HSS 3108 Notes (Final) PDF

Health Promotion: process of enabling people to increase control over, and to improve their health; moves beyond a focus on individual behavior towards a wide range of social and environmental interventions - Seeks to change each of the determinants of health → individual, socioeconomic,...

Health Promotion: process of enabling people to increase control over, and to improve their health; moves beyond a focus on individual behavior towards a wide range of social and environmental interventions - Seeks to change each of the determinants of health → individual, socioeconomic, sociocultural, and environmental - Three key elements to health promotion - Government that governs for health - People who have health literacy - Healthy cities, towns, and suburbs Action Areas: Building healthy public policy Creating supportive environments Strengthening community action Developing personal skills Reorienting health services 3 P's of Public Health Prevention ○ Prevention of disease Promotion ○ Promotion of wellness Protection ○ Protection of health Disease Prevention: procedure through which individuals, particularly those with risk factors for a disease, are treated in order to prevent a disease from occurring; treatment normally begins either before signs and symptoms of the disease occur or shortly thereafter - Population based and individual based interventions for primary and secondary (early detection), aiming to minimize the burden of diseases and associated risk factors 4 Types of Health Care and Disease Prevention Primordial ○ Risk factor reduction targeted towards an entire population through a focus on social and environmental conditions → such measures typically get promoted through laws and national policy ○ Government has a role in individual and population health ○ Includes policies and laws that protect populations ○ Smoking policies in public buildings, restaurants, and bars; regulations that ensure safe drinking water, public sanitation and seatbelt laws Primary ○ Refers to actions aimed at avoiding the manifestation of a disease May include actions to improve health through changing the impact of social and economic determinants of health; the provision of information on behavioral and medical health risks, alongside consultation and measures to decrease them at the personal and community level; nutritional and  food supplementation; oral and dental hygiene education; and clinical preventive services such as immunization and vaccination of children, adults and the elderly, as well as vaccination or post-exposure prophylaxis for people exposed to a communicable disease ○ Approach to health and a spectrum of services beyond the traditional health care system ○ Includes all services that play a part in health, such as income, housing, education and environment ○ Addresses the majority of a person’s health needs throughout their lifetime; includes physical, mental, and social well-being ○ People-centered ○ Health promotion, disease prevention, treatment, rehabilitation, palliative care ○ A primary health care approach includes three components: meeting people’s health needs throughout their lives; addressing the broader determinants of health through multisectoral policy and action; and empowering individuals, families and communities to take charge of their own health. (WHO) Secondary ○ Deals with early detection when this improves the chances for positive health outcomes Evidence-based screening programs for early detection of diseases or for prevention of congenital malformations; and preventive drug therapies of proven effectiveness when administered at an early stage of the disease ○ Requires more (primary) specialized care ○ People who have the disease (example: hypertension) and are seeking treatment, but still function with their instrumental activities of daily living (IADLs) ○ Screening to identify diseases in the earliest Tertiary ○ Intervention to reduce complications of established disease Ophthalmology examinations in diabetic patients, physical therapy following an injury, statin use in post-myocardial patients, and cardiac rehabilitation following a heart attack ○ People who have the disease and require treatment from health care professionals; people who are admitted to hospitals/hospice/rehab, etc ○ Managing disease post diagnosis to slow or stop Prevention strategies Healthy Habits Health Promotion - Begins with identification of ‘at risk’ individuals/populations - Clearly identifies what they are at risk for (disease/illness) - Works towards education and empowerment Origins of Health Promotion - First discussed in 1945 by Sigerist - Defined the four major tasks of medicine as promotion of health, prevention of illness, restoration of the sick, and rehabilitation - Health promoted by providing a decent standard of living, education, physical culture, means of rest and recreation and required the support of multiple disciplines - Initially began with the Ottawa Charter in 1986 - Health is heavily influenced by factors outside the domain of the health sector, especially social, economic, and political forces Program evaluation - Health promotion programs are evaluated in terms of their success (measured by outcomes); cost benefit ratios; relevancy - Governments are key stakeholders in health promotion ➔ What are the five 5 principles of health promotion? A broad and positive health concept; Participation and involvement; Action and action competence; A settings perspective and Equity in health. 