current recommendations, for an average healthy adult: 45-65% of daily 140-180 g per day calories  Protein vFound in every cell throughout the entire body – in muscle, bone, blood, hair, skin, and fingernails, etc. vDifferent combinations of 20 building blocks, called amino acids make up proteins in the body. There are 8 essential amino acids: Isoleucine Leucine Lysine Methionine Phenylalanine Threonine Tryptophan Valine In recent times, Histidine has been added to the list of essential amino acids FOOD SOURCES: meat, poultry, fish, eggs, beans, nuts, cheese, tofu, vegetables, grains Digestive enzymes in the stomach and small intestine break down protein from food into amino acids. PROTEIN PEPTIDES AMINO ACIDS Protein quality is determined by the adequacy and balance of essential amino acids, and the digestibility of protein. § provide ample amounts of all essential amino acids Complete Proteins § food of animal origin (e.g., meat, fish, poultry, eggs, dairy) § provide limited amounts of some essential amino acids Incomplete Proteins § food of plant origin (e.g., grains, fruit, vegetables, legumes) The protein quality of food containing incomplete proteins can be improved by matching specific foods together. These are sometimes called complementary proteins. This food COMPLEMENTS this food Whole Grains Legumes Rice and Beans Legumes Nuts and/or Seeds Chili with Caraway Seeds Dairy Products Whole Grains Cheese Sandwich Legumes Chili topped with Cheese Nuts and/or Seeds Yogurt with Nuts The key functions of protein in the body are: - form new body tissues - build antibodies, enzymes, hormones - provide the body with energy Current recommendations, for an average healthy adult: 0.8 g/kg per day 10-30% of calories Fat and Cholesterol Triglycerides Phospholipids Sterols Energy Fats that are used Carry hormones Fat and alcohol to make adipose and fat-soluble compounds with tissue and are vitamins in blood no calories burned for and extracellular (e.g., cholesterol) energy fluid Fatty acids are the building blocks of fats. FOOD SOURCES: animal products, snack food, avocado, nuts, oils, butter, margarine Fats are distinguished by the type of fatty acids in their chemical structure. Saturated Fats Unsaturated Fats More saturated fatty More unsaturated fatty acids than unsaturated acids than saturated fatty acids fatty acids Saturated fats are comprised of fatty acids where carbon atoms are saturated with hydrogen atoms. v Solid at room temperature and will get harder when chilled. Unsaturated Fats v Cause a rise in low-density lipoprotein (LDL) cholesterol and therefore, increase risk of heart disease. Sources: bacon, red meat, dairy products, coconut, cream, butter Unsaturated fats are comprised of fatty acids that have more than one double-bonded carbon in the molecule. v Liquid at room temperature and will not change when chilled. Unsaturated Fats v Can improve blood cholesterol levels; prevent blood clots, lower triglycerides, and lower LDL cholesterol Sources: avocado, nuts and seeds, peanut butter, olive oil, salmon Cholesterol is a form of fat found in certain foods and manufactured by our bodies that circulates in our blood. v Low-Density Lipoprotein (LDL) à protein and fat particles that supply cholesterol to body cells, BUT, can pass through blood vessel walls and contribute to plaque formation. v High-Density Lipoprotein (HDL) à protein and fat particles too dense to pass through blood vessel walls, so they carry cholesterol back to the liver for metabolism and removal. The key functions of fat in the body are: - provide the body with energy - carry fat-soluble vitamins (A, D, E, K) - protect internal organs from injury Current recommendations, for an average healthy adult: < 10% of calories 25-35% of calories from saturated fats  Vitamins vVitamins are organic chemicals (substances that contain carbon, hydrogen, and oxygen) that are essential for normal growth, development, and bodily functions. vThe body needs them in small amounts to support a variety of physiological processes. vSince the body cannot produce most vitamins, they must be obtained through the diet or supplements. Classified as either: § Dissolve in fat, absorbed through intestine and stored Fat Soluble § Vitamins A, D, E, and K § Dissolve in water, absorbed into blood and washed out Water Soluble § B Vitamins, Vitamin C  § Antioxidant; promotes good eye and skin health Vitamin A § Bone and teeth growth, immunity, reproduction § Milk, eggs, leafy greens, orange fruit and vegetables § Mineralization of bones and teeth Vitamin D § Promotes calcium and phosphorus absorption § Fortified milk or