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Social & Behavioral Sciences

Social & Behavioral Sciences
Applied to Health

Chapters 1-8

Comprehensive Exam Review

Hana Osman, Ph.D.

Coreil, J; Bryant, C.A.; & Henderson, J.N. (2001) Social and behavioral foundations of public health. Thousand Oaks: Sage Publications, Inc.

Chapter 1

1) Prevention

a) Primary

– i) Preventing disease from developing in the first place

ii) Exercise

iii) Diet control

iv) Refrain from smoking

b) Secondary

i) Early screening

ii) Breast examination

iii) Pap smear

iv) Prostate examination

c) Tertiary

i) Aims to prevent further injury or deterioration

ii) Physical therapy post injury

iii) Dietary counseling to dialysis patients

iv) Health promotion activities with patients recovering from cardiac surgery

2) The Social Ecology of Health Model

a) Provides a framework that allows one to locate disparate public health issues within a coherent organization

b) Complex social ecology model

c) Social environmental variables

d) Within a social and physical environmental context

e) Individual to family to community to social institutions to the state to the global systems (derived from general systems theory)

f) Mutually interacting components

g) One variable has implications on all other variables

3) Components of the social ecology of health model (cont.)

a) Integration

b) Change

c) Adaptation

i) How a mother reacts to her child's illness is influenced by her social context (family, housing, work, school, medical system/insurance, others)

ii) Cross-sectional or synchronic view of interacting factors

4) The Health Impact Model

a) Ideology (beliefs, attitudes, values, the need for prenatal care)

b) Behavior (actions and activities of individuals & groups, lifestyle activities, exercise, smoking, taking time off from work)

c) Social structure (relationships to groups, gender roles)

d) Technology (use of knowledge & technical methods, dependence on cars, emergency medical transportation)

e) Diachronic view

Chapter 2

1) Demographic Measures

a) Fertility

b) Mortality

c) Population growth

d) Fertility Rates

i) This is the rate of childbearing in a population

2) Demographic definitions

a) Total fertility: mean number of children born per woman in a particular population (between 1-10). Two in the US vs 7.1 in Niger in 1998

b) Crude birth rate: number of children born in a given year per 1,000 population (range: 10-50)

c) Age-adjusted fertility rate: number of live births per 1,000 woman between 15-44 years old

3) Mortality Rates

a) Computed for specific age groups and phases of life

i) Crude death rate: refers to the number of deaths in a year per 1,000 population

ii) Infant mortality rate: widely used demographic measure in public health . It is the most sensitive indicator for overall health and QOL- mortality during the first year of life per 1,000 live births

iii) Adult mortality rate: number of adult deaths in a year per 100,000 population

vi) Maternal mortality ratio: a specialized indicator based on reproductive deaths (contraception, abortion, pregnancy & childbirth)

v) Population growth rate: the speed at which groups increase or decrease in size – including migration (calculation below)

Population (1) + Birth – Death +/- migration = Population (2)

(time) (time)

4) Developmental Transitions

a) Demographic Transition

b) Epidemiologic transition

c) Health transition

5) Demographic Transition

a) Rural agricultural

b) Urban industrialized

c) A predicted course of change

- d) Pre-transition:

i) High rates of fertility & mortality (infant & child)

- e) Transition:

i) Death rates decrease in response to improvements in living conditions and health care

ii) Fertility remains high (expectations of infant mortality)

iii) Results in elevated population growth rates

6) Epidemiologic Transition

a) As a result of the demographic transition, patterns of disease change

b) Pre-transition:

i) High rates of infectious diseases (diarrheal, respiratory, parasitic)

ii) Poor nutritional status

c) Posttransition:

i) Infectious diseases decline

ii) More children survive to adulthood

iii) Life expectancy increases

d) Chronic diseases affecting older population become a problem

i) Most developing countries are in the early stages of this transition

7) Health Transition

a) An area of study that seeks to understand the cultural, social, and behavioral determinants of health that underlie the epidemiologic transition

- Impact of maternal education on health activities

- Impact of household organization on health-related behavior

b) Key Concepts

i) Culture is the patterned ways of thought and behavior that characterize a social group, which are learned through socialization processes and persist through time

ii) Long-term culture change: over several generations, centuries or millennia. The move from hunting-and-gathering to food-producing subsistence

iii) Short-term culture change: within a single generation or a few years (cars, mass communication, cell phones, internet, medical technologies)

iv) Cultural evolution: long-term cultural change that develops slowly, and often in stages that build on previous phases(cont.)

