PUBLIC HEALTH                 MYTHS AND REALITIES:                                         International University       ...
WHAT IS                                                    Section I                               PUBLIC                 ...
TWO PARABLESStarfishDownstreamers                    改善
A New Parable of      the Downstreamers           Daniel Jordan, PhD, ABPP, drdanj@roadrunner.comAdapted and Revised From:...
People Were Drowning! Downstream villagers saw the first  drowning person in the river many  years ago, but they could of...
People Kept Drowning! But more drowning people kept  floating down the river. Sometimes it took hours to pull  dozens fr...
People Kept Drowning! The Downstreamers wrote a grant  to get specialized life saving  equipment. They raised private fu...
But Things Just Got Worse! The number of victims kept  increasing, so . . . They analyzed specific patterns of  how peop...
Finally Things Improved! Outcomes research showed that  Downstreamers’ rescues increased  from 27.8% to 62.3% in 20 minut...
Downstreamers were Proudof Services and Supports . . . New hospital at the edge of the river, A flotilla of rescue boats...
Downstreamers are Proudof Services and Supports . . . This has been good for the economy A lot of “good people” have goo...
. . . But Some Downstreamers Disagree They believe that people need to take  care of themselves They’re upset with havin...
Both Groups Overlook Some Key Questions.Someone finally asks . . .
What’s Going on      Upstream??!!Who Keeps Throwing People     in the River??!!    Are systemic causes getting people in t...
And then in the mostRadical Act of All . . .
. . . a couple of Downstreamers Shift       their focus:They ask why drowningpeople are in the river at             all
Even Worse:   They decide to go  upstream to find outwho is throwing people in the river, and even    worse than that:   T...
Many Downstreamers GetUpset with the Questioners Some complain that the people going  upstream are too radical. If people...
Many Downstreamers Say  These People are too        Radical The couple are told they should keep  working “inside the sys...
The Downstreamers Act! Downstreamers hold a meeting and  decide to ostracize the couple. The couple load their car to go...
And Everyone Upstreamand Downstream Lived  Happily Ever After  Except for the drowning people of course, and those who wan...
PUBLIC HEALTH IS . . . A shift in focus: The community,  society Serve individuals for community  welfare Community is ...
HYPOTHESIS IIf we just keep helping people at the individual level, the needs will be the same or worse 10, 20, 100 years...
HYPOTHESIS IIThe degree, extent or rate of inequality and discrimnination are the two most consistent predictors of socia...
SIX TENETS THAT                       MAINTAIN INEQUALITY    Elitism is efficient (and efficiency is     good)    Exclus...
NASW ETHICAL RESPONSIBILIT Y:   SOCIAL JUSTICE & DISCRIMINATIONPursue social change, with and for vulnerable and oppresse...
NASW ETHICAL RESPONSIBILIT Y:         TO BROADER SOCIET YPromote general welfare of society, local to global levels, deve...
NASW ETHICAL RESPONSIBILIT Y:     SOCIAL & POLITICAL ACTIONEngage in social and political action to ensure that all peopl...
NASW ETHICAL RESPONSIBILIT Y:     SOCIAL & POLITICAL ACTIONAct to expand choice and opportunity for all, especially vulne...
NASW ETHICAL RESPONSIBILIT Y:     SOCIAL & POLITICAL ACTIONAdvocate cultural competence, and policies that safeguard righ...
NASW ETHICAL RESPONSIBILIT Y:        GLOBAL SOCIAL JUSTICEAct to prevent and eliminate domination of, exploitation of, an...
FUNDAMENTAL CONCEPTPublic health is about helping people find ways to lead healthier lives, in every sense.Public health...
THREE COREFUNCTIONSTENESSENTIALPUBLICHEALTHSERVICESSYSTEMMANAGEMENT       改善
More                     Lower steps can                          be used to Citizen Control         influence higher   ...
PRAXIS &                    CRITICAL                  COMMUNITY                                                           ...
Community worker                              Community workerseeks:                                        raises awarene...
