Education

1. DETERMINANTS OF HEALTH
AND TAKING RISKS
PUP 2224
JOYCE SCRUTTON

2. LEARNING OUTCOMES 1 AND 2
• 1. ANALYSE PATTERNS OF HEALTH, DISEASE AND INEQUALITY AND HOW THEY CAN IMPACT
UPON THE LONG TERM HEALTH OF ADULTS.
• 2. DEMONSTRATE AN ENHANCED UNDERSTANDING OF HOW PHYSICAL, SOCIAL AND
PSYCHOLOGICAL HEALTH DETERMINANTS IMPACT UPON ADULTS WITH LONG TERM CONDITIONS.

3. AIMS OF THE SESSION: USEFUL
INFORMATION FOR YOUR ASSIGNMENT!
• To revisit lay concepts of health
• To define what ill health means
• To revisit wider determinants
• To define ‘risky behaviours’ in context with government policy
• Link risk to health outcomes (physical, psychological, social)
• Discuss barriers to health advice/services
• Consider the Gallagher family; view of health, risk taking behaviour, wider determinants and how
these impact upon the Gallagher with a long term condition

4. LAY CONCEPTS OF HEALTH
• Most sociological studies of lay health beliefs agree that public conceptions of health and illness
vary according to the immediate material & social circumstances in which people find
themselves. These circumstances can act to constrain the possibilities for action to change an
'unhealthy lifestyle'. For example;
‘SMOKING AND LUNG CANCER HAS BEEN SEEN BY SOME AS NOT LINKED’(DH 2004)

5. REVISITING HEALTH: ACTIVITY
• WRITE ONE SENTENCE OF YOUR OWN VIEW OF THE TERM ‘HEALTH’
• CONSIDER IF THIS IS YOUR PERSONAL BELIEF OR IF IT IS INFLUENCED BY YOUR STATUS OF
STUDENT NURSE
• WHAT DO YOU THINK INFLUENCES YOUR OWN ‘HEALTH?’

6. ILL HEALTH
• WHAT DO YOU CONSIDER AS ‘ILL HEALTH’
• WHAT DETERMINES ILL HEALTH?
• THINK ABOUT A TIME WHEN YOU OR A CLOSE FRIEND/FAMILY MEMBER HAS BEEN UNWELL – NOTE
DOWN THE EFFECTS OF THIS ILLNESS IN PHYSICAL, PSYCHOLOGICAL AND SOCIAL MEANINGS

7. PROFESSIONAL VS LAY CONCEPTS ABOUT
BEHAVIOUR
From a professional point of view binge- drinking is seen to be harmful, risky behaviour that needs to be
brought under control. The ‘binge- drinker’ is almost viewed as being deviant. Binge- drinking is seen as
being bad for your health (Courtney &Polich, 2009)
Drawing on lay perspectives, binge- drinking is often viewed as being much less problematic the practice
is viewed as a way of ‘letting your hair down’ and creating space to be free from inhibitions and the
stresses of modern day life. Binge- drinking can therefore be seen as almost being ‘good’ for health, a
way of managing or coping with stress for example. The benefits of the practice are seen to outweigh the
negatives

8. DAHLGREN AND WHITEHEAD (1991)
DETERMINANTS OF HEALTH

9. http://www.bridgingthegap.scot.nhs.uk/understanding-health-
inequalities/introducing-the-wider-determinants-of-health.aspx

10. ACTIVITY
• LOOK AT THE ‘RAINBOW DIAGRAM’AND LIST HOW EACH SECTION INFLUENCES YOUR OWN
HEALTH AND WELLBEING
• HOW MUCH CONTROL DO YOU THINK YOU HAVE OVER EACH LAYER/SECTION?

11. DETERMINANTS AFFECT INDIVIDUAL, FAMILY,
COMMUNITY AND POPULATION HEALTH
• AGE, GENDER AND HEREDITARY FACTORS INFLUENCE OUR THOUGHTS ON
HEALTH AND ILLNESS (Tones & Green 2010)
1. Individual lifestyle factors differ according to social class (DH 2010a)
2. Social and community influences affect our views about health and influence health choices
(Bradshaw 1972)
3. Employment, education, housing are all factors that influence health and illness (Rowntree 2010)
4. Socio-economic position, cultural beliefs and environmental issues all influence our wellbeing
(Acheson 1988)

12. SO, WHAT IS MEANT BY RISKY BEHAVIOUR?
‘Risky behaviours are those that potentially expose people to harm, or significant risk of harm
which will prevent them reaching their potential’(Rollnick&Miller 2008)

13. RISKY BEHAVIOURS ACCORDING TO
DEPARTMENT OF HEALTH (2010B)
• SMOKING
• ALCOHOL MISUSE
• DRUG MISUSE
• LOW CONSUMPTION OF FRUIT AND VEGETABLES
• LOW LEVEL OF PHYSICAL EXERCISE
• SEXUAL BEHAVIOUR

14. ACTIVITY
• SELECT ONE TOPIC FROM THE LIST
• WRITE DOWN WHAT RISKS THESE POSE FOR PHYSICAL HEALTH, SOCIAL HEALTH AND
PSYCHOLOGICAL HEALTH
• CAN YOU THINK OF ANY POTENTIAL PUBLIC HEALTH CONCERNS THAT MAY EMERGE FROM THESE
BEHAVIOURS?

