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Lawrence W. Green and Robert A. Hiatt
Oxford Textbook of Public Health
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Target of public health approaches.
The shifting role of behaviour ( simple-complex)
Behavioural risk fac...





control or cajole the healthrelated behaviour of
individuals.
protect individuals from the
behaviour of others, an...


Simple or discrete
behaviours
( injuriesinfections)



complex behaviour
(chronic diseases)


the simple and discrete behavior can be
influenced directly by health education
targeted at individuals and groups.


...






Some behaviour clearly increases the risk of
developing disease.
Other behaviours correlate with and precede
bet...
Sep 20, 2007 issue of the New England Journal of Medicine,
Dr. Steven A.
Sep 20, 2007 issue of the New England Journal of Medicine,
Dr. Steven A.
Physical, social and
environmental causes

Health,
Disease,
Injuries or
Death

Behavioral
Causes

Health-care
environmenta...


intentionally most dramatic
(automobile, gun)



Unintentionally most
dramatic (toxic substances,
slippery surface)

...


behaviour remains a critical
mediator of the relationships
between environmental measures
and health outcomes.



impr...


Genes, via their influences on morphology
and physiology, create a framework within
which the environment acts to shape...


Predisposing factors



Enabling factors



Reinforcing factors
13

1
6

11

12

7
14
2

5

8

4

10
15

3

9
1- Educational strategies inform
and educate the public about
issues of concern such as :
 the dangers of drug misuse,
 ...
2- Automatic-protective strategies are directed
at controlling environmental variables, that
minimize the need for individ...
3- Coercive strategies employ legal and other
formal sanctions to control individual
behaviour, such as:
 required immuni...





Population behavioural and educational
diagnoses enable public health to intervene
strategically on the behaviour ...





Through Human Genome Project genetics
information became available to individuals.
The first assumption remains to...




the limited influence of the genes so far
implicated in specific mortality or morbidity
outcomes, and their interact...




The threshold effects are
sometimes found beyond
income or other SES
indicators.
The gradient adheres
whether the SE...
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





SES as a predisposing determinant of
behaviour
SES as an enabling determinant of behaviour
The educational en...


‘denormalization’ of smoking behaviour in
public places. legal restrictions- social norms



The combination of new sm...






These differences cannot be attributed solely
to biological determinants related to sexual
differentiation
The so...


The dynamic relationships among
the specific measures creates a
complex system of social,
economic, cultural, and
behav...


public health programmes shuold plan for behaviour
change in three categories of determinants:


direct communications to influence the
knowledge, attitudes beliefs, and perceptions of
the population concerning the b...


Behaviour is an inescapable link in the chain of
causation between most environmental and genetic
determinants and the ...
Behavioral determinant
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Behavioral determinant

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Target of public health approaches.
The shifting role of behaviour ( simple-complex)
Behavioural risk factors (itself- determinant-consequent)
determinants of behaviour
Public health strategies to influence determinants of behaviour
The interaction of socioeconomic status (SES), environments, and behaviour
Denormalizing behaviour
Public health interventions and conclusion

Published in: Health & Medicine, Technology
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Behavioral determinant