margarine, eggs, sunlight § Antioxidant; regulation of cell membranes Vitamin E § Helps maintain reproductive system, nerves, muscles § Leafy greens, whole grains, nuts, seeds § Synthesis of blood-clotting proteins Vitamin K § Needed to make bone and kidney tissue § Leafy greens, cheese, soybeans, vegetable oils  § Antioxidant; collagen synthesis, amino acid metabolism Vitamin C § Strengthens resistance to infection, aids iron absorption § Citrus fruits, dark green vegetables, strawberries, peppers § B vitamins (B1, 2, 3, 6, 9, 12, Biotin, Pantothenic Acid) B Vitamins § Varied functions: energy metabolism, new cell synthesis § Meat, poultry, fish, milk, cheese, eggs, whole grains  Minerals vMinerals are chemical elements (substances composed of only one kind of atom). vessential for various bodily functions, including building strong bones, teeth. vminerals are not produced by the body and must be obtained through food or supplements. Major minerals - minerals that the body requires in vClassified as either: relatively large amounts, typically more than 100 § Sodium, Potassium, Chloride, Calcium Major Minerals mg/day. § Phosphorus, Magnesium, and Sulfate Trace minerals - minerals § Iron, Zinc, Selenium, Molybdenum, Iodine needed by the body in much Trace Elements § Copper, Manganese, Flouride, Chromium smaller amounts, generally less than 100 mg/day.  § Component of bones and teeth Calcium § Needed for muscle and nerve activity, blood clotting § Milk and dairy products, tofu, greens, legumes § Helps maintain fluid and acid-base balance in cells Sodium § Critical to nerve impulse transmission § Salt, soy sauce, processed foods § Aids in transport of oxygen Iron § Component of myoglobin, energy formation § Red meat, fish, poultry, eggs, legumes, dried fruits The key functions of vitamins and minerals in the body are: - regulate growth, maintain tissues, promote healing - assist in metabolizing carbohydrates, protein, fat - prevent nutritional deficiency diseases - aid in the absorption of vitamins Current recommendations, for an average healthy adult are based on the Dietary Reference Intakes (DRIs) which have different values based on the age and sex of individuals. Canada’s Food Guide v The food guide is a basic educational tool designed to help people follow a healthy diet. v Translates nutritional science into practical patterns of food choices, incorporating variety and flexibility. v Purpose of Canada’s Food Guide is to: 1. Guide individual food selection 2. Promote the nutritional health of Canadians Canada's first food guide, the Official Food Rules, was introduced to the public in July 1942. This guide acknowledged wartime food rationing, while endeavoring to improve the health of Canadians. It identified six food groups: (1) milk; (2) fruit; (3) vegetables; (4) cereals and breads; (5) meat, fish, etc.; and (6) eggs. In the 1992 revision, a rainbow graphic displayed four food groups The groups were: (1) grain products, (2) vegetables and fruit, (3) milk products, and (4) meat and alternatives. The guide encouraged more servings of grains, vegetables and fruits. The current version of Canada’s Food Guide was revised and released in January 2019. Unlike previous guides, which recommended specific numbers of servings, this version focuses on proportions rather than specific servings. E.g., ½ your plate should consist of vegetables and fruits, ¼ should consist of whole grains, ¼ should be protein foods, with an emphasis on plant-based proteins.  GUIDELINE 1 Nutritious foods are the foundation for healthy eating. § Vegetables, fruits, whole grains, and protein foods should be consumed regularly. § Replace foods containing mostly saturated fat with foods containing mostly unsaturated fat § Water should be the beverage of choice GUIDELINE 2 Processed or prepared foods and beverages that contribute to excess sodium, free sugars, or saturated fat undermine healthy eating and should not be consumed regularly. GUIDELINE 3 Food skills are needed to navigate food environments and support eating. § Cooking with nutritious foods should be promoted as a practical way to support healthy eating § Food labels should be promoted as a tool to help Canadians make informed food choices Food Labels 1. Nutrition Facts 2. Amount of Food 3. % Daily Value 4. Core Nutrients 5. Nutrition Claims 6. Ingredient List There are two types of nutrition claims on packaged food: Nutrient Content Claims Health Claims Describe the amount of State the helpful effects a nutrient in a food of certain foods Nutrition Facts changes: List of Ingredients changes: ORIGINAL INGREDIENTS: FLOUR, FANCY MOLASSES, VEGETABLE