5 strategies set out in the Ottawa Charter for Health Promotion are essential for success: 1. Build healthy public policy a. Step 1: identify, describe and analyze the problem b. Step 2: identify and analyze policy options c. Step 3: determine and understand decision-makers and influencers d. Step 4: assess readlines for policy development  e. Step 5: develop an action plan f. Step 6: implement the action plan 2. Create supportive environments a. Improving the living conditions of individuals by increasing equity and improving access to health services and facilities 3. Strengthen community action a. Health promotion works through concrete and effective community action. In setting priorities, making decisions, planning strategies, and implementing them to achieve better health b. The core of this process is the empowerment of communities. Ownership in controlling their own health 4. Develop personal skills a. Strategies for empowering the community include leadership training, learning opportunities for health, and access to resources including material and funding b. Empowerment helps people to identify their own needs and concerns, and gain the power, skills and confidence to act upon them. It is a bottom-up strategy which requires the health promoter to act as a facilitator and catalyst for change 5. Reorient health services a. Shift of emphasis from provision of curative services. b. Health care system must be equitable and client-centered. c. May necessitate reengineering and organizational change, especially in the areas of professional education and training,management, recruitment and deployment of health personnel, and planning, development and delivery of services ➔ Literacy influences one’s ability to access information and to navigate highly literate environments ➔ Strong link between health status, education, and income ➔ Higher income and social status are linked to better health ➔ The greater the gap between the richest and poorest people, the greater differences in health ➔ Approximately 42% of canadians between the ages 16 and 65 years fail to achieve level 3 proficiency (equivalent to grade 12) ➔ Over 40% of Canadians who score at level 1 are unemployed, and over 50% of Canadians who are unemployed at any given time score lower than level 3 ➔ Individuals with poor literacy skills are also more likely to be out of work longer; those at level 1 and 2 are twice as likely to be unemployed for six or more months than those at or above level 3 ➔ A person at Level 1 would typically be unable to determine the amount of medicine to administer to a child based on simple instructions printed on a bottle ➔ Those at Level 2 can read simple materials only. Because they frequently develop coping skills that mask their difficulty and allow them to deal with everyday literacy demands, these individuals (and others) may overestimate their proficiency, although they have difficulty in novel situations, such as learning new job skills. Literacy statistics in Canada 42% of Canadian adults between the ages of 16 and 65 have low literacy skills. 55% of working age adults in Canada are estimated to have less than adequate health literacy skills.  Shockingly, 88% of adults over the age of 65 appear to be in this situation Impoverished adults often do not have the literacy skills required to get into job training programs. They may need literacy skills upgrading before they can succeed in training programs but only about 5 – 10% of eligible adults enroll in programs Less than 20% of people with the lowest literacy skills are employed A 1% increase in the literacy rate would generate $18 billion in economic growth every year Investment in literacy programming has a 241% return on investment Health Literacy: ability to success, understand, evaluate, and communicate health information allowing one to promotes, maintain or improve health - 60% of adults and 88% of seniors in Canada are not health literate (Public Health Agency of Canada) Health Equity: all people (individuals, groups, and communities) have fair access to, and can act on, opportunities to reach their full health potential; they are not disadvantaged by social, economic and environmental conditions including socially constructed factors such as race, gender, sexuality, religion and social status; absence of unfair systems and policies that can cause health inequalities - Seeks to reduce inequalities and to increase access to opportunities and conditions conducive to health for all Health Inequities: refers to differences in health between groups of people that are the result of the unfair distribution of the underlying conditions required for good health; includes the social, economic and environmental conditions and the imbalances of power that put groups who already experience disadvantages at further risk of poor health outcomes; result of societal choices that are avoidable, unfair, unjust, and modifiable - Example: Canadians who live in remote or northern regions do not have same access to nutritious foods such as fruits and vegetables as other Canadians Terms Literacy: the ability of adults to read, write, and comprehend information at the 8th-grade