- Cultural Evolution (cont.)

a) Foraging groups (3 million years BP i.e. Before Present day)

b) Settled villages (15000 BP)

c) Preindustrial cities (1200-1700 CE i.e. Common Era)

d) industrial cities (1750-1950 CE)

e) Postindustrial society (1950-present)

a) Foraging Groups-
i) evolutionary medicine

ii) Hunting and gathering skills rely on human energy and simple tools

iii) Persisted until 10-15,000 years ago

iv) Small groups that move around for food- nomadic

v) Women collected food (roots and vegetables) and prepared it

vi) Men hunted

vii) Low fertility rates because women breastfed their children frequently till age 4 – inhibiting ovulation

viii) Limited exposure to estrogen lessened chances to develop breast, endometrial and ovarian cancers

viiii) Cosleeping with mothers regulated babies' breathing (no SIDS)

x) Low population density = low rates of infectious disease

xii) Life expectancy was low (parasitic diseases from animals, risks of injury & trauma)

viii) Maternal mortality was high

b) Settled Villages (15,000 BP)

i) Settling down in small villages – growing crops and raising livestock

ii) More densely populated areas

iii) Waste accumulation and infectious diseases flourished

iv) More sedentary lifestyle

v) Horticulture – the use of simple tools for agriculture (digging sticks and hoes)

vi) Concentration of disease vectors such as insects – spread of malaria

vii) Diets are high in carbohydrates and low in protein resulted in malnutrition and conditions such as Kwashiorkor (severe malnutrition in infants and children that is caused by a diet high in carbohydrate and low in protein) and dental caries (tooth decay)

viii) Higher fertility rates due to earlier menstruation caused by high fat content in the diet, shorter breastfeeding schedules, and shorter child-spacing

c) Preindustrial Cities (1200-1700 CE)

i) Devastating epidemics, the Great Plague killed 1/3 of the world's population in 14th century

ii) Infectious diseases were attributed to the noxious vapor emitted from the swamps and marshes - the miasma theory of disease developed

iii) In the middle ages (500-1500) disease and religious dogma were intertwined – disease was attributed to moral or spiritual transgression

iv) Diseases such as bubonic plague, tuberculosis, typhus, diphtheria, leprosy, smallpox, measles, influenza, anthrax, leprosy flourished

v) In the 14th century, quarantine (isolation for 40 days) was instituted

d) Industrial Cities (1750-1950 CE)

i) Mechanization of work, emergence of the factory, mass production of goods, increased urbanization, rapid transportation, government

ii) Problems with food, water, shelter and sanitation increased with increased populations

iii) Pollution, air and water contamination

iv) In the early 19th. century the sanitary reform movement was the beginning of the public health effort

v) Improvements in living conditions accounted for most of the decline in mortality rate, and overall life expectancy increased

vi) Cholera became a major problem because of introduction of feces to the water sources

vii) In 1849 John Snow studied the public water supply in London and concluded that people who drank from a particular water supply contracted cholera

viii) In 1883 Koch isolated and cultivated the cholera pathogen, proving Snow's theory

e) Postindustrial Society (1950-present)

i) Immunization, improvements in sanitation disease prevention, medical care, improvements in QOL reduced mortality at all ages

ii) Emergence of health needs of the elderly due to chronic conditions

iii) Government regulates pollution, the water supply and protects the workforce

iv) Sedentary lifestyle, high fat/low fiber diet resulted in obesity, cardiovascular disease, & diabetes

v) Cancer, substance use and abuse increased

vi) Violent behavior and injuries increased

vii) Motor vehicle injuries from cars, motorcycles and trucks are the leading cause of injury leading to death in the US

- Motor Vehicle Injuries

a) Highest fatality rates among boys and men aged 15-24

b) Elder people are at increased risk due to their fragility

c) More people die from traffic injuries in rural areas than in cities or suburban communities

d) Highest death rates are experienced by Native Americans, followed by whites, blacks, and Asians (cont.)