OIL, SHORTENING, BROWN SUGAR, LIQUID WHOLE EGG, SUGAR, SALT, SODIUM BICARBONATE, SPICES, COLOUR CONTAINS: WHEAT, EGG Serving Size changes:  Active Living Lecture 7 Instructor: Dr. Colin Francis Objectives § Describe the benefits of regular physical activity § List the Canadian Physical Activity Guidelines § Outline the components of an aerobic exercise program § Describe muscle resistance programs for strength and endurance § Explain the stretching exercises designed to improve flexibility  Any body movement produced by the skeletal Physical Activity muscles that results in a substantial increase over resting energy expenditure. Consists of physical activity that is planned, Exercise structured, and repeated for the purpose of conditioning the body. Ability to respond to routine physical demands, Physical Fitness handle unexpected demands, and to protect oneself against potential health problems.  Benefits of Physical Activity The Four Key Components of Physical Fitness Muscular Fitness Flexibility Cardiorespiratory Body Fitness Composition Physical Fitness Together, these components contribute to overall Physical Fitness, promoting a well-rounded, healthy lifestyle. Cardiorespiratory Fitness v Ability to sustain aerobic whole-body physical activity for a prolonged period of time. v To improve cardiorespiratory fitness, engage in: § Sweating a little bit, breathing harder Moderate PA § e.g., brisk walking § Sweating, elevated heart rate, out of breath Vigorous PA § e.g., running Cardiorespiratory fitness is measured based on VO2 max. What is VO2 max? § maximal oxygen consumption during intense activity § graded exercise test where intensity is progressively increased § measures O2 and CO2 concentrations of inhaled and exhaled air § Reached when O2 consumption remains at steady state For the average person, aerobic exercise should be to the point of breathlessness, not VO2 max. Resting Heart Rate  Heart rate during aerobic activity should be 55 to 90% of maximum to gain cardiorespiratory benefit. § Estimate your maximum heart rate Step 1 200 § Take 220 minus current age § (e.g.; for a 20-year-old) Step 2 § Determine your lower heart rate limit 110 § Value from Step1 multiplied by 0.55 § Determine your upper heart rate limit Step 3 180 § Value from Step1 multiplied by 0.90 Example: Target Heart Rate (THR) = 110-180 beats per minute Relationship between different levels of exercise effort (as a percentage of maximum effort or heart rate) and the effects on physical performance and health. Stages of an aerobic workout include: Warm-Up Activity Cool Down Brisk walk and/or Walk for 5-10 Aerobic activity for stretching for minutes at a desired duration about 5 minutes comfortable pace Benefits of cardiorespiratory fitness training may include a reduced risk of the following: Obesity Hypertension Heart Disease Stroke Type 2 Diabetes Cancer Current recommendations are: Accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more Muscular Fitness v There are two main dimensions of muscular fitness: ENDURANCE STRENGTH Repeated effort of muscle or Amount of force within a group of muscles muscle or group or muscles Measured by the number of Measured by the absolute times a person can lift, push, or maximum weight a person can press a given weight lift, push, or press one time Comparison Between Training Variables For Muscle Endurance And Strength Development 8-12 4-8 Muscles can do only two things: contract or relax. Types of muscle contractions include: ISOMETRIC ISOTONIC ISOKINETIC ISOMETRIC The muscle generates force without changing its length.  Dynamic muscle movement ISOTONIC against a constant resistance Concentric (shortening) Phase Eccentric (lengthening) Phase  Dynamic muscle movement that ISOKINETIC regulates the resistance and/or speed through the full range of motion A weight workout should exercise the primary muscle groups: Muscle Group Exercise Quadriceps, Gluteals Leg press Hamstrings Leg curl Pectorals Chest press Latissimus Dorsi Lat pull down Deltoids Lateral raise Triceps Triceps press Biceps Biceps curl Abdominals Curl-up  Pectorals Deltoid Trapezius Biceps Triceps Abdominals Latissimus dorsi Gluteus Quadriceps Hamstrings maximus Gastrocnemius Rest and Recovery is important as well: Allow 48 to 96 hours between training sessions to recover from a workout, avoid injury and overtraining. If you are weight training every day, alternating muscle groups is best; upper body and lower body. Benefits of muscular fitness training include the following: Improve balance Prevent skeletal Minimize weight and energy muscle loss gain over time Current recommendations are: Muscle and bone strengthening activities using major muscle groups of the body should be completed at least 2 days per week. Flexibility v The range of motion achievable without injury at a particular joint or series of joints. v Muscles, tendons, and ligaments shorten and tighten when they are not used through their full range of motion. v Stretching elongates muscles and keeps joints limber. STATIC DYNAMIC PNF  STATIC Static stretching involves a gradual, slow stretch held for a short time (10-60 seconds). vTypically performed after a workout or competition, to lengthen muscles and increase flexibility. vSince a slow stretch provokes less of a reaction from the stretch receptors, muscle can safely stretch farther. vExamples: quadriceps (pulling the foot toward the buttocks), triceps (pulling bent elbow above and behind head). DYNAMIC Dynamic stretching involves slow, controlled movement to increase range of motion. v Usually performed before a workout or competition, to increase reach and speed of movement. v Does not force the body beyond its usual range of motion. v Examples: yoga (sun salutations, downward-facing dog), walking lunges, side bends, knee lifts, spinal twists.  PNF Proprioceptive Neuromuscular Facilitation combines passive and active stretches. v Uses an external force (body, partner, gravity, or weight) to help the joints move through their range of motion. v Allows for a more intense stretch, but risk of injury is also greater; “hold-relax” or “contract-relax” techniques. v Examples: hamstring stretch with partner, pectoral stretch with arm extended against a wall. Benefits of flexibility training may include the following: Prevention of Relieve muscle Better athletic injuries stiffness performance Relieve muscle Improved Preserve range soreness posture of motion Current recommendations are: Do flexibility exercises at least two or three days each week. Body Composition A two-component model divides the body into: § Essential fat; found in bones, heart, lungs, Fat Mass liver, spleen, etc. § Storage fat; located around internal organs and underneath skin § Muscles, bones, ligaments, tendons, and Fat-Free Mass internal organs Practical methods of measuring body composition include: Skinfold Measurements Bioelectrical Impedance Analysis Hydrostatic Weighing Benefits of normal body composition include the following: Lowered Health Risk Hypertension and Heart Disease Blood Lipids (fat, cholesterol) Type 2 Diabetes Mellitus Current recommendations are: Women: 16-35% body fat AND Men: 7-25% body fat  Long Term Fitness Planning Beginning Progression Maintenance Phase Phase Phase § 4-6 weeks § 16-20 weeks § >21 weeks § slow and low § duration, intensity § mix it up  Overload To become stronger, the body must work against a greater- Principle than-normal resistance or challenge than accustomed to. FITT sums up the four dimensions of progressive overload. Frequency Intensity Time Type How Often How Hard How Long Specific Activity Reversibility Opposite of overload principle; the body will adapt to Principle lower levels of physical demands that are placed upon it. v The phrase “use it or lose it” sums up the principle. v If you stop exercise, up to 50% of any gains in fitness can be lost within 2 months. v To retain fitness, it’s important to maintain the intensity of your exercise, even if the frequency or duration is reduced. Sedentary Behaviour v Occurs when we are awake, but sitting or lying down. v Sources include: Occupation Transport Leisure Why should Sedentary behaviour negatively impacts health, we care? despite other factors (e.g., weight, diet, exercise) What is the Sedentary behaviour is associated with increased health risk? risk of Type 2 Diabetes and Cardiovascular Disease Weight Management Lecture 8 Instructor: Dr. Colin Francis Objectives § List several factors that contribute to obesity § Describe methods used to assess weight-related health risk § Explain methods used to assess body composition § Define underweight, normal weight, overweight, and obesity § List health problems that are associated with excess weight § Explain how weight bias can impact quality of health care Percentage of adults who are obese (aged 18 and over) by province and territory Green represents provinces/territories with a low prevalence of obesity (less than 20%). Yellow represents provinces/territories with a moderate prevalence (20-25%). Orange represents provinces/territories with a high prevalence (over 25%). Factors contributing to weight management includes a combination of behavior, environment, and genes-related factors. 