PUBLIC HEALTH AND     COMMUNIT Y TRANSFORMATIONShow up, shut up, and ListenIn other words,therapists have a lotto offer e...
WHAT WE HAVE TO OFFER THE       COMMUNIT Y                            改善
改善
SERIOUS INCREASES IN DISEASES AND             ILLNESSESExposure to toxins, pesticides, poisonsAir quality: diesel exhaus...
FAST FOOD NATION, FAST FOOD WORLD                                改善
HERE’S WHERE WE GOT OFF COURSESince 1991 US obesity rates increased 74%.                                         改善
NAURU: MOST OBESE NATION ON EARTH           95% OBESIT Y Average BMI = 35 (obesity = height to weight ratio >30)         ...
CONSIDER THE MOST OBESE    NATION ON EARTH                          改善
PUBLIC            HEALTH                                                    Section VI              AND        INEQUALITY©...
HEALTH DATA STATISTICS: PART ONEMillions, perhaps billions have been spent on obesity and diabetes reduction and treatmen...
HEALTH PATTERNSHypothesis: The greater the degree of inequality in a society the higher the levels of virtually every typ...
WORKING DEFINITIONS     Level of income disparity [inequality] in the      study was the difference between the upper    ...
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
Drill Down Example                  CDC DATA:             OBESITY AND                DIABETES                             ...
Obesity Trends* Among U.S. Adults                             BRFSS, 1985                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1986                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1987                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1988                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1989                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1990                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1991                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1992                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1993                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1994                 (*BMI ≥30, or ~ 30 lbs. overweig...
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults                   Note the Percentage Scale:  ...
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
CONCLUSIONS     Growing inequality will result in increasing      rates of disease and illness     Rich developed societ...
CONCLUSIONS     In brief: two main ways of reducing      income inequality          smaller differences in pay before ta...
WHAT IF WE REDUCED INEQUALIT Y?     Trust among people, and quality of life,      would go up 75%     Mental Illness and...
WHAT ABOUT THE RICH?     Increasing equality is good for everyone,      the rich included.     Life gets better for all:...
ARE WE                                                    Discussion                       KILLING OUR                    ...
WHAT’S THE BIG DEAL?• In 1974 The Lancet identified obesity as “the  most important nutritional disease in the  affluent c...
改善
A NUMBER OF NEW YORKERS ARE UPSET BY MAYOR  BLOOMBERG’S SODA BAN, SAYING THAT IT IS A CHANGE THAT WILL DRAMATICALLY EFFECT...
ABOUT “IT’S JUST   ONE SODAx 365 days/year = 15 pounds of body fatSo-called “juice drinks” and“power drinks” are just asba...
ABOUT RESTAURANTS• A typical restaurant portion size is two to  three times more than servings should be.• We’ve been conn...
ABOUT RESTAURANTS• Kids get hit the hardest: They get twice as  many calories in restaurant meals than they  need.• This s...
“SPEC” MODEL:                      ISAAC PRILILTENSKY Traditional Focus                          Transformative Focus Defi...
DO OUR CURRENT HEALTH SYSTEMS               WORK?No. If they did, we would see successes. “A trap we must avoid, set by ...
RESULTS OF HEALTH EDUCATION1. education has weak effects, if any;2. it drains resources;3. it makes industry seem on the s...
ABOUT INDIVIDUAL BEHAVIORThis epidemic is about more than just individual behavior.Analyzing only individual behavior, a...
QUESTIONSSo why does the US continue spend any money at all on health information and education, obesity prevention, heal...
CONSIDER“If people want to drink 24 ounces of soda, it’s their choice, and nobody else’s business.” Does social, economi...
“CLEAN SHEET” EXERCISEBrainstorming Context: Forget everything you know about health, healthcare, mental health, substanc...
“CLEAN SHEET” EXERCISE If we were to create a health system from scratch  today, how would we organize ourselves and allo...
CLEAN SHEET EXERCISE Try to develop something that you could work toward  in your own community. How would you design yo...
CORE ASSUPTION:            CONTEXT MATTERSIf we keep doing things the way we do them right now, 50 years from (assuming t...
