Cagayan State University

Foundation
of Health Care Learning
Module

Vilma T. Villaluz

2020
 Unit 1:
Enhanced Health for Individual
(12 hours)

Introduction

How does health affect your everyday life?

The WHO Constitution (1946) envisages “…the highest attainable standard of
health as a fundamental right of every human being.”
The 1987 Philippine Constitution, Article II, Section 15 declares that “The
State shall protect and promote the right to health of the people and instill
health consciousness among them. Also, Articles XIII, on Social Justice and
Human Rights on Health, declares to “adopt an integrated and comprehensive
approach to health development, to make essential goods, health and other
social services available and affordable, priority for the needs of the under-
privileged, sick, elderly, disabled, women, and children.
Public health can appear to be a world of ‘don’ts’: don’t smoke, don’t eat that.
don’t touch that. don’t do that. Promoting health at the population levels starts
with encouraging healthy behavior at the individual level. Sometimes, the
public health community has to identify and warn against behaviors that may
harm us. After all, the purpose of public health isn’t treatment: It’s to facilitate
the choices you, as an individual, should make to preserve your good health
and the health of those around you. But health problems don’t exist simply
because people don’t know what choices they should make. Is the problem
really that people do not know which foods are healthy, or that exercise is
important or that smoking has adverse health effects? Or are there societal,
environmental and economic pressures that make the ‘healthiest’ choice less
feasible or even impossible? Factors such as structural inequalities, financial
constraints and limited access to health resources limit the autonomy people
have over their health decisions. Public health and clinical medicine work in
tandem. Since we do not live in a world of perfect equality, prevention cannot
be the only line of defense between people and disease. So, to maintain the
health of a population by ensuring the health of individuals, the public health
sector and the clinical health sector need to collaborate. With an exponentially
growing world population and finite health resources, public health and
clinical medicine cannot afford to operate independently of one another; they
must work in tandem.
In this unit, you will learn the concept of public health, evolving definitions of
health from the different writers including the inclusion of spiritual aspect on
the definition of World Health Organizations commended by Pope John Paul
the II. Several dimensions of health, Health Continuum into optimal health,
relative and dynamic nature of health, perception of health, health behaviors of
young people, influences the health of individuals and a typology of nursing
problems in family nursing practice.

Learning Objectives
At the end of this unit, students will be able to:

 Define Health.

Presentation of Contents

Topic I. HEALTH (definition is evolving)

“Health is an importance resource. It is a means to an end. In order to be

productive in society, a PERSON must be healthy in all aspects.

Technical definitions of health have changed over time and general definitions
range from person to person. If you google definitions of health one of the first
definitions to come up is:

The state of being free from illness or injury

However, this definition is very limiting and does not take into account the
various dimensions of health and their interaction with each other. The World
Health Organization (WHO) has a more full definition of health:

Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.

This definition from WHO has not changed since 1948 and identifies the
physical, mental and social dimensions of health, but still neglects the spiritual
and emotional dimensions.

The definitions of health above could easily be simplified to be a state of

complete well-being. However, they could also be expanded to say:

Health is a state of complete physical, mental, social, emotional and spiritual

well-being, not merely the absence of disease or infirmity. (Pope John Paul II)

Today if you asked anyone they would have a different definitions for health,
though many would focus on the physical dimension of health and think of it
as the absence of disease or injury, as well as the mental aspects of health.
Frequently people leave out the social, emotional and spiritual dimensions.

1.1. Check out the video below for some more subjective definitions of
health.
https://youtu.be/GGxPL37j234?
list=PLesvqngPCeVPwV0eyoG9H0Q6D7TsCQ6Eq

These definitions of health show that there is a general consensus around

health as both a physical and mental issue, but there is still more work to be
done in order to get the general public to understand that health consists of all
five (5) dimensions of health.

[1] Preamble to the Constitution of the World Health Organization as adopted

by the International Health Conference, New York, and 19-22 June, 1946;
signed on 22 July 1946 by the representatives of 61 States (Official Records of
the World Health Organization, no. 2, p. 100) and entered into force on 7 April
1948.

A dynamic state or condition which is multidimensional in nature and results

from the adaptation to his/her environment.

Health is an optimum level of functioning of an individual.

Definition of Health by: Ottawa Charter for health promotion (1986)

Health is a resource of everyday life, not the objective of daily living. It is a
positive concept emphasizing social and personal resources as well as physical
capacities. An enabling factor that will allow a person to achieve his or her
life’s aspirations, whether for himself for herself, his or her family or for the
Community as whole.

Health is the ability to maintain internal milieu. Illness is the result of failure
to maintain internal environment (Claude Bernard).

Health is the ability to maintain homeostasis or dynamic equilibrium.

Regulated by negative feedback mechanisms (Walter Cannon).

Health is being well and using one’s power to the fullest extent. Health is
maintained through prevention of disease via environmental health factors
(Nightingale).

Positive health symbolizes wellness. It is a value term defined by the culture

or individual. (Rogers)

Health is a state of process of being and becoming an integrated and whole

person. (Roy)

Health is a state characterized by soundness or wholeness of developed

human structures and of bodily and mental functioning (Orem).

Health is dynamic state in the life cycle: illness is an interference in the life
cycle (KING)

Wellness is the condition in which all parts and subparts of an individual

are in harmony with the whole system (Neumann).

Health is viewed in terms of individual’s ability to perform 14 components of

nursing care unaided (Virginia Henderson):

1. Breathe normally. Eat and drink adequately.

2. Eliminate body wastes.
3. Move and maintain desirable postures.
4. Sleep and rest.
5. Select suitable clothes-dress and undress.
6. Maintain body temperature within normal range by adjusting clothing and
Modifying environment.
7. Keep the body clean and well-groomed.
8. Avoid dangers in the environment and avoid injuring others.
9. Communicate with others in expressing emotions, needs, fears, or opinions.
10. Worship according to one’s faith.
11. Work in such a way that there is a sense of accomplishment.
12. Play participate in various forms of recreation.
13. Learn, discover, or satisfy the curiosity that leads to normal development
and health
14. Use the available health facilities.
The first nine (9) components are physiological.
The tenth and fourteenth are psychological aspects of communicating and
learning.
The eleventh component is spiritual and moral.
The twelfth and thirteenth components are sociologically oriented to
occupation and recreation

Health is an elusive, dynamic state influenced by biologic, psychologic, and

social factors. Health is reflected by the organization, interaction,
interdependence and integration of the subsystems of the behavioral system.
(Johnson).

Health is a state of wellbeing in which the person is able to use purposeful,

adaptive responses and processes physically, mentally, emotionally,
spiritually, and socially. (MURRAY 2009).

Health is an actualization of inherent and acquired human potential through

goal directed behavior, competent self-care, and satisfying relationship with
others. (Pender’s 2006)

Health is a state of person that is characterized by soundness or wholeness of

develop human structures and bodily and mental functioning (Orem 2001).

Application

Feedback

1. Fill in “What I have Learned” column by writing down what you have
learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned

TOPIC 2. Several Dimensions of Health

 Learning Objectives
At the end of this unit, students will be able to:

 Differentiate several dimensions of health.

.

Presentation of Contents

According to Saylor (2004). WHO definition considers.

There are five (5) dimensions of health: physical, mental, emotional, spiritual,
and social. These will provide a full picture of health as a change in any
dimension affects the others.

Five (5) Dimensions of Health

Physical
The physical dimension of health refers to the bodily aspect of health. It refers
to the more traditional definitions of health as the absence of disease and
injury. Physical health ranges in quality along a continuum where a
combination of diseases such as cancer, diabetes, cardiovascular disease or
hypertension are at one end and a person who is at optimum physical
condition (think health not fitness) is at the other.
Physical health can affect the other dimensions of health as a decline in
physical health can result in a decline in other forms of health. E.g. a person
who suddenly gets the flu is often isolated socially as to not infect others,
struggles to focus in order to study or learn anything new, and may feel sad as
a result of their isolation.
The body has a natural health ability and is programmed for balance
(homeostasis). 

What is the quality with which your body functions on a daily basis?

Mental
Mental health refers to the cognitive aspect of health. Often mental health is
linked to or includes emotional health, I want to distinguish the two. Mental
health is more the functioning of the brain, while emotional health refers to the
person’s mood often connected to their hormones. Mental health then includes
many mental health issues such as Alzheimer’s and dementia. It refers to the
person’s ability to use their brain and think. This may be to solve problems or
to recall information, but the focus is on the cognitive aspect of the person.
Mental healthcare affect the other dimensions of health. An increase in mental
health can come as a result of increased physical activity, and good mental
health can then lead to an increase in self-esteem as mental performance
improves. Greater self-esteem then leads to more confidence in social
situations and can lead one to ask the larger questions about life leading to
increased spiritual health.

What is the quality of growth and intellectual expansion in all areas of your
life?

