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

1. Lawrence W. Green and Robert A. Hiatt
Oxford Textbook of Public Health

2. 
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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. 
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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. 
Simple or discrete
behaviours
( injuriesinfections)

complex behaviour
(chronic diseases)

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. 
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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. Sep 20, 2007 issue of the New England Journal of Medicine,
Dr. Steven A.

8. Sep 20, 2007 issue of the New England Journal of Medicine,
Dr. Steven A.

9. Physical, social and
environmental causes
Health,
Disease,
Injuries or
Death
Behavioral
Causes
Health-care
environmental causes

10. 
intentionally most dramatic
(automobile, gun)

Unintentionally most
dramatic (toxic substances,
slippery surface)
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Less dramatic , but no less
lethal (DI, smoking, alcohol,
inactivity)

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. 
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. 
Predisposing factors
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Enabling factors

Reinforcing factors

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11
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5
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4
10
15
3
9

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. 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. 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. 
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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. 
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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. 
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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. 
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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

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

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. 
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.