DISCUSSIONSmall group presentations.What are the implications of using the NASW standards and to reform the helping prof...
ADDITIONAL REFERENCES      B un ke r JP, Fra z i er H S, M o s teller F. Im prov i ng h e a lt h: m e a suring e f fe c t...
CONTACT FOR MORE INFORMATION     About this presentation:          Daniel Jordan, PhD, ABPP at           publichealth@iu...
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Public Health: Myths and Realities

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Presented at the International University for Graduate Studies annual residency program in St. Kitts and Nevis, July 13, 2012.

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  • @OrangeKrate Jim, FYI, I uploaded my Mass Fatality Planning presentation presented at NACCHO a couple of years ago.

    http://www.slideshare.net/DrDanJordan/mass-fatality-planning-daniel-jordan-phd
    I see a serious issue in disaster planning of resistance to addressing truly large scale disasters, e.g., earthquake scenarios are never beyond the capacity of existing infrastructure. My point is it can happen. We need to develop plans as tools for people to recover more effectively. Thus my mass fatality plan addresses what to do if, e.g., more than 10, 20% of the population died in a pandemic, and no mutual aid were on the way. (drdanj@roadrunner.com)
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  • @OrangeKrate Jim, hey thanks for the kind comments. I'd really like to find ways for people in health professions to have discussion of the kinds of issues I raised in this IUGS seminar.
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  • Dan your presentation is brilliant as always. I will show this to my daughter who is currently a nursing student. I will share the link with my professional colleagues too. Outstanding job. Solid work friend. Jim Eads
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Public Health: Myths and Realities

  1. 1. PUBLIC HEALTH MYTHS AND REALITIES: International University for Graduate Studies July 2012 Daniel Jordan, www.iugrad.edu.kn PhD, ABPP 改 善© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  2. 2. WHAT IS Section I PUBLIC HEALTH?© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改 善
  3. 3. TWO PARABLESStarfishDownstreamers 改善
  4. 4. A New Parable of the Downstreamers Daniel Jordan, PhD, ABPP, drdanj@roadrunner.comAdapted and Revised From: Ardell, D. (1986). The Parable of the Downstreamers. High Level Wellness: An Alternative to Doctors, Drugs & Disease. Ten Speed Press. Berkeley, CA.
  5. 5. People Were Drowning! Downstream villagers saw the first drowning person in the river many years ago, but they could offer little help. No one knew how to swim, so they organized swim training. Some even got certificates and advanced degrees.
  6. 6. People Kept Drowning! But more drowning people kept floating down the river. Sometimes it took hours to pull dozens from the river, and then only a few would survive. Some drowners even jumped back into the water and were swept away.
  7. 7. People Kept Drowning! The Downstreamers wrote a grant to get specialized life saving equipment. They raised private funds to build a waterside rescue facility. Volunteers staffed it 24/7. They finally got funds for paid staff.
  8. 8. But Things Just Got Worse! The number of victims kept increasing, so . . . They analyzed specific patterns of how people were floating down the river, looked for specific eddies and currents, then modified those water flow patterns to reduce local risks and improve the ability to respond
  9. 9. Finally Things Improved! Outcomes research showed that Downstreamers’ rescues increased from 27.8% to 62.3% in 20 minutes or less, 16.7% are saved in 7 minutes or less! Downstreamers were very proud! They wrote articles, attended conferences, got awards
  10. 10. Downstreamers were Proudof Services and Supports . . . New hospital at the edge of the river, A flotilla of rescue boats ready, Comprehensive plans for staffing Highly trained and dedicated swimmers ready to risk their lives Mental health counselors deal with trauma
  11. 11. Downstreamers are Proudof Services and Supports . . . This has been good for the economy A lot of “good people” have good paying jobs, they also feel productive and useful, fulfilled Downstreamers hold an awards banquet every year They get government honors and grants, newspaper articles
  12. 12. . . . But Some Downstreamers Disagree They believe that people need to take care of themselves They’re upset with having to help people “who won’t help themselves” by learning to swim They say other needs go unmet, and they are being taxed to death for people who arent Downstreamers anyway, send them back where they came from No new taxes!!!!!!