Emotional
Emotional health is about the person’s mood or general emotional state. It is
our ability to recognize and express feelings adequately. It relates to you self-
esteem as well as your ability control your emotions to maintain a realistic
perspective on situations. The relationship between emotional and mental
health is clear and as such some illnesses relate to both, such as: depression
and anxiety.
Emotional health affects the other dimensions of health as a person with a
good self-esteem is more confident in social settings, makes friends quickly
and often performs better in physical activity.

What is the quality of your emotional expression and understanding?

Spiritual
Spiritual health relates to our sense of overall purpose in life. People often find
this purpose from a belief or faith system, while others create their own
purpose. A person who has purpose to life is said to be healthier than those
who don’t see a purpose to life.
Spiritual health will very easily affect emotional and mental health as having a
purpose in life can help you to apply yourself to achieving goals. Having a
purpose to life can also help people to maintain a proper perspective on life
and overcome adversity. Often people who are spiritual meet together
regularly around their spiritual purpose, which helps to improve their social
health.

What is the quality of the spiritual dimension in your life?

Social
The social dimension of health refers to our ability to make and maintain
meaningful relationships with others. Good social health includes not only
having relationships but behaving appropriately within them and maintaining
socially acceptable standards. The basic social unit of relationship is the
family, and these relationships impact a person’s life the most. Other key
relationships are close friends, social networks, teachers, and youth leaders.
Social health affects the other dimensions of health in many ways. A bad
social life can lead a person to question their purpose in life or feel isolated
and unwanted. Such feelings can demotivate people from physical activity and
lead them towards depression.

What is the quality of your interactions and relationships with others?

Application

Feedback

1. Fill in “What I have Learned” column by writing down what you have
learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned

Topic 3. Health Continuum into Optimal Health

Learning Objectives
At the end of this unit, students will be able to:

 Illustrate Health Continuum into optimal health.

Presentation of Contents

Health is not a stationary state of being. All health is in constant flux, as the 5
areas of our health (as mentioned above) engage in a continual dance of
balance that works with our most present needs and alongside our specific
challenges. We are dynamic beings, as is all life, and this dynamic exchange is
the core of the health continuum. So whether you are doing relatively well
right now, or are plagued by some condition, you can still always make a
difference in the quality of your life. This is where things like the right
nourishment for your body, mind and spirit, can provide amazing support for
achieving complete optimal health.
We can visualize the health continuum as a type of scale, where on one end is
optimal health and wellness, while on the other end of the spectrum is
extremely poor health. Where you fall on the scale right now and how you can
change your position, depends on several key factors in your life. The first
step to achieving optimal health is acknowledging those 5 areas of complete
health in your life and reflecting accordingly on each of the questions that
accompany it.

Examine the following diagram:

There are numerous degrees that separate each ranking on the Health

Continuum Scale. It is, perhaps, impossible to determine the number of
degrees of separation between each level or have a universal ranking system,
 as each human being is so diverse in their thinking, body composition, activity
levels, amount of health problems, etc. The most important factor to see is that
we all fall somewhere on that scale. Subsequently, if you are not satisfied with
where you fall on the scale right now, you are not stuck with where you rank
today. Through conscious living in all areas of your life, you are able to climb
towards achieving complete optimal health, and oscillating within that range if
you continue with positive health habits.

Here are some key pointers to give you an idea to which end of the health
continuum you currently belong to and therefore what state your complete
health is in:

You are near the top end of the Health Continuum if:

1. You have a strong self esteem

2. You have an excellent ability to meet life’s demands
3. You do not compare yourself or compete with others
4. You have a healthy lifestyle (i.e. eat right, exercise, don’t smoke, etc.)
5. You have positive social relationships
6. You have a healthy balance between your mind, body, and spirit
7. You are not inflicted with any diseases
8. You do not experience common undesirable physical symptoms
9. You have an effective way of handling any debilitations or disabilities.

You are near the bottom end of the Health Continuum if:

1. You often go through emotional breakdowns

2. You have a poor image of yourself
3. You constantly feel inadequate
4. You have an unhealthy lifestyle (i.e. poor eating habits, lack of exercise,
smoking, etc.)
5. You live in isolation from others or feel isolated or alone, even when amongst
others
6. You often feel depressed and/or have mental illness
7. You lack a healthy balance between your mind, body, and spirit
8. You suffer from various physical illnesses
9. You are unable to cope with a severe mental or physical disability

Conclusion:

Remember that health is not constant throughout one’s life, as it depends on

many factors. Hence doing the right thing today may not guarantee positive
results for the future. It all depends at how you engage all 5 areas of your
health at any given time. At the same time, engaging in poor habits today,
does not mean that you are scarred for life. Your health is dynamic, your body
is resilient, and your mind is malleable. The optimal health that you can create
at any given time will come from a consistent application and attention to all 5
areas of your health.
The most important thing to do is to effectively engage in seeking, integrating,
and applying new information and habits that are most in alignment with what
you want and need. You may find it easy to adjust your thoughts, habits, and
actions accordingly to be in alignment with complete optimal health, or you
may find that no matter how much you try, it is a struggle for you. Either way,
be loving with yourself or take things one step at a time. Remember: there is
lots of information and help out there today that can improve any or all areas
of your health. All you have to do is make the choice to accept it into your life
and change your current status quo. Stepping out of your comfort zone may be
tough, but it does not serve you to stay in an area that you are unsatisfied with.
Life is meant to be enjoyed, so don’t sabotage your health! Rather, engage
mindfully in creating healthy habits that positively influence each of the 5
areas of your health. (Evita Ochel).

Application

Feedback

1. Fill in “What I have Learned” column by writing down what you have
learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned

Topic 4. The relative and dynamic nature of health.

Learning Objectives
 At the end of this unit, students will be able to:

 Distinguish relative and dynamic nature of health

Presentation of Contents

The relative nature of health refers to the use of others to compare the health

status of a particular person. The term relative means:

Considered in relation or in proportion to something else:

Relative and dynamic nature of health

Therefore, the relative nature of health is when a person decides that an elite
sports person is healthier than their friend who is into tennis. Or when you
look at your friends and decide that these three (3) are healthier than you, but
that you are healthier than the rest. However, this is hard to say objectively
due to the dimensions of health coming into play. Many people use physical
appearance to determine the relative health of another without thinking about
the social, spiritual, mental or emotional aspects of health.

The dynamic nature of health refers to the fact that the health status of anyone
is continually changing and can change dramatically with little notice. A
person may well have been healthy yesterday, but today there was a dramatic
event that has caused ill to their health. This could be an injury, sickness,
bullying, divorce, questioning of faith, or being kicked off a sports team.

Health, however, more frequently changes slowly. Think of the older person
who frequently talks about how they used to go to the gym, played at an elite
level, used to eat their vegetables or used to be thin and active. Maybe they
used to have a vibrant social life, have lost their parents, or have simply let
themselves go (see video below). Some people develop lifestyle diseases, most
of which slowly develop.

4.1. Check video on relative and dynamic nature of health:

https://youtu.be/9dL4lN6GKi4?
list=PLesvqngPCeVPwV0eyoG9H0Q6D7TsCQ6Eq
Others may change for the better and start to eat a healthy diet, take up a new
sport, subscribe to a particular religion or have made a new friend. All of these
can have a positive impact on health.

Health can also change because of a change in circumstance. Think of the

person who starts at a new school after moving states because their parents
divorced. They need to redevelop their social life, may become depressed and
anxious. They need to find new ways to be physically active etc. Other people
may not have money to choose to eat better food, or may live in an area with
little or no access to gyms, or sporting fields. They may have long distances to
travel to meet up with friends or have someone show them that their belief
system is flawed.

Application

Feedback

1. Fill in “What I have Learned” column by writing down what you have
learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned

Topic 5. Perceptions of health

Learning Objectives
At the end of this unit, students will be able to:

 Describe perceptions of health.

Presentation of Contents

Perceptions of health is a natural progression from the relative nature of

health. The term perception is about how something is interpreted and
understood. It is similar to perspective, but is not limited to what you see, but
how you interpret what you see.

E.g. the glass is half full or half empty. The technical definition of perception:

The way in which something is regarded, understood, or interpreted

This dot point then, focuses on how health is regarded, understood and
interpreted. It relates to people’s opinions of health and how these opinions are
formed. How something is understood often relates to preconceived ideas and
belief systems, which are affected by society around us. This includes: media,
family and peers influences on your understanding of health, as well as
considering how society as a whole influences your construct of health – what
it means? How to be healthy? Etc. Everyone has an idea of what health is, and
what health is to you will be different from what it is to the person next to you
and the person across the other side of the world. These ideas of health are
very subjective and open to change. They also affect your behavior, and if
your perception of your health is incorrect it can lead to dangerous behaviors.

5.1 Check on the video on perceptions of health:

https://youtu.be/KnlaS6CsuYk

Perceptions of their Health

Your perception of your own health will change over time as your health
changes and as any of the above change. For example, if you become more
educated about the five dimensions of health, you may realize that four aspects
of your health are great, but you still need to work on your physical health.