e) Whites have the highest death rates for motorcycle injuries

f) Native Americans have higher death rates as motor vehicle occupants and pedestrians

g) Higher percentage of Hispanics are killed at younger ages than of other ethnic groups

h) People with higher incomes are less likely to die than those with lower incomes

i) 2/5 of all motor vehicle deaths are alcohol related

-Haddon Matrix (page 44)

a) Nine cell matrix that classifies factors relating to an injury by (some cells are combined):

b) The phase of injury

i) Pre-event (factors influencing whether an event occurs)

ii) Event (factors influencing whether the event results in injury)

iii) Post event (factors influencing the severity of the injury's consequences)

● Type of factor

● Victim (age, alcohol consumption, personal capabilities – driving, eyesight, seat belt use, physical condition)

● Vector (quality of the vehicle, weight and height of the vehicle, air bags, child restraints)

● Environment (road conditions, lighting, signage, signals, speed limits, guard rails, response time and skill level of first responders)

Chapter 3

1) Epidemiology

a) The core discipline of public health

b) Distribution of health conditions across time, space, and social groups, analyzing factors associated with the incidence & prevalence of disease

- Incidence: number of new cases of illness during a certain time per 100,000 population

- Prevalence: total number of cases in a population at a particular time

2) Social & Behavioral Epidemiology

a) Social: subfield of epidemiology is concerned with the social characteristics or psychosocial risk factors associated with patterns of disease within and across populations, e.g. gender, age socioeconomic status, ethnicity

b) Behavioral: focuses on specific behaviors that contribute to the etiology of disease, e.g. lifestyle factors, sleep habits, stress management

3) The Causality Continuum

a) Relevant to social epidemiologic research

b) Different degrees o of directness of effect

Proximate: most direct effect

a) Beliefs, attitudes, behavior, genetics, biology

Intermediate: buffers for distal factors, intervening variables

a) Health culture, family organization, social support, health care system, occupation

Distal: more removed, macrolevel sociocultural and environmental context

a) Ecological setting, demographic features, political economy, social structure, cultural patterns

4) The Precede/Proceed Model

a) Health education planning model

b) Later expanded to include program design and evaluation and renamed

- Precede/Proceed

a) Focuses on the following factors:

Predisposing: knowledge, attitudes, beliefs, values (e.g. believing that exercise is beneficial)

Reinforcing: incentives to continue the behavior after it has occurred (feeling good or losing weight after exercise)

Enabling: having the economic resources to perform the activity or access to health services (being able to join health club, or having health insurance to treat injuries)

5) Poverty & Health

a) Tendency to downplay the relationship between poverty and health- due to discomfort with social class differences

b) Health status is usually reported by age, race/ethnicity and gender

c) Consequently, race has become a proxy for SES, a fact that reinforces stereotyping

d) Countries with more social equality have a higher life expectancy than those countries with a wide gap between upper and lower income range

e) Health is adversely affected when the gap between “rich” and “poor” is large

6) Health Selection Theory

a) Health determines social position

b) People who are unhealthy are less productive and drift down the socioeconomic gradient

c) Healthier people are more productive, and migrate up

d) Examples are people with schizophrenia, or people who became ill as children, and never completed their education

e) This theory is largely rejected

7) The Social Ecology of Inequality

a) Health status and social standing are linked in many interrelated social, cultural, and psychological factors

b) Relative vs absolute deprivation: people feel deprived relative to what others have – may lead to feelings of hopelessness and failure

i) May trigger hostility, depression and other psychological reactions that adversely affect health

c) The disparity between the people can result in feelings of distrust, discontent and strained social relationships leading to less social cohesiveness, limited social support, and violent crime

d) Countries with large income disparities have shorter life expectancies than do more egalitarian countries

- Public Health Implications

a) Universal access to health care may be one solution

b) Increase in standard of living among the poor (better housing, nutritious diet, sanitary conditions)

c) Strengthen social network ties, build trust, and increase communities' collective efficacy

d) Enact policies to reduce income inequality to enable everyone to have access to the resources necessary for a long and healthy life