  13. 13. Both Groups Overlook Some Key Questions.Someone finally asks . . .
  14. 14. What’s Going on Upstream??!!Who Keeps Throwing People in the River??!! Are systemic causes getting people in trouble?
  15. 15. And then in the mostRadical Act of All . . .
  16. 16. . . . a couple of Downstreamers Shift their focus:They ask why drowningpeople are in the river at all
  17. 17. Even Worse: They decide to go upstream to find outwho is throwing people in the river, and even worse than that: They decide to do something about it.
  18. 18. Many Downstreamers GetUpset with the Questioners Some complain that the people going upstream are too radical. If people are drowning, it’s their own fault. Others worry that trying to change things will mean people drowning right now won’t get helped. Their work is important. But: What if drowning people stopped floating down the river?
  19. 19. Many Downstreamers Say These People are too Radical The couple are told they should keep working “inside the system,” thats how change really happens. Don’t make waves, even more people will drown. Theyre told not to make too much of a fuss, it isnt polite, and funders might decide to stop giving grants. The couple say theyre going anyway and start to pack.
  20. 20. The Downstreamers Act! Downstreamers hold a meeting and decide to ostracize the couple. The couple load their car to go upstream. Downstreamers rush the couple, grab them, and throw them into the river. They float away.Problem solved!
  21. 21. And Everyone Upstreamand Downstream Lived Happily Ever After Except for the drowning people of course, and those who wanted to reduce the need.
  22. 22. PUBLIC HEALTH IS . . . A shift in focus: The community, society Serve individuals for community welfare Community is the client Social model not medical model Physical, mental, and emotionalContext MattersWhat is the responsibility of the primary care provider? 改善
  23. 23. HYPOTHESIS IIf we just keep helping people at the individual level, the needs will be the same or worse 10, 20, 100 years from now. 改善
  24. 24. HYPOTHESIS IIThe degree, extent or rate of inequality and discrimnination are the two most consistent predictors of social problems 改善
  25. 25. SIX TENETS THAT MAINTAIN INEQUALITY Elitism is efficient (and efficiency is good) Exclusion is necessary Prejudice is natural Greed is good Despair is inevitable, and is the goal to assure conformity [These conditions are sustainable]Derived from Danny Dorling, Injustice: why social inequality persistshttp://sasi.group.shef.ac.uk/presentations/injustice/ 改善
  26. 26. NASW ETHICAL RESPONSIBILIT Y: SOCIAL JUSTICE & DISCRIMINATIONPursue social change, with and for vulnerable and oppressed individuals and groups: Confront poverty, unemployment, discrimination, and other forms of injusticeNot practice, condone, facilitate, or collaborate with any form of discrimination based on race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, or mental or physical disability 改善
  27. 27. NASW ETHICAL RESPONSIBILIT Y: TO BROADER SOCIET YPromote general welfare of society, local to global levels, development of people, communities, and environmentsAdvocate living conditions that fulfill human needsPromote social, economic, political, and cultural values and institutions to realize social justice 改善
  28. 28. NASW ETHICAL RESPONSIBILIT Y: SOCIAL & POLITICAL ACTIONEngage in social and political action to ensure that all people have equal access to resources, employment, services, and opportunities to meet basic human needs and develop fullyBe aware of impact of politics on practiceAdvocate for changes in policy and laws to improve conditions to meet basic human needs and promote social justice 改善
  29. 29. NASW ETHICAL RESPONSIBILIT Y: SOCIAL & POLITICAL ACTIONAct to expand choice and opportunity for all, especially vulnerable, disadvantaged, oppressed, and exploited people and groupsPromote respect for cultural and social diversity nationally and globallyPromote policies and practices that show respect for difference, support expansion of cultural knowledge and resources 改善
  30. 30. NASW ETHICAL RESPONSIBILIT Y: SOCIAL & POLITICAL ACTIONAdvocate cultural competence, and policies that safeguard rights of and confirm equity and social justice for all people 改善
