An Invitation To Health, Third Canadian Edition Lecture Notes

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AN INVITATION TO HEALTH AND WELLNESSCHAPTER 1LEARNING OBJECTIVESAfter studying the material in this chapter, students should be able todefinehealth and wellness[Bloom’s Taxonomy: Remember]describeanddiscusshealth promotion and wellness models[Bloom’s Taxonomy: Understand]namethe six dimensions of wellness and describe how they relate to total wellness[Bloom’sTaxonomy: Remember]listanddescribethe social determinants of health[Bloom’s Taxonomy: Remember]listthe factors thatshape the developmentofpositivehealth behaviours[Bloom’s Taxonomy:Remember]describehow beliefs and attitudes influence behaviour[Bloom’s Taxonomy: Understand]applya behaviour-change theory toapersonalhealthand wellness actionplan[Bloom’sTaxonomy: Apply]KEY TERMSAction—Amodification ofbehaviour according to a plan. A commitment of time and energy isrequired.Attitude—A somewhat stable set ofbeliefs, manner, disposition, feeling, or position with regardto a person or thing.Belief—An opinion;a conviction;a confidence in truth.Contemplation—Awareness thatthere is a problem behaviour and consideration ofchanging itwithin the next six months.Enabling Factors—Factors that make it possible oreasier forpeople or populations to changetheir behaviours; include individual physical capabilities and mental capacities, resources, livingconditions, societal support, and accessible facilities, programs, and services as well asdeveloping skills in addition to predisposing existing skills.Epidemiology—The study of how often diseases occur in different groups of people and why.Globalization—The increased transnational movement of capital, goods, people, and politicalsystems,and a rapid turnover of ideas and images through new communication technologies.Health—A state of completephysical, mental, and socialwell-being.

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Health Belief Model—Developed in the 1950s by social psychologists Hochbaum, Rosenstock,and Kegels, and updated in the 1980s, the model helps to explain and predict healthbehaviours.HealthPromotion—The process of enabling people to increase control over and to improve theirhealth.HealthyEnvironments—The creation of conditions and surroundings conducive to health.Holism—An emphasis on the interconnectedness between the individual andhis or hermind,body,and spirit.Hygiene—Healthy; akin to well and to living; a science of the establishment and maintenance ofhealth; conditions or practices conducive to health.Locus ofControl—An individual’s belief about the source of power and influence overhis or herlife.Maintenance—Continued work at changing behaviour. The change may take up to six months toa lifetime.Some lapsesmay be temporary.Modelling—Observing other people and emulating their behaviours, successes, or positivelifestyle choices.Morbidity—The number of disease rates in one period of time or in one place.Mortality—The number of deaths in one period of time or in one place.MutualAid—The actions people take to help each other cope.Norms—The unwritten rules regarding behaviour and conduct expected or accepted by a group.Panacea—Aremedy for all difficulties;a cure-all.PopulationHealth—A way of thinking about the social and economic forces that shape health. Itbuilds upon public health and health promotion, but goes beyond our more traditionalunderstanding of the causes of health and illness.Positive Visualization—Creating a mental picture of a goal or a behaviour change andvisualizing yourself making that change.Precontemplation—Not even aware that you have a problem, whereas others around you mightbe. No intention of making a change.Predisposing Factors—Factors that encourage or inhibit us from changing such as knowledge,attitudes, beliefs, values, self-efficacy, behavioural intentions, and existing skills.Preparation—Intentionto change a problem behaviour within the next month.

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Prevention—Information and support offered to help healthy people identify their health risks,reduce stressors, preventpotential medical problems, and enhance their well-being.Protection—Measures that an individual can take when participating in risky behaviour toprevent injury or unwanted risks.Rational-Emotive Therapy (RET)—Form of therapy developed by Ellis that focuses onchanging irrational beliefs and faulty interpretations, which result in negative emotions andsevere anxiety.Reinforcements—Reward or punishment for a behaviour that will increase or decrease one’slikelihood of repeating the behaviour.Reinforcing Factors—Factors that reinforce behaviour change. They include praise from familyand friends, rewards from others, or encouragement and recognition for meeting goals. Theyalso include healthy community policies such as smoke-free facilities and on-site workplacehealth and wellness programs.Self-Care—The decisions and actions individuals take in the interest of their own health.Self-Efficacy—Belief in one’s ability to accomplish a goal or change a behaviour.Self-InstructionalMethods—The practice of positive self-talk to help an individual cope betterwith stressful situations.Self-Talk—Repetition of positive messages about one’s self-worth to learn optimistic patterns ofthought, feeling, and behaviour.SocialDeterminants ofHealth (SDOH)—Income inequity, job security, working conditions,housing and food security, education and care in early life,and social exclusion of individualsand groups—all aspects that are very important to health and wellness status.Termination—Can take two to five years for a behaviour to become so deeply ingrained that aperson can’t imagine abandoningit.Wellness—A state of optimal health.CHAPTER OUTLINEI.Healthand Wellness1.Many health and wellness programs arebased on very similar health risk–reductionstrategies.2.The earliest and most enduring icons of medicine and health date back to ancientGreece and Asklepios, the Greek god of health and father of medicine.3.His daughter Panacea believed the best way to help people was to treat illness.