8) Epidemiologic Paradox

a) Southwestern Hispanics in the US are an exception

b) Sociodemographic profile is closer to African Americans than to Caucasians

c) Less wealthy and less well educated, and have linguistic and cultural variations that tend to marginalize them

d) Health outcomes such as CVD, cancer, infant mortality, life expectancy are closer to Caucasians

e) Speculations: high value on children and care of pregnant mothers, family support, selective migration, diet, and genetic heritage

Chapter 4

1) Health Belief Model

a) 1950s in response to the population not responding to new information regarding screening and prevention programs

i) Individual's perception of his or her personal susceptibility or vulnerability to a disease

ii) Severity of the disease or condition

iii) Perceived efficacy of the behavior dealing with the condition

iv) Perceived barriers to adopting the behavior

2) Theory of Reasoned Action - 1980

a) Individual motivation as a determinant of engaging in a specific behavior

b) The focus is on one's attitudes, beliefs, and intentions

c) Attitudes are linked to consequences: positive consequences create positive attitudes and negative consequences lead to negative attitudes

- Extension: theory of planned behavior which focuses on the “perceived individual control”

3) Social Cognitive Theory

a) 1986 rooted in Alfred Bandura's early career research on observational learning

b) Humans learn by watching what others do and what happens to them when they do it (consequences)

c) Observational learning or vicarious learning: Large “bobo doll” to demonstrate that children who observe violent, aggressive behavior are more likely to demonstrate this behavior than are children who do not observe it

b) Self efficacy is the concept that we are more likely to attempt a new behavior if we are self confident and we believe we can accomplish the intended results (e.g. participating in a weight reduction program)

4) Transtheoretical Model

a) 1986 Prochaska and DiClemente define the stages people go through as they attempt behavior change

i) Precontemplation (no intention to change)

ii) Contemplation (thinking about it - next 6 months)

iii) Preparation (intend to take action in 1 month or less)

iv) Action (actually started the behavior)

v) Maintenance (preventing relapse)

vi) Termination (no longer experiencing temptation)

-Progression is not linear – may stop and start smoking several times before behavior change is complete

5) Factors that prompt help-seeking behaviors

-General Theory of Help-Seeking

a) 1978 David Mechanic: illness behavior is grounded in perception and coping resources

i) Perceived symptoms (visibility, recognition, cultural assumptions)

ii) Disruptive and persistent nature of the symptom

iii) Competing needs (go to the clinic or purchase school supplies for children)

iv) Coping resources and treatment options, accessibility of care

-Therapeutic Networks

v) Lay referral network: family, friends, colleagues

vi) Professional referral system: advice of medical specialists and consultation with other professionals

vii) Sick-Role Behavior

1) Once treatment has started, the patient is expected to follow the medical recommendations

- Compliance is generally low!

a) 30-60% fail to comply fully (use partial prescription)

b) 50% adhere to long-term care

c) 50% do not take medications as prescribed

d) 75% do not follow medical recommendations when there are no overt symptoms

- Noncompliance

a) Failure to fill prescriptions

b) Stoppage before recommended (antibiotics)

c) Incorrect dosing (more, less)

d) Supercompliance (taking medications from more than one provider)

e) Compliance is lower with chronic illnesses, minimally disruptive symptoms, socially unacceptable conditions

f) Noncompliant patients tend to be at older or younger extremes

g) Research problems: patient self-report or physician estimates

Chapter 5: The Social Environment & Health

1) Gender and Health

a) The gender gap is the discrepancy in mortality between men and women

b) Men and women have different physiological reactions to medications

c) Men have lower morbidity but higher mortality

d) Men use fewer medical resources than women

e) Breast cancer and prostate cancer have similar morbidity and mortality rates – breast cancer has more public support, research money, public discussion

f) Screening for prostate cancer lags behind mammograms screening for breast cancer

2) Gender and Sex

a) Gender is socially defined

b) Sex is physiologically defined – anatomical, physiological, hormonal, and reproductive

c) Women's health problems are viewed in a more sympathetic light – women are victims

d) Men's health problems are relayed as a result of their behavior- perpetrators (result of their bad eating habits, smoking, drinking, fighting, “couch potato” laziness

