Week 7:

1. Week 7: Health, Wellness, and Preventive Medicine

2. Preventive Medicine • The best way to avoid medical procedures and medications, which include inherent risks, is to avoid becoming sick in the first place; prevention and early intervention are also cost effective • Type II Diabetes, for example, can be related to poor diet and lack of exercise • Vaccines • Inoculations are an important way to prevent the spread of contagious diseases • From Jan. - June, 2011 there have been more cases of measles in the U.S. than at any other time since 1996, and most of the cases were linked to foreign travel and involved U.S. residents who were not vaccinated

3. Preventive Medicine (cont.) • Screenings • An important weapon against cancers and diseases is to identify and treat them early on • i.e., screenings for colorectal cancer, breast cancer, and cervical cancer could potentially save thousands of lives • Prevention programs & Outreach • Multidisciplinary programs are most effective (e.g., target at-risk groups through various forms of media, educational classes and workshops, screening days, free clinic days, etc.)

4. Prevention Programs & Outreach (cont.) • Programs should be mindful of the target population, e.g.: • Should media efforts be in multiple languages? • What are some region-specific exercise activities or healthy food options that make sense for this population and its existing culture? • Remember that small behavioral changes are easier for people to make than drastic behavioral changes • Outreach involves professionals going out into the community—in this case—to promote physical health • Free Clinics of America sets up massive, one-day free clinic events with volunteers to serve the community: http://freeclinics.us/

5. Getting the Stats • In order to target efforts, we need to know how many people have a disease/illness/condition, where they are located, whether the disease is spreading, how to prevent and/or treat it, whether there are many new cases of it, etc. • Epidemiology: “the study of the occurrence and distribution of diseases and other health-related conditions in populations” • In conducting this research, we can determine the prevalence of diseases (how many total cases) and the incidence of diseases (how many new cases) • The Centers for Disease Control (CDC) and the World Health Organization (WHO) work to keep track of these statistics to inform treatment and prevention efforts

6. Health Insurance • Literally a life-or-death issue, healthcare is an area of serious debate in the U.S., partly because there is so much money involved; i.e., if medical treatment was very cheap, people might just pay out of pocket or we might decide to create universal coverage through tax dollars, and it wouldn’t be such an issue • But, medical treatment and medications are expensive, and there are several powerful players involved: insurance companies, employers/companies who provide health insurance to their workers, pharmaceutical companies, doctors/nurses/staff/administrators, and legislators; individual patients seem to have less power than these entities

7. Health Insurance (cont.) • Health insurance becomes more expensive for everyone who still pays for it when more people don’t have or lose their insurance because the non-insured do not get preventive treatment and wait until their condition is so severe that they require expensive procedures, emergency room visits, and even hospital stays • Half of all personal bankruptcies in the United States are caused by health problems • Under the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals are required to provide emergency treatment to anyone, regardless of citizenship or ability to pay; this has left hospitals with extra expenses

8. Health Insurance (cont.) • From the U.S. Census Bureau: • The percentage of uninsured individuals is growing • In 2008, 46.3 million people were uninsured (15.4% of the population) • In 2009, 50.7 million people were uninsured (16.7% of the population) • The percentage of people with employment-based health insurance coverage in 2009 was the lowest since 1987

9. Health Insurance (cont.) • Medicare and Medicaid (established 1965 under LBJ): • Medicare is a federally funded insurance program for people 65 years of age or older or for individuals with certain disabilities • Medicaid is a partially federally and partially state funded program that is designed to serve healthcare needs of poor populations that fall into a specific eligibility category, such as children and/or their parents, pregnant women, individuals with disabilities, and elderly who are in need of nursing home care • Individuals may qualify for Medicare or Medicaid or both