level or above. Illiteracy: the ability of adults to read, write, and comprehend information at the fourth-grade level or below, or not at all. Low Literacy: the ability of adults to read, write, and comprehend information between the 5th- to 8th-grade levels of difficulty. Health Literacy: the ability to read, interpret, and comprehend health information to maintain optimal wellness. Functional Illiteracy: in adults, the lack of fundamental reading, writing, and comprehension skills needed to operate effectively in today’s society. Readability: the ease with which written or printed information can be read. Comprehension: the degree to which individuals understand and accurately interpret what they have read. Numeracy: the ability to read and interpret numbers. Reading: the ability to transform letters into words and pronounce them correctly (word recognition). Iloralacy: the inability to comprehend simple oral language communicated through speaking of common vocabulary, phrases, or slang words. Trends associated with literacy problems - Rise in the number of immigrants - Aging of our population - Increasing complexity of information - Increasing sophistication of technology - Added number of people living in poverty - Changes in policies and funding for public education - Disparity of opportunity between minority versus nonminority populations Those at risk - Economically disadvantaged - Older adults - Immigrants (particularly illegal ones) - Those with english as a second language - Racial minorities - High-school dropouts - Unemployed - Incarcerated individuals - Inner city and rural residents - Those with poor health status Assessment: Clues to look for Most people with limited literacy abilities are masters of concealment Possible signs of poor or nonexistent reading ability include: ○ Reacting to complex learning situations by withdrawal or avoidance ○ Using the excuse of being too busy, not interested, too tired, or not feeling well enough to read instructional materials ○ Claiming they lost, forgot, or broke their glasses ○ Surrounding themselves with books, magazines, and newspapers to give the impression that they are able to read ○ Insisting on reading the information at home or with a spouse or friend present ○ Asking someone to read information for them ○ Becoming nervous when asked to read ○ Acting confused or talking out of context about the topic of conversation ○ Showing signs of frustration when attempting to read ○ Having difficulty following directions ○ Listening and watching attentively to try to memorize information ○ Failing to ask questions ○ Turning in registration forms or questionnaires that are incomplete, illegible, or not attempted Impact of Illiteracy on Motivation and Compliance - People with poor literacy skills think in very concrete, specific and literal terms  - Characteristics of thinking: - Disorganization of thought - Limited perception of ideas - Slow rate of vocabulary and language development - Poor problem-solving skills - Difficulty analyzing and synthesizing information - Difficulty formulating questions - Struggles when handling more than one piece of information at a time - Cultural literacy involves the ability to understand nuances, information, slang, and sarcasm. Noncompliant behavior may be the result of not understanding what is expected rather than an unwillingness to follow instructions. Ethical, Legal and Financial Concerns - Printed education materials (PEMs) that are too difficult to read or comprehend result in miscommunication between consumers and healthcare providers. - The Joint Commission requires that patients and their significant others are provided with information that is understandable. - The Patient’s Bill of Rights mandates that patients receive complete and current information in terms they can understand. - Informed consent, as a result of verbal and/or written instructions, must be voluntary and based on an understanding of benefits and risks to treatment or procedures. - Healthcare professionals are liable, legally and/or ethically, when information shared is above the level of the patient’s ability to comprehend. Readability of Printed Education Materials (PEMs) - Research findings indicate that most PEMs are written at grade levels that far exceed the reading ability of the majority of patients. - The readability level of PEMs is between the 10th and 12th grade, yet the average reading level of adults falls at the 8th grade level. - People typically read at least two grades below their highest level of schooling. - PEMs serve no useful teaching purpose if patients are unable to understand them. Socioeconomic Characteristics Variables affecting health status and health behaviors ○ Education level ○ Family income ○ Family structure All three variables affect health beliefs, health practices and readiness to learn Social class ○ Types of indices for measurement Occupation of parents Income of family Location of residence Educational level of parents ○ Poverty circle, low education level results in occupations with lower levels of pay, prestige, and intellectual demand; families at this level become part of the cycle that does not allow one to easily change a pattern of change Impact of socioeconomics on health ○ Lack of financial resources has a negative impact on prevention of illness, compliance with