- Western Male Identity (generalization!) and its' implications for men's health:

a) “no sissy stuff”: lack of preventive behavior and greater risk taking

b) “the big wheel”: injury-related competitiveness and stress-related frustration

c) “the sturdy oak”: denial of symptoms and delay in seeking treatment

d) “give'em hell”: the high rate of male-to-male violence, heavy drinking, and fast driving

3) Stress, Social Support, & Health

a) 1897 Emil Durkheim

i) Link between social integration and suicide

ii) Established the link between social factors and individual health

b) 1929 Walter Cannon

i) Human beings respond physiologically to external threats (fight-or-flight response)

c) 1956 Hans Selye

i) The body goes through a predictable series of stages in response to stress (general adaptation syndrome) that if prolonged can lead to illness or death

- Stress, Social Support, & Health: Definition & Types of Support

a) Social support is the aid and assistance exchanged through social relationships and interpersonal transactions

– i) Is generally positive, but can have negative results if too enmeshed

ii) 4 different types:

1) Emotional (love, trust, caring)

2) Instrumental (tangible, a ride to the doctor, help shopping)

3) Informational (advice, suggestions, information)

4) Appraisal (self evaluation)

- Stress, Social Support, & Health: Types of Support

1) Direct

- Provision of any kind of aid that is immediately useful to the receiver

2) Indirect

- Self esteem building and assertiveness training

3) Formal

- Contractual such as between a patient and a therapist (hierarchical, one way)

4) Informal

- Family members, friends, and associates (two way)

Chapter 6: Social Differentiation, Cultural Diversity, and Community Health

1) Diversity challenges the best laid out public health interventions

a) Human communities

b) Groups are formally organized,

c) Informally recognized, and

- Constantly changing

a) Family membership can be biogenetic terms or blended families

b) Varied religions, languages, family histories

c) PH interventions may fail without understanding the above variables

d) Intra group variations are numerous- misunderstanding can lead to missing the target intervention

e) The “writhing knot” of culture- a tangled web of values, beliefs, and perceptions

2) Subsistence

a) To exist, people have to extract sustenance from the earth, and/or participate in economic systems to acquire basic necessities

b) The health of the community is directly related to their work, exposure to toxins such as asbestos (families suffer from mesothelioma), or farmers missing doctors appointments due to the harvest

3) Religion

a) Jehovah's witness members refusing blood transfusions

b) Religions that foster dietary restrictions (alcohol and tobacco)

c) Cervical cancer (high prevalence rates for prostitutes and low rates for nuns)

4) Socioeconomic Status

a) More money and education translate into better health

b) Reasons?

5) Race, Minority Status, and Ethnicity

a) Race

i) Biologically indefensible construct

ii) In 1962, Frank Livingstone delineated the genetic specifics that show that all living humans have physical variances

iii) Nose structure, hair type, and skin and eye color variations can be found in all groups

6) Race, Minority Status, and Ethnicity

a) Minority Status

i) Quantitative measurement of groups of people

ii) The designation results in social stigma (handicapped, homosexual, HIV/AIDS, old)

iii) “Minority” usually refers to social and economic disability, not to cultural differences

iv) The political climate may influence the allotment of research monies (e.g. AIDS vs. breast and prostate cancer)

7) Ethnicity

a) Irish Catholics, orthodox Jews, Asian Americans

b) Generation after migrating to the US, how long, language, marriage

c) How is ethnicity determined when a person is half-white and half African-American?

d) How do you define Cuban-Americans who appear African, speak fluent Spanish, have Chinese surnames, and practice a religion based on Catholicism and African shamanism?

e) History and politics of the region may determine

- Ethnic culture: patterns of behavior and beliefs

- Ethnic group membership: network of people with whom one affiliates

- Ethnic identity: perceptions and attachments that a person has to their own group and culture

8) Case Study: Community Support Group Interventions

a) A support group project developed in Tampa to provide support services to caregivers of Alzheimer's Disease patients failed to engage members of the African-American community because the meetings were to be held in a church

b) The invisible barrier (going to another pastor's church) kept the loyal church members from attending the meetings

c) A “culturally neutral” location (city library) later became the meeting place, and community members from a variety of churches attended