10. Healthcare Around the Globe • Although the U.S. spends more money than any other country in the world on medical expenses, we rank 26th in life expectancy and 29th in low newborn mortality • According to the World Health Organization (WHO), currently, 27 countries from the Organization for Economic Co-operation and Development (OECD) cover all of their citizens with health services from pooled funds supplemented with limited direct out-of-pocket payments

11. Healthcare Around the Globe (cont.) • The WHO performed an international ranking of healthcare systems in 2000; France ranked #1: they provide universal coverage that covers about 70% of costs (employer/private insurance covers the rest of the costs); 42% can get a same-day doctor’s appt., they can see any doctor they want, their life expectancy and mortality rates are more favorable than the U.S., and their government spends half of what the U.S. does per person on healthcare • In the same WHO ranking, the U.S. ranked 37th • In Taiwan, citizens have a “smart card” that has all of their medical information on it that has reduced paperwork and has cut costs substantially; the card is also used to efficiently bill the government for their health services • Click this link for more info. on healthcare around the globe: http://health.howstuffworks.com/medicine/healthcare/insurance/10-health-care-systems.htm

12. Health Disparities • An important area of research, health disparities refers to different health outcomes for different groups, usually racial and/or SES groups in the U.S. • Ethnic minorities and those with a lower SES tend to have less insurance coverage and higher rates of illness and even higher mortality rates, particularly among adults and infants/newborns • Health disparities among African-American women: http://www.youtube.com/watch?v=4le46UCmL4c&feature=related

13. Health Disparities (cont.) • A landmark study (Schulman et al., 1999) showed that when presented with fictitious patients with identical cardiac symptoms, doctors were less likely to refer African-American patients and female patients for additional cardiac testing compared to White patients and male patients; this reflects bias among physicians that may contribute to health disparities among ethnic minorities • One explanation for this finding is that some physicians don’t believe ethnic minority patients will follow through on additional testing anyway, so the physicians don’t recommend it • Addressing health disparities (an example from the bay area): http://www.youtube.com/watch?v=5wQv4xUwtEQ&feature=related

14. Stress, SES, and Health • Health Psychology is a field that addresses the interplay of psychological and physiological factors • Being physically ill makes psychological coping more difficult, and difficulty with coping (e.g., higher stress) makes one more vulnerable to physical illnesses • Psychoneuroimmunology is the field of study devoted to understanding the connection between psychological factors, the nervous system and immune function • Major stressor events, as well as chronic stressors, such as low SES, can have a negative impact on immune function, partly due to stress hormones • Reduced access to healthcare services, healthy foods, and health information among low SES individuals may also partially explain poorer health outcomes among the poor

15. Stress Response

16. Major Health Issues • We will address: • Obesity • Teen Pregnancy • HIV/AIDS • Alcohol, tobacco, and other drugs • The elderly

17. Obesity • From 2007-2008, U.S. prevalence of obesity among adults was approx. 34%; the combined prevalence of overweight and obesity was approx. 68%! • From 2007-2008, among children and adolescents in the U.S., obesity was approx. 17%, a large increase since the 1970’s • Obesity is linked to a variety of health problems, including cardiovascular disease, Type II Diabetes, certain cancers, and overall reduced life expectancy

18. Obesity (cont.) • With proper diet and exercise, obesity can be prevented in most individuals and is a major, preventable cause of death worldwide • When was the last time you saw a commercial for fruits and veggies (i.e., carrots, apples, or squash), whole grain bulgur, celery, or spinach? • When was the last time you saw a commercial for cheeseburgers, pizza, soda, or burritos? • What do you think kids watching TV are going to want to eat? (or adults, for that matter!) • Since diet and exercise are behavioral choices, think about the role Community Psychologists can play in influencing these behaviors and making environments healthier (to encourage exercise and make healthy foods more accessible) • Community norms that promote healthy behaviors can include farmer’s markets and bicycling, for example

