At the beginning of the semester, I knew hardly anything about
global/international health. I still
think this is much to be learned, but taking International Health and World
Food Problems has helped a lot. I
believe the class as a whole agrees that positive deviance is very
important. At least it appeared that way
from the last class. I personally think
globalization was one of the most important concepts we talked about. Globalization needs to be understood or at
least thought about. It has always been
around, but we do not think about it.
Globalization has led to many changes around the world both good and
bad. Even if it involves the same people
or object, it can have different effects.
Look at what we learned about women and globalization. It is starting to become more acceptable for
women to seek out paid work. I do not know
where this started, but the United States has obviously been supportive of paid
women’s work. The glass ceiling aside,
women are allowed to work in developed countries. Having more women in the work force has
uncovered problems that we were not aware of before. The stress of having to work a paid job,
raise a family, and do all other day-to-day tasks is daunting. Women are strong enough to handle, but
societal norms are not making it easy on them.
Finding good childcare and financing it are extremely difficult for
many. Hopefully, we will come up with
better solutions in future years. We
have are all capable of being this solution.
I talked about globalization because I found it to be so important. There were other concepts we learned about
that are also significant. Wherever I
end up career wise, I believe I can use the concepts taught from these courses
to improve how I address the issues I face.
Internationalhealthseminar
This BLOG is a space for reflections on international/ global health by the awesome people in the International health seminar classes at Purdue.
Saturday, December 10, 2016
Monday, December 5, 2016
Reflection
As the semester is coming to an end, I reflect on what I have learned in all of my classes and how they all relate to one another. While they all had their specific focus areas, one thing that stuck out to me is the depth that public health interventions must entail in order to be successful. No public health issue can be moved in a positive direction by using a narrow approach. Individual, interpersonal, structural, physiological, and societal factors all have their own impact on one's health. Also noted, that as much as public health professionals believe that an intervention they have created will be successful, they cannot initiate it without proper funding and resources, which is a big obstacle in this field. In addition, policy changes are most often out of our control and policy can be very beneficial or detrimental to a targeted health behavior. Specifically, in regards to global health, I have learned that there is a lot to be done around the world. There are so many alarming health disparities that I was not completely aware of prior to this class. Like all interventions, we must understand what our target population wants and needs what they will respond to. Also, we must make changes that will make it able for these communities to sustain better health once the intervention is over. We cannot put a quick, simple fix on a long, complex problem. While there are many obstacles and challenges in public health, and while some tasks may seem way too out of reach to tackle, we can all make a difference if we put our mind, time, and effort into it. I believe public health is a very rewarding field, and the impacts we have the ability to make on people's lives is worth all of the hard work we will put in as public health professionals.
Saturday, December 3, 2016
Preventing Prevention: What's stopping us from using contraceptives?
Contraception is a public health issue with worldwide
prevalence, complicated by difficulties with access, proper use, stigma, cost,
and more. Unfortunately, many
misconceptions exist that limit use of birth control, whether through public
policy or individual choice. Public
policy that restricts birth control access is very difficult to fight, being
that it is grounded in social norms and cultural beliefs of the majority or of
the governing party. For example, I have
been researching women’s health care access in Italy, where emergency
contraception is still prescription-only; this barrier is even more problematic
when you consider the time-sensitive nature of emergency contraception. One study found that some Italian doctors
will refuse to write prescriptions because they misunderstand the medical
mechanism, considering it to be like an abortion rather than a true prevention
of fertilization; this forces women to try clinic after clinic until they can
finally get a script for what should be an easily accessed method of pregnancy
prevention (Bo, Casagranda, Charrier, & Michela Gianino,
2012).
In addition to public policy challenges, personally- or
societally-held misconceptions can limit birth control use in practice, even if
it is not limited by policy. A recent
article from Science Daily (“Fear of
gaining weight may influence contraception choices,” n.d.) discussed the very real fear
that many women have of gaining weight due to oral contraceptives, and how this
deters them from using this method. The
study they referred to (Bhuva, Kraschnewski, Lehman, & Chuang, 2016) found that women who were
overweight or obese were more likely to use either highly effective forms of
birth control (IUD or implant), or minimally
effective forms (condom, withdrawal) to none at all, but had lower rates of
pill use. Pill usage has been linked in
the public discourse to weight gain, but literature review has shown no true
correlation (Gallo, Lopez, Grimes, Schulz, & Helmerhorst,
2006). I have many friends who have stopped or never
started oral contraceptives because a fear of weight gain, but in reality any
initial weight gain is usually due to a shift in water weight and normalizes
after a few cycles of the pill. The fact
that this study showed that overweight or obese women tended to avoid the pill
is concerning, because some of them ended up using less effective to no method
of contraception. Just last week I was
reading about factors that influence pregnancy outcome: pregnancy intention
leads to better outcomes for mother and baby, but more than half of all
pregnancies in the U.S. are unintended (Frayne et al., 2016). This means we must fight any and all
misconceptions about birth control that are preventing women from using it, in
addition to access and policy barriers, here and throughout the world. Proper education about contraception, free of
misconception, myth, or stigma, is vital.