Intercultural Influence & Public Health

d) The use of incomplete or flawed concepts about cultural diversity establishes problematic initial conditions that cannot always be overcome

e) May precipitate the feeling that the recipient is offered superficial or substandard quality of intervention

i) Intercultural influence: is the complex interplay of cultural systems regardless of artificially demarcated group boundaries

f) There are no culturally homogeneous societies

g) There are intra- and inter-group interactions

h) Public health interventions must take into account the complexities of intercultural influences

- Intercultural influences can be understood by means of data collection (cont.)

Intercultural Influence & Public Health (cont).

a) Ethnography

b) Key informant interviewing

c) Focus groups

d) Social marketing

e) Newspapers, radio, TV

f) Activities of community organizations

g) INTERPRETATION of the collected data

Chapter 7- Deviance and Social Control

1) The Sick Role

a) The sick person is “blameless” because illness is outside of the person's control

b) The sick person is exempt from social responsibilities

c) Expected to seek professional help, and get well as soon as possible

d) The sick role can be abused (missing work, skipping school)

e) Physicians are expected to be the gatekeeper to minimize abuse

f) Chronic illnesses tend to have social constructs (take responsibility for their illness through smoking cessation) and do not conform to the sick role as well as acute illnesses

2) Medicalization

a) The process by which nonmedical problems become defined and treated as medical conditions

b) Transforms socially rooted conditions into personal pathologies

i) Examples: compulsive behaviors, childbirth, homosexuality, developmental changes, eating disorders

c) Demedicalization

i) In response to social pressures, some conditions have been demedicalized

ii) Examples: masturbation, homosexuality, childbirth

Legal Measures to Control Public Health Problems

iii) To control drug abuse by pregnant women, screening during prenatal care has resulted in incarcerating pregnant drug abusers

vi) Unanticipated result is that pregnant women did not receive needed prenatal care in penal institutions

v) Societal cost is the separation of pregnant mothers from their children

vi) Poor, and members of minority groups, have a higher representation because they tend to seek prenatal care from public clinics, and are more likely to be reported to the authorities

3) Violence

a) Political violence:

i) Genocide, ethnic cleansing, human rights abuses, terrorism

ii) Wars result in displacement of segments of he population creating refugees

iii)Terrorism as in attacks against abortion clinics (murder, arson, bombing, kidnapping, death threats, vandalism, harassment and intimidation)

b) Community Violence

i) Examples: suicide, homicide, rape, gang violence, assault, and battery

ii) Linked with social and economic inequality, ethnic heterogeneity, and residential mobility

iii) Characterized by rapid population turnover, high housing/population density, illegal markets for drugs and firearms

c) Family Violence

i) Spouse abuse, child maltreatment, elderly abuse

ii) Better screening is needed to identify maltreatment at all ages

iii) Improvements in reporting mechanisms

iv) Creating a s response system to handle reported cases of abuse

Chapter 8

1) Comparative Health Cultures

- Health Culture

Comparative Health Cultures: the cross-cultural study of preventive and therapeutic traditions (past and present)

a) It is the complex system of beliefs, practices, and social arrangements related to the management of illness

b) It addresses:

i) How populations evaluate signs & symptoms of illness, and

ii) The actions that people take once illness is recognized

- Goals

1) Better understand how human populations anticipate and respond to illness

2) Focus on prevention, symptoms, and actions (sufferers and practitioners)

3) Based on social constructionism

2) What is Social Constructionism?

a) People interpret and assign meaning to their experiences based on a worldview that they share with others in their community

- Includes:

1) Symptom recognition

2) Illness labeling

3) Help-seeking responses

3) Terminology

1) Cultural relativity: aspects of a cultural system can be judged or evaluated within the context of its own parameters; e.g. attributing illness to the supernatural

2) Ethnocentrism: applies the ideology and standards of one culture to assess another; e.g. western medicine approach to illness and disease