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4.Her sister Hygeia (hygiene) believed that it was important to teach people how tolive so that they did not become ill.A.First Nations Health and Wellness1.Aboriginal health emphasizesthe interconnectedness between the physical andspiritual world, between individualsand their environment, and between the mind,body, and spirit,which guides the concept of holism.2.Elders’ stories teach that it is important for an individual to attempt to liveBimaadiziwin,“the good life.”3.First Nations Medicine Wheels encourage a balance through the four aspects of self:physical, mental, emotional,and spiritual.4.We are asked to live the four fundamental values of kindness, honesty, sharing, andstrength.We are asked to respect nature.5.The control of decisions regarding health and wellness rest with the individual.II.Health and Health PromotionA.WhatIs Health?1.The WorldHealth Organization defines health as “not merely the absence of diseaseor infirmity but a state of complete physical, mental and social well-being.”2.In 1974 the Lalonde Report presented a conceptual framework called the HealthField Concept, which included four main elements: human biology, environment,lifestyle, and health-care organizations.3.This report acknowledged that vast sums of money were being spent to treat illnessesthat could have been prevented.4.The definition of health moved from measuringmorbidity(disease) and mortality(death) rates to viewing health as part of everyday living.5.In 1986 the Ottawa Charter expanded health toward building healthy public policythrough health promotion.6.A follow-up report identified three national health challenges: reducing inequities,increasing prevention effort,and enhancing people’scapacity to cope.7.The three mechanisms to health promotion were identified as self-care, mutual aid,and healthy environments.8.The Health Belief Model was developed to help explain and predict healthbehaviour.9.Other health models includethe Precede-Proceed Model for Health PromotionPlanning and Evaluation and the Quality of Life Model.10.Canadian health agencies, programs,and initiatives includethe Canadian Institutefor Health Information (CIHI);Canadian Population Health Initiative (CPHI);PublicHealth Agency of Canada;Canadian Institute of Health Research (CIHR);FirstNations,Inuit& AboriginalHealth Branch of Health Canada; a special commissionheaded by RoyRomanow, whichdelivered its report recommending sweepingchanges to Canada’s health-care system; ParticipACTION;anew website calledHealthy Canadians; Physical and Health Education Canada (PHE Canada,formerlycalled CAHPERD);andthe Canada Research Chairs Program.B.WhatIs Epidemiology?1.Epidemiology is the study of how often diseases occur in different groups of peopleand why.

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2.Epidemiology can be used to evaluate health strategies, prevent certain illnesses, andguide health-care providers.3.Epidemiological research uses a variety of methodological approaches.4.Researchers can examine the distribution of disease in a specific population, calleddescriptive epidemiology, or investigate hypothesized causal factors, calledanalytical epidemiology.III.Wellness and the Wellness MovementA.WhatIs Wellness?1.Wellness has been defined as purposeful, enjoyable living or, more specifically, adeliberate lifestyle choice characterized by personal responsibility and optimalenhancement of physical, mental, and spiritual health.2.Halburt Dunn, a pioneer in the wellness movement,believed wellness was a dynamicprocess of continually moving toward one’s potential for optimal functioning.3.Dr. John Travis founded the first Wellness Resource Centerin the U.S.4.Dr. Bill Hetler cofounded the National Wellness Institute and developedtheLifestyle Assessment Questionnaire (redesigned as TestWell) andthe SixDimensions of Wellness Model.B.Social Dimension1.This dimension encourages a collectivist view of the world—that of contributing tosociety, helping others, and valuing the concept of interdependence betweenourselves and our environment.2.Current researchshowsthat people withspouses, friends, anda rich social networkmay outlive isolated loners by as much as 30 years.C.Occupational Dimension1.A “well” occupation is consistent with personal values, interests, and beliefs.2.In a well work environment, you share your unique gifts, skills, and talents, andenjoy work that is meaningful and rewarding.D.Spiritual Dimension1.Identifying your basic purpose in life; learning how to experience love, joy, peace,andfulfillment; and helping ourselves and others achieve our potential are all aspectsof the spiritual dimension.2.Spirituality has been described as transcendence, connectedness, a power, a force, anenergy,and a connectionto a formal religion.E.Physical Dimension1.Physical wellness is met through participating in regular physical activity,maintaining a healthy body weight,and avoiding harmful behaviours such as tobaccouse, drug misuse, and excessive alcohol consumption.F.Intellectual Dimension1.Intellectual health refers to your ability to think and learn from life experience, youropenness to new ideas, and your capacity to question and evaluate information.G.Emotional Dimension

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1.Emotional wellness includes the degree to which one feels positive and enthusiasticabout oneself and life.2.When you are emotionally well you have the capacity to express and manageyourown feelings, to work independently, but to also recognize the importance of beingable to ask for help or support when needed.IV.Health ChallengesA.WhatIs the Average Life Expectancy?1.In 2007the average age at death forthe overall population was 80.7 years (78.3 formen, 83.0for women).2.Cancer and heart disease are the two leading causes of death for Canadians followedby chronic lower respiratory diseases and Type 2 diabetes (which is strongly linkedto being overweight).3.Hypertension (high blood pressure)is a major contributor to poor health,affectingoneinfiveCanadians.4.Mental health issues are also concerning.B.Do Sex and Gender Matter?1.Sex is aclassification, generally as male or female, according to the reproductiveorgans and functions that derive from the chromosomal complement.2.Gender refers to a person’s self-representation as male or female, or how that personis responded to by social institutions on the basis of theindividual’s genderpresentation.3.The experience of being male or female in a particular culture and society can anddoes have an effect on physical and psychological well-being. This realization isboth new and revolutionary.4.Gender differences persist in sickness as well as in health.5.Gender-specific medicine is replacing one-size-fits-all health care with newdefinitions of what is normal for men and women.C.Social Determinants1.New research in the area of the social determinants of health (SDOH) supportsthenotion thatincome and income distribution, education, unemployment and jobsecurity, employment and working conditions, early childhood development, foodinsecurity, housing, social exclusion, social safety net, health services,Aboriginalstatus, gender, race, and disabilityare also very important to health and wellnessstatus.D.Diversity and Social Exclusion1.We live in the most diverse nation on earth,and increased disparities are evident asmany different groups of Canadians do not have equal access to health care andhealth and wellness opportunities.2.There is evidence that there is a growing inequality in social and economic statusbetween groups of Canadians, and that a larger gap lowers the health status of theoverall population.3.Members of minority groups often encounter much difficulty accessing health-careservices in Canada due to poverty and social exclusion.4.Social exclusion is based on gender, age, ability, sexual orientation, race, ethnicity,