As you consider perceptions of their health, you are asked to examine these
perceptions of health by considering the following questions
How healthy am I? How healthy do other people think I am?

As you consider how healthy you think you are, you should also consider why
you might think this? Especially if you consider yourself unhealthy and others
disagree and think you are healthy, or vice versa. It is important for you to
consider why such differences may occur. It could be a cultural background or
people not knowing what you eat when they are not looking. It could be the
impact of family or friends that cause them or you to think differently.

Try placing yourself on the health continuum and asking others to do the same
for you and see what the differences are. Make sure you ask them why they
have placed you there on the continuum? As this is what is important.

Perceptions of their health is all about you. How do you see your health and is this
accurate?

Perceptions of the health of others

Your perceptions of the health of others is largely influenced by your view of health
and what you know about the person. Just like your view of your own health was
influenced by your level of education, beliefs, family and more, so your perception of
the health others is affected by them. However, unlike our view of our own health, we
tend to judge others very superficially. Many of us perceive elite athletes, models etc
as healthy. Our society has worked hard to tell us that being healthy means being
beautiful, but this is not the truth. Given that health consists of five dimensions and
looks relates only slightly to one of them, then we cannot make health judgements
based on these criteria alone.
Our perceptions of the health of others is open to change. As our
understanding of the person changes, as our education changes, as their health
changes. In order to judge someone else’s health, it is important to have a
better understanding of who they are? What they do? Who is around them?
and more.

If we continue our example of the person who is beautiful, we may think that
they are healthy, but then we question them and discover that they have no
real friends, just lots of acquaintances. They spend lots of time in a gym, but
also eat very little food, and it tends to be junk. This person also has no idea of
their purpose in life, and although seems to be popular at school, rarely goes
out and is emotionally abused at home. Suddenly our perception of their health
changes.

The video below helps to show how our preconceived ideas and bias influence
our thought about, and also our actions towards others.

Implications of different perceptions of health

There are a number of implications of different perceptions of health. This is

true for the individual and for society as a whole. It is important that a
person’s perception of their health is as accurate as possible in order to guide
their behavior in the correct direction. If a society has a false perception of what
health is, this can also have a negative impact on the health of individuals,
governments, organizations and more.

How might an individual’s perception of health affect their behavior and

wellbeing?

At an individual level the implications of different perceptions of health

relates to a person with an inaccurate perception. A classic example of this is a
person with anorexia. Such a person continually sees themselves as
overweight and unhealthy leading to them not eating. However, it does not
have to be so drastic. It could be a person who goes to the gym regularly to
increase muscle mass, and believes that they are healthy. However, they are
not eating fruit or vegetables, spending little time with their family and friends
and often feel sad or angry.

In contrast to someone with a different perception, a person with a correct

perception of their health may acknowledge that they are overweight and that
their weight makes them more likely to have a range of lifestyle diseases:
hypertension, cardiovascular disease, cancer etc. Such as person may then
change their diet, cut out refined sugars, soft drinks, and consume more fruit
and vegetables to correct their health.

As a society, the implications of different perceptions of health can be

devastating for the health of a country. If our perception of health is different
to the truth, then our actions will not improve our health, and may in fact make
it worse.

An example of this may be a society who thinks that being beautiful is the
same as being healthy. This can lead people to go to great extents – anorexia,
fad dieting, surgery, drugs etc – to be “beautiful” thinking that being beautiful
also means they are healthy.

Another possibility is a society that gives too much power to pharmaceutical

companies who then control government legislation, academic organizations,
and produce mass advertising. This leads people to think that the drugs
produced by the pharmaceutical companies are safe and effective, when it may
not be the case. For example, the company’s advertisements make us think
that it is ok to fix a headache caused by dehydration or low blood sugar, by
taking a drug, rather than drinking water or eating a meal. The companies may
also fund a university or Journal alive to public research, which now focuses
on the positive effects of the drugs. Such a society may then begin to become
over-reliant on the drug and may produce further health problems. An example
of this may be the production of superbugs after the over use of antibiotics.

These are just some of the implications of different perceptions of health. The
implications of different perceptions of health then can have a large impact
upon the health of individuals and society as a whole.
Perception of health as social constructs

Perceptions of health as social constructs requires you to understand that the

various understandings and different meanings people have or attribute to
health are mostly created by their society. That is, our understanding and
interpretation of health is created and developed by our society. A good way to
think about it is that your perception of health is greatly affected by your
context. Have you ever wondered the question below, because social
construction is the answer, as well as the previous individual factors
(knowledge, skills, attitude, genetics).

5.2 Check on the video Perceptions of health as social constructs:

https://youtu.be/q9AHBPICjH0

Why would my perceptions of health be similar or different to others?

If you think about a person in a third world country who has no access to clean
water, cannot afford foods other than maze, has lost their family due to war
and lives in a refugee camp. What they think about what it means to be healthy
and what health is will be largely affected by the circumstance of their life.
Compare that to a wealthy business man, who runs an international gym
company, has a university degree in health and spends lots of time with his
family and gets his food delivered from an organic farm. His thoughts and
understanding of health will be very different to the refugee.
Your understanding of perceptions of health as social constructs should
identify that an individual’s interpretation of health is largely influenced by
their: socioeconomic status (education, employment, income), sociocultural
status (family, peers, media, religion, culture), and environment (geographical,
political, social, access to information and technology) among other things.

Perceptions of health as social constructs also means that the interpretation of

health changes with time. This can be seen with the commoditization of fitness
and the growth of the health industry alongside pharmaceuticals and the
medical system. We have many large groups invested heavily in the concept
of health, including what is means to be healthy and how to be healthy.

We also expect people in different contexts and from different cultures to have
different perceptions of health. They have different meanings and
interpretations of health because their understanding is a result of their society,
just as our perception is a result of ours.

Determine the degree to which perceptions of health are socially

constructed:

The degree to which perceptions of health are socially constructed is more

than you think. Our society likes to tell us that we are unique and have come
up with our own ideas and interpretations, but reality is much different. How
we interpret health and what we think it means is more a result of our society
tells us this, than it is us coming up with such an interpretation.

Even sitting in this lesson is society constructing your perception of health.

The government and other bodies, including teachers have decided that you
need to learn what health is. You would have learnt this in your younger years
at school as well. We then all use much the same text or website to get our
information. You will also be affected by the quality of your education, your
parent’s education and the value your culture puts the dimensions of health.

Australia for example, places a much larger emphasis on physical health than
social or spiritual health. Whereas many Asian cultures value social and
spiritual over mental health. The emphasis is a result of the society and what
you think about health, the images that come to mind and the concept of what
health is, is a result of the society in which you live.

Impact of the media peers and family

Considering the impact of the media peers and family is large on any issue, the
effects on this should not be surprising. You probably have already considered
the impact of the media peers and family for other issues, such as health
behaviors or the value you place on health. There is a great impact of the
media peers and family on our perceptions of health. How we understand and
interpret health is largely influenced by those closest to us, including our
friends and family. More and more, our understanding of any concept is being
shaped by media. So, let’s look at some of the impact of the media peers and
family on perceptions of health.

Media
The impact of the media on our perception of health has dramatically
increased with advances in technology. It used to be the case that in order to
see an advertisement you had to walk into town to see a billboard, or go to a
cinema to watch a show. Now we wake up in the morning and the first thing
we do is check our phone.
We now access our magazines, news, sports, friends, clients, businesses,
movies and TV over the internet using personal technology. The increase in
exposure to media has meant a rise on the impact that media can have on our
perception of anything, including health. Media communicates information
about health in two ways: implicit and explicit. The easily identifiable ways
are explicit. Shows like the Biggest Looser, or news articles that discuss the
rising obesity levels or raise awareness for prostate cancer are all explicit.
However, the implicit communication is usually more effective in affecting
our understanding of health and bring about changes in our perception without
us realizing. Implicit communication occurs through movies, marketing and
television shows. The use of beautifully workshopped images to advertise
health products or frequently seeing beautiful actors playing the happy healthy
person affects the way we think about health and then affects our behavior.

Peers
Peers impact our perception of health also, as our frequent conversations occur
with them, and often they are the first person we go to for answers to our
questions. This applies to many things, including health. You will have more
conversations about health with your peers than anyone else. And in groups,
humans tend to adopt the position of the group leader rather than do their own
research and come up with their own understanding and interpretation.
With regards to health, interpretation is usually acquired by the person most
beautiful in the group, or the person who is sportiest. This person may or may
not have a good understanding of health, but regardless, what they say
influences your perception of health. Once the group position health is
established new members will take on this position in order to be in the group,
rather than because it is the right perception.
For example, a group that values health and encourages each other to eat
vegetables and fruit as part of a balanced diet. Who value time together and
accept people putting family first, and may even all believe in the same higher
purpose for life, will cause others to be similar. However, if the group smoke,
drink and drive dangerously, people who join the group are more likely to
accept these behaviors and views of health.
Family
Family possibly have the largest impact on our perception of health. Family
construct the basis of your beliefs, knowledge, wealth, environment, and more
for the first 16-30 years of your life. The opinion of your parents will often
outweigh that of an expert in health because of their position and not their
knowledge. The interpretation you develop concerning health while living
with your parents will likely be the interpretation you have when you are older
and what you pass on to the next generation.
For example, if you are raised in a family that is abusive, smokes, eats fast
food and thinks they are healthy, you are likely to think this as well. However,
if your family go for a walk every day together, eat plenty of nutritious food,
have a thriving social life and have no mental or emotional issues, you are
likely to develop the same habits and values and interpret health within your
upbringing. The impact of the media, peers and family on our perceptions of
health is much larger than what has been touched upon here.