3) Emic: refers to the “insider” perspective of members of a population

4) Etic: refers to the more universal approach, observers' perspective

12 Cultural Universals in Health Beliefs & Practices

1) Illness and care

2) Prevention and treatment

3) Role specialization

4) Explanatory models of disease

5) Metamodels of disease causation

6) Ritual & faith

7) Core cultural values

8) Structure: the sectors of health care

9) The sick role

10) Social & moral control

11) Therapy managing group

12) Therapeutic networks


1) Illness & Care

a) Health problems are part of the human condition

b) Disease, disability and illness exist in all cultures

c) Organized systems to deal with illness exist in all cultures

d) No evidence of any groups that do not attempt to alleviate the pain and suffering associated with illness

2) Prevention & Treatment

a) All human groups take deliberate actions to maintain health and prevent illness

b) Examples of attempts to prevent illness:

i) Eating health foods, drinking fortified teas and herbal preparations; exposure to extremes of temperature, ritual activities, immunization

c) Aspirin, digitalis, quinine are contemporary drugs derived from plants that indigenous groups have used for centuries

3) Role Specialization

a) Healing is the oldest profession

i) Shamans: respected community leaders specialized in the management of spiritual and natural misfortune

b) Complex societies added others such as: birth attendants, herbalists, and bonesetters

c) Physicians were the next generation of healers

d) Nurses became play a vital role since the 19th century

e) Specialization within the modern medical and nursing professions increase the skill level, but also contribute to the fragmentation of the health care delivery system

4) Explanatory Models of Disease

a) Organized patterns of focused and tailored response to illness

b) Caretakers determine: nature of the illness, what caused it, what steps need to be taken to deal with it, identify help-seeking strategies

c) Each set of symptoms mobilizes a certain set of responses from those affected by the illness

5) Metamodels of Disease Causation

a) There are some ubiquitous (found in most cultures) models:

i) Equilibrium/disequilibrium (the balance of hot and cold)

ii) Hydraulic system (the healthy flow of fluids within the body)

iii) Contamination (invasion by an outside force)

6) Ritual & Faith

a) Rituals at physician's office

b) Rituals before surgery

c) Faith or placebo effect is well recognized

d) Some believe in the power of prayer in the healing process

7) Core Cultural Values

a) In western culture values individualism, mastery over nature, action oriented, personal responsibility (internal locus of control)

b) Faith in the healing powers of technology

c) Keeping doctors' appointments, following medical instructions

d) Taking personal responsibility for one's health

8) Structure: The sectors of Health Care

a) Popular sector:

i) Self-care, over-the-counter (OTC) remedies, family care, advice from friends & neighbors; peer support groups

b) Folk sector: traditional midwives (now very regulated), energy channelers, root doctors, spiritualist healers

c) Professional sector: provided by formally trained and licensed professionals (physicians, nurses, therapists)

d) Orthodox care: generally covered by insurance policies

e) Alternative care: massage therapy, relaxation therapy can be considered “orthodox” if prescribed by a physician

9) The Sick Role

a) Rights: Sick individuals are exempt from traditional roles

b) Responsibilities: Expected to follow professional advice

10) Social & Moral Control

a) Illness is used by society to enforce societal morals

b) Societal control is exercised through labeling, e.g. labeling alcoholism as a “disease” and treating it within the medical model

c) Societal control is also exercised through stigmatization as in the social stigma associated with smoking, sexually transmitted diseases (behaviors that are considered immoral)

11) Therapy Managing Group

a) Informal social groupings to provide social support for individuals

b) May include family members, friends, and professional case managers

12) Therapeutic Networks

a) Consulting informal networks frequently precedes involvement with professionals

b) “Shopping” for the right treatment, or professional may follow

4) Western Medicine as an Ethnomedical System

a) Rational and empirical study of physical phenomena

b) Objectively observed and measured

c) Depends on physical examination, laboratory tests, electronic machines

d) Founded in scientific observations, not patient subjective reports

e) Values efficiency, maximizing the use of human resources (physician time)

5) The Culture of Public Health

a) Health is a state of complete well being rather than merely the absence of disease

b) Disease is influenced by multiple factors

c) Public health professionals continue to search for the interrelated factors that result in disease, illness, and premature death

d) Government is expected to work towards greater social equity

e) An overwhelming desire to make a difference, and to improve the health of populations

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