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and religious beliefs.5.Publichealth experts arereplacing the word“minority”with“underserved.”E.Job Security and Working Conditions1.Globalization has led to changes in the workforce that include layoffsandtheincrease in temporary,part-time, casual, contract,and self-employment situations,leading to job insecurity for half of working Canadians.F.Housing and Food Security1.Low-income families, especially Aboriginal ones; new immigrants; and single-parentfamilies struggle with housing issues in Canada.2.Low-income families are 13 times more likely to report that their children go hungrythan higher income families; this is especially true for single mothers.G.Education and Care in Early Life1.We do not have enough regulated childcare spaces in Canada for children of workingparents.2.Budget cutbacks to public school education endangerthe health of Canadians and thewell-being of the social structure of our society.3.Aboriginal students have lower rates of high-school graduation,and their attendanceis well below the national average.H.Taking Action1.Six key strategies to enhance thesocial determinants of health have been adopted byhealth agencies and provincial governments:a.adopting a framework for social inclusionb.promoting full employment, job security, and healthy working conditionsc.protecting universal access to our high-quality health systemd.protecting Canada’s high-quality publiceducation systeme.ensuring the right of all Canadians to adequate housing and foodf.reducing income disparities by ensuring minimum wages and levels of socialassistanceV.TheHealth of College and University Students1.College-aged men are more likely thancollege-agedwomen to engage in risk-takingbehaviours, to use drugs and alcohol, to engage in risky sexual behaviours such ashaving multiple partners and having sex while under the influence of alcohol, and todrive dangerously.2.Dormitories have proven to be breeding grounds for serious infectious diseases suchas meningitis;second-hand smoke can pose a long-term threat tosmokers’roommates;and binge drinking imperils drinkers and those surrounding them.3.Undergraduates face risks to their psychological health. College students reportedmore distress than the general population or their peers not enrolled in college.4.First-year students suffer the most interms ofphysical and emotional well-being.5.Increased education has long-term health benefits.VI.Making Healthy ChangesA.Understanding Health Behaviour1.To make lasting beneficial changes, it helpsto understand the three types of

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influences that shapebehaviour: predisposing, enabling,and reinforcing factors.2.Predisposing Factorsa.Predisposing factors include knowledge, attitudes, beliefs, values,andperceptions.b.People are most likely to change health behaviour if they hold three beliefs:Susceptibility—They acknowledge they are at risk for the negativeconsequences of their behaviour.Severity—They believe they may pay a high price if they don’t make achange.Benefits—They believe the proposed change will be an advantage totheir health.c.The value or importance we give to health also plays a major role in changingbehaviour.3.Enabling Factorsa.Enabling factors include skills, resources, accessible facilities, and physicaland mental capacities.4.Reinforcing Factorsa.Reinforcing factors may include praise from family and friends, rewards fromteachers or parents, or encouragement and recognition for meeting a goal, butlasting change dependson an internal commitment and sense of achievement.B.Decision-Making1.The entire process of maintaining or restoring health depends on your decisions; itcannot start or continue without them.2.If you think of decision-making as a process, you can break down even the mostdifficult choices into manageable steps,which include setting priorities, informingyourself, considering all your options, tuning into your intuitivefeelings, andconsidering a “worst-case” scenario.C.The Health Belief Model1.Usethis modelto explain and predict health behaviours by focusing on attitudes andbeliefs.2.According to this model, people will take a health-related action based on thefollowing factors:perceived susceptibility, perceived severity, perceived benefits, cues to action, andself-efficacy.3.This model has been used over the years to help people change unhealthy behaviourssuch as smoking, overeating, and inactivity.D.How Can I Begin to Make Lifestyle Changes?1.Change is never easy; when youdecide to change a behaviour, you have to give upsomething familiar and easy for something new and challenging.2.Change always involves risk—and the prospect of rewards.3.Researchers have identified various approaches that people use in making beneficialchanges,including the moral model, the enlightenment model, the behavioural model, themedical model, andthe compensatory model.

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4.Before they reach the stage where they can and do take action to change, mostpeople go through a processthat includes reaching a level of accumulatedunhappiness that makes them ready for a change, and then they have a moment oftruth that makes them want to change.5.Social and cultural norms—behaviours that are expected, accepted, or supported by agroup—can make change much harder if they’re constantly working against aperson’s best intentions.6.If you’re aware of the norms that influence your behaviour, you can devise strategieseither to change them or adapt to them.E.Strategies for Prevention—Setting Realistic Goals1.SMART Model—Goals and objectives must be Specific, Measurable, Achievable,Realistic, andTrackable or Time-Based.F.Strategies for Change—More Options for Change1.Modelling—observing other people and emulating their behaviours, successes, orpositive lifestylechoices.2.Positive Visualization—creating a mental picture of a goal or a behaviour changeand visualizingyourself making that change.4.Shaping—building desired behaviour in small steps and rewarding positivebehaviour changes overtime.G.Stages of Change1.Pre-contemplation—Individualsin this stage arenot even aware they have a problemand have no intention of making a change.2.Contemplation—Individualsareaware they have a behavioural problem and areconsidering changing it within the next six months.3.Preparation—People in this stage intend to change a problem behaviour within thenext month.4.Action—People in this stage are actively modifying theirbehaviour according totheir plan.5.Maintenance—In this stage individuals have continued to work at changing theirbehaviour.6.Termination—While it may take two to five years, a behaviour becomes so deeplyingrained thatindividualscan’t imagine abandoning it.H.Successful Change1.Some people find it helpful to sign a “contract,” a written agreement in which theymake a commitment to change.2.Changealsodepends on the belief that you can and will succeed(self-efficacy).3.Another crucial factor islocus of control.a.If you believe that your actions will make a difference in your health, yourlocus of control is internal.b.If you believe that external forces or factors play a greater role, your locus ofcontrol is external.