treatment, and motivation to learn; focus is on day-to-day survival  Impact of illness on socioeconomics ○ The cost of medical care and supplies can negatively impact a person’s/family’s financial well-being, especially if socioeconomic level is already low Personal health literacy: is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others Organizational health literacy: is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others New definitions of health literacy Emphasize people’s ability to use Health information rather than just understand it Focus on the ability to make “well-informed” decisions rather than “appropriate” ones Acknowledge that organizations have a responsibility to address health literacy Incorporate a public health perspective Why is Health Literacy important? - Leads to building trust and advancing health equity - Trust is an important part of a person’s willingness to engage in care and behaviors that promote health How can we achieve health literacy? - Using plain language - Using your audience’s preferred language and communication channels - Using culturally and linguistically appropriate language How does disease prevention differ from health promotion? ➔ Both focus on keeping people healthy ➔ Health promotion targets empowering individuals ➔ Disease prevention focuses on efforts aimed at reducing chronic disease 3 strategies used to target health promotion and disease prevention 1. Communication a. Raising awareness about healthy behaviors to the general public 2. Education a. Empowering behavior change and actions through increased knowledge 3. Policy, systems, environment a. Making systematic changes - through improved laws, rules, and regulations (policy) b. Functional organizational components (systems) c. Economic, social, or physical environment - to encourage, make available, and enable healthy choices Priorities in Assessing Disease Prevention - In Canada, chronic diseases account for 89% of all deaths and more than $80 billion in annual health care costs. - Adopting healthy lifestyle behaviors, such as healthy eating, has the potential to prevent 80% of type 2 diabetes and cardiovascular disease, 40% of cancers, and other chronic diseases. How do we prevent disease? - Preventative stages: primordial, primary, secondary, tertiary; combined, these strategies not only aim to prevent the onset of disease through risk reduction, but also downstream complications of an already existing disease Risk of Disease - Health risk increases chance of developing a disease Modifiable vs Non-modifiable Risk Factors Things you can change ○ Behavior ○ Lifestyle ○ Diet Things you cannot change ○ Genetics ○ Age ○ Sex ○ Family hx ○ Ethnicity ➔ Social determinants of Health are the economic, social, cultural, and political conditions in which people are born, grow, and live that affect health status ◆ Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups Determinants of Health - broad range of personal, social, economic and environmental factors that determine individual and population health 1. Income and social status 2. Employment and working conditions 3. Education and literacy 4. Childhood experiences 5. Physical environments 6. Social supports and coping skills 7. Healthy behaviors 8. Access to health services 9. Biology and genetic endowment 10. Gender 11. Culture 12. Race / Racism - Determinants of health enables us to measure health status and develop strategies to reduce inequality in health What are health disparities? - Differences in health outcomes and their causes among groups of people - Reducing health disparities is a MAJOR goal in public health - Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations Who is vulnerable to health disparities? - Mental health - Indigenous health  - Rural health - Marginalized populations ➔ Differences in the health status of individuals and groups are called health inequalities ◆ Differences can be due to your genes and the choices you make. For example, whether you exercise or drink alcohol. However, the social determinants of health can also have an important influence on health. For example, Canadians with higher incomes are often healthier than those with lower incomes. What is Canada doing to reduce health inequalities? 1. Strengthening the evidence base to inform decision-making 2. Engaging beyond the health sector 3. Sharing knowledge of action across Canada Pan-Canadian Public Health Network In addition to its 5-year strategic priorities, the PHN also focuses efforts on: ○ limiting the emergence and spread of drug resistance pathogens ○ urgent issues related to overdoses and deaths linked to the use of opioids and other substances ○ standards on sharing, usage, disclosure and protection of public health information among jurisdictions for: infectious diseases public health emergencies of international concern ○ advancing Canada's national dementia strategy What is public health? - “the science and art of preventing disease prolonging life and promoting health, through the organized efforts of society” - Improves health of populations - Making people healthy and saving lives Who is responsible for public health? - All sectors of society - Health departments - Coordinated efforts - other stakeholders - Other areas of government - Private sector - NGOs - International organizations - Community How