Building Better Health. A Handbook Of Behavioural Change

Table of Contents Prologue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii PART I . LAYING THE FOUNDATION 1. General Principles of Health Promotion and Disease Prevention . . 3 Human and Economic Values of Prevention . . . . . . . . . . . . . . . . 3 Disease Prevention and Health Promotion . . . . . . . . . . . . . . . . . 6 Three Levels of Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Primary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Secondary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Tertiary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 The Actual Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Box: The Ten “True” Leading Causes of Death . . . . . . . . . . . . . . 8 The Next Step Needed to Advance “Health for All” . . . . . . . . . . 9 2. Principles of Community Health Intervention . . . . . . . . . . . . . . . 11 Box: Puzzles to Solve for Building Better Health . . . . . . . . . . . . . 11 Strategies for Identifying Causes . . . . . . . . . . . . . . . . . . . . . . . . 11 Agent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Host. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Interpersonal Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Social/economic Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Cultural/ideological Level . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Using the Epidemiologic Triangle in Prevention Programs. . . . . 17 Multiple Contributing Causes . . . . . . . . . . . . . . . . . . . . . . . . 18 Selecting Which Conditions to Prevent. . . . . . . . . . . . . . . . . . . . 19 Selecting the Target Populations to Receive Help . . . . . . . . . . . . 21 Working with the Whole Community or Only with the High-risk Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 The Prevention Paradox. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Specifying the Changes in Behaviors and Environments Required to Reach the Health Goals . . . . . . . . . . . . . . . . . . 28 PART I I . IMPROVING HEALTH THROUGHOUT THE LIFE CYCLE 3. Infants and Children Up to 14 Years Old . . . . . . . . . . . . . . . . . . 33 In Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Risk Factors for Low Birthweight, Fetal Anomalies, and Infant Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Social Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Personal Biological Factors . . . . . . . . . . . . . . . . . . . . . . . . . 36 iii TA B L E O F C O N T E N T S Personal Behavioral Factors . . . . . . . . . . . . . . . . . . . . . . . . 37 Psychological Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . 37 Screening Pregnant Women . . . . . . . . . . . . . . . . . . . . . . . . . 38 Box: Screening Checklist for Pregnant Women . . . . . . . . . . 38 From Birth through Age 4 Years . . . . . . . . . . . . . . . . . . . . . . . . 39 Prevention and Early Detection of Developmental Problems. . . 42 Screening Checklist for Newborns . . . . . . . . . . . . . . . . . . . 42 Preventing Postnatal Disabilities . . . . . . . . . . . . . . . . . . . . . . . 43 Reducing Sudden Infant Death Syndrome (SIDS) . . . . . . . . . . . 44 Predisposing and Precipitating Risk Factors for SIDS. . . . . . . 45 Preventing SIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Increasing Immunization Coverage. . . . . . . . . . . . . . . . . . . . . 47 Reducing Respiratory Diseases . . . . . . . . . . . . . . . . . . . . . . . . 48 Controlling Diarrheal Diseases . . . . . . . . . . . . . . . . . . . . . . . . 50 Primary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Secondary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Oral Rehydration—How to Do It . . . . . . . . . . . . . . . . . . . . 52 Reducing Rates of Unintentional Injuries. . . . . . . . . . . . . . . . . 53 Preventing Impact Injuries to Children Inside Motor Vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Preventing Impact Injuries to Children Outside of Motor Vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Preventing Impact Injuries to Children on Playground Equipment or Climbing . . . . . . . . . . . . . . . . . . . . . . . . . 57 Preventing Injuries on Household Stairs and Windows. . . . . 57 Preventing Burn Injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Preventing Poisoning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Preventing Cuts and Lacerations . . . . . . . . . . . . . . . . . . . . 60 Preventing Drownings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Dealing with Insect and Animal Bites . . . . . . . . . . . . . . . . . 61 Preventing Strangulation/Choking . . . . . . . . . . . . . . . . . . . 62 Preventing Suffocation . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Preventing Firearm Injuries. . . . . . . . . . . . . . . . . . . . . . . . . 63 Child Abuse and Neglect. . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Prevalence and Severity of the Problem . . . . . . . . . . . . . . . 65 Cross-cultural Considerations. . . . . . . . . . . . . . . . . . . . . . . 66 Clinical Signs of Child Abuse . . . . . . . . . . . . . . . . . . . . . . . 66 Box: The Explanation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Box: Professionals’ Checklist for Questionable Injuries . . . . . . . 68 Child Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Box: Checklist of Signs of Possible Neglect for Health Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Tertiary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Secondary Prevention of Abuse and Neglect . . . . . . . . . . . . 70 Primary Prevention of Child Abuse and Neglect . . . . . . . . . 70 Screening Summary from Birth to Age 4 Years . . . . . . . . . . . . 73 Box: Screening Checklist from Birth to Age 4 Years. . . . . . . . . 