Application

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learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned
TOPIC 6. Health behaviors of young people

Learning Objectives
At the end of this unit, students will be able to:

 Identify the health behaviors of young people.

Presentation of Contents

The health behaviors of young people are often dramatized in the media, with
focus given to risk behaviors among the few. The fact is the health behaviors
of young people in Australia continue to get better as our determinants of
health (environmental, socioeconomic, sociocultural, and individual) also
improve for them. The teacher note just before this dot point says:

When studying this core, emphasis should be on drawing from realistic

contexts relevant to students. These include food habits, body image, physical
activity, drug use, mental health, sexual health and road safety.

6.1 Check out the video below for some health behaviors of young people.
https://youtu.be/in9gklGuGQMhttps://youtu.be/in9gklGuGQM

Protective behaviors and risk behaviors

Health Protective Behaviors

Health protective behaviors are actions linked to decreasing risk factors,

reducing negative health outcomes, and facilitating a healthy lifestyle. Health
protective behaviors can be at the individual, familial, or community level,
which all work together to eliminate risk factors that impair health. Individual
factors incorporate having constructive perceptions about one’s character;
such as a positive self-image, good self-control, and proficient social skills.
Upholding a positive self-image can reduce mental health issues and
encourage confidence in one’s capabilities. Exercising self-control lowers the
risk of substance abuse and various addictions, resulting in better health and
wellbeing.
Adept social skills help individuals function in society. A study published in
the Journal of Health Communication suggests that, “Boosting the frequency
and quality of social interactions could help stave off the negative effects that
stress and loneliness can have on physical and mental health” (Segrin, 2017).
Family and community dynamics work interchangeably, influencing health
protective behaviors. Both offer various types of social support: emotional,
instrumental, belonging, and informational. Emotional support is
encouragement from friends, family, or peers to either stop, start, or continue a
certain behavior. Instrumental support is tangible help; for example, a friend
or family member picking up someone’s child from daycare for them, so that
they can go to the gym. Belonging is when some individual feels most
comfortable, perhaps in particular social settings that promote health
protective behaviors. The last form of social support is informational. This
type of support is derived from information one attains from their social
networks.

Bandura’s social cognitive theory and reciprocal determinism helps to

demonstrate the numerous factors that can affect health protective behaviors.
It demonstrates how the individual and their environment both interact with
and affect one another.

Social Cognitive Theory (SCT) started as the Social Learning Theory (SLT) in
the 1960s by Albert Bandura. It developed into the SCT in 1986 and posits
that learning occurs in a social context with a dynamic and reciprocal
interaction of the person, environment, and behavior. The unique feature of
SCT is the emphasis on social influence and its emphasis on external and
internal social reinforcement.   SCT considers the unique way in which
individuals acquire and maintain behavior, while also considering the social
environment in which individuals perform the behavior. The theory takes into
account a person's past experiences, which factor into whether behavioral
action will occur. These past experiences influences reinforcements,
expectations, and expectancies, all of which shape whether a person will
engage in a specific behavior and the reasons why a person engages in that
behavior.

Many theories of behavior used in health promotion do not consider

maintenance of behavior, but rather focus on initiating behavior. This is
unfortunate as maintenance of behavior, and not just initiation of behavior, is
the true goal in public health. The goal of SCT is to explain how people
regulate their behavior through control and reinforcement to achieve goal-
directed behavior that can be maintained over time. The first five constructs
were developed as part of the SLT; the construct of self-efficacy was added
when the theory evolved into SCT.

1. Reciprocal Determinism - This is the central concept of SCT. This refers

to the dynamic and reciprocal interaction of person (individual with a set of
learned experiences), environment (external social context), and behavior
(responses to stimuli to achieve goals).

2. Behavioral Capability - This refers to a person's actual ability to perform a

behavior through essential knowledge and skills. In order to successfully
perform a behavior, a person must know what to do and how to do it. People
learn from the consequences of their behavior, which also affects the
environment in which they live.

3. Observational Learning - This asserts that people can witness and observe
a behavior conducted by others, and then reproduce those actions. This is often
exhibited through "modeling" of behaviors.   If individuals see successful
demonstration of a behavior, they can also complete the behavior successfully.

4. Reinforcements - This refers to the internal or external responses to a

person's behavior that affect the likelihood of continuing or discontinuing the
behavior. Reinforcements can be self-initiated or in the environment, and
reinforcements can be positive or negative. This is the construct of SCT that
most closely ties to the reciprocal relationship between behavior and
environment.

5. Expectations - This refers to the anticipated consequences of a person's

behavior. Outcome expectations can be health-related or not health-related.
People anticipate the consequences of their actions before engaging in the
behavior, and these anticipated consequences can influence successful
completion of the behavior. Expectations derive largely from previous
experience.   While expectancies also derive from previous experience,
expectancies focus on the value that is placed on the outcome and are
subjective to the individual.

6. Self-efficacy - This refers to the level of a person's confidence in his or her

ability to successfully perform a behavior. Self-efficacy is unique to SCT
although other theories have added this construct at later dates, such as the
Theory of Planned Behavior. Self-efficacy is influenced by a person's specific
capabilities and other individual factors, as well as by environmental factors
(barriers and facilitators).

Limitation of Social Cognitive Theory

There are several limitations of SCT, which should be considered when using
this theory in public health. Limitations of the model include the following:

1. The theory assumes that changes in the environment will automatically lead
to changes in the person, when this may not always be true.

2. The theory is loosely organized, based solely on the dynamic interplay

between person, behavior, and environment. It is unclear the extent to which
each of these factors into actual behavior and if one is more influential than
another.

3. The theory heavily focuses on processes of learning and in doing so

disregards biological and hormonal predispositions that may influence
behaviors, regardless of past experience and expectations.

4. The theory does not focus on emotion or motivation, other than through
reference to past experience. There is minimal attention on these factors.

5. The theory can be broad-reaching, so can be difficult to operationalize in

entirety.

Social Cognitive Theory considers many levels of the social ecological model
in Addressing behavior change of individuals. SCT has been widely used in
health promotion given the emphasis on the individual and the environment,
the latter of which has become a major point of focus in recent years for health
promotion activities. As with other theories, applicability of all the constructs
of SCT to one public health problem may be difficult especially in developing
focused public health programs

Societal perceptions

Our society often has miss-perceptions about young people and their
protective and risk behaviors. Much of this feeds from the media, which likes
to pick up and run with negative stories. Many of these stories portray young
people as taking high risks as they:

 get drunk every weekend

 take illicit drugs, particularly ice
 drag race and speed in their cars
 bully and abuse, or
 participate in sexting and pornography
Often these stories have one or two stories that are used to make sweeping
judgments about young people as a whole. However, it is important to be
mindful of the facts presented in research conducted by the Australian Bureau
of Statistics and Australia’s Institute of Health and Welfare. Publications from
such groups provide facts and figures that indicate that alcohol consumption,
and illicit drug taking is on a decline. While other stories may have some truth
to them, it leads to an overemphasis on the negative side of our young
Australians.

Relevant Issues

A number of relevant health issues for young people. This list includes: food
habits, body image, physical activity, drug use, mental health, sexual health
and road safety. You are required to identify protective behaviors and risk
behaviors for these issues and how the combination of these behaviors
increases or decreases the risk.

For example, risk behaviors for sexual health include:

 becoming sexually active

 watching pornography
 not using a condom
 combining drugs, or alcohol with sexual activity
 sexting, or using media (photos, videos, etc) to record sexual activity
 anal sex

Protective behaviors include:
 abstinence
 sexual education
 having respectful relationships with the opposite sex
 barrier method contraception

When risks are combined, such as a young female who is drunk and does not
use a condom when having sex, greatly increases the risk of contracting a
sexual infection, being recorded (with or without consent), being seen etc.
This then decreases a person’s overall health, including their social, mental,
emotional, physical and spiritual health.
 Application

Feedback

1. Fill in “What I have Learned” column by writing down what you have
learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned

TOPIC 7. Influences the health of individuals:

Learning Objectives
At the end of this unit, students will be able to:

 Determine influences the health of individuals.