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4.Reinforcement (either positive or negative) can also play a role.5.Self-talk, the messages you send yourself, also can play a role in change.VII.Healthand WellnessEducationA.ThePower ofPrevention1.No medical treatment can compare with the power of prevention.2.Prevention can take many forms: primary (or before the fact);consumer education;identifying people at risk;targeting a specific community, group, or individual.3.In the past, physicians did not routinely incorporate prevention into their professionalpractice;however,medical schools are now providing more training in preventivecare.B.The Potential of Protection1.There is a great deal of overlap between prevention and protection.2.The very concept of protection implies some degree of risk—immediate and direct orlong-term and indirect.C.Assessing Risks1.We allface a host of risks, from the danger of being the victim of violence to thehazards ofself-destructive behaviours like drinking and drugs.2.At any age, the greatest health threats stem from high-risk behaviours—smoking,excessive drinking, not getting enough exercise, eating too many high-fat foods, andnot getting regular medical checkups, to name just a few.3.Environmental health risks also need to be assessed.4.Here are some key factors in considering environmental risks:a.Are there possible benefits?Someadvantagesmay make some risks worthtaking.b.Isthe risk voluntary?c.Isthe riskfair?d.Are there alternatives?e.Are lives saved or lost?D.The Future of Health and Wellness1.Medical science is moving ahead at an astonishing speed.2.Even with advances in medical science it is still important to make healthylifestylechoices that support all the dimensions of health and wellness.STUDENT MOTIVATIONunderstanding health from the perspective of a college or university student (seepages15to16)recognizing differences in racial and ethnic backgrounds and how this relates to culturalattitudes about healthdetermining where students lie on the wellness-illness continuum, what factors mayaffect their place on the scale, and what an optimum state of health means to eachstudentunderstanding the process of behaviour change and how it can be applied to one’s life—students are likely to have different ways in which they want to change their present

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lifestyleBARRIERS TO LEARNINGdifferentiatingbetweenthe words “gender”and“sex”and what this means in terms ofhealth-related conditions (see Figure 1-7for some direct comparisons)differentiatingbetween the terms “health” and “wellness”(compare health,pages 4to5to wellness,pages9to11)comparing“self-responsibility”and“social responsibility”and how having anappreciation for self-responsibility will allow students to better take care of others aswellDISCUSSION QUESTIONSSix Domains of Health:Discuss with students which domain of health is most prominent in theirlives. Why do they feel this way? Which are they least concerned with?Ask students what theycould do in order to incorporate all components into their lives.What are some of the obviousdifferences between those who do incorporate all of these aspects into their livesandthose who onlyconcentrate on one or two of these components?Canadian Health Agencies and Initiatives:What Canadianhealth agencies, programs,orinitiatives have had an impact onstudents’ health or the health and wellness of their friends andfamilies? How didtheyenable thestudentsto improve their health and wellness?What programsand initiatives are lacking or need improvement? Where are there gaps in the system?Diversity andSocial Exclusion:What challenges dothesocial determinants of health bring to thehealth-care system?What actions can government, universities, hospitalsand other health-carefacilities,and individuals take to address these differences?Identify some of theaspects of socialexclusionthat might affect the overall health of an individual. What factors in the health-caresystem might keep various individuals from keeping up with their health?Oneexampleis whenbrochures only display one race, andareonly in one language. Anotherexample iswhenphysiciansdo not clarify health questions, such as “Are you sexually active?”Doesthis mean in the last week,twohours ago, in your lifetime…?Also,what does“sexually active”mean?How is this term interpretedif you are lesbian or a gay man? What about,“Doyou drinkalcohol?”Aperson might reply, “Yes, but only once a week.” This may still be a problem if the onetime a week he or she drinksfive to eightdrinks.Personal Health Assessment:After reviewing thePrecede-ProceedModelfor Health PromotionPlanning and Evaluation, and the Quality of Life Model,encourage students to keep a small journalhandy in order to record their thoughts, reactions,and experiences related to each chapter’smaterials.How does the information presented in each chapter apply to their values, attitudes, andbehaviours?What might they do in order to change unhealthybehaviours? What are some of thebarriers that might keep them from a healthier lifestyle? What are some of the benefits of a healthylifestyle? Is a healthy lifestyle the same for everyone?

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College/UniversityStudents and Health:Ask students how they handle thepossiblenewfoundfreedom they have achieved since attending college/university.How do their parents handle andreact to it?How does this sense of independence affect their health?What health challenges do theyface?Wellness-Illness Continuum:Have students identify where they are on the Wellness-IllnessContinuum(Figure 1-4).Be sure they include all six domains of health. What does the Wellness-Illness Continuum represent? Can you fluctuate on this continuum?Changing Health Behaviour:Ask students to reflect onapersonal change attempt.Discusspositive strategies they used.Discuss unsuccessful attempts.Why were they unsuccessful?Whatcould they have done differently?Point outthe Stages of Change(Figure 1-10)andcomparesuccessful and unsuccessful changes.GUEST SPEAKERS AND PANEL PRESENTATIONSCompose a panel ofclass members or community representatives from diverse ethnic, religious,andracial groups to discuss their cultures’views about health and illness.In particular,you mightinvitemembers of the First Nations communityto your classroom to discuss theirspiritual beliefsand culture so that others might have a better understanding of theirperspective on health andwellness.Form a panel,possibly comprisinga psychologist, sociologist, environmentalist, and physician,andhave the membersshare their definitionsof health and how they work to protect it.Invite someone who has recently overcome a major health obstacle or problem to discuss whathelped them to adjusttoor overcome the problem.Invite a member of a community support group (e.g.,AlcoholicsAnonymous, Weight Watchers) toshare their methods/steps to creating behavioural change.CLASS ACTIVITIESActivity #1Meet Your ClassmatesPurpose:1. To meet your classmates and learn to appreciate the differences we all share2.To appreciate nonverbal communicationTime:Ten to fifteen minutes