74 iv B U I L D I N G B E T T E R H E A L T H From Ages 5 through 14 Years . . . . . . . . . . . . . . . . . . . . . . . . . 75 Major Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Health Promotion Opportunities . . . . . . . . . . . . . . . . . . . . . . 76 Box: Screening Checklist for ages 5 to 14. . . . . . . . . . . . . . . . 78 4. Adolescents and Young Adults 15–24 Years Old. . . . . . . . . . . . . 79 Nurturing the Seeds for a Healthy Future . . . . . . . . . . . . . . . . . . 79 Major Health Problems at Ages 15–24 . . . . . . . . . . . . . . . . . . . . 81 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Morbidity and Disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Risk Behaviors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Box: Two Common Dynamics of Weight-losing Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Psychosocial Foundations of Most Health Problems at These Ages 93 Conveying Learning and Values to Overcome Health Vulnerabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Box: How to Develop Systematic Health Programs for Youth . . 96 Box: Useful Principles Taken from Studies of Youth and Adult Learning Which Have Cross Cultural Value . . . . . 97 Protective Factor: Promote the “Universal Vaccine”. . . . . . . . . . . 97 Box: Screening Checklist for Ages 15 to 24 Years: by Interview and Observation . . . . . . . . . . . . . . . . . . . . . . 100 A Screening Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Inquiry Topics from the “Youth Risk Behavior Survey” . . . . . . . 105 5. The Prime of Life: Ages 25 to 64 Years . . . . . . . . . . . . . . . . . . . 109 The Growing Importance of Adult Health. . . . . . . . . . . . . . . . . . 109 Major Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Cardiovascular Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Major Causes of Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Special Issues for Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Special Issues for Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Avenues for Reaching Adults with Preventive Programs. . . . . . . . 119 Screening by Interview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Eating Habits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Regular Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Alcohol Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Use of Other Mood Altering Substances. . . . . . . . . . . . . . . . . 122 Social and Emotional Well-being . . . . . . . . . . . . . . . . . . . . . . 122 Sexual Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Risks of Motor Vehicle Trauma or Injury . . . . . . . . . . . . . . . . . 123 Risks of Occupational Injury. . . . . . . . . . . . . . . . . . . . . . . . . . 124 Social Support Network. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Health Problems in Other Family Members . . . . . . . . . . . . . . . 125 Home Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 v TA B L E O F C O N T E N T S Screening by Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Appearance and Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Clinical and Laboratory Screens and Prophylaxes. . . . . . . . . . . . . 126 Height and Weight Measurement . . . . . . . . . . . . . . . . . . . . . 126 Blood Pressure Measurement. . . . . . . . . . . . . . . . . . . . . . . . . 126 Mammogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Pap Smears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Skin Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Oral Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Sexually Transmitted Infections . . . . . . . . . . . . . . . . . . . . . . . 127 Ischemic Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Tetanus-Diptheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Digestive Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 6. The Older Years: 65 to 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Health Goals for the Later Years . . . . . . . . . . . . . . . . . . . . . . . . 129 Major Health Problems at These Ages . . . . . . . . . . . . . . . . . . . . 131 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 General Systemic Diseases and Disabilities . . . . . . . . . . . . . . . 132 Box: Leading Noncommunicable Disease Causes of Disability Worldwide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Risk Factors for Major Causes of Death and Disability . . . . . . . 132 Protective Factors for Major Causes of Death and Disability . . . 133 Musculoskeletal Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Osteoporosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Preserving Physical and Mental Functioning . . . . . . . . . . . . . . . . 136 Protective Factors for Mental Abilities. . . . . . . . . . . . . . . . . . . 137 Treating Pain and Suffering . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Box: Action Checklist for General Preventive Measures for Ages 65 Years and Older . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Community Action for Older Citizens. . . . . . . . . . . . . . . . . . . . . 139 PART III. BETTER UNDERSTANDING THE LEADING FORMS OF DEATH AND DISABILITY 7. Brain and Behavioral Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 143 Disabilities of Brain and Behavior . . . . . . . . . . . . . . . . . . . . . . . . 143 Who is Vulnerable?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 A Healthy Scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Teasing Out the Causes of Brain and Behavioral Disorders. . . . . . 147 Box: Sources that Influence the Risk of Brain and Behavioral Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Eleven Crossroads where Risk and Protective Factors Meet . . . . . 150 Genetic Strengths and Vulnerabilities . . . . . . . . . . . . . . . . . . . 150 The Intrauterine Environment . . . . . . . . . . . . . . . . . . . . . . . . 151