References
Bhuva, K., Kraschnewski, J. L., Lehman,
E. B., & Chuang, C. H. (2016). Does body mass index or weight perception
affect contraceptive use? Contraception.
Bo, M.,
Casagranda, I., Charrier, L., & Michela Gianino, M. (2012). Availability of
emergency contraception: A survey of hospital emergency department
gynaecologists and emergency physicians in Piedmont, Italy. The European
Journal of Contraception & Reproductive Health Care, 17(5), 373–382.
Fear of
gaining weight may influence contraception choices. (n.d.). Retrieved December
3, 2016, from https://www.sciencedaily.com/releases/2016/11/161117101728.htm
Frayne, D.
J., Verbiest, S., Chelmow, D., Clarke, H., Dunlop, A., Hosmer, J., … Zephyrin,
L. (2016). Health Care System Measures to Advance Preconception Wellness:
Consensus Recommendations of the Clinical Workgroup of the National
Preconception Health and Health Care Initiative. Obstetrics & Gynecology,
127(5), 863–872.
Gallo, M. F., Lopez, L. M., Grimes, D.
A., Schulz, K. F., & Helmerhorst, F. M. (2006). Combination contraceptives:
effects on weight. The Cochrane Database of Systematic Reviews, (1),
CD003987.
Social Media & Health Promotion
Social Media &
Health Promotion
In an age of globalization and the rapid growth of
technology, developing countries are increasing their use of social media and
have gained access to technologies including cell phones and internet. As a
result, many health interventions have utilized social media as a communication
tool in order to change health behaviors due to its ability to increase information
access as well the ability for such programs to be customizable to a population
(Levac & O’Sullivan,
2016).
However, as a relatively new medium, I have questioned the
unintended consequences of such an outlet on a variety of factors. For
instance, what impact does this have on social skills and potential it has on
limiting physical activity among a given population. Also, with the reliance of
such interventions on the internet and technologies, are they effective and
reliable in global health initiatives? How may we as health professionals
experience the benefit of social media as an effective tool and at the same
time, have little negative impacts on the population we are targeting. Also,
researchers such as Levac and Sullivan (2016) question the long-term
effectiveness of such strategies as the nature of technologies is one that is
in constant change and fluctuation. Social media sites also are sensitive to
the nature of information and the ability for unreliable information to be
published and referred to in at-risk communities. This lack of control increased
the need to educate the public on ways to effectively utilize such social media
tools for it to be effective.
As I read this article, I was interested in your thoughts as
public health professionals from various fields and how you think social media
may or may not have unintended consequences in utilizing it as a strategy in
global health initiatives? Should we continue to use this as a reliable
communication tool?
Reference
Levac, J. J., & O’Sullivan, T. (2016). Social Media and its Use in
Health Promotion. Revue Interdisciplinaire Des Sciences de La Santé -
Interdisciplinary Journal of Health Sciences, 1(1), 47–53.
https://doi.org/10.18192/riss-ijhs.v1i1.1534
'Tis the Season for Test Anxiety
As we are heading into
finals, my personal thoughts are constantly being about final projects, exams,
and presentations. I do not know about
you all, but even though we are in graduate school, I experience peak anxiety
during this time. While for some classes
we might not have written final exams, we continue to have finals that
determine large parts of our overall grades.
Test anxiety is a curious thing.
Why do some people feel it so harshly while others are hardly affected? What is the science behind this? Test anxiety is correlated negatively with
academic examination performance (Aysan et al., 2001). Salehi and Marefat categorized anxiety as
trait and state anxiety. Trait anxiety
is a tendency towards anxiety on a relatively stable scale. This type anxiety is basically a personality
trait. These are people that tend to
also have some level of anxiety. State
anxiety is situation-based anxiety.