  31. 31. NASW ETHICAL RESPONSIBILIT Y: GLOBAL SOCIAL JUSTICEAct to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class based on race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, or mental or physical disability 改善
  32. 32. FUNDAMENTAL CONCEPTPublic health is about helping people find ways to lead healthier lives, in every sense.Public health’s roots tap into social work activism about the betterment of society.Public health standards are divided into three core functions further broken down into ten essential services 改善
  33. 33. THREE COREFUNCTIONSTENESSENTIALPUBLICHEALTHSERVICESSYSTEMMANAGEMENT 改善
  34. 34. More Lower steps can be used to Citizen Control influence higher steps, e.g., therapy Empowerment can be a tool to raise awareness to Delegated Power educate and TEN LEVELS OF Partnership empower people. Education Placation Consultation CHANGE Informing Therapy Modified from, Arnstein, Sherry R. Eight Rungs on the Ladder of Citizen Manipulation Participation. In Cahn, Edgar S. and Passet, Barry A, eds. CitizenLess Participation: Effecting Community Change. New York, Praeger, 1971., p. 70. 改善
  35. 35. PRAXIS & CRITICAL COMMUNITY Section II EDUCATION: EMANCIPATION FOR EMPOWERMENT Role of the change agent© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改 善
  36. 36. Community worker Community workerseeks: raises awareness• To gain acceptance Identify of health and social PRAXIS & by community Felt issues, e.g., help• Listens and Needs community CRITICAL empathises members develop COMMUNITY• Encourages video voice maps EDUCATION: expression of ideas of environ-mental Identify conditions, public EMANCIPA- Community speaking exercises TION FORSuccess breedssuccess. New needs Leaders EMPOWER-identified by community MENTmembers. They Identify root causesdevelop skills and gain of social problems,confidence to Provide e.g.,environmental,undertake new tasks. Supports social, economic, Develop political Community From: Tones. K. Skills Self- (2002) Reveille Advocacy for Radicals! Praxis: Stage of The paramount Reflection and Action: purpose of Establish health Solutions identified, Community education. discussed, and acted on Oxford J. Coalitions Community Action 改 改 善
  37. 37. PUBLIC HEALTH AND COMMUNIT Y TRANSFORMATIONShow up, shut up, and ListenIn other words,therapists have a lotto offer efforts tochange the contexts thatcause social problems 改善
  38. 38. WHAT WE HAVE TO OFFER THE COMMUNIT Y 改善
  39. 39. 改善
  40. 40. SERIOUS INCREASES IN DISEASES AND ILLNESSESExposure to toxins, pesticides, poisonsAir quality: diesel exhaust, carbon monoxideNoise pollution (leads to decreased academic performance)Water pollutionPerverse incentives: Fast food would not be cheaper without tax incentives to produce those types of products 改善
  41. 41. FAST FOOD NATION, FAST FOOD WORLD 改善
  42. 42. HERE’S WHERE WE GOT OFF COURSESince 1991 US obesity rates increased 74%. 改善
  43. 43. NAURU: MOST OBESE NATION ON EARTH 95% OBESIT Y Average BMI = 35 (obesity = height to weight ratio >30) 改善
  44. 44. CONSIDER THE MOST OBESE NATION ON EARTH 改善
  45. 45. PUBLIC HEALTH Section VI AND INEQUALITY© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改 善
  46. 46. HEALTH DATA STATISTICS: PART ONEMillions, perhaps billions have been spent on obesity and diabetes reduction and treatment.Have the numerous campaigns to reduce the rates of obesity and diabetes been effective?Time period: 1985-2010 (Note: the CDC changed its reporting methods in 1995) 改善
  47. 47. HEALTH PATTERNSHypothesis: The greater the degree of inequality in a society the higher the levels of virtually every type of social problem, including health problems. Sources  Wilkinson and Pickett. The Spirit Level: Why Greater Equality Makes Society Stronger http://www.equalitytrust.org.uk/  The State of Working America Economic Policy Institute: Working Group on Extreme Inequality http://www.stateofworkingamerica.org / http://extremeinequality.org/  20 Facts About US Inequality Everyone Should Know http://www.stanford.edu/group/scspi/cgi -bin/facts.php 改善
  48. 48. WORKING DEFINITIONS Level of income disparity [inequality] in the study was the difference between the upper 20% and the lowest 20%. Inequality can be low one of two ways:  Everyone is relatively rich or Everyone is relatively poor  Examples:  Arkansas: Low inequality, low overall income  New Hampshire: Low inequality, high overall income  Correlation is not causation, but . . .  When a hypothesis can be formed, and literally dozens of measures all point in the same direction, a case begins to emerge that two factors that correlate consistently are likely to have a causal relationship.© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改善