19. Teen Pregnancy • Scope of the problem: http://www.cdc.gov/VitalSigns/TeenPregnancy/LatestFindings.html • Approx. 400,000 adolescent girls give birth every year in the U.S. (and approx. 750,000 to 1 million become pregnant every year) • Teen birth rates in the U.S. are up to 9 times higher than in most other developed countries, which is mainly explained by less contraceptive use (not lower rates of sexual activity) in the U.S. • Teen motherhood leads to an increased risk of school dropout, lower employment security, and they are more likely to live and raise the child in poverty • Teen fathers are also less likely to complete their education and tend to earn less money than adolescent boys who are not fathers

20. Causes and Strategies to Address Teen Pregnancy • Causal Factors from an Ecological Viewpoint: • Media messages that emphasize sex and rarely include contraception • Peer and cultural messages may condone or promote sex at an early age • Adolescents may be lacking parental or other adult role models and support/supervision • Adolescents may lack education about sex and access to contraception • Also see Chapter 7 of your text for more info

21. Strategies to Address Teen Pregnancy • Abstinence only programs: can be helpful when introduced to children at a younger age, but the majority of adolescents have had sex by age 18 • Sex education and/or access to contraception alone is probably not enough • More holistic programs are ideal, from a Community Psychology perspective: encourage parental involvement and education, healthy family communication, the value of education in general and future employment for the adolescent; education about gender roles, sexual harassment/assault, and sex in the media; provision of medical and mental health services, and extracurricular activities.

22. HIV/AIDS • Scope of the Problem: • Originally, HIV/AIDS in the U.S. was almost exclusively in the MSM (men who have sex with men) population, but now slightly less than half are due to IV drug-users or heterosexual sex; rates are higher in ethnic minority populations than among Whites; globally, more than half of those infected are female • From 2003 to 2007, deaths due to HIV in the U.S. decreased by 17% and the average life expectancy for those diagnosed with HIV in 2005 is approximately 23 years after diagnosis • Note: your textbook is WRONG on page 262 when it says “Once you have tested positive for HIV, it is certain that you will develop AIDS.” This used to be true, but is no longer the case.

23. HIV/AIDS (scope of the problem, cont.) • Globally, in 2009, approx. 2.6 million people became infected with HIV; approx. 33 million total adults and children are living with HIV • Globally, since 1999, the number of new infections has decreased by 19%; the majority of new HIV infections still occur in sub-Saharan Africa, although rates of new infections there are declining • While rates of HIV infection have decreased or stabilized in most areas of the world, in Eastern Europe and Central Asia, the number of people living with HIV has almost tripled since 2000 and reached an estimated total of 1.4 million in 2009, compared with 760,000 in 2001 • This increase has primarily been blamed on injecting drug users who share needles and sex workers

24. Changes in the incidence of HIV infection worldwide

25. HIV/AIDS: Prevention & Treatment • Stigma: HIV is different from many other health problems because it has considerable stigma associated with it and methods of prevention (e.g., giving out condoms or clean needles) are controversial • The stigma of HIV also can make disclosure of HIV status to a partner or even HIV testing more difficult • Many prevention campaigns have focused on condom use and getting tested for HIV • “No glove, no love” is a slogan used in many HIV prevention campaigns • Unlike diet and exercise, which are individual health-related behaviors, condom use is a behavioral decision that involves two people • Antiretroviral Therapy (ARV’s or ART’s) has had a dramatic impact on life expectancy and quality of life, with many patients on ARV’s having few or even no symptoms • Those on ARV’s can have an undetectable viral load, which also decreases the risk of HIV transmission to others

26. Alcohol, Tobacco, and Other Drugs

27. Tobacco • From 2000 to 2004, the average annual number of deaths due to cigarette smoking was approx. 443,000 in the U.S.; to put this into perspective, in the entire Civil War (considered the deadliest conflict in U.S. history) 620,000 soldiers died. • FDA’s latest efforts include graphic images posted on cigarette packages, including corpses, cancer patients, and diseased lungs: http://abcnews.go.com/Health/Wellness/cigarette-packaging-graphic/story?id=12109439 • Do you think these graphic images will help to deter people from smoking? • Take a look at this anti-smoking tour (click the video on the website): http://www.thetruth.com/ • Tobacco not only endangers the life of the smoker, but also of anyone near the smoker (second-hand smoke), and can cause serious health problems or even death in developing fetuses