does public health work? Core areas ○ Protection Control of infectious diseases Managing environmental hazards Managing health emergencies Healthy workplaces ○ Prevention Vaccination Screening ○ Promotion Promoting health behaviors Improving the social determinants of health Governance, advocacy, capacity, information Health disparities in Canada - Mostly result from inequalities in the distribution of the underlying determinants of health across populations - Factors associated with health disparities - Socio-economic status (SES), Aboriginal identity, gender and geographic location - Factors are interdependent Groups at risk for experiencing health disparities in Canada Indigenous peoples Sexual minorities Racial minorities Immigrants People living with functional limitations Those living with inequalities by socioeconomic status (income, education levels, employment, and occupation status) Other identified disparities - Age - Place of living  ➔ According to PHAC, men in the lowest income quintile live an average of five years less than men in the highest; the gap among women is two years. WHY? ◆ Canadians in the bottom SES quintile are five times more likely to rate their health as fair or poor as people in the highest. WHY? Personal health practices, such as smoking, diet, and physical activity, vary with educational and income level. Cost of Health Disparities - Canadians in the lowest quintile of income groups use approximately twice as much in the way of health care services as those in the highest quintile - they are more often and more severely sick or injured PHAC and STATSCAN - Health care costs generally decline as income rises - this pattern is the same for both women and men - For the services included in this report, socio-economic health inequalities cost Canada's health care system at least $6.2 billion annually. - This represents over 14% of total spending on acute care in-patient hospitalizations, prescription medications and physician consultations - There is potential to reduce these costs if all Canadians could match the health care usage patterns of the highest income group. - Lowest income group accounts for 60% ($3.7 billion) of the health care costs of socio-economic health inequalities - Improving the health of this group could significantly reduce these costs A better understanding of the direct economic burden can help us consider how: - Improving health and reducing health inequalities could produce economic and other gains - To balance health spending between prevention and treatment - 80-20 rule - To assess investments in other social, economic and environmental policy areas that support healthy lifestyle choices ➔ Community characteristics, like governance and cultural continuity, are associated with health disparities ◆ BeetBox.Ca Definition of Mental Health - State of your psychological and emotional well-being. It is the necessary resource for living a healthy life and a main factor in overall health. It does not mean the same thing as mental illness - Poor mental health can lead to mental and physical illness - WHO - “A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” History of Mental Health in Canada - In 1942, the Canadian Public Health Association (CPHA) approved its first resolution concerning mental health. - That resolution called for improvement to the provision of mental health services for Canadians in light of the effect of the war effort on the availability of such services domestically - In 2003, Roy Romanow’s report on the future of healthcare in Canada - “We must transform our health care ‘system’ from one in which a multitude of participants, working in silos, focus primarily on managing illness, to one in which they work collaboratively to deliver a seamless, integrated array of services to Canadians, from prevention and promotion to primary care, to hospital, community, mental health, home and end-of-life care.” - In 2024 - Strategies (funding social programs/federal, provincial, or regional) - Policies (many directed at marginalized/vulnerable populations) - Focus on health equity ➔ Mental health is not a new concept and huge costs associated with it (on all levels - primordial, primary, secondary, tertiary) ➔ Government of Canada invests $12.2 M in Mental Health Promotion ◆ Public Health Agency of Canada - Many Canadians struggle with mental health issues, but certain people in Canada face disproportionate challenges when it comes  to mental health because of racism, discrimination, socio-economic status or social exclusion. The Government of Canada remains committed to promoting positive mental health for everyone, recognizing how the COVID-19 pandemic has exacerbated the mental health and substance use of many people in Canada. ➔ Only about 7.2% of Canada’s health care budget is dedicated to mental health, with the bulk of that funding seemingly directed to treatment programs rather than prevention and promotion Pareto Principle - Applies to: - Indigenous health - Mental health - Rural health - Population health - Public health efforts - Primary health care vs tertiary, Etc. ➔ Promoting mental health results in individual and population health benefits, including improved physical health, faster recovery from illness, healthier behaviors, higher levels of education and employment combines with a reduction of health inequalities Quick Facts - One in three Canadians will be affected by mental illness in their lifetime. - Community-based projects focused on mental health promotion have the potential to improve health outcomes over the life course. - Promoting mental health has several individual and population health benefits, including improved physical health, faster recovery from illness, healthier behaviours, higher educational achievement and increased employability combined with a reduction of health inequities. Some factors to positively influence mental health in vulnerable populations? And in non-vulnerable populations?  