  49. 49. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  50. 50. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  51. 51. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  52. 52. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  53. 53. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  54. 54. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  55. 55. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  56. 56. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  57. 57. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  58. 58. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  59. 59. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  60. 60. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  61. 61. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  62. 62. © Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com
  63. 63. Drill Down Example CDC DATA: OBESITY AND DIABETES Case Study: Trends in Diagnosed Obesity and Diabetes CDC’s Division of Diabetes Translation. November, 2011 National Diabetes Surveillance System: http://www.cdc.gov/diabetes/statistics© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改 善
  64. 64. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% Note the Percentage Scale
  65. 65. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% Note the Percentage Scale
  66. 66. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% Note the Percentage Scale
  67. 67. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% Note the Percentage Scale
  68. 68. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% Note the Percentage Scale
  69. 69. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% Note the Percentage Scale
  70. 70. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% Note the Percentage Scale
  71. 71. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% Note the Percentage Scale
  72. 72. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% Note the Percentage Scale
  73. 73. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% Note the Percentage Scale
  74. 74. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults Note the Percentage Scale: 14% was the original high
  75. 75. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  76. 76. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  77. 77. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  78. 78. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  79. 79. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  80. 80. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  81. 81. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  82. 82. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  83. 83. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  84. 84. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  85. 85. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  86. 86. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  87. 87. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  88. 88. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  89. 89. Age -Adjusted Prevalence of Obesity andDiagnosed Diabetes Among U.S. Adults
  90. 90. CONCLUSIONS Growing inequality will result in increasing rates of disease and illness Rich developed societies have reached a turning point in sustainability Politics needs to become about the quality of social relations and how we can develop harmonious and sustainable societies. Inequality predicts disease and illness Focusing on individual behavior offers little opportunity for change.© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改善
  91. 91. CONCLUSIONS In brief: two main ways of reducing income inequality smaller differences in pay before tax (e.g., Japan) redistribution through taxes and benefits (e.g., Sweden) Economic and Political Democracy are both necessary to improve health (US and UK have neither right now)© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改善
  92. 92. WHAT IF WE REDUCED INEQUALIT Y? Trust among people, and quality of life, would go up 75% Mental Illness and Obesity would drop by 65% Teen births would be cut in half Prison populations could drop by half People would live longer and could work two weeks less a year as well. Etc. . . . .© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改善