Presentation of Contents

What influences the health of individuals is the second critical questions for
Better Health for Individuals. The key to this question is to get a really solid
understanding of the determinants of health. This lays the foundation to better
understand the degree of control people have over their health and how health
is a social construct. The three (3) dot points of this critical question are:

 the determinants of health

 the degree of control individuals can exert over their health
 health as a social construct

The determinants of health are: individual, sociocultural, socioeconomic, and

environmental factors. This is essentially a list of what influences the health of
individuals. Therefore, understanding them deeply is a must. Not only must
you know the determinants, but you must know how they interact to affect a
person’s health, and how certain factors are beyond a person’s control, while
others are easily changed. As a person grows the degree of control generally
increases and what influences the health of individuals begins to shift more to
the individual rather than society.

However, health remains a social construct and societal influences and control
over many determinants means that our society must work together to bring
about better health for the individual. The determinants of health interrelate
meaning that negative influences in one area, may impact upon another
determinant and so on. Health needs to be assessed as a social construct and
this construct used to analyze what influences the health of individuals.
Particularly people groups who have poorer health outcomes.

What influences the health of individuals? Is a great critical question. It brings

together lots of information and seeks to shift students’ thoughts about health
responsibility away from the personal only and towards a more complete
picture of health and its influences.

7.1. Check on this video the Determinants of Health:

https://youtu.be/LP32-90UClk
The determinants of health fall under the following categories of factors:
individual, socioeconomic, sociocultural, and environmental. The
determinants of health influence the health of all individuals and combine
together to affect a person’s health either positively or negatively.

The determinants of health, is the foundational knowledge that must be

grasped in order for you to get a good understanding of the degree of
control individuals can exert over their health and how health is a social
construct. So make sure you put in extra effort to understand this content.

Within each determinant of health category there are various influences on an

individual’s health. These requires you to analyze how these factors combine
to affect an individual’s health. That is, how they can multiply the likelihood
of an individual’s health being positive or negative.

Determinant of health category

For example, if an individual has a high level of education, has a high income,
lives in a city with access to the best health facilities, was raised in a family
that valued health and promoted a holistic approach to health, and was taught
the skills required to research and improve their health and the health of
others, such a person has a much higher likelihood of being healthy, than a
person who comes from a low socioeconomic background, dropped out of
school in year 8 and was raised in a family that valued risk taking. Such a
person is more likely to be unhealthy, especially if they also have poor access
to health facilities or are blocked from accessing health information because of
language or cultural barriers.
The WHO defines the social determinants of health as conditions in which
people are born, grow, live, work, and age, including the health system. These
circumstances are shaped by the distribution of money, power and resources at
global, national and local levels, which are themselves influenced by policy
choices. The social determinants of health of health are mostly responsible for
health inequities-the unfair and avoidable differences in health status seen
within and between countries (WHO 2011).

The determinants of health fall under the following categories of factors:

Individual Factors
The individual factors that determine health are factors identified within an
individual, including: attitudes, knowledge, skills, genetics, and personal
characteristics. There are a range of individual factors that determine the
health of an individual.

Knowledge
What a person knows is one of the more influential individual factors that
determine health. In order to improve their health an individual needs to have
good health knowledge. That is, they need to know:

 where to get information

 healthy food choices
 recommended levels of physical activity
 how things affect our health (protective and risk behaviors)
 how to interpret food labels, and
 have a wealth of other knowledge related to health
Often health knowledge is linked with health literacy. Health literacy is the
ability to understand and interpret health information in order to promote
the health of yourself and of others. However, health literacy requires both
knowledge and skill.

Skills
Individual factors such as skill affect the health of the individual. Skills that
are related to health include:

 critical inquiry (know who to trust for information)

 research skills (how to find information)
 practical skills such as:
o Decision-making
o communication
o problem-solving, and
o movement skills

Such skills can help and individual achieve good levels of health especially
when combined with other factors, such as access to information and health
professionals, money, and an environment in which they can use these skills in
a positive manner.

Attitudes

An individual’s attitude can have either a positive or negative affect on their

health. Often achieving good health requires resilience, perseverance, self-
belief and determination. People who value health and have these attributes
are likely to achieve better health than those who do not. Within attitude the
value people place on health is pivotal. People who have a high value of health
are more likely to priorities their health over other demands. This relates to
time, money and other aspects of life priorities.
For example, a person who highly values their health and has a high level of
perseverance is more like to quit smoking, or not take it up in the first place.
They are also more likely to stick to exercise plans and make time to improve
their social health as well as their mental and physical health.

Genetics

Genetics is another of the individual factors that affect health. Genetics refers
to the genes you inherit from your parents. These genes can pre-dispose (make
things more likely) you to particular diseases or health issues. For example, if
your parents have diabetes or cardiovascular disease then you are more likely
to also get such diseases.
Furthermore, particular people groups suffer more from particular diseases and
are more likely to develop them. An example of this is the higher rates of
diabetes among indigenous people, as such indigenous people may be
genetically predisposed to diabetes (although this is hard to determine with so
many lifestyle factors). Another example is people who are born with white
skin and fair hair, who are more likely to develop skin cancer.
Sociocultural factors

The sociocultural factors that affect health relate to society (socio) and culture
(cultural). Within society and culture, have five (5) sociocultural factors that
determine health.

Family

Family is by far the greatest influence on health from the sociocultural factors.
Family will determine your culture and often have a huge impact on your
choice of religion, friends and may even decide what and how much media
exposure you have (particularly at a young age).

Your family are your most intimate relationships and have a huge influence on
your attitude towards health, the value you place on health, and influence your
behavior choices relating to protective and risk behaviors. For example, if you
grew up in a house where your parents eat fast food frequently (say 3 times a
week) you are more likely to think this is normal and even if you know it is
not healthy, you’re more likely to eat it, because this is what your family are
eating. You may also think that cutting back on eating this sort of food, means
only eating it once a week, rather than 3 times a week.
Conversely, if your family are health practitioners, such as a nutritionist and
an exercise sport scientist, then you are more likely to priorities healthy eating
and exercise. However, you may have an overemphasis on physical health and
neglect the other dimensions of health.

Peers

Peer pressure is often the first thing that people think about when it comes to
peer influences, however, there is little evidence to say that you are more
likely to smoke because your friends tell you to. Instead, your peers influence
you by creating environments where you seek to fit into the group by adapting
their behaviors. This can be positive, if your group have lots of protective
behaviors that they engage in, or negative, if the behaviors increase risk.
This pressure to fit into your peer groups is most sharply felt during
adolescence. During the teenage year, many young people select behaviors
that place them within a particular peer group that they wish to belong to. This
may be developing sporting skills to fit in to the group that love sport, or
picking up binge drinking if your peers regularly participate in such activities
on the weekend.

Media

The media is another of the sociocultural factors that determine health. The
media plays a large role in shaping health. This can be done through marketing
campaigns such as “Quit”, “Coco-pops”, or McDonalds advertising. It can be
direct through news articles that focus on pink ribbon day or TV shows such
as “The Biggest Loser”.
However, most of the influence from the media is not so obvious. It is done
through regular shows and subtle phrases that promote particular aspects.
When a series shows the cool kids smoking, or drinking, or engaging in sexual
activity, it makes the viewer start to think that these are behaviors associated
with those particular groups. People then begin to seek to live out the character
displayed on their screens.

For example, many of our current images used in advertising depict women in
sexually seductive or available poses. These are chosen deliberately to get
your attention in order to advertise their products, but it also communicates
that women are objects to be used sexually and exploited in such ways. The
rise in sexual images and videos that are considered normal today cannot be
underestimated. What you now see on billboards advertising perfume used to
be center page fold out posters in pornography magazines. Our society is
becoming increasingly desensitized to these graphic images leading to
increases in sexual assault, harassment, and higher risk sexual activity at
younger ages. As we start to think that these things are normal, we begin to act
on it which leads to risk behaviors.

7.2 Check on the video mental health and social media

https://youtu.be/KwIIe7Y0GJA?
list=PLesvqngPCeVPwV0eyoG9H0Q6D7TsCQ6Eq
Religion

Your religion is another of the sociocultural factors that influence your health.
This can often be in a positive manner, providing a purpose for life and
promoting self-worth. Given that Spirituality is an entire dimension of health,
it is no surprise that your religion will influence your health. Often regions
also have rules, such as not getting drunk, no sex before marriage, that
promote protective behaviors in individuals and promote health.
However, religion can also be limiting. Some regions place restrictions on
clothes and social interactions, which can have negative effects on the health
of the individual. For example, a monk who takes a vow of silence and lives in
isolation will lack social interaction. Other religions limit the social interaction
between sexes or prevent contact between those belonging to the religion and
“outsiders”.

Religion can also limit your choices in relation to health care. For example,
the Seventh Day Adventists will refuse a blood transfusion as it is against their
beliefs.

Culture

The last of the sociocultural factors mentioned in the syllabus is culture.