1. More calories associated with bigger portions (fast food) 2. Physical inactivity (sedentary), passive entertainment (screen time) 3. Prenatal factors (e.g., pre and during pregnancy) 4. Genetics (e.g., the GAD2 and Ob genes, are linked to obesity) 5. Social networks (e.g., peer groups): promotion of unhealthy habits by peers can negatively impact your ability to manage weight. 6. Social determinants (e.g., lower socioeconomic status (SES), education) The health dangers of excess weight include: Type 2 Diabetes Hypertension Heart Disease Stroke Cancer Other Energy Balance Equation Theory Calories In versus Calories Out Calories In versus Calories Out Here’s how calories measure up in 1 gram of the following foods: Carbohydrates: 4 calories Protein: 4 calories Fat: 9 calories Calorie requirements per day, females and males, ages 19-30: 2350 3000 2100 2700 Active Active 1900 2500 Low Active Low Active Sedentary Sedentary Calories In versus Calories Out 60-70% 20-35% Basal Metabolic Rate Voluntary 5-10% Muscular Activity Thermic Effect of Food Minimal energy required to maintain survival Actions normally controlled by individual volition Energy to digest, absorb, transport, and store nutrients  EER = 662 – (9.53 x age [years]) + PA* x {(15.91 x MEN weight [kilograms]) + (539.6 x height [metres])} WOMEN EER = 354 – (6.91 x age [years]) + PA* x {(9.36 x weight [kilograms]) + (726 x height [metres])} Low Active Active PA values Sedentary (30-60 min daily) (>60 min daily) Men 19+ 1.00 1.11 1.25 Women 19+ 1.00 1.12 1.27 Guidelines no longer focus on body weight, but rather the following as indicators of weight-related health risk: Body Mass Waist Waist-to-Hip Index Circumference Ratio  Body Mass Index v Ratio between weight and height; a mathematical formula that correlates with body fat. BMI = weight (kg) / height (m2) Limitations: § May be overestimated in muscular individuals § Not for growing children, pregnant or nursing women, elderly § Does not give an indication of % body fat.  BMI (kg/m2) Classification Risk of developing health problems Less than 18.5 Underweight Increased 18.5 to 24.9 Normal Least 25.0 to 29.9 Overweight Increased 30.0 to 34.9 Obese, Class I High 35.0 to 39.9 Obese, Class II Very high 40.0 and over Obese, Class III Extremely high  EXAMPLE Susan is 5’4” (1.63m) tall, and weighs 165 lbs (75kg) Calculate and interpret Susan’s BMI. What is her weight-related health risk? BMI = weight (kg)/height (m2)  Waist v Apple shape (Android): Circumference v Commonly used along with BMI as a measure of risk associated with excess abdominal fat. v Pear shape (Gynoid): v Used to assess for Apple (Android) or Pear (Gynecoid) shape Where weight is carried is more important than how much is carried. Limitations: § Does not give an indication of % body fat. Waist Circumference (WC) guidelines are as follows: The cutoff points are: § Caucasian: ≥ 102cm (40.2 inches) MEN § Asian: ≥ 90 cm (35.4 inches) § Caucasian: ≥ 88 cm (34.6 inches) WOMEN § Asian: ≥ 80 cm (31.5 inches) A larger waist circumference above these thresholds (cutoff points), indicates a higher level of abdominal fat, which is associated with high cholesterol, hypertension and increased risk of coronary heart disease and type 2 diabetes.  Waist-to-Hip Ratio v Ratio between waist circumference and hip circumference; predictive for older individuals. v Measured as smallest natural waist and at widest part of the buttocks or hips. Limitations: § Does not give an indication of % body fat. Waist-to-Hip Ratio (WHR) guidelines are as follows: The waist-to-hip ratio is calculated by dividing the waist circumference by the hip circumference provides an indication of body fat distribution A higher WHR indicates: MEN § 1.00 high WOMEN § 0.85 high Exceeding these WHR cutoff points is associated with high cholesterol, hypertension and increased risk of coronary heart disease and type 2 diabetes.  EXAMPLE Steve has a waist circumference of 103cm and a hip circumference of 94cm. Calculate and interpret Steve’s WHR and WC. What is his weight-related health risk? WHR = waist circumference/hip circumference: Practical methods of assessing body composition include: Bioelectrical Skinfold Hydrostatic Impedance Measurements Weighing Analysis  Skinfold Measurement v Measure the amount of skinfold (body fatness) on various sites; minimum 2 measurements per site. v Typical sites include: triceps, biceps, subscapular, chest, abdomen, thigh, medial calf Limitations: § Lack of precision in taking measurements § Difficult to perform if high amount of body fat  Bioelectrical Impedance Analysis v A low-level electric current is passed through the body and impedance (opposition) to the flow is measured. Conductor Insulator Electricity flows easily. Electricity does not flow. = Resistance is low. Muscle = Resistance is high. = Impedance is low. Body Water Fat = Impedance is high. Limitations: § Strict pre-rest protocol (e.g., not exercising before test) § Poor reliability based on hydration state  Hydrostatic Weighing v An individual is submerged underwater, and the weight of displaced fluid is measured. v Lean Mass (muscle, bones, organs, and water) is denser and weighs more than Fat Mass. v People with more fat will displace less water compared to lean individuals because fat is less dense than water. Limitations: § Expensive, limited equipment available § Fear of being underwater and exhaling completely Successful weight management requires a lifelong commitment to healthy lifestyle behaviours. The goal of any weight management program should be to improve quality of life. Programs must: v emphasize sustainable and enjoyable eating practices and daily physical activity v be tailored to an individual’s sex, lifestyle, and cultural, racial, and ethnic values Weight management approach for a serious weight problem depends on how overweight a person is: Overweight Obesity Obesity (BMI 25-29) (BMI 30-39) (BMI 40+) Cut back Try a 6-month trial Medical treatment moderately on of lifestyle may be performed; food intake, focus therapy, including e.g., gastric bypass on developing a supervised diet surgery. healthy eating and and exercise plan. exercise habits. Five common diet traps to avoid include: § Diet Foods § Yo-Yo Syndrome § Very Low-Calorie Diets § Fad Diets § Diet Pills  Weight bias is the negative weight-related attitudes, beliefs, assumptions, and judgements one holds towards individuals at either end of the weight spectrum. Source: Rudd Center for Food Policy & Obesity Identify your weight-related attitudes and integrate sensitivity when working with overweight individuals: § Consider patients’ previous negative experiences § Recognize that being overweight is a product of many factors § Explore all causes of presenting problems, not just weight § Recognize that patients have tried to lose weight repeatedly § Emphasize importance of behavior changes § Acknowledge the difficulty of making lifestyle changes § Recognize that small weight losses can improve health Reproductive Health Lecture 9 Instructor: Dr. Colin Francis Objectives § Describe the various types of intimate and committed relationships § Identify components of the male and female reproductive system § Describe the menstrual cycle and human conception § Compare and contrast the various types of birth control Two key types of relationships include family and friends. FORMING These relationships are fundamental for social and emotional well-being. RELATIONSHIPS Family: Relationships with family members provide emotional support, security, and a sense of belonging. Family ties often offer lifelong connections, shared values, and FAMILY experiences. These relationships play a crucial role in shaping identity and values. Friends: Friendships involve voluntary connections based on mutual interests, trust, and shared experiences. FRIENDS They provide companionship, emotional support, and can significantly influence personal growth and social skills. Friendships can help individuals explore new perspectives and form a broader support network beyond family. Sternberg's Triangular Theory of Love Sternberg’s Love Triangle (1986) categorizes different types of love based on the presence or absence of three components: intimacy, passion, and commitment. Emptiness Liking Liking: (commitment alone) (intimacy alone) Infatuation: Infatuation (passion alone) Empty Love: A combination of pairs of components Sternberg’s Love Triangle (1986) form three types of love: Companionate love Romantic Love: (intimacy + commitment) nt me Fatuous Love: mit Com Fatuous love Romantic love (passion + commitment) (intimacy + passion) Companionate Love: The center of the triangle, Sternberg’s Love Triangle (1986) where all three components intersect representing consummate love. Consummate love is considered the most complete form of love encompassing intimacy, passion, and commitment. this type of love is often seen as the ideal in romantic relationships where emotional closeness, physical attraction, commitovent and to each other are all present.  