State anxiety is also considered part of trait anxiety, but will arise
during situations that cause individuals stress. The researchers have found that test taking
while experiencing a language barrier is even worse (2014). Aysan et al. discussed different methods for
dealing with test anxiety. Their sample
population was Turkish MA postgraduate students. They recommended practicing yoga and meditation
to deal with everyday anxiety. The
researchers’ main focus was to look into performing pranayama or a type of
Hindu yoga. Pranayama is regulation of
breathing that has been shown to control and reduce anxiety during test taking
(2001). I chose this topic to write
about not to get everyone down with thoughts of finals, but to give at least an
understanding of test anxiety.
Hopefully, this blog makes you realize that everyone has the potential
for test anxiety. Good luck on all of
your finals whether they are exams, presentations, projects, etc. You can do it!
Aysan, F., Thompson, D., & Hamarat, E. (2001). Test anxiety, coping
strategies, and perceived
health in a group of
high school students: A turkish sample. The Journal of Genetic Psychology,
162(4), 402-11. Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/228397512?accountid=13360
Salehi, M., & Marefat, F. (2014). The effects of foreign language
anxiety and test anxiety on
foreign language
test performance. Theory and Practice in Language Studies, 4(5), 931-940.
Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/1527307504?accountid=13360
Friday, December 2, 2016
Public Health as Global Health
Education informs the public about health and
unhealthy behavior choices and it is up to the public to decide whether they
are going to change their behavior based upon evidence. One would think that when someone is informed
of negative health effects and the benefits of pursuing one course of action
over the other that they would always make the correct choice but that is not
how we operate as human. Also, we do not
always have the tools necessary to make the correct decision. Also even with the correct tools we may not
have the means or mode to make those corrective changes. It takes more than just education, even
regulation is not a cure all because some of the same problems that I just
spoke of will still exist. When we look
at the cause of death and disease that are plaguing the population we would be
incline to say that people choose their own health, but I beg the differ.
The top three cause of death are smoking, poor diet
and physical inactivity followed by alcohol consumption. Behind each of these cause of death is an
underlying problem that we may be able to see or fix with changes in health
behavior. Some of the causes of why
people drinks, smoke, overeat, etc., are systematic and physiological. Without
looking at the root of these issues can we treat the problem or are we only
putting on a band aid? I would say in
order for people to change their behavior and move towards better health we
must look at the underlying causes and address those as well. People living in
food deserts and in poverty are not overweight because they may just love to
eat, but because they are not eating the appropriate things or because their
body has stored fat due to many days of lack of food. When these people do eat
they are not thinking about nutrition, but survival. The idea of survival overrides the knowledge
of health. Also what we eat does make a difference.
In today’s society we are encourage to eat better, eat
healthier, however the foods that are affordable are not healthier food. Organic food, cost about twice that of
regular food. Buying junk food could
cost a dollar, whereas fruit and vegetables could range from $1/lb to $4/lb
according to the season. So yes, education does work, but survival is
necessary. With education should also
come measures to reduce consumer cost at the grocery stores! Many of the fruit
and vegetables when not bought would be thrown away, but this does not make
national new nor does it come into account when making statements regarding the
health of a nation. There are many factors
that go into why people are unhealthy, and some of those are income inequality,
access and means.
In conclusion, No, I do not believe that people choose
their own health. Many factors go into
this equation along with what is in the environment, additives in the food etc.
Global Effects of the Tobacco Industry
As I was driving home one evening,
I noticed a construction worker carrying one of my favorite things: coffee; and, one of my least favorite things: a cigarette.
I have always been curious about the global numbers of smoking and the
effect of the tobacco industry in developing countries, so I decided to do a
little more research for my blog post this week.
In a
study by Jha & Peto (2014), researchers look to an interesting ratio to
measure the success of tobacco control. In developed worlds (USA, Europe, etc.) among
men and women 45-64 years old, there are about as many current smokers as there
are former smokers. In contrast, in
developing countries, among in this same age category, there are much fewer
former smokers than current smokers.
This shows that while smoking in the developed worlds has plateaued or
even decreased, it has increased in developing worlds (Table 1).
Why the
decrease in developed countries and not developing countries? Some point fingers at the effects of advertising
– according to WHO (2013), one third of cigarette use that starts in youths
occurs as a result of tobacco promotion and advertisement. Attracting new users is the main reason tobacco
companies spend tens of billions of dollars on advertising, promotion, and
sponsorship (WHO, 2013). The effects of advertisement
bans are especially visible in Australia, where already existing bans have been
strengthened by the introduction of “plain packaging” in 2011 (Jha & Peto, 2014). Out of curiosity, I investigated these
effects a little further and found Figure 1 on the Australian Government’s
website (2016).