Culture is all the traditions, values, and a number of other behaviors, including
traditional foods or social activities. Culture is passed down by the immediate
and wider family. A sense of connection and belonging to your culture can
have a positive influence on health, especially improving the social dimension
of health.
Many cultures have traditional meals which can affect health. The
Mediterranean cultures have a diet high in healthy fats and vegetables leading
to lower rates of cardiovascular disease. They also have a high value for
family, and community increasing social health. The Japanese have very low
intakes of meat and high intake of fresh vegetables, which both positively
impact health.
Each culture also has their preferred method of treating illness and fixing the
body. Traditional Chinese Medicine for example uses herbs, and acupuncture
as their main medicinal treatments, while many western countries such as
Australia and America utilize the pharmacological (drug) method.

Socioeconomic factors

The socioeconomic factors that determine health include: employment,

education, and income. Socioeconomic refers to society related economic
factors. These factors relate to and influence one another. For example, your
employment will dictate your income. Your income level often correlates to
your level of education and your level of education helps to dictate your
employment. That is, someone with a Bachelor in Applied Science, a Masters
in Medicine and a PhD in Neurological surgical techniques is in a prime
position to earn a large income as a specialist Neurological surgeon. This then
allows them to pay for and usually leads to expectations upon that person’s
children to achieve a similar level of education, employment and income.
These socioeconomic factors then influence health.

Research: Philippine income and wealth distribution

Employment

The first socioeconomic factor is employment. Your employment is your job.

What you do for a living. Your employment status and your particular
occupation has a large impact on your health. For example, people with
physically active jobs, such as a laborer or a personal trainer are more likely to
complete the recommended 30 min a day, 5 days a week for vigorous physical
activity. However, a high level executive who works long hours and sits at a
desk all day is less likely to do physical activity, is more likely to be stressed
and have a poor social life. Other examples could include the increased risk of
skin cancer in those who work outside, such as life guards, or PE teachers.
People who work in mines will also have higher exposure to chemicals and
breathe in dust as they work, making them more susceptible to lung infections
and cancers. People who work as radiologist spend more time around radiation
making them more likely to suffer from cancers. People who work in the
transport industry are more likely to be involved in an accident leading to both
emotional and physical consequences.

Some more positive examples could include: farmers having a more active
lifestyle, greater community involvement, and fresh air. Sports coaches being
more active, community workers having good support networks, and a priest
or pastor will have greater community involvement and a solid purpose to life.

Education

Education is another socioeconomic factor that determines your health. Not

only will education influence your choice of employment, but your education
will directly impact your health. Education does not just refer to your level of
education. That is, it does not just refer to whether you complete your HSC, go
to University etc. Your education and health can be specific.

It will include your knowledge about what a healthy diet is, how much
exercise you should do, how the 5 dimensions of health interact, and more.
But it will also include your level of reading and how well you can do
research. Knowing where to get information from, how to know if it is reliable
and then interpreting this information in order to make a good decision about
your health.

Generally speaking, people who have lower levels of education, will also have
lower levels of health education, but this is not always true. For example,
someone who has had a personal experience of cancer may well know where
to find information, who to trust and how cancer works to much greater degree
than a PhD graduate who studied business and has not ever really looked into
cancer. So, education as a socioeconomic factor can be general and specific as
it determines health.

Income

The final socioeconomic factor is income. Income will dramatically influence

and help determine your level of health. Income relates to the amount of
money coming into your bank account and often the more you earn the better
your health can be. People with higher levels of income can afford many of
the health care services that are not completely covered by Medicare.
For example, someone with a higher income can afford to see a
physiotherapist to recover from a knee injury, while a person from a lower
socioeconomic background cannot. They can also afford dental care, to
purchase better quality foods (organic etc.), pay to join a gym or have a
personal trainer, pay for social activities etc.

Essentially, a higher income provides you with better choice. Even the choice
of location for where to live, better parks, cleaner home, taking regular
holidays etc. It all contributes towards a better overall health status.

Those with a lower socioeconomic status are at higher risk of having poor
health. They are less educated, leading to poorer health choices; have less
money leading to less health choice, and often work in occupations that
provide increased risks to health, such as the transport industry or
administrative roles.

Environmental Factors

Environmental factors are the final of the determinants of health.

Environmental factors include not just geographical location but also access to
health services and technology. When it comes to the environment, there are
both natural and built aspects of the environment.

Geographical location

Where someone lives can greatly determine their health. Within Australia
there are people who are homeless, others who live in third world conditions,
some who live in rural and remote areas, while many live in cities around the
country. Someone’s geographical location can mean that they are exposed to
pollution, or have limited access to fresh water. Geographical location can
mean that foods purchased have had to travel further and have less nutrients in
them as well as meaning a lack of educational or employment opportunities.

Range of environmental determinants of health, including:

 contamination of food and water

 vector borne diseases transmitted by insects and other animals
 disease caused by air pollution or exposure to chemicals
 injuries that are a results of workplace or traffic systems
 disasters or changes in ecological systems associated with climate
change

Examples of the environment leading to chronic disease include: high UV

exposure leading to higher rates of skin cancer, air pollution or dampness or
mold exposure leading to respiratory diseases and infections, and increased
asthmatic episodes. Event design of the environment “for example, street
connectivity, land use patterns, residential density, encourages physical
activity and active forms of transport; inverse relationship with obesity.”

Environmental factors affect one-another. Where someone lives can influence

their access to health services. There are locations in Australia that are hours
away from the closest hospital. People who live in rural and remote areas have
less access to medical technology and fewer health specialists. Many are
required to travel to major cities, particularly for kidney dialysis, which is
needed on a regular basis.

The video below is Episode 2 from the SBS series “First Contact”. The
beginning of this video shows what life is like on Elcho Island, and discusses
why this environment is like this. Such an environment, including poor
housing, a lack of access to health services and much more has a negative
impact on health.

7.3 Check on video some of Environmental factors: 

https://youtu.be/9fMod5nTzck

Access to health services

Someone with easy access to health services is more likely to have better
health outcomes than someone who has to travel long distances or cannot
afford to access particular health services. As such, this environmental factor
relates to socioeconomic factors as well as the other environmental factors.
 Tugugarao City, Cagayan

Accessing health services requires both money and physical access. People
who live in rural or remote areas have less access to health services, with few
specialists, fewer hospitals (with staff shortages), and a shortage of other
health care providers, such as nutritionist, physiotherapists, radiologists and
more. A lack of access means people who require these services either have to
travel to get it, or do not get the benefits at all.

This is particularly the case for those with lower incomes. They cannot afford
particular health care services, such as dental, resulting in poorer health
outcomes, such as increased cavities, losing teeth, or chronic pain from
arthritis. Chronic disease has a very high burden of disease, resulting in people
taking me time off work, costing the government more money to treat and
people suffer physically, socially, mentally, emotionally and physically from
the diseases.

Access Technology

Access to technology includes access to health care technology, such as

kidney dialysis machines, as well as access to technology for knowledge, such
as the internet. A person’s access to technology, just like their access to health
services, is affected by their geographical location and socioeconomic status.
Accessing surgical technology or the latest hearing technology requires access
to the health service that utilize and provide such technology, but also require
money. There are many technologies that re paid for through Medicare within
the public health care system, but many are only available through private
health providers, meaning they cost the consumer.

Analyze how an individual’s health can be determined by a range of factors

acting in various combinations.
In order to analyze how an individual’s health can be determined by a range of
factors acting in various combinations you should first understand what each
determinant of health consists of, and identify relationships within them.

For example, education is within the socioeconomic factors and this directly

affects the individual factors, such as knowledge and skill. So someone with a
Master’s in Public Health will have great health related knowledge and skills
compared to someone who dropped out of school in year 10.

Furthermore, a person’s environment is greatly controlled by their

employment and income. People spend many hours at work, and can only live
where they can afford. So, someone who works in the city in an office job
spends many hours sitting down. If their job does not pay well, they may live a
long distance from their work and have long travel times, increasing their time
away from family and social activities.

Conversely where you live geographically can limit your education and
employment opportunities. People who live in rural or remote areas have
smaller schools, less universities available to them and a limited range of
employment choices. Such people, then suffer poorer health outcomes not
only because of a lack of access to health services, but also a lack of access to
education and employment. For example, they may finish year 12, and then
work outside on the family farm increasing their likelihood of cancer and
injury.

Low income can also affect your access to health services by limiting your
choices. For example, a person who has a large income can afford private
health care and see a dentist or physiotherapist when needed, while someone
with a lower income cannot afford to these options and suffers from tooth
decay or a bad knee because they cannot afford the health care.

Sociocultural factors can also affect your education levels access to health

services. Speaking a language other than English can limit your ability to
succeed in education. This reduces access to university (which if not a resident
or citizen must be paid for) and makes them less able to navigate or interpret
the health care system. They may also require an interpreter for health care
services, which may not always be provided.

Modifiable and non-modifiable health determinants

The modifiable and non-modifiable health determinants help us to understand

how much control an individual has over their own health. You have already
covered the health determinants as socioeconomic, sociocultural, individual,
and environmental factors. These “modifiable and non-modifiable health
determinants” seeks to identify which of the determinants can be modified and
which cannot.