Monogamy Monogamy is a committed relationship with exclusive involvement between two partners. There are different ways of practicing monogamy: PHYSICAL EMOTIONAL SOCIAL  Monogamy Physical Monogamy: This involves exclusive physical or sexual relations with one partner. – In this form, both partners agree to remain physically faithful to each other and avoid physical intimacy with others. Emotional Monogamy: This type focuses on emotional exclusivity, where both partners are committed to sharing emotional intimacy and support solely with each other. – Emotional monogamy means avoiding forming romantic or deep emotional bonds with others outside the relationship. Social Monogamy: This involves maintaining a socially exclusive relationship, where both partners are recognized as a couple in their social circle, community, and society. – Social monogamy may include shared living arrangements, public commitments, or a family structure. Cohabitation is when two people live together as a couple, without official ties such as marriage. 1. Shelter, share accommodation 2. Behaviour, intimate interdependent relationship 3. Services, share traditionally functions of a family 4. Social, portray themselves as a couple to others 5. Societal, treated by others as a partnership 6. Children, interact parentally with each other’s children Marriage is more common among Canadian adults than cohabitation (39% versus 9%, respectively). Crucial ingredients for commitment: § shared values; § a willingness to change in response to each other; § a willingness to tolerate flaws; § a match in religious beliefs and; § the ability to communicate effectively Best predictor of relationship satisfaction … Understanding Sexual and Gender Identity SEXUAL A person’s self-identification and expression of IDENTITY themselves in sexual relationships. (Ex: identifying as a heterosexual, homosexual, or bisexual, etc. ) GENDER A person’s internal sense of themselves as being IDENTITY male, female, or transgender. Identifying as the opposite sex they were assigned at birth Understanding Sexual and Gender Identity  Testis - Produces sperm and testosterone. Male Reproductive System Epididymis - Stores sperm and is the site of sperm maturation. Vas Deferens - Transports mature sperm to the urethra in preparation for ejaculation. Seminal Vesicle - Produces a sugar-rich fluid that provides sperm with energy and helps with sperm motility. Prostate Gland - Adds additional fluid to the ejaculate, which helps nourish and protect sperm. Penis - Contains the urethra, which serves as the passageway for semen to exit the body Cowper's gland: secrete a small amount of clear fluid that helps during ejaculation. to lubricate the urethra and neutralize any acidity from residual urine.  Ovaries - Produce eggs (ova) and secrete Female Reproductive System hormones like estrogen and progesterone. Fallopian Tubes - Transport the egg from the ovary to the uterus; fertilization typically occurs here. Uterus - A muscular organ where the fertilized egg implants and grows during pregnancy. Cervix - The lower part of the uterus that opens into the vagina, allowing the passage of sperm into the uterus. Fimbriae are finger-like projections Vagina - Serves as the passageway for sperm located at the end of each fallopian tube. to enter the reproductive tract and is the – Primary function - help guide the birth canal during childbirth. released egg from the ovary into the fallopian tube. Every menstrual cycle begins in the brain with the production of gonadotropin-releasing hormone (GnRH): 1. In response to signals from the hypothalamus, the pituitary gland releases two hormones—follicle-stimulating hormone (FSH) and luteinizing hormone (LH)— which stimulate and regulate the menstrual cycle. 2. FSH stimulates follicle development in the ovary; follicle produces estrogen while it matures; the high level of estrogen results in a surge of LH which causes the follicle to rupture, releasing an ovum (egg) into the fallopian tube (ovulation). 3. The ruptured follicle (corpus luteum) produces estrogen and progesterone which stimulates the lining of the uterus (endometrium) to become thicker in preparation for a fertilized egg. 4. If the egg is not fertilized, progesterone decreases and the endometrium is shed (menstruation); blood hormone levels drop and cycle begins again. Spermatogenesis (creation of sperm) starts at puberty. Sperm cells form in seminiferous tubules, stored in epididymis. Nuclei of sperm and egg cells merge forming a zygote; zygote divides, fluid enters the ball of cells, and becomes known as a blastocyst. It then burrows into the endometrium, a process called implantation. Birth Control Options  External condoms cover the erect penis and catch ejaculate; can be used for oral, vaginal, and anal sex. The three types include: LATEX POLYURETHANE NATURAL Most common type Used if one partner Protects against of condom used has a latex allergy pregnancy, not STIs Prevents pregnancy by keeping sperm away from vagina.  