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Method:1. Go to an areawherestudents can easily move around.2. Divide the group into two or three teams.3. Have them stand in a straight line.4. Give them a topic regarding health (e.g.,times a week you exercise, number of fruits andvegetableseaten daily,number ofsports teams played onin high school)5. Have them line up accordingly (e.g.,most to least, least to most).6. Keep track of time to see which group lines up first (and then compare times afterwards).7. To add a twist, don’t let them talk while trying to line up.8. Repeat many times so that the students get a chance to be in different location eachtime.Discussion:1. Elaborate on the following communication facts:a.Verbal messages(words)accountfor 7 percent of communication.b.Nonverbal cues (e.g., expression, gesture, or dress) account for93percentofcommunication.2. Discuss with the students how they felt when they couldn’t talk.What did they rely onto communicate?a. How dideach of themcommunicate? Were there different styles?b. Is nonverbal communication as effective as verbal communication? Explain.3. Discuss whether anyone was always in the same place in line or not.Discussdifferencesamongst each other.4. How might these differences reflect how we treat ourselves? Our lifestyle behaviours?Activity#2The Dimensions of HealthPurpose:1.To introduce and investigate the dimensions of health and how various individualsperceive these dimensions2.To analyze human behaviour in the context of physical, psychological, social,intellectual, environmental,and spiritual health3. To meetyourclassmatesTime:Twenty to thirty minutesMethod:1. Form a circle in the room.2. Instruct studentsto introduce themselvesand identify a dimension of health thatrepresents their lifestyle by acting it out.Discussion:1.Discussthevariouswaysthatpeopleperceivethedimensions,notonlythroughhowindividualsact out the dimensionsbut also from the audience’s reactions.

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Activity#3Presentation on Various CulturesPurpose:To better understand the healthneeds and practices of various culturesTime:Two to threeclass periodsMethod:1. Have students select (or assign) various cultures to research the health needsand practices ofeach culture. You may want to put them in groups.a. Ask students to research the various dimensionsof health regarding theirselected (orassigned)culture.2. Give the students ample time to research their given culture.3. Have students present to either small groups or to the entire class; whatevertime allows.Discussion:1. Discuss the various ways that people perceived the dimensions and how others fromdifferentcultures might interpret these dimensions.2. Ask the students how they feel about these various cultures after having a chance tolook at themmore closely.Activity#4HowDoWe Compare?Purpose:To introduce and investigate the various health concerns and illnesses around the world andcompare them to those inCanadaTime:Oneclass periodMethod:1. Reserve a classroom that has access to enough computers for your class.2. Have students investigate the World Health Organization website and theHealth Canadawebsite,and make a list of the top illnesses around the world.3. To add another dimension,give the students a particular case study and askthemtoidentifysymptoms or methods of treatment as reported by these two organizations.Discussion:1. Discuss why certain countries are more susceptible than otherstoparticular diseases.2. What prevention methods are in place to combat those diseases inCanada? Are theyeffective?Why or why not?

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REFERENCES, READINGS,AND RESOURCESAnspaugh, D.J., Digman, M.B., &Anspaugh, S.L. (2000).Models forhealthpromotioninterventions.InPlanning,implementing andevaluatinghealthpromotionprograms.Boston: McGraw Hill.Commission on the Future of Health Carein Canada. (2004,October 1).Finalreport.HealthCanada. Available athttp://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/romanow-eng.phpConstitution of the World Health Organization.(1947).Chronicle of the World Health Organization.Geneva, Switzerland: WHO.Edwards, P.,et al. (2004, May–June).ParticipACTION:Themousethatroared: Amarketing andhealthcommunicationssuccessstory.Canadian Journal of Public Health, 95 Supplement 2.Available atwww.usask.ca/archives/participaction/english/impact/CPHA.htmlEpp, J. (1986).Achievinghealth forall: Aframework forhealthpromotion.Ottawa: Minister ofSupply and Services Canada. Available athttp://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/1986-frame-plan-promotion/index-eng.phpFederal/Provincial/Territorial Advisory Committee on Population Health (1999).Toward ahealthyfuture.Secondreport on thehealth of Canadians. Ottawa: Health Canada.Health Canada. (2004).Youngpeople in Canada: Theirhealth andwell-being. Report. Available atwww.phac-aspc.gc.ca/dca-dea/publications/hbsc-2004/pdf/hbsc_summary_2004_e.pdfKulchyski, P., McCaskill, D., & Newhouse, D. (1999).Introduction.InP. Kulchyski, D.McCaskill,& D. Newhouse (Eds.),In thewords ofelders: Aboriginalcultures intransition(pp. iv, xi–xxv).Toronto: University of Toronto Press.LaLonde, M. (1974).Anewperspective on thehealth of Canadians.Ottawa: Government of Canada.Available atwww.hc-sc.gc.ca/hcs-sss/com/fed/lalonde-eng.phpMcKenzie, B., &Morrissette, V. (2003, April). Socialworkpractice with Canadians of Aboriginalbackground: Guidelines forrespectfulsocialwork.Envision: The Manitoba Journal of ChildWelfare, 2(1).Ottawa Charter for Health Promotion.(1986). World Health Organization, Health and WelfareCanada, and Canadian Public Health Association. Available atwww.who.int/hpr/NPH/docs/ottawa_charter_hp.pdfQuality of life model.(n.d.)QOL Concepts.Quality of Life Research Unit, University of Toronto.Available at www.utoronto.ca/qol/concepts.htm

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Scott, K. (2002, November).Alost decade: Incomeequality and the healthof Canadians.Paperpresented at the Social Determinants of Health Across the Life-Span Conference, Toronto.FILMS(DVDS/VIDEOCASSETTES)The Concept of Holistic Health(improving overall health;shows all dimensions)Hogg Foundation LibraryP.O. Box 7998University of TexasAustin, TX 78712Doctors Ought To Care(Dr. Alan Blumdiscusses good and bad health habits and self-prevention strategies.)Hogg Foundation for Mental HealthHogg Foundation LibraryP.O. Box 7998University of TexasAustin, TX 78712Health and Lifestyles(Lifestyles have an effect upon health; it’snever too late to begin the change process.)Spectrum Films2755 Jefferson Street, Suite 108Carlsbad, CA 92088Healthy Lifestyles(This two CD-Rom set multimedia program provides information to help viewers make the bestdecisions forhealthyliving and feeling great.)Films for Humanities and SciencesP.O. Box 2053Princeton, NJ08543-2053Homeostasis(observes what happens to the body during a marathon race)Films for Humanities and SciencesP.O. Box 2053Princeton, NJ08543-2053Promoting Healthy Behavior(This program introduces the basic concepts of health and wellness, emphasizing that well-being isa multi-dimensional concept that exerts an ongoing influence throughout one’s life.)Films for Humanities & SciencesP.O.Box 2053Princeton, NJ08543-2053The Science of Wellness