Non-vulnerable populations ○ Work-life balance (avoid getting burnouts); social support (family and friends); preventive care (regular check ups) ○ Lifestyle factors (modifiable) - stress management (meditation, mindfulness); physical health (regular exercise, healthy eating; building and maintaining social networks ○ Lifestyle factors (non-modifiable) - genetics (recognizing and addressing hereditary risks for mental health conditions) Vulnerable populations ○ Access to mental health services - affordable; secure housing; social supports (family and friends); education; policy support ○ Lifestyle factors (modifiable) - regular physical exercise to reduce stress; healthy eating; substance use (avoiding alcohol, tobacco) ○ Lifestyle factors (non-modifiable) - genetics (recognizing and addressing hereditary risks for mental health conditions) Enhance mental health - Regular physical exercise - Pursue activities like painting, cooking, reading - Prioritizing sleep - Eating healthy (maintaining a balanced diet) - Setting realistic goals - accomplishing small goals can build confidence and avoid the feeling of overwhelming Canadian constitution refers to Aboriginal Peoples as those who as: Inuit - first inhabitants of arctic regions Metis - mixed, settlers and First Nations First Nations - status and non-status ○ Great diversity between groups - lands, languages, cultures, and colonial experiences but all have experienced colonization ➔ Long term effects of colonization has created inequalities in indigenous health status ◆ This has targeted the physical, social, emotional, and mental health and wellbeing of indigenous people ➔ Colonization: action or process of setting among and establishing control over the indigenous people of area ◆ Lost their lands ◆ Imposed new cultures ◆ Traditional lifestyle were disrupted ➔ Colonization has created inequities in the aboriginal and non-aboriginal peoples ◆ Culture has been changed Indigenous Health In comparison to general population, Indigenous Canadians experience: ○ Disproportionate incidence of diabetes ○ Hypertension ○ Substance abuse  ○ Mental health concerns ○ Overall morbidity and mortality ○ A significantly reduced life expectancy Risk factors ○ Settler colonialism has created the conditions that have led to disproportionately poorer health outcomes ○ Food insecurity ○ Education/occupation/income ○ Poor housing ○ Substance misuse Indigenous people experience: ○ Disproportionate burdens of ill health: Higher rates of infant mortality Tuberculosis Child and youth injuries and death Obesity and diabetes Youth suicide Exposure to environmental contaminants Jordan’s Principle - an initiative to ensure that First Nations children who require support to meet a health, education or social need — as recommended by a professional — can access those services in the same ways as other children in Canada 8 key issues for indigenous peoples in Canada 1. Poorer health 2. Higher rates of death in children and youth 3. Higher levels of incarceration 4. Higher rates of unemployment 5. Lower income levels 6. Lower levels of education 7. Higher rates of suicide 8. Inadequate housing conditions Rural Disparity - Rural risk factors for health disparities includes - Geographic isolation - Lower socioeconomic status - Higher rates of health risk behaviours - Limited access to healthcare specialists and limited job opportunities ➔ Rural Canadians experience health disparities due to a multitude of modifiable and non-modifiable factors including the limited number of services that are available in their communities. Barriers including long travel distances, inclement weather conditions, lack of accessible methods of transportation, and limited health care resources in rural communities further impose health risks to rural residents and limited access to appropriate resources leaving them vulnerable to poorer health outcomes than their urban counterparts. Canadians are entitled to accessible health care services, meaning essential services (including emergency care) should be accessible to all Canadians within a reasonable timeframe. Nursing in Rural Communities In 2006, there were over 6 million Canadians (or ~20% of the Canadian population) living in rural areas of Canada (Statistics Canada, 2009). The Canadian Institute of Health Information (CIHI) reports ~18% of registered nurses working in Canada work in rural areas. Nursing in rural communities is unique in that rural nurses are required to be highly skilled and often are cross trained to work in other areas. Concerns in rural nursing are the challenges in recruiting and retaining rural nurses and in obtaining skills and maintaining competencies, and the aging workforce. One of the potential