Others may point a finger at
tobacco pricing – doubling the price of cigarettes in developed countries and
tripling the price in developing countries has the potential to reduce smoking
worldwide by a third. In the US and UK,
cigarette consumption has taken nearly 30 years to reduce by half. In contrast, with the use of large tax
increases, France and South Africa reduced tobacco consumption by half in just
15 years (Jha & Peto, 2014).
How do we reduce tobacco use while respecting
the rights of a TNC? What are some
unforeseen consequences of some of these interventions (ban on advertisement,
increased taxation, etc.)? What other
global effects do you see? Think about positive deviance that we learned about this past week, what are the areas with low numbers doing right?
References
Australian
Government Department of Health. (2016, June 29). Tobacco Control key facts and figures. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-kff
Jha, P., & Peto, R. (2014). Global effects
of smoking, of quitting, and of taxing tobacco. New England Journal of Medicine, 370(1), 60-68.
World Health Organization. (2013). WHO report on the global tobacco epidemic, 2013: enforcing
bans on tobacco advertising, promotion and sponsorship. World Health Organization.
Pediatric Dental Caries and Food Insecurity
Dental caries is a major public health problem. It is
considered to be the most prevalent chronic disease worldwide. Pediatric dental
caries not only causes pain and eating difficulties, it also affects speech,
esthetics, sleep, growth pattern, social communications, self-esteem, academic
performance, and quality of life. In
some conditions, untreated oral infections maybe so severe to the extent of causing
systemic manifestations and consequently threatening children lives.
Low socio-economic status (SES) has been identified as a
strong determinant of dental caries among children. As low SES is strongly
linked to food insecurity, it is worthy to ask whether food insecurity can be a
potential risk factor for this global threat.
Families that suffer from the food insecurity tend to prioritize
quantity rather than quality in making their food-purchasing decisions. For
example, they may go for sugar sweetened beverages that are less expensive and
more accessible, however, in the same time, has a damaging effect on their
children teeth. Food insecure households
may also live in food desserts which limit their food choices to processed food
and snakes especially in the era of globalization where transnational
corporations (TNCs) find such places as easy markets for a guaranteed high
profit. Such types of food subject children to highly refined carbohydrates
which are strong predictors of dental caries. Additionally, children living in
food insecure houses, especially in the developing world, may take the responsibility
of managing their food resources and options. In most cases, such management
usually take the form of increasing the frequency of small non-healthy snakes
that increase the periods of exposing their teeth to cariogenic food resulting
in ideal conditions for oral bacteria to produce cariogenic acids that further potentiate
caries risk.
Nowadays, most interventions tackling the global threat of
dental caries focus mainly on preventive oral health behaviors such as teeth brushing,
flossing, fluoride application, dental sealants, …etc. Although, such issues
are extremely important, they can be potentiated by taking into consideration
the social determinants of the threat and by addressing food insecurity
especially within vulnerable populations who struggle under harsh structural and
financial conditions.
Reference:
Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic
status, food security, and dental caries in US children: mediation analyses of
data from the National Health and Nutrition Examination Survey, 2007-2008. Am J
Public Health. 2014 May;104(5):860-4
Saturday, November 26, 2016
Health Benefits of Pet Ownership
When talking to people
before heading home for break, I discovered that most students were really
excited to see their pets at home. This
got me thinking about what having pets does for us. The health benefits of pet ownership have
been shown as contradictory in previous studies (Utz, 2014). These studies have used inconsistent methods
and biased samples, so the results have been inconclusive. Utz reported on a study done to address the
previous studies problems (2014). This
recent study showed that pet ownership does appear to have a positive effect on
health. Owners of pets are less likely
to be diagnosed with congestive heart failure, report arthritis, or be
obese. People with pets also report and
are physician assessed to have excellent or very good health ratings. This is true for overall health except for
allergies and asthma. Pet owners have
been documented to having more prevalence of allergies and asthma than non-pet
owners. This could be an artificial
increase because pet owners have more contact with animals and are more likely
to be aware of asthma and allergies (Utz, 2014).