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(This program investigates the ramifications of applying the theories of preventionmedicine:modifications in diet and lifestyle.)Films for Humanities and SciencesP.O. Box 2053Princeton, NJ08543-2053To Live orDie(How lifestyle choices affect diseasesis demonstrated. Connection between disease and behaviourin the lives of two individuals is discussed after their deaths.)Perennial Education, Inc.930 Pitner AvenueEvanston, IL 60202The Wellness Revolution(Take charge of your physical and mental well-being; choosing healthful lifestyles.)Modern Talking Picture ServiceFilm Scheduling Center500 Park StreetNorth St. Petersburg, FL 33709What Is Your Health Hazard Risk?(provides guidance for improving health and longevity through health quiz)IBIS Media175 Tompkins AvenuePleasantville, NY 10570You Can’t Buy Health(health maintenance program described by medical authorities)Produced by Burd and CavanCommunications CompanyOrder from Blue Cross and Blue Shield Insurance Company.INTERNET RESOURCESCanadian Institute for Health Information (CIHI)Access information about national health indicators and standards, health spending, current healthresearch, and the Canadian Population Health Initiative (CPHI).www.cihi.ca

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Public Health Agency of CanadaFind credible and practical e-health information gathered from federal, provincial, and municipalagencies; university libraries;and community groups.www.publichealth.gc.caCanadian Institutes for Health ResearchLearn about Canada’s lead federal funding agency and funding opportunities for health researchinfour areas: biomedical, clinical, health systems and services, and population and public health.www.cihr-irsc.gc.ca/e/193.htmlThe FirstNations,Inuit& Aboriginal Health Branch ofHealth CanadaDiscover public health and health-promotion services for First Nations,Inuit& Aboriginal peoplein Canada.www.hc-sc.gc.ca/fniah-spniaHealth CanadaHealth information can be found at thisfederal government website. Check outThe Daily, a specialpage that keeps Canadianson top of current health issues.www.hc-sc.gc.caSpeakwellVisit thisaward-winning e-wellness website from Speakwell, a health and wellness educationcompany. Check out the WELL newsletter, which is free of charge.www.speakwell.com

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Build Your FutureMaking Healthy ChangesUltimately you have more control over your health than anyone else. Use this course as anopportunity to zero in on at least one less-than-healthful behavior and improve it. Here are somesuggestions for small steps that can have a big payoff. Check those that you commit to makingtoday, this week, this month, or this term. Indicate “t,” “w,” “m,” or term, and repeat this self-evaluation throughout the course.___Use seat belts. In the last decade, seat belts have saved more than 40,000 lives and preventedmillions of injuries.___Eat an extra fruit or vegetable every day. Adding more fruit and vegetables to your diet canimprove your digestion and lower your risk of several cancers.___Get enough sleep. A good night’s rest provides the energy you need to make it through thefollowing day.___Take regular stress breaks. A few quiet minutes spent stretching, looking out the window, orsimply letting yourself unwind are good for body and soul.___Lose a pound. If you’re overweight, you may not think a pound will make a difference, but it’sa step in the right direction.___If you’re a woman, examine your breasts regularly. Get in the habit of performing a breastself-examination every month after your period (when breasts are least swollen or tender).___If you’re a man, examine your testicles regularly. These simple self-exams can spot the signsof cancer early, when it is most likely to be cured.___Get physical. Just a little exercise will do some good. A regular workout schedule will be goodfor your heart, lungs, muscles, bones—even your mood.

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___Drink more water. Eight glasses a day are what you need to replenish lost fluids, preventconstipation, and keep your digestive system working efficiently.___Do a good deed. Caring for others is a wonderful way to care for your own soul and connectwith others.

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Self-SurveyAre You in Control of Your Health?To test whether you are the master of your fate, asserting control over your destiny or justhangingon, hoping for the best, take the test below. Depending on which statement you agree with, checkeither a or b for each of the following.1.(a)Many of the unhappy things in people’s lives are partly due to bad luck. ___(b)People’s misfortunes result from mistakes they make. ___2.(a)One of the major reasons why we have wars is that people don’t take enough interest inpolitics. ___(b)There will always be wars, no matter how hard people try to prevent them. ___3.(a)In the long run,people get the respect they deserve in this world. ___(b)Unfortunately, an individual’s worth often passes unrecognized no matter how hard he tries.___4.(a)The idea that teachers are unfair to students is nonsense. ___(b)Most students don’t realize the extent to which their grades are influenced by accidentalhappenings. ___5.(a)Without the right breaks, one cannot be an effective leader. ___

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(b)Capable people who fail to become leaders have not taken advantage of their opportunities.___6.(a)No matter how hard you try, some people just don’t like you. ___(b)People who can’t get others to like them don’t understand how to get along with others. ___7.(a)I have often found that what is going to happen will happen. ___(b)Trusting to fate has never turned out as well for me as making a decision to take a definitecourse of action. ___8.(a)In the case of the well-prepared student, there is rarely, if ever, such a thing as an unfair test.___(b)Many times exam questions tend to be so unrelated to course work that studying is reallyuseless. ___9.(a)Becoming a success is a matter of hard work; luck has little or nothing to do with it. ___(b)Getting a good job depends mainly on being in the right place at the right time. ___10.(a)The average citizen can have influence in government decisions. ___(b)This world is run by the few people in power, and there is not much the little guy can doabout it. ___11.(a)When I make plans, I am almost certain that I can make themwork. ___

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(b)It is not always wise to plan too far ahead because many things turn out to be a matter ofluck anyway. ___12.(a)In my case, getting what I want has little or nothing to do with luck. ___(b)Many times we might just as well decide what to do by flipping a coin. ___13.(a)What happens to me is my own doing. ___(b)Sometimes I feel that I don’t have enough control over the direction my life is taking. ___