consequences of this crisis is the lack of human resources may potentiate the possibility of closure of essential services. In 2023 ○ Just over 41,500 RNs work in rural Canada, that is, the areas of the country outside the urban centres with core populations of 10,000 or more. Although there are regional variations, only 17.9% of all RNs employed in nursing in Canada work in rural areas, but they serve 21.7% of the population ○ 17.8% of Canadians live in rural areas ○ Less than one in five Canadians live in a rural area ○ Because of these differences in population growth, the share of the population living in rural areas decreased from 18.7% in 2016 to 17.8% in 2021 Barriers to Health Promotion and Disease Prevention in Rural Areas - In rural communities, many factors influence health. Rural communities experience a higher prevalence of chronic conditions than their urban counterparts. - Examples of chronic conditions include heart disease, cancer, chronic respiratory disease, stroke, and diabetes. - People who live in rural areas, for example, are more likely than urban residents to die prematurely from all of the five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. These rural health disparities have many causes: - Health Behaviors: Rural residents often have limited access to healthy foods and fewer opportunities to be physically active compared to their urban counterparts, which can lead to conditions such as obesity and high blood pressure. Rural residents also have higher rates of smoking, which increases the risk of many chronic diseases. - Health Care Access: Rural counties have fewer health care workers, specialists (such as cancer doctors), critical care units, emergency facilities, and transportation options. Residents are also more likely to be uninsured and to live farther away from health services. - Healthy Food Access: National and local studies suggest that residents of low-income, minority, and rural neighborhoods often have less access to supermarkets and healthy foods. - Demographic Characteristics: Residents of rural areas tend to be older, with lower incomes and less education than their urban counterparts. These factors are linked to poorer health. - Rural communities also experience higher rates of mortality and disability than urban communities - Limited access to health promotion and disease prevention programs and healthcare services contribute to these health challenges Opportunities for Health Promotion and Disease Prevention in Rural Areas - Rural programs are well positioned to implement successful health promotion and disease prevention strategies, despite facing challenges such as chronic disease, poverty, lower educational attainment, and access to transportation, among others. Successful health  promotion programs will identify and draw upon community strengths.These strengths may help rural communities to overcome barriers to implementing health promotion and disease prevention programs. Social Determinants of Health that are Barriers for Rural Communities Higher poverty rates, which can make it difficult for participants to pay for services or programs Cultural and social norms surrounding health behaviors Low health literacy levels and incomplete perceptions of health Linguistic and educational disparities Limited affordable, reliable, or public transportation options Unpredictable work hours or unemployment Lower population densities for program economies of scale coverage Availability of resources to support personnel, use of facilities, and effective program operation Lack of access to healthy foods and physical activity options Health Promotion has three main ethical issues: 1. What are the ultimate goals for public health practice, i.e. what 'good' should be achieved? 2. How should this good be distributed in the population? 3. What means may be used in trying to achieve and distribute this good? Ethical Principles: Beneficence (doing good) ○ Acting in the best interest of the patient Non-maleficence (doing no harm) ○ Not to purposely cause harm Justice ○ To treat all people equally and equitably ○ Fairness ○ Moral obligation to tell the truth i.e. no lies Telling truth Respect for people and their autonomy ○ Giving persons independence in their decisions and actions to the extent to which they do not harm others or do not violate others' rights People are individual and free to make (some) choices People have value and dignity The right to informed consent Ethics - Standards of conduct which indicate how one should behave based on moral duties and virtues rising from principles of right and wrong - Five core values: honesty, fairness, responsibility, respect, and compassion Five tests that are useful in determining whether or not an action is wrong: 1. The legal test: is the action legal? If not, it may be unethical. 2. The professional standards test: is the action consistent with the accepted standards of your profession? 3. The gut feeling test: how do you intuitively feel about the action? Does it feel wrong? 4. The front-page test: how would you feel if your action was published on the front page of a newspaper? 5. The role model test: would your role model perform the action? Paradigms ➔ Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number ➔ Concerns raised about health promotion can be divided into two groups: 1. efficacy-based considerations – are they cost-effective or ineffective? 