15. WHY DON’T PEOPLE LISTEN?
• THINK ABOUT HEALTH PROMOTION AND YOUR ROLE AS A STUDENT NURSE
• WHY DO YOU THINK PEOPLE MAY NOT TAKE YOUR ADVICE?
• THINK ABOUT THE TOPIC YOU HAVE JUST DISCUSSED. WHAT SERVICES DO YOU KNOW OF THAT ARE
IN PLACE TO SUPPORT PEOPLE?
• WHAT ARE THE BARRIERS TO ACCESSING THE SERVICES AND WHAT ARE THE CONSEQUENCES?

16. TAKING RISKS WITH YOUR OWN HEALTH
• IN PAIRS IDENTIFY ONE RISK YOU HAVE TAKEN WITH YOUR OWN HEALTH IN THE PAST FOUR
WEEKS. CONSIDER PHYSICAL, SOCIAL, AND PSYCHOLOGICAL HEALTH.
• DISCUSS WHETHER THIS RISK WAS ACCEPTABLE TO YOU AND WHY
• WOULD YOU CHANGE YOUR BEHAVIOR BASED ON HOW YOUR COLLEAGUE/FRIEND REACTED TO
YOUR CONFESSION?

17. POINTS TO CONSIDER
• Does a persons view of health influence their risk taking behavior? ie if you value your social
health you may drink alcohol to support your social life
• Speaking to people about their health related behaviour involves judgement – the students
‘judged’ each other
• Our values may influence how and when we speak to patients about their lifestyles
• WE MAKE ASSUMPTIONS

18. THE GALLAGHERS: ACTIVITY
• DIVIDE INTO GROUPS OF TEN
• SELECT A GALLAGHER
1. LOOK AGAIN AT THE ‘RAINBOW DIAGRAM’AND LIST HOW EACH SECTION INFLUENCES YOUR CHOSEN GALLAGHERS
HEALTH AND WELLBEING
2.HOW MUCH CONTROL DO YOU THINK THEY HAVE OVER EACH LAYER/SECTION?
3. WHAT RISKS IS YOUR GALLAGHER TAKING WITH THEIR HEALTH? (CONSIDER PHYSICAL, SOCIAL, AND PSYCHOLOGICAL
HEALTH)
4. HOW DIFFICULT WOULD IT BE FOR YOUR CHOSEN GALLAGHER TO CHANGE HIS BEHAVIOR? DO YOU THINK HE SHOULD?
5. WHAT SERVICES ARE AVAILABLE TO SUPPORT YOUR GALLAGHER AND WHY DO YOU THINK HE/SHE MAY NOT ACCESS THESE
SERVICES?

19. CLINICIAN ASSUMPTIONS
(ROLLNICK & MILLER 2008)
• This person ought to change
• This person wants to change
• Health is the prime motivating factor.
• If the person doesn’t change the intervention/service has failed.
• People are either motivated or they are not
• Now is the right time for the person to consider change.
• A tough approach is best.
• I am the expert.

20. BEHAVIOUR AND CHANGE
• Clinicians generally find that altering patients' health behaviour (helping them to stop smoking,
exercise, etc.) is agonizingly slow and difficult. (Tones & Green 2010)
• Reliance on solely a behaviour change approach has been criticized as ‘victim blaming’ for
placing the onus on the individual (Rowntree 2010)

21. A SNEAKY BIT OF LEARNING OUTCOME 4
• ‘The promotion of positive health is the mutual responsibility of the individual, who has to take
responsibility for his/her own health by adopting healthy behaviour, and of the state, which also
has responsibility through the development and implementation of national and local health
policy to address the wider determinants of health in order to improve the health status of the
nation (DH 2010b)
THEREFORE
• **NURSES NEED TO BE AWARE OF POLICY AGENDA WHEN CONSIDERING ADVICE ABOUT
INITIATIVES THAT HELP ADDRESS HEALTH NEEDS

22. HOWEVER, BEING CRITICAL I WOULD AGREE
THAT…….
‘It is relatively easy to agenda set and communicate simple information. It is increasingly difficult
to change attitudes, teach complex skills and persuade to adopt behaviours, especially where these
involve exertion, discomfort, or the abandoning of pleasure’ (Tones & Green 2010)
ANY QUESTIONS?

23. REFERENCES
• Acheson, D (1988) Public Health in England. London: HMSO
• Bradshaw, J.R (1972) The Concept of Social Need. New Society, 496: 640-43
• Courtney, K.E., Polich, J (2009) Binge drinking in young adults: Data, definitions and determinants.
Journal of Advanced Nursing (1): 142-56
• Dahlgren, G.,Whitehead, M (1991) Policies and strategies to promote social equity in health. Institute
for Future Studies, Stockholm (Mimeo)
• Department of Health (2004) Choosing Health: making healthy choices easier. London: HMSO
• Department of Health (2010a) Improving the Health and Wellbeing of People with Long Term
Conditions. London: DH
• Department of Health (2010b) Healthy Lives, Healthy People: our strategy for public health in England.
London. DH

24. • Rollnick, S., Miller, W.R and Butler, C.C (2008) Motivational interviewing in Health Care:
helping patients change behavior. New York. Guilford Press
• Rowntree (2010) Monitoring Poverty and Social Exclusion. http://www.jrf.org.uk (accessed on
9/4/14)
• Tones, B.K., Green, J (2010) Health Promotion. Planning and Strategies. London. Sage
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