A further study done
in China proved that dogs have some benefits on their owner’s health. Owning a dog is positively associated with
feeling healthier. Dog owners in this
Chinese demographic are also less likely to miss work and have fewer nights of
bad sleep. This means that it is
possible for pet dogs to contribute to considerable health care savings (Headey
et al., 2008). Other studies have also
been done in the United States, Australia, and Great Britain on pet cat and dog
ownership and health benefits. The
results of these studies showed that having a cat or dog relieves feelings of
loneliness. The presence of a pet in
home is also good for a friendly atmosphere and putting people at ease. The results of these studies make me happy
and appreciate my pets even more.
·
Headey, B. (1999). Health benefits and health
cost savings due to pets: Preliminary
estimates from an australian national survey. Social
Indicators Research, 47(2), 233-243. Retrieved from
http://search.proquest.com.ezproxy.lib.purdue.edu/docview/197667607?accountid=13360
·
Headey, B., Na, F., & Zheng, R. (2008). Pet
dogs benefit owners' health: A 'natural
experiment' in china. Social Indicators Research, 87(3),
481-493. doi:http://dx.doi.org.ezproxy.lib.purdue.edu/10.1007/s11205-007-9142-2
·
Utz, R. L. (2014). Walking the dog: The effect
of pet ownership on human health and
health behaviors. Social Indicators Research, 116(2),
327-339.
doi:http://dx.doi.org.ezproxy.lib.purdue.edu/10.1007/s11205-013-0299-6
Friday, November 25, 2016
The year was 1621
Thanksgiving 1621
The year was 1621 when many believe the first thanksgiving
meal was celebrated with the abundant harvest that had ended the famine that
resulted in many deaths across the pilgrim population. This is what Americans
have been celebrating this weekend! Not being American myself, I was curious as
to why such a holiday was celebrated more so here than in Canada. The history
of how this holiday was a triumph over an epidemic of famine among a population
brings hopeful light onto many global health concerns we have today of food
insecurity and diseases associated with such. It is each year that we are given
this rebirth of hope needing to be cherished as well as reflected upon in how
we can use this new-found hope to address our current health situations across
the world. By learning through historical events, we can identify ways to
reduce food insecurity, create bountiful harvests and agricultural practices.
There is a much needed movement needing to be had to detach
ourselves from the marketing holiday that it has come to be towards one of humbleness,
a moment to reflect on what the history books would say about the year 2016 and
thanksgiving. Perhaps it is time to create a new holiday that celebrates a new
day of health, a new solution to a problem we currently have. For example, as
we sit in traffic jams this weekend to reach many different destinations for
that thanksgiving feast, the stress thousands of vehicles have on our climate
that impact our current health concern of warming temperatures. Or even perhaps
once we finally get to our destination, reflecting on where our food has come
from and the trickling down effect on the small scale farmers of where the brussel
sprouts, potatoes, and ingredients in the pumpkin pie have come from. How can
we address these issues? How can we create a movement away from such a heavily market-created
holiday towards one of reflection and inspiration in order to address many global
health concerns we have today?
Saturday, November 19, 2016
Complementary Feeding, Globalization and Child Health
Per the WHO, Complementary feeding is defined as the process
starting when breast milk alone is no longer sufficient to meet the nutritional
requirements of infants, and therefore other foods and liquids are needed,
along with breast milk. The transition from exclusive breastfeeding to family
foods is referred to as complementary feeding. Formerly, the ideal age of this
transition was at the age of 4 months. However; recently, based on the new WHO
recommendations, exclusive breastfeeding is found to be of maximum benefit to
the child health when it continues till the age 6 months. Starting from 6 – 24 months
of age, complimentary feeding should continue side by side with breastfeeding
which should continue through this period. This period is critical for child
growth during which, nutrient and micro-nutrient deficiencies contribute
globally to higher rates of child malnutrition which is the underlying cause for
multiple diseases that account for high child mortality rates of children under
five worldwide. Apart from timing, adequacy, appropriateness, and cleanliness
are crucial with the transition to complimentary food.
In the developing countries, the problem is complicated.
Women in the era of globalization are forced to go to labor market to afford
money for themselves, babies, and families. The work conditions are not
suitable to maintain the exclusive breastfeeding till the age of 6 months and
mothers tend to either shift to formula and/or complimentary feeding earlier.
In most of the developing countries this carries disastrous influences on child
health. These countries mostly lack access to clean and safe water and/or
refrigeration. Hence; the risk of illness dramatically increases when babies
start solids and/or formula especially that they did not get their sufficient immunity
from their mothers’ breast milk. With introducing solid foods and or/formula to
babies, potential exposure to pathogens from contaminated food, water, or
utensils will significantly increase. Additionally, the solid food introduced
to the child is mostly dependent on availability of food in households rather
than adequacy and appropriateness to the child age which could expose the child
health to further complications.