Modifiable means that it can be changed and as such it can be controlled to

a certain extend. Below is a list of the determinants which are modifiable:

 knowledge, skills, attitude (individual)

 peers, religion (sociocultural)
 employment, education, income (socioeconomic)
 geographical location, access to health services and technology
(environmental)

It should be clear that some of these modifiable determinants are more easily
changed than others. For example, to change your employment can be a very
hard thing to do, especially if you also need to improve your education in
order to do this. It can also be very difficult to change geographical location,
especially if there is a cultural or family connection to your current location.
Often moving also requires money, which the individual may or may not have.
So, although these are modifiable, the degree to which a person is able to
change them and to what extent they can change them will vary from person to
person.

The difficulty in changing any of these modifiable health determinants also

depends on the individual’s age, however, this will be discussed under the
changing influence of determinants through different life stages.

Shifting from the modifiable to the non-modifiable health determinants we

have the following:

 genetics (individual)
 family, media, culture (sociocultural)
These non-modifiable health determinants are never able to be changed.

Understanding the modifiable and non-modifiable health determinants helps

us to better understand why some people can feel powerless when it comes to
improving their health, while others feel they can easily change.

What can individuals do to modify the determinants they have little control
over?

Sometimes the answer to this question is very little. In order to change some
of the modifiable health determinants individuals need a context where this is
possible. People’s actions are also affected by how easy the determinant is to
change. Not many people are willing to quit their job and move house in the
hope of improving their health.

However, there are many things individuals can do to improve their health
determinants. For example, an individual can choose to have a positive
attitude towards their health and to make it a priority. They can seek to
improve their level of education increasing their knowledge and skills, which
will in turn increase their employment options and possible income. An
individual, could choose to spend time with peers who also prioritize their
health and engage in more protective rather than risk behaviors. An individual
can also move location to an environment more conducive to health.

The changing influence of determinants through different life stages:

The changing influence of determinants through different life stages examines

how the determinants level of influence on your health changes as you age and
move through various life stages. Life stages include more than just ageing.
Life stages include things such as graduating (HS. College), getting married,
buying a house, having children and much more. At any stage in life you are a
particular age in a particular context.

To assess the degree of control individuals, have over their health, by

exploring questions such as:

How does the level of influence of the determinants change over time?
It is easy to say that at a young age the determinants have a much larger
influence on your health than as you get older, but this is not entirely true.
For example, a child’s health is largely determined by their parents. Parents
control what they eat, where they live, when they access health services, who
their peers are, what kind of education they might have in the future and much
more.

However, their parents are also restricted by the more influential determinants
for their stage of life. They may have financial and work commitments which
limit their ability to choose where to live or they access to health services.
They may have a poor level of education and chose to eat unhealthy food
thinking that it is good for them. They can change some of these things, but
often change requires money and/or support. If neither is available, if income
is low and family are not close or the relationship is bad then change becomes
harder and risky, resulting in many not choosing to make the changes
necessary. Thus their health is still heavily influenced by the determinants.

Other examples of the changing influence of determinants through

different life stages include:

 Adolescence when peers have a larger influence on your health than

they did when you were younger and the influence of family begins to
decline.
 Leaving home can result in less influence from parents, or peers and a
greater influence from your own knowledge and skills.
 An adult with a mortgage is highly influenced by socioeconomic
factors.
 Children are heavily influenced by sociocultural factors as family
control many aspect and input values, religion and cultural traditions.
 Between ages 5-21 in Australia education increases in influence as
your level of education increases dramatically.
 Geographic location increases if disability occurs or increases (often
with age), e.g. moving into a nursing home when you need 24/7 care
for dementia.

The changing influence of determinants through different life stages varies

from person to person, but has a general flow with some determinants having
less influence as you move through life (peers, parents), while others can
increase (employment, children, environment).

7.4 Health as a Social Construct: https://youtu.be/q9AHBPICjH0

Health as a social construct is one of the harder concepts to understand. “What

influences the health of individuals?” Identify that health is not a result of
individual choices only, but is actually constructed by society and as such
responsibility for health falls upon not just the individual, but society as a
whole.
Health as a social construct examines how an individual’s context impacts
upon their health status. It recognizes the interrelationship of the determinants
of health and notes that many of the determinants are either out of the
individual’s control, or made difficult to change because of their context. The
result of this is the concept that health is not solely an individual’s
responsibility, and that some responsibility must fall to the society as a whole.

It may be worth going back and revisiting perceptions of health as social

constructs as the concept here is much the same. Health as a social construct is
based upon a recognition of the determinants of health and their
interrelationship. The better your understanding of these determinants the
abler you will be to see health as a social construct. So, our next step is to
identify and understand this interrelationship at a deeper level.

Recognizes the interrelationship of determinants

In order to understand that health is a social construct a student recognizes the

interrelationship of the determinants. The interrelationship of the determinants
has been touched on previously, looking at various factors that work in
combination to determine health. It is important to understand exactly how
these determinants interact with each other and affect one another. This then
has a cumulative effect on the individual as the determinants interact and
relate to one another.
Every determinant of health affects another, often more than one. The four (4)
categories of determinants overlap with one another as they interrelate to
determine the health of an individual.

Environmental factors, such as your geographical location affect your health

on their own, but they also affect other determinants of health. For example,
your geographical location can limit or increase your employment and
educational options. It can also improve your access to health services, affect
your peer group and media exposure.

Socioeconomic factors also interrelate to other determinants. Your level of

education will impact your employment options and can limit or increase you
options for geographic location as you need to be able to afford where you
live. Your education will also affect your knowledge and skill levels for
accessing and understanding health and health services. Socioeconomic
factors can determine your peer groups, as you may or may not be able to
afford to do the activities around which people socialize. Your education can
affect your income and your access to health services and technology,
especially when considering elective surgery or ancillary care (non-medical
care, e.g. physiotherapy, dental care etc).

Sociocultural factors will also interrelate with determinants of health. Your

family will at various stages in your life affect your peer group, income,
geographic location, genetics, attitude towards health, religion, access to
technology or health services and more.

Finally individual factors, such as knowledge and skill levels will greatly

impact your choice of employment and can affect your level of education. It
can then affect your geographic location and ability to access or navigate the
health care industry.
It is important that a student recognizes the interrelationship of determinants.
With such knowledge it becomes easier to understand that health is a social
construct, and to identify that an individual is not solely responsible for their
health. Whenever someone recognizes the interrelationship of determinants
they are acknowledging that health is a much greater and more complex issue
than it is often thought.

The World Health Organization recognizes the interrelationship of

determinants as well. This is why it has a wider definition of health and
developed the Ottawa Charter in 1986, which has action areas that help to
improve as many determinants of health as possible, rather than simply leave
health as the individual’s responsibility.

Challenges the notion that health is solely an individual’s responsibility

Health as a social construct challenges the notion that health is solely an

individual’s responsibility. Because health is affected by your context, other
people, society, culture, environment, education, income and much more, it
must be viewed as something for which society has some responsibility.

In addition to this, that fact that some health determinants are non-

modifiable means that our health is affected by things beyond our control.
Furthermore, there are a number of determinants that are difficult to change,
and some that really cannot be changed throughout a person’s life time. For
example, a young child does not have control over what they eat, where they
live, they access to health services and technology, their family income, their
level of education, and much more.

Having a number of the determinants of health beyond our control, some of

which are controlled by others, both individuals and corporately, challenges
the notion that health is solely an individual’s responsibility. Health cannot be
solely the individuals’ responsibility.

Of course the individual has some responsibility for their health. We should
seek to change things within our control in order to improve our health. We
should lower our risk behaviors and increase our protective behaviors. But
eating well, doing exercise and sleeping are not all there is to having good
health. Good health often requires lots of money, high levels of education, and
a supporting social network, among other things.

Health is a result of the interrelationships between the determinants of health

and the individual. It is a result of not only the person, but their entire context,
from the country they are born in to their closest friends and family. This
complex nature of health, shows us that health is a social construct and
challenges the notion that health is solely an individual’s responsibility and
helps explain why some groups have better health than others.
How the determinants of health explain why some individuals and group
have better or worse health than the others?

As you investigate how the determinants of health explain why some

individuals and groups have better or worse health than others. You will learn
more about particular groups who experience inequities in health, such as:
Aboriginal and Torres Strait Islanders, socioeconomically disadvantaged
people, or the elderly. These inequities are caused by the determinants
working in relationship with each other.

Let’s investigate how the determinants of health explain why some individuals

and groups have better or worse health than others by looking at
socioeconomically disadvantaged people. The Australian Institute of Health
and Welfare provide the following information:

An individual’s level of education directly impacts their employment options

and level of income (of course these are generalizations and there are
exceptions, but this is the norm). Lower income means your choice of
environment to live is also limited. Lower income levels cannot afford to live
in the city or on the beach. They may not afford to own their house, and can
even be in housing commission, where living conditions are not ideal. Where
you live can affect your access to health services, and lower income levels will
also impact a person’s access to some health services not covered by
Medicare, such as dental or natural therapies.