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Scoring:Give yourself one point for each of the following answers:1a, 2b, 3b, 4b, 5a, 6a, 7a, 8b, 9b, 10b, 11b, 12b, 13bYou do not get any points for other choices.Add up the totals. Scores can range from 0 to 13. A high score indicates an external locus ofcontrol, the belief that forces outside yourself control your destiny. A low score indicates an internallocus of control, a belief in your ability to take charge of your life.Source: Based on J. B. Rotter, “Generalized Expectancies for Internal versus External Control ofReinforcement,”Psychological Monographs, Vol. 80, Whole No. 609 (1966).If you turned out to be external on this self-assessment quiz, don’t accept your current score as agiven for life. If you want to shift your perspective, you can. People are not internal or external inevery situation. At home you may go along with your parents’ or roommates’ preferences and letthem call the shots. In class you might feel confident and participate without hesitation.Take inventory of the situations in which you feel most and least in control. Are you bold on thebasketball court but hesitant on a date? Do you feel confident that you can resolve a dispute withyour friends but throw up your hands when a landlord refuses to refund your security deposit? Lookfor ways to exert more influence in situations in which you once yielded to external influences. Seewhat a difference you can make.

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CHAPTER2PSYCHOSOCIALHEALTHLEARNING OBJECTIVESAfter studying the material in this chapter, students should be able toidentifythefour dimensions of psychosocial health—emotional,mental,social,and spiritual[Bloom’s Taxonomy:Remember]discussthe concepts of emotional and spiritual intelligence[Bloom’s Taxonomy:Understand]describethe relationship of needs, values, self-esteem, a sense of control, and relationships topsychosocialhealth[Bloom’s Taxonomy: Understand]determineways in which you can live a fulfilling life [Bloom’s Taxonomy:Understand]explainthe differences between mental health and mental illness, andlistsome effects of mentalillness onpsychological andphysical health[Bloom’s Taxonomy:Understand and Remember]describethe major mental illnesses—anxiety disorders, depressive disorders, attentiondisorders,and schizophrenia—and the characteristic symptoms of each type[Bloom’s Taxonomy:Understand]discusssome of the factors that may lead to suicide as well as strategies for prevention[Bloom’sTaxonomy:Understand]describethe treatment options available for those with psychological problems[Bloom’sTaxonomy:Understand]KEY TERMSAltruism—Acts of helping or giving to others without thought of self-benefit.Antidepressant—A drug used primarily to treat symptoms ofdepression.Anxiety—A feeling of apprehension and dread, with or without a known cause; may range frommild to severe and may be accompanied by physical symptoms.Anxiety Disorders—A group of psychological disorders involving episodes of apprehension,tension,or uneasiness, stemming from the anticipation of danger and sometimes accompanied byphysical symptoms; causes significant distress and impairment to an individual.Assertive—Behaving in anon-hostile,confident manner to make your needs anddesires clear toothers.Attention Deficit Disorder (ADD)—A term often used interchangeably with attentiondeficit/hyperactivity disorder (ADHD).Attention Deficit/Hyperactivity Disorder (ADHD)—A spectrum of difficulties in controllingmotion and sustaining attention, including hyperactivity, impulsivity, and distractibility.

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Autonomy—The ability to draw on internal resources; independence from familial and societalinfluences.Behaviour Therapy—Psychotherapy that emphasizes application of theprinciples of learning tosubstitute responses and behaviour patterns for undesirable ones.Bipolar Disorder—Severe depression alternating with periods of manic activity and elation.Cognitive-BehaviouralTherapy(CBT)—A technique used to identify an individual’s belief andattitudes, recognize negative thought patterns, and educate in alternative waysof thinking.Culture—The set of shared attitudes, values, goals,and practices of a group that are internalizedby an individual within the group.Depression—In general, feelings of unhappiness and despair; as a mental illness, alsocharacterized by an inability to function normally.Depressive Disorders—Agroup of psychological disorders involving pervasive and sustaineddepression.Emotional Health—The ability to express and acknowledge one’s feelings and moods.Emotional Intelligence—A term used by some psychologists to evaluate the capacity of peopleto understand themselves and relate well with others.Generalized Anxiety Disorder (GAD)—Ananxiety disorder characterized as chronic distress.Happiness—A feeling that is buildable and measurable, and directly connected to engagementwith family, work, or a passionate pursuit and finding meaning from some higher purpose.Homelessness—Not having a home; includes absolute homelessness, being at risk forhomelessness, and hidden homelessness.Interpersonal therapy (IPT)—A technique used to develop communication skills andrelationships.Learned Helplessness—Blaming others for our failures and transferring our responsibility foradopting healthy lifestyle choices over to society.Locus of Control—An individual’s belief about the source of power andinfluence over his or herlife.Major Depression—Sadness that does not end.Mental Health—The ability to perceive reality as it is, to respond to its challenges, and todevelop rational strategies for living.

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Mental Illness—Behavioural or psychological syndrome associated with distress or asignificantly increased risk of suffering pain, disability, loss of freedom, or death.Mood—A sustained emotional state that colours one’s view of the world for hours or days.Obsessive CompulsiveDisorder (OCD)—An anxiety disorder characterized by obsessionsand/or compulsions that impair one’s ability to function and form relationships.Optimistic—The tendency to seek out, remember, and expect pleasurable experiences.Panic Attacks—Short episodescharacterized by physical sensations of light-headedness,dizziness, hyperventilation, and numbness of extremities, accompanied by an inexplicable terror,usually of a physical disaster such as death.Panic Disorder—An anxiety disorder in which the apprehension or experience of recurring panicattacks is so intense that normal functioning is impaired.Phobias—An anxiety disorder marked by an inordinate fear of an object, a class of objects, or asituation, resulting in extreme avoidance behaviours.Post-traumatic Stress Disorder (PTSD)—The repeated reliving of a trauma through nightmaresor recollection.Premenstrual Dysphoric Disorder (PMDD)—A disorder, not related to PMS, that occurs in anestimated 3 to 5 percent of allmenstruating women and is characterized by regular symptoms ofpsychological depression during the last week of a woman’s menstrual cycle.Premenstrual Syndrome—A disorder that causes bodily discomfort and emotional distress forup to two weeks, from ovulation until the onset of menstruation.Psychiatric Drugs—Medications that regulate a person’s mental, emotional, and physicalfunctions to facilitate normal functioning.Psychiatrists—Licensed medical doctors(M.D.)with additional training in psychotherapy,psychopharmacology, and treatment of mental disorders.Psychoanalyst—Can be either a psychiatrist or psychologist who has taken special training inpsychoanalysis. They assist clients in overcoming past traumas.PsychodynamicPsychotherapy—Interpreting behaviours in terms ofearly experiences andunconscious influences.Psychologists—Mental health professional who has completedadoctoral orgraduate program inpsychologyand is trained in a variety of psychotherapeutic techniques,butwho is not medicallytrained and does notprescribe medications.