  93. 93. WHAT ABOUT THE RICH? Increasing equality is good for everyone, the rich included. Life gets better for all: Remember, quality of life is NOT related to income or wealth within a society. The rich may think they wind up better off, but in the end they lose as well.© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改善
  94. 94. ARE WE Discussion KILLING OUR KIDS?© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改 善
  95. 95. WHAT’S THE BIG DEAL?• In 1974 The Lancet identified obesity as “the most important nutritional disease in the affluent countries of the world.” • Infant and adult obesity [editorial]. Lancet 1974; i:17 -18.• What happened since then? We got fatter.• Worldwide, we’re dying at higher rates and nations are becoming obese.• It’s a syndemic: Obesity, diabetes, asthma, other related diseases are tied together. 改善
  96. 96. 改善
  97. 97. A NUMBER OF NEW YORKERS ARE UPSET BY MAYOR BLOOMBERG’S SODA BAN, SAYING THAT IT IS A CHANGE THAT WILL DRAMATICALLY EFFECT THEIR LIFEST YLE. 改善
  98. 98. ABOUT “IT’S JUST ONE SODAx 365 days/year = 15 pounds of body fatSo-called “juice drinks” and“power drinks” are just asbad.They all rot your teeth.Half of Americans’ caloriescome from soda. Half! 改善
  99. 99. ABOUT RESTAURANTS• A typical restaurant portion size is two to three times more than servings should be.• We’ve been conned into measuring quality of food in terms of quantity.• We get far more saturated fat and far fewer nutrients than we should. We’re starving while becoming obese. 改善
  100. 100. ABOUT RESTAURANTS• Kids get hit the hardest: They get twice as many calories in restaurant meals than they need.• This simple fact yields a population of kids that is amazingly obese, will have lifelong health problems, and will die younger than they should.• Our marketing system is killing our kids, and we’re letting it happen. 改善
  101. 101. “SPEC” MODEL: ISAAC PRILILTENSKY Traditional Focus Transformative Focus Deficits-based Strengths-based Reactive Primary Prevention Individual & Family Empowerment Professional-driven Community Conditions Role shift: From “expert helpers” to “critical change agents” Focus shift: From individual to community (context) Power shift: From “providers” to community members Locus of control shift: From victim to empowered actorHttp://people.Vanderbilt.edu/~isaac.prilleltensky 改善
  102. 102. DO OUR CURRENT HEALTH SYSTEMS WORK?No. If they did, we would see successes. “A trap we must avoid, set by the food industry [is] the belief that education is the answer to nutrition problems. The ostensible rationale is that people do not understand nutrition, that educating them will drive up demand for healthier foods, and that the industry will be happy to meet that demand. The hidden rationale is that such programs will have little impact, allowing industry to do business as usual. I can see industry executives jump with glee each time government officials point to education as the answer.”  Kelly D. Brownell. http://www.latimes.com/news/opinion/la -op-dustup19sep19,0,1026838.story 改善
  103. 103. RESULTS OF HEALTH EDUCATION1. education has weak effects, if any;2. it drains resources;3. it makes industry seem on the side of consumers; and4. it bolsters industrys hope that government will allow it to self-regulate while government agencies sit on the sidelines.5. It is the “perfect” script for public health failure.• K e l l y D . B r o w n e ll. h t t p : / / www. la t i m e s . c o m / n e ws / op in io n / l a - o p- d us t u p 19 s e p1 9 , 0 , 1 0 26 8 38 . s t o r y 改善
  104. 104. ABOUT INDIVIDUAL BEHAVIORThis epidemic is about more than just individual behavior.Analyzing only individual behavior, assigning blame just to each individual does not explain the stunning change in the pattern of behavior across individuals.Something more than just “individual responsibility” is going on. (But that doesn’t let individuals off the hook!) 改善
  105. 105. QUESTIONSSo why does the US continue spend any money at all on health information and education, obesity prevention, healthy lifestyles, etc., when it clearly does not work?If a similar pattern were experienced in any domain – private business, government, non- profit – what would you advise be done?Follow the money: Who benefits from these realities?The Point: You have to dig deeper. 改善