Lower levels of education also result in lower health literacy. This leads to
poorer health choices, higher risk behaviors, and lower protective behaviors.
Socioeconomically disadvantaged people often live in similar areas where
housing is cheaper. This can lead to peer groups and communities that have
higher rates of violence, alcohol consumption and theft. It can be dangerous to
go for a walk at night after work, or to use public transport, even though they
may not be able to afford a car.

For statistics on the health of socioeconomically disadvantaged people:

Despite achieving some success, wealth-related disparities in the utilization of

maternal and child health services persist in the Philippines. The study has
found moderate wealth-based disparities in the utilization of institutional
delivery in the Philippines. The results confirm the importance of recent
efforts made by the Philippine government to implement equitable, pro-poor
focused health programs in the most deprived geographic areas of the
country. The importance of addressing the social determinants of health,
particularly education, as well as developing and implementing effective
strategies to encourage institutional delivery for higher order births, should
be prioritized. (Andrew Hodge1 et al research article).

This is how the determinants of health explain why some individuals and
groups have better or worse health than others. Some people are born into a
social situation where they have less money, live in poorer areas,
difficult schools, or have a family that do not value health and participate in
more risk behaviors. Such situations result in poorer health outcomes for the
individual in this group. Conversely if someone is born into a wealthy family,
with high levels of education and who place a high value on health, they are
more likely to have better health outcomes. Health is a result not just of
individual choices, but of the society and context such an individual is born
into.

7.5The video below provides a good inside into the current economic and
education distribution in the world.
https://youtu.be/QFrqTFRy-LU?
list=PLesvqngPCeVPwV0eyoG9H0Q6D7TsCQ6Eq

What strategies help promote the health of individuals? Is the last critical
question for Better Health for Individuals? 
 Application

Feedback

1. Fill in “What I have Learned” column by writing down what you have
learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned

TOPIC 8. A Typology of Nursing Problems in Family

nursing practice

Learning Objectives
At the end of this unit, students will be able to:

 Differentiate the typology of nursing problems in family nursing

practice.

Presentation of Contents

First Level Assessment

I. Presence of Wellness Condition-stated as potential or Readiness-a clinical

or nursing judgment about a client in transition from a specific level of
wellness or capability to a higher level. Wellness potential is a nursing
judgment on wellness state or condition based on client’s performance, current
competencies, or performance, clinical data or explicit expression of desire to
achieve a higher level of state or function in a specific area on health
promotion and maintenance. Examples of this are the following:

A. Potential for Enhanced Capability for:

1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s developing/unfolding of mystery
through harmonious interconnectedness that comes from inner
strength/sacred source/God (NANDA 2001)
B. Readiness for Enhanced Capability for:
1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others. Specify.

II. Presence of Health Threats-conditions that are conducive to disease and

accident, or may result to failure to maintain wellness or realize health
potential. Examples of this are the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases,

metabolic syndrome)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards specify.
1. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices
specify.
1. Inadequate food intake both in quality and quantity
2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors. Specify.
1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.
1. Inadequate living space
2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sights of vectors of diseases
5. Improper garbage/refuse disposal
 6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self-medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of /inadequate exercise/physical activity
11. Lack of/relaxation activities
12. Non-use of self-protection measures (e.g. non-use of bed nets in malaria
and Filariasis endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse control
K.Health History, which may Participate/Induce the Occurrence of Health
Deficit, e.g. previous history of difficult labor.
L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father
not
assuming his role.
M. Lack of Immunization/Inadequate Immunization Status especially of
Children
N. Family Disunity-e.g.
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement

III. Presence of health deficits-instances of failure in health maintenance.

Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by
medical practitioner.
B. Failure to thrive/develop according to normal rate
C. Disability-whether congenital or arising from illness; transient/temporary
(e.g. Aphasia or temporary paralysis after a CVA) or permanent (e.g. leg
amputation secondary to diabetes, blindness from measles, lameness
from     polio)
IV. Presence of stress points/foreseeable crisis situations-anticipated periods
of
unusual demand on the   individual or family in terms of adjustment/family
resources. Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy

Second-Level Assessment
I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge

B. Denial about its existence or severity as a result of fear of consequences of
diagnosis of problem, specifically:
1. Social-stigma, loss of respect of peer/significant others
2. Economic/cost implications
3. Physical consequences
4. Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a
problem
II. Inability to make decisions with respect to taking appropriate health action
due to:
A. Failure to comprehend the nature/magnitude of the problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about by
Perceive magnitude/severity of the situation or problem, i.e. failure to
breakdown problems into manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of action
open to them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding
action to take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative
attitude
is meant one that interferes with rational decision-making.
J. In accessibility of appropriate resources for care, specifically:
1. Physical Inaccessibility
2. Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of
action

III. Inability to provide adequate nursing care to the sick, disabled, dependent

or vulnerable/at risk member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition (nature,
severity, complications, prognosis and management)
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature or extent of nursing care
needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary
intervention or treatment/procedure of care (i.e. complex therapeutic
regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt,
fear/anxiety, despair, rejection) which his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled,
dependent, vulnerable/at risk member
I. Member’s preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of
family
members.
K. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload

IV. Inability to provide a home environment conducive to health maintenance

and personal development due to:
A. Inadequate family resources specifically:
1. Financial constraints/limited financial resources
2. Limited physical resources-e.g. lack of space to construct facility

B. Failure to see benefits (specifically long term ones) of investments in home

environment improvement
C. Lack of/inadequate knowledge of importance of hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/philosophy in life which is not conducive to health
maintenance and personal development
I. Lack of/inadequate competencies in relating to each other for mutual growth
 and maturation (e.g. reduced ability to meet the physical and psychological
needs of other members as a result of family’s preoccupation with    current
problem or condition.

V. Failure to utilize community resources for health care due to:

A. Lack of/inadequate knowledge of community resources for health care
B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic,
rehabilitative) specifically:
1. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines prescribe
I. Feeling of alienation to/lack of support from the community, e.g. stigma due
to mental illness, AIDS, etc.
J. Negative attitude/ philosophy in life which hinders effective/maximum
utilization of community resources for health care

8.1 Health Threats https://youtu.be/-BLuJ3iNeRQ

Application

PART I. Based on the image below, answers the following questions:

  Develop your own definition of health.
 What influences the health of individuals?
 What are your perceptions of health to others?

PART II. Enumerate Health behaviors of young people. At least 15.

PART III. In 300 words, give your analysis on the picture showing the current
Philippine health system., & give at least (10) causes.

Feedback

2. Fill in “What I have Learned” column by writing down what you have
learned from this topic. (Please write your feedback in a long bond paper.)
What I already Know What I Want to know What I have Learned
Summary of the Unit

• Health is a BIRTHRIGHT. Clearly explicate that every Filipino has the

right to quality health care regardless of their status in society.

• The most familiar definition of health in 1947, by (WHO) is the state of

complete physical, mental and social well-being and not merely the absence of
disease or infirmity which was humbly suggested by Pope John Paul II, the
inclusion “spiritual” aspect in the definition of health.

• Better health for individuals examines the meanings of health, both technical

and opinion, while also considering the relative and dynamic nature of health.
It looks at the perceptions individuals have about health and the range of
factors and behaviors that influence this, such as the media, peers, family and
religion.
• The determinants of health are: individual, sociocultural, socioeconomic, and
environmental factors. This is essentially a list of what influences the health of
individuals. 
• Health as a social construct examines how an individual’s context impacts
upon their health status. It recognizes the interrelationship of the determinants
of health, that health is not solely an individual’s responsibility, and that some
responsibility must fall to the society as a whole.
• A Typology of Nursing Problems in Family nursing practice
First Level Assessment on the presence of wellness condition, presence of
health threats-conditions that are conducive to disease and accident, presence
of health deficits-instances of failure in health maintenance. The second-level
assessment, inability to recognize the presence of the condition or problem,

Reflection:

Based on your readings in Unit I. In 300 words. Answers the following

questions.

How healthy am I? How healthy do other people think I am?

How healthy do I think other people are?
Why would my perceptions of health be similar or different to others?
How might an individual’s perception of health affect their behavior and
wellbeing?

Other References:

1. DOH, Public Health Nursing in the Philippines, 2007

2. Cuevas, Frances Prescilla L. Public Health Nursing in the Philippines 10th
edition, c. 2007
3. Josie Quiambao Udan, Fundamentals of Healthc.2009
4. Adion, Diana et al Manual and Checklist on Basic Health Care Procedures,
c. 2009
5. Famorca, Zenaida et al, Nursing Care in the Community, c. 2013
6. Carolyn Jarvis, Pocket Companion for Physical Examination and Health
Assessment 7th edition, c. 2016
7. Kozier, Fundamentals of Nursing, c. 202