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Psychosocial Health—A complex interaction of processes or factors that are both psychologicaland social in nature and encompass our emotional, mental, social, andspiritual states.Psychotherapy—Treatment designed to produce a response by psychological rather than physicalmeans, such as suggestion, persuasion, reassurance, and support.Resilient—A person’s ability to figure things out and to ask for help when dealing with difficultsituations or complex challenges.Schizophrenia—A general term for a group of mental disorders with characteristic psychoticsymptoms, such as delusions, hallucinations, and disordered thought patterns during the activephase of the illness, anddurationof at least six months.Seasonal Affective Disorder(SAD)—Severe bouts of feeling down all of the time, low energy,problems with sleep and appetite and have difficulty functioning at home and at work, during thefall and winter seasons.Selective Serotonin Reuptake Inhibitor (SSRI)—A class of compounds used as antidepressantsin the treatment of depression, anxiety disorders, and some personality disorders.Self-Actualization—A state of wellness andfulfilmentthat can be achieved once certain humanneeds are satisfied; living to ones full potential.Self-Efficacy—Belief in one’s ability to accomplish a goal or change a behaviour.Self-Esteem—Confidence and satisfaction in oneself.Social Bonds—The degree to which people are integrated into and attached to their families,communities, and society.Social Health—The ability to interact with the people around us as well as our capability tofunction as a contributing member of society while helping others to do the same.Social Isolation—A feeling ofunconnectednesswith others caused by andreinforced byinfrequency of social contacts.Social Phobia—A severe form of social anxiety marked by extreme fears and avoidance of socialsituations.Social Responsibility—A principle or ethical theory that suggests governments, corporations,organizations, and individuals have a responsibility to contribute to the welfare of society.Social Supports—The care and security that family, friends, colleagues, and professionalsprovide us.Spiritual Health—The ability to identify one’s basic purpose in life and to achieve one’s fullpotential; the sense of connectedness to a greater power.

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Spiritual Intelligence—The capacity to sense, understand, and tap into the highest parts ofourselves and the world around us; also described at times asintuition.Stigma—A severe social disapproval; also a situation where people are discriminated against,subjected to violence and abuse, and not allowed to participate fully in society.Suicide—Taking one’s own life; a leading cause of death,usually the result of a tragicconsequence of emotional and psychological problems.Values—The criteria by which one makes choices about one’s thoughts,actions,goals, andideals.CHAPTER OUTLINEI.WhatIs PsychosocialHealth?1.Psychosocialhealthencompasses emotional, mental, social, and spiritual states.2.Emotional health generally refers to feelings and moods.3.Mental health describes our ability to perceive reality as it is, to respond to itschallenges, and to develop rational strategies for living.4.Spiritual health involves our ability to identify our basic purpose in life and toexperience thefulfillmentof achieving our full potential.5.In Canada, we are entering a time when First Nations spirituality is being respectedand embraced as a living faith tradition and a way of healing.6.Culture helps to define psychological health.A.Emotional Intelligence1.Emotional intelligence has five components:self-awareness, altruism, personalmotivation, empathy, and the ability to love and be loved by friends, partners, andfamily members.II.How Can I Lead a Fulfilling Life?1.Positive psychology is an approach that emphasizes building personal strengthsrather than simply treating weaknesses.2.A key belief is that young people who learn to be optimistic and resilient are lesslikely to suffer from mental disorders and more likely to lead happy, productivelives.

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A.Know YourNeeds1.Maslow believed that human needs are the motivating factors in personalitydevelopment.2.First we must satisfy basic physiological needs(food, water, shelter, sleep, andsexual expression), then higher needs, although few individuals reach self-actualization—functioning at the highest possible level.3.Erikson’s Theory of Psychosocial Developmentexplores three aspects of identity—ego identity (self), personal identity (our peculiarities), and social/cultural identity(the roles weplay)—and how social experience shapes an individual throughouthis/her lifetime from birth to death.B.Clarify Your Values1.Values—the criteria by which you evaluate things, people, events, and yourself—represent what’s most important to you.2.Milton Rokeach distinguished between two types of values:a.Instrumental values represent ways of thinking and acting that we holdimportant.b.Terminal values represent goals, achievements, or ideal states that we strivetoward.3.Values are more than ideals we’d like to attain; they should be reflected in the waywe live day by day.C.Strengthen YourSelf-Esteem1.Self-esteem—belief or pride in ourselves—gives us the confidence to achieve atschool or work and to reach out to others.2.Self-esteem is not based on external factors—it develops over time; the seeds of self-esteem are planted in childhood.3.One of the most useful techniques for bolstering self-esteem and achieving yourgoals is developing the habit of positive thinking and talking.4.Self-esteem has proven to be one of the best predictors of college and universityadjustment.D.ManageYour Moods1.A mood is a sustained emotional state that colours our view of the world for hours ordays.2.The most effective way to banish a bad mood istochangewhat caused it in the firstplace.3.Cognitive reappraisal orreframinghelps you look at a setback ina new light.4.Exercise consistently ranks as the single most effective strategy for banishing badfeelings.5.Leisure activity and connecting with friends can also elevate mood.III.Feeling in Control1.Albert Bandura’s social cognitive theory ofhuman functioning suggests that self-efficacy—our belief that we canproduce an effect—is a foundation of humanmotivation, well-being, and personal accomplishments.A.Developing Autonomy

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