  1. 1. Lawrence W. Green and Robert A. Hiatt Oxford Textbook of Public Health
  2. 2.         Target of public health approaches. The shifting role of behaviour ( simple-complex) Behavioural risk factors (itself- determinantconsequent) determinants of behaviour Public health strategies to influence determinants of behaviour The interaction of socioeconomic status (SES), environments, and behaviour Denormalizing behaviour Public health interventions and conclusion
  3. 3.    control or cajole the healthrelated behaviour of individuals. protect individuals from the behaviour of others, and mobilize the behaviour of groups to influence healthrelated social and physical environments.
  4. 4.  Simple or discrete behaviours ( injuriesinfections)  complex behaviour (chronic diseases)
  5. 5.  the simple and discrete behavior can be influenced directly by health education targeted at individuals and groups.  complex behavior required combination of educational, organizational, economic, and environmental interventions in support of changes in both behaviour and conditions of living.
  6. 6.     Some behaviour clearly increases the risk of developing disease. Other behaviours correlate with and precede better health, but their causal link is more tenuous. many behaviours are, in fact, contributing causes (causal risk factors) of specific diseases. the easiest examples of clear causal linkages are those established for single action behaviours such as ingesting a contaminated food
  7. 7. Sep 20, 2007 issue of the New England Journal of Medicine, Dr. Steven A.
  8. 8. Sep 20, 2007 issue of the New England Journal of Medicine, Dr. Steven A.
  9. 9. Physical, social and environmental causes Health, Disease, Injuries or Death Behavioral Causes Health-care environmental causes
  10. 10.  intentionally most dramatic (automobile, gun)  Unintentionally most dramatic (toxic substances, slippery surface)  Less dramatic , but no less lethal (DI, smoking, alcohol, inactivity)
  11. 11.  behaviour remains a critical mediator of the relationships between environmental measures and health outcomes.  improvement of the socioeconomic condition is accompanied by a shift in mortality  the three most important predictors of infant mortality rates were households sanitation, literacy rate, and safe water.
  12. 12.  Genes, via their influences on morphology and physiology, create a framework within which the environment acts to shape the behavior of an individual.  Genes also create the scaffold for learning, memory, and cognition that can be used in shaping behavior.  The environment can affect morphological and physiological development; in turn behavior develops as a result of that mechanism.
  13. 13.  Predisposing factors  Enabling factors  Reinforcing factors
  14. 14. 13 1 6 11 12 7 14 2 5 8 4 10 15 3 9
  15. 15. 1- Educational strategies inform and educate the public about issues of concern such as :  the dangers of drug misuse,  the benefits of automobile restraints,  the relationship of maternal alcohol consumption to foetal alcohol syndrome.  …..
  16. 16. 2- Automatic-protective strategies are directed at controlling environmental variables, that minimize the need for individual decisions in structuring each behaviour, such as:  milk pasteurization,  fluoridation,  infant immunizations, and  the burning of marijuana crops.  ……………….
  17. 17. 3- Coercive strategies employ legal and other formal sanctions to control individual behaviour, such as:  required immunizations for school entry, mandatory tuberculosis testing of hospital employees,  compulsory use of automobile restraints.  arrests for drug possession or use.  …………
  18. 18.    Population behavioural and educational diagnoses enable public health to intervene strategically on the behaviour of populations. But health problems have other determinants in the environment and in genetics. Behaviour also can play a role in influencing those determinants.
  19. 19.    Through Human Genome Project genetics information became available to individuals. The first assumption remains to be supported by true evidence of effectiveness (susceptibility to illness-sensitivity to drug) The second assumption, that having such information would motivate more concerted effort to change one's behaviour
  20. 20.   the limited influence of the genes so far implicated in specific mortality or morbidity outcomes, and their interactions with the environment . the ethics of offering such information to the individual with anything more than a cautionary note of possible relevance to their reproductive decisions or their behavioural choices
  21. 21.   The threshold effects are sometimes found beyond income or other SES indicators. The gradient adheres whether the SES measure is education, income, occupational status, or place of residence
  22. 22.       SES as a predisposing determinant of behaviour SES as an enabling determinant of behaviour The educational enabling influence of SES on behaviour The cultural-environmental predisposing influence of SES SES as a reinforcing determinant of behaviour The ‘status identity factor’ and social norms
  23. 23.  ‘denormalization’ of smoking behaviour in public places. legal restrictions- social norms  The combination of new smoke-free or ‘clean air’ ordinances and by-laws with mass media emphasizing the carcinogenic properties of second-hand smoke and the rights of nonsmokers
  24. 24.    These differences cannot be attributed solely to biological determinants related to sexual differentiation The social construct of gender, as opposed to the biological categories of sex, was conceptualized to refer to cultural and social conventions, roles and behaviours assigned to men and women The gender interactions with SES and health have been variously attributed to differential occupational experiences
  25. 25.  The dynamic relationships among the specific measures creates a complex system of social, economic, cultural, and behavioural factors.  The system interwoven with disease risk factors and health status, and influenced by the healthcare and physical environments.
  26. 26.  public health programmes shuold plan for behaviour change in three categories of determinants:
  27. 27.  direct communications to influence the knowledge, attitudes beliefs, and perceptions of the population concerning the behaviour-health relationship;  indirect communications through social organizations, parents, peers, employers, and others who control rewards and approval that would reinforce behaviour.  legal, engineering, financial, organizational levers and resource development that would enable or prohibit the behaviour.
  28. 28.  Behaviour is an inescapable link in the chain of causation between most environmental and genetic determinants and the health outcomes in which they are implicated.  The social environment presents a further complexity in the mediating and moderating of behaviour and environment in their determination of population health.  The individuals are acting upon, and in reaction to, each other as their health outcomes are being shaped by their actions.

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