  106. 106. CONSIDER“If people want to drink 24 ounces of soda, it’s their choice, and nobody else’s business.” Does social, economic, political context have an impact on individual behavior? Are we “free” in some abstract way or does the context in which we live impact our choices? 改善
  107. 107. “CLEAN SHEET” EXERCISEBrainstorming Context: Forget everything you know about health, healthcare, mental health, substance abuse, wellness, systems and programs.Using the core assumption: If you were free to spend a health budget however you could, what would you do? 改善
  108. 108. “CLEAN SHEET” EXERCISE If we were to create a health system from scratch today, how would we organize ourselves and allocate resources, and what would be our community priorities? Work in small groups and develop clean sheet systems of care. Brainstorm wild ideas as well as practical. Choose a policy domain(s) of interest to your group. You can focus on real agencies, your own communities, local entities, state or national policy, your choice. 改善
  109. 109. CLEAN SHEET EXERCISE Try to develop something that you could work toward in your own community. How would you design your approach to developing your plan? Who would you talk to? What procedures would you use to implement your plan? How would you promote it? What community-level indicators would you measure? 改善
  110. 110. CORE ASSUPTION: CONTEXT MATTERSIf we keep doing things the way we do them right now, 50 years from (assuming the world hasn’t imploded) the next generation will be doing exactly the same things we’re doing now.Only the need will be even greater.The more an intervention engages power equalization, the more transformative it will be (Isaac Prilitensky) 改善
  111. 111. DISCUSSIONSmall group presentations.What are the implications of using the NASW standards and to reform the helping professions, health care plans in this case?15 minute small groups, design a broad intervention strategy. 改善
  112. 112. ADDITIONAL REFERENCES  B un ke r JP, Fra z i er H S, M o s teller F. Im prov i ng h e a lt h: m e a suring e f fe c t s o f m e di c al c a re . M i l ba nk Qua r te rl y 1 9 9 4 ; 7 2: 2 25 - 5 8.  B o l en JR, Sl e et DA , Ch o rba T, et a l . Ove r view o f e f fo r t s to preve n t m oto r ve h icle - relate d i n jur y. In : P reve nt ion o f m oto r ve h ic le -rela ted i n j uries: a c o m pe ndium o f a r t i c l es fro m t h e M o rbi di t y a n d M o r t a l it y We e kly Re po r t , 1 9 8 5 - 1 9 9 6 . At l a n t a, G e o rg ia: US D e pa r t m e nt o f H e a l t h a n d H um a n Se r v i c es, Ce n te r s fo r D i s ease Co n t ro l a n d P reve n tio n, N a t i o nal Ce n te r fo r In j ur y P reve nt ion a n d Co n t ro l, 1 9 97.  H oye r t D L, Ko c h a ne k K D , M urphy SL. D e a t h s : fi n a l da t a fo r 1 9 97. H ya t t s ville , M a r y l an d: US D e pa r t m e nt o f H e a l t h a n d H um a n Se r v i c es, CD C, N a t i o n al Ce n te r fo r H e a l t h St a t i s tic s, 1 9 9 9 . ( N a t ion al v i t a l s t a t ist ic s re po r t ; vo l 47 , n o . 2 0).  CD C. Fa t a l o c c upa t i onal i n juri es - - Un i te d St a te s , 1 9 8 0 - 1 99 4. M M WR 1 9 9 8 ; 47: 2 97 - 30 2.  An o nymo us. Th e s i x t h re po r t o f t h e Jo i n t N a t i o nal Co m mit tee o n P reve nt ion , D ete c t i on , E va lua t ion, a n d Tre a t m ent o f H i g h B l o o d P re s sure . Arc h In te rn M e d 1 9 97 ; 157: 241 3 - 4 6.  B ur t B A , E k l und SA . D e n t ist r y, de n t a l pra c t i c e , a n d t h e c o m mun it y. P h i ladelphia , Pe n n sy lvania: WB Sa un de r s Co m pa ny, 1 9 9 9 : 2 04 - 2 0.  P ubl i c H e a l t h Se r v i c e. Fo r a h e a lt hy n a t i on : ret urn s o n i nvest ment i n publ i c h e a lt h . At l a n t a, G e o rgia : US D e pa r t m e nt o f H e a l t h a n d H um a n Se r v i c es, P ubl i c H e a l t h Se r v i c e, Of fi c e o f D i s ease P reve nt ion a n d H e a l t h P ro m ot ion a n d CD C, 1994.© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改善
  113. 113. CONTACT FOR MORE INFORMATION About this presentation: Daniel Jordan, PhD, ABPP at publichealth@iugrad.edu.kn About the International University for Graduate Studies graduate programs: www.iugrad.edu.kn© Daniel Jordan, PhD, ABPP, drdanj@roadrunner.com 改善
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