2. autonomy-based concerns – (to what extent) do they interfere with free choice, i.e. attempt to direct social values and lifestyles? ➔ Kohlberg's stages of moral development (1958) ◆ Level 1 (Pre-Conventional) 1. Obedience and punishment orientation  2. Self-interest orientation (What's in it for me?) ◆ Level 2 (Conventional) 3. Interpersonal accord and conformity (The good boy/good girl attitude) 4. Authority and social-order maintaining orientation (Law and order morality) ◆ Level 3 (Post-Conventional) 5. Social contract orientation 6. Universal ethical principles (Principled conscience) Theory - Supported by evidence; it's a principle formed as an attempt to explain things that have already been substantiated by data Concept - Framework - Model - Theory Concept - word choice - grief, futility Framework - rules - structure Model - replica - visible Theory - abstract - prediction Five health promotion models 1. Health belief model People’s experiences affect their health outcomes According to theory, one would have to look at people’s lifestyles, psychological health, and social and cultural environment to understand most of their health-related decisions Based upon susceptibility Model defines the key factors that influence health behaviors as: ○ an individual's perceived threat to sickness or disease (perceived susceptibility), ○ belief of consequence (perceived severity), ○ potential positive benefits of action (perceived benefits), ○ perceived barriers to action, exposure to factors that prompt action (cues to action), and ○ confidence in ability to succeed (self-efficacy). 2. Health promotion model Aims to explain the factors underlying motivation to engage in health-promoting behaviors 3. Transtheoretical model of change 4. Theory of reasoned action Suggests that a person's behavior is determined by their intention to perform the behavior and that this intention is, in turn, a function of their attitude toward the behavior and subjective norms 5. Diffusion of innovation Pattern and speed at which new ideas, practices, or products spread through a population Population health promotion model Ecological models ➔ “... the interaction between, and interdependence of, factors within and across all levels of a health problem. It highlights people's interactions with their physical and sociocultural environments.”  ➔ Recognizes multiple levels of influence on health behaviors, including: ◆ Intrapersonal/individual factors, which influence behavior such as knowledge, attitudes, beliefs, and personality ◆ Interpersonal factors, such as interactions with other people, which can provide social support or create barriers to interpersonal growth that promotes healthy behavior ◆ Institutional and organizational factors, including rules, regulations, policies, and informal structures that constrain or promote healthy behaviors ◆ Community factors, such as formal or informal social norms that exist among individuals, groups, or organizations, can limit or enhance healthy behaviors ◆ Public policy factors, including local, state, and federal policies and laws that regulate or support health actions and practices for disease prevention including early detection, control, and management Social cognitive theory “Social Cognitive Theory based on the concept that learning is affected by cognitive, behavioral, and environmental factors” ○ Self-efficacy: belief that an individual has control over and is able to execute a behavior ○ Behavioral capability: understanding and having the skill to perform a behavior ○ Expectations: determining the outcomes of behavior change ○ Expectancies: assigning a value to the outcomes of behavior change ○ Self-control: regulating and monitoring individual behavior ○ Observational learning: watching and observing outcomes of others performing or modeling the desired behavior ○ Reinforcements: promoting incentives and rewards that encourage behavior change ➔ Draconian Law is referencing laws or rules that are really harsh and repressive ◆ In ancient Athens, Draco made some strict laws - so rules that are too restrictive or just plain unfair are called draconian ➔ Martial law involves the temporary substitution of military authority for civilian rule and is usually invoked in times of war, rebellion or natural disaster. When martial law is in effect, the military commander of an area or country has unlimited authority to make and enforce laws Government - Local/organizational - Municipal - Provincial - Federal - Global Law development - Ideas → research - Policy - By-law - Law 8 steps to build public policy Idea to Policy to By-law - Problem: smoking leads to lung cancer (and other health issues) - Hospital policy: can not smoke in the hospital - By-law: fined if smoked (9 meters from the entrance, on hospital property) - Smoking laws in Canada: Smoking in Canada is banned in indoor public spaces, public transit facilities and workplaces (including restaurants, bars, and casinos), by all territories and provinces, and by the federal government Public health policies - Involves incentivizing health promoting behaviors (e.g., provision of financial benefits to parents when children are vaccinated) - Disincentivizing unhealthy behavior (e.g., heavy taxation of things like cigarettes and alcohol)