How do the health needs of women in developing countries differ from those of women in the United States? How are they similar?

Health Promotion and Disease Prevention

Chapter 3

Health Promotion and Disease Prevention

Efforts to actively bring people to good health (or keep them there) and

prevent disease.

“An apple a day keeps the doctor away.”

Leading Behavior-Related Causes of Death in the United States

Major behavioral and environmental risk factors that contribute to death and disease worldwide include the following: •Underweight •Unsafe sex •High blood pressure •Tobacco consumption •Alcohol consumption •Unsafe water, sanitation, and hygiene •Iron deficiency •Indoor smoke from solid fuels •High cholesterol •Obesity

Most Health Care in the U.S. Focuses on Fixing Problems, Not Preventing Them

• If you have advanced heart disease, lung cancer, or another serious condition, you can get the best treatment in the world.

• But… it’s more effective, cheaper, and less painful for everyone to get someone to quit smoking than it is to try and cure lung cancer.

• The United States is not as good when it comes to prevention.

The Department of Health and Human Services (DHHS)

Figure 3-1

The Department of Health and Human Services (DHHS)

• National Institutes of Health (NIH) • Food and Drug Administration (FDA) • Centers for Disease Control and

Prevention (CDC)

• Agency for Toxic Substances and Disease Registry (ATSDR)

The Department of Health and Human Services (DHHS)

• Indian Health Service (IHS) • Health Resources and Service

Administration (HRSA) • Substance Abuse and Mental Health

Services Administration (SAMHSA) • Agency for Healthcare Research and

Quality (AHRQ)

• Centers for Medicare and Medicaid Services (CMS)

• Administration for Children and Families (ACF)

• Administration on Aging (AoA)

The Department of Health and Human Services (DHHS)

Economic Dimensions The costs and benefits of prevention programs • A smoking cessation program saves quality-

adjusted years of life ($1109–$4542). • Each $1 spent on school STI/HIV programs saves

$2.65 on medical and social costs. • Cost of 100 Pap tests saves $5,907 and 3.7 years

of life (and Pap tests, though useful, are quite inefficient!)

• Every $1 spent on preconception care programs for women with diabetes saves $1.86 by preventing birth defects.

• Mammograms can also save money and lives (best schedule is under debate).

Important Terms

Epidemiology: Study of pattern of disease in a population

Incidence: New cases of a condition that occur during a specified period of time

Prevalence: The total number of people affected by a given condition at a point in time or during a period of time

• Mortality rate: The incidence of death in a given population during a particular time period. It is calculated by dividing the number of deaths in a population by the total population.

• Morbidity rate: The incidence of illness in a given population during a particular time period. It is calculated in a similar manner to mortality rate.

Measures of Mortality

Levels of Prevention

Primary prevention • Reducing exposure to a risk factor that may lead

to the disease • Examples

– Healthy nutrition (preventing heart disease and cancer)

– Regular physical activity (preventing heart disease and other diseases)

– Cessation of smoking (preventing lung cancer and other diseases)

– Safe sexual practices (preventing sexually transmitted infections)

Health Promotion and Disease Prevention

Chapter 3

Levels of Prevention

Secondary prevention • Early detection and prompt treatment of disease • Examples

– Screening tools such as mammography, Pap smears, and HPV testing (find cancer early)

– Prompt use of medications after a disease is diagnosed

– Lifestyle behaviors to control chronic diseases that cannot be prevented (e.g., keep diabetes, asthma under control)

Levels of Prevention

Tertiary prevention • Takes place once a disease has advanced • Examples

– Alleviating pain, providing comfort to a cancer patient

– Halting progression of an illness – Limiting disability after a serious injury – Restoring function through rehabilitation after a

person has had a stroke

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The Diversity of Women

The heterogeneity of women is reflected in difference of: •Race/ethnicity •Socioeconomic status •Geographic location •Sexual orientation •Country of origin •Employment •Education

The Changing Face of Women

By 2030 • 1 in 5 American women will be Hispanic. • 1 in 14 American women will be Asian. • 1 in 4 American women will be over 65 years of age.

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The Diversity of the Population

Figure 3-3: Projected U.S. population by race and Hispanic origin, 1995–2030

U.S Census Bureau

Diversity of Motherhood

• Delay of marriage and family to focus on careers – New issues: fertility, parenting at older ages

• Teenage mothers – Issues: childbearing responsibilities,

grandparents raising children

• Choice to not have children – Issues: pursue career and other opportunities

Diversity of Sexual Orientation

• Misconceptions about health needs of lesbians by healthcare providers and individuals themselves

• Barriers to health care – Belief that routine gynecological care or contraception

to protect from STIs is not needed – Homophobia from healthcare providers – Lack of health insurance because of lack of eligibility

for lesbian partner vs. heterosexual spouse

Other Types of Diversity • Incarcerated women

– Drug addictions, mental health issues

– Lack of regular health care

• Women with disabilities – Focus of less research and clinical attention

– Possible physical barriers, such as inaccessible facilities or examination equipment

– Possible communication barriers

• Ten leading risk factors account for more than 40% of the disease burden worldwide (WHO).

• Almost 300,000 global deaths related to childbirth—99% in developing countries

• Infectious diseases, many of them curable, are a much bigger problem in the developing world.

• Chronic, “first world” diseases (heart attacks, diabetes, cancer, strokes) are also important health concerns throughout the world.

Global Health Issues

The 10 Leading Causes of Death

Global 1.Heart disease 2.Stroke 3.COPD 4.Lower respiratory disease 5.Bronchial disease 6.HIV/AIDS 7.Diarrheal disease 8.Diabetes 9.Road injury 10.Hypertensive disorders

United States 1. Heart disease 2. Cancer 3. Lower respiratory disease 4. Stroke 5. Accidents 6. Alzheimer’s disease 7. Diabetes 8. Kidney diseases 9. Flu and pneumonia 10.Suicide

*Source: WHO

Another Way to Look at Health Promotion: Stages of Life

1. Adolescence

2. Young adulthood

3. Midlife

4. The senior years

Adolescence

• Begins with onset of puberty and continues until approximately age 17

• Secondary sex characteristics/menstruation

• Sense of identity • Peer pressure • Risky behaviors—sexual

relations, substance use, tattooing and piercing

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Adolescence

Top six causes of death for female adolescents: •Accidents (unintentional injuries) •Cancer •Suicide •Birth defects •Heart disease •Homicide

Young Adulthood (Ages 18–44)

• Sense of self with increased independence • Risky behaviors—sexual activity, substance

abuse, violence (date rape), poor nutrition, lack of exercise

• Top five causes of death for young adult women: – Unintentional injuries

– Homicide – Cancer – Suicide

– Heart disease

Midlife (Ages 45–64) • Job advancement and establishment of

productive careers • Raising children, caring for elderly parents,

working to keep healthy relationships • Menopause • Top five causes of death for women of midlife:

– Cancer – Heart disease – Stroke – Chronic obstructive pulmonary disease – Diabetes

Senior Years (Ages 65+)

• Increased life expectancy for women • Issues of retirement, possible loss of spouse

and friends, depression, chronic conditions • Top five causes of death for women of senior

years: – Cancer – Heart disease – Chronic lower respiratory diseases – Stroke – Diabetes

Discussion/Summary

• What are some ways that you as an individual/class can work to promote your own health and prevent diseases?

• How do the needs you have as an individual/class compare to those of your parents? To younger siblings? To a class of similar women in the developing world?