External condoms § Easy to find and cheap to purchase § Available over the counter without a prescription ADVANTAGES § Can delay ejaculation, prolonging some kinds of sex § Very effective at preventing STIs § May break if improperly stored or used incorrectly DISADVANTAGES § Applied before intercourse, reducing spontaneity § May reduce sensitivity during intercourse § Oil based products can cause condoms to break  Internal condoms are inserted into the vagina or rectum; can be used for oral, vaginal, and anal sex. Consist of two rings (one open and one closed) and a polyurethane sheath that loosely lines the vagina or rectum. One ring is anchored internally and the other rests externally at the vaginal or anal opening. Prevents pregnancy by keeping sperm away from vagina.  Internal condoms § Available over the counter without a prescription § One size condom can be used for all ADVANTAGES § May be effective at preventing STIs § Can be inserted up to 6 hours before intercourse § Can be expensive and hard to find DISADVANTAGES § May take time to get used to inserting and using  Combined hormonal birth control pills are oral contraceptive pills that are taken on a daily basis. Pills contain 2 hormones (estrogen and progestin); COMBINED take 21 days of active pills and 7 days of placebo pills. Monophasic: releases hormones at a constant level during cycle Multiphasic: releases hormones at different levels throughout the cycle Prevents pregnancy by thickening the cervical fluid, stopping the release of an egg, and thinning the lining of the uterus.  Combined hormonal birth control pills § Period may be more regular and lighter § Can be used to skip or shorten periods ADVANTAGES § Reduction in acne breakouts § Decreased risk of ovarian and uterine cancer § Must remember to take a pill every day DISADVANTAGES § Rare but serious complications (e.g., blood clots) § Not appropriate for those who cannot take estrogen § Does not offer any protection against STIs  Progestin-only hormonal birth control pills are oral contraceptive pills that are taken on a daily basis. Pills contain 1 hormone (progestin); PROGESTIN-ONLY take 28 days of active pills and no placebo pills. Mini Pill: releases a lower dose of progestin during the cycle Prevents pregnancy by thickening the cervical fluid; may also stop the release of an egg in some users.  Progestin-only hormonal birth control pills § Lighter or no periods (which is safe) ADVANTAGES § Hormone related side-effects may be less § A good choice for people who cannot use estrogen § Must remember to take a pill every day DISADVANTAGES § Irregular bleeding (spotting) is common § Does not offer any protection against STIs  Vaginal ring is a clear, flexible, thin, plastic ring that is placed into the vagina for one cycle. Releases a low dose of the hormones estrogen and progestin into the surrounding tissue. Ring must be worn for at least 21 days, after that: § take a ring-free break of no more than 7 days OR § wear for 21 or 28 days and immediately insert a new ring Prevents pregnancy by thickening the cervical fluid, stopping the release of an egg, and thinning the lining of the uterus.  Vaginal ring § Period may be more regular and lighter § Can be used to skip or shorten periods ADVANTAGES § Reduction in acne breakouts § Decreased risk of ovarian and uterine cancer § Must remember to remove and replace every month § Rare but serious complications (e.g., blood clots) DISADVANTAGES § Not appropriate for those who cannot take estrogen § Does not offer any protection against STIs  Birth control patch sticks to clean, dry, lotion-free skin on lower belly, upper arm, buttocks, or back. Contains the hormones estrogen and progestin that are absorbed through the skin (transdermal). Each patch is worn for 7 days (total 21 days), after that: § take a patch-free break of no more than 7 days OR § remove and immediately apply a new patch Prevents pregnancy by thickening the cervical fluid, stopping the release of an egg, and thinning the lining of the uterus.  Birth control patch § Period may be more regular and lighter § Can be used to skip or shorten periods ADVANTAGES § Reduction in acne breakouts § Decreased risk of ovarian and uterine cancer § Must remember to change the patch every week DISADVANTAGES § Rare but serious complications (e.g., blood clots) § Not appropriate for those who cannot take estrogen § Does not offer any protection against STIs  Birth control shot is a long-acting injectable option; injection is repeated appro