28. Alcohol • If you’ve noticed posters on the SHU campus with drinking statistics, it’s part of the Counseling Center’s campaign to promote responsible behaviors among students • It’s based on social norms theory, which asserts that we should focus on how popular responsible behaviors are, rather than focusing on scare tactics: www.mostofus.org • Unlike tobacco, which primarily has direct, negative health effects, alcohol has not only direct, negative health effects, but also indirect effects in that it can lead to risky and potentially fatal behaviors: • i.e., unprotected sex, experimenting with drugs, and driving while intoxicated; alcohol use has also been linked to sexual assault and physical assault, including domestic violence • Do you think the news attention on celebrities and DWI’s and rehab affects people’s perception of drug and alcohol use? Are the effects positive, negative, or neutral?

29. Preventing Alcohol and other Drug Use • Building up supportive family and social networks so that living a drug-free life is “the norm” • Encouraging healthy activities that don’t involve drinking, smoking, or drug use • Targeting adolescents in these efforts • Legal enforcement to reduce underage drinking and smoking, to stop drug trafficking, and to eliminate advertising and selling substances near schools • Encouraging parents to lock medicine and liquor cabinets (e.g., a new issue is prescription drug abuse) • Encouraging responsible behaviors, such as being or using a designated driver, alternating alcohol with water/soda, setting a limit on drinking, looking out for one’s friends to reduce their risky behaviors, and “safe rides” programs that offer intoxicated individuals a safe ride home

30. Baby Boomers and The Elderly • With advances in medicine, life expectancy is relatively high for the Baby Boomers • The term “sandwich generation” has been applied to Baby Boomers because many of them were/are caring for their own children and/or grandchildren, as well as their own elderly parents • In 10-15 yrs., Baby Boomers will be in their 70’s; our healthcare system will be increasingly strained by this large generation, and the subsequent generation (Gen. X—my generation!) may not have the physical or financial resources to care for them

31. Improving Healthcare • Electronic Medical Records (EMR’s) allow for quick access to patient data and improved continuity of care between different doctors • Under the ARRA (Stimulus Package), billions of dollars have been set aside to assist with modernizing health information technology systems, with the goal of creating seamless EMR’s • Allocation of Resources: • Our current system rewards expensive surgeries and procedures, rather than prevention (i.e., a Cesarean section can be double the cost compared to a natural childbirth and can therefore incentivize more C-sections for greater reimbursement to the hospital) • This could be changed through a change in Medicare reimbursement fee structures because most insurance companies use pricing similar to Medicare, which reimburses procedures more than prevention • See these ideas for cost control, especially focusing on C-sections: http://hrsa.dshs.wa.gov/news/fact/FS009-007Hospitalpurchasing-rates-C-sections4-8-09.pdf • Taxing unhealthy substances, including cigarettes, alcohol, and even soda, is another strategy to assist with healthcare funding

32. Improving Healthcare (cont.) • Malpractice Insurance and “Defensive Medicine”: • Physicians’ decisions about patient care may be influenced by concerns about being sued (“defensive medicine”) • This could include unnecessary lab testing, over-prescribing medication, avoiding patients or procedures that are high risk, or even leaving/avoiding a field that is high risk for law suits (and has expensive malpractice insurance), such as OB/GYN • Improved patient education and medical treatment adherence/compliance • We should encourage patients to educate themselves and be responsible for their health; this may include regular check-ups, asking their doctor lots of questions, getting a second opinion when in doubt, being fully informed about medication instructions, and developing a collaborative medical treatment plan with their doctor