Tackling the problems of exclusive breastfeeding and complimentary
feeding practices is crucial due to their global influence on child health and
mortality rates. However; interventions in the developing world is very
complicated. Although lack of knowledge is a major factor, I believe that it is
neither enough nor successful in such communities. In my opinion, these problems
should be tackled from multi-perspectives, taking into consideration the individual
level along with the structural barriers and the social suffering of the mothers
in the globalized world.
Reference:
What if the World went Vegan?
What if the World went Vegan?
Vegetarianism and
Veganism have been discussed in our class a minimal amount in terms of global
health; however, rising popularity of this lifestyle in North America has
flourished with numerous research studies and documentaries on its impact on
health (i.e.: Before the Flood) and its relation to climate change (also a topic
of concern on how it too can impact the global health environment). Recently, I
came across an article hypothesising the effects of a scenario in which the world
went vegan.
Researchers at the
University of Oxford used a data set from the UN Food and Agriculture Association
and WHO and compared the effects across global health.
Fact:
ü Greenhouse gas emissions would
fall by 50% by 2050
ü Health costs due to the
decrease in noncommunicable diseases world wide per year= $735 billion US (following
international guidelines of a healthy diet), $973 billion (vegetarian diet), $1
trillion (vegan diet)
ü Decrease in deaths= 5.1
million (healthy diet), 7.3 million (vegetarian), 8.1 million (vegan)
ü 75% of these benefits occurring in developing
countries
Developing countries
are in deed where many of the global health concerns we have discussed are
present and a lot of these benefits would be seen there. Many pro meat consumption
arguments include the livestock’s capacity to generate business for small and
local farmers, being a way of life, health benefits, as well as the cultural
symbolism that meat consumption is often associated with. However, these
concerns have supporting counterarguments mentioned above including the health benefits.
It is also interesting to note that “the
world’s agricultural system would need to produce 25% more fruits and vegetables,
and 56% less red meat” (DeWeerdt, 2016). This production can be shifted towards local farmers who would
otherwise be farming for meat consumption with strategic processes in place to identify
which crops can be best grown in certain countries due to their climate.
I certainly am not suggesting
everyone goes vegan, simply considering the alternative of even reducing meat
consumption to the international dietary standards would be a desirable change.
Presenting the evidence in this light that is supported by data is worthy of
consideration. Perhaps efforts should be weighed more heavily on adopting a global lens towards diet and food
consumption (including increased donor funding towards planning and
implementation) that a significant impact on many global health concerns we
have today will be addressed.
I would love to hear your thoughts on this as I know many of you do consume meat and animal products and are public health professionals!
Reference
DeWeerdt (2016). What if the Whole
World Went Vegan? Conservation. University
of Washington. http://conservationmagazine.org/2016/03/can-vegans-really-save-planet/
At the Mercy of our Environment: Epigenetic Influences Have Complex Impact
Last week I attended a talk by Dr. Valerie Knopik, a genetic biologist, entitled "Genes + Environment = behavior?" The concept of nature and
nurture both coming together to affect our biology and behavior is nothing
new, but Knopik challenged the assumption that some sort of linear model could
sufficiently describe the relationship.
Rather than genes and environment each contributing separately to our
behavior, she eloquently displayed the complex web of factors relating the two. Not only do nature and nurture influence us,
but they also influence each other in complex ways, sometimes even before they
affect us. What does this mean for international health? I feel we often talk about how cultural, political, historic, and geographic factors have effects on people's health to no fault of their own, and that not everyone has equal access to health. However, Knopik's talk shows how this can go beyond social factors to influence our actual biology in serious and lasting ways.
Dr. Knopik discussed her work with smoking during
pregnancy (SDP) and how that relates to ADHD in children. First she described some of the variables
that can predict for smoking during pregnancy, most notable of which is, as
could be expected, chronic smoking abuse.
However, this behavior is also linked to a variety of other circumstances,
such as social phobia and depression, and church attendance actually had a
protective effect against it. Ultimately
this research into related variables to smoking during pregnancy found that
this behavior was also a proxy for other behaviors, and that it was also
genetically influenced. When we turn our
attention to children who faced SDP in utero, children are at highest risk for
developing ADHD when they have genetically inherited the risky allele for the
nicotinic receptor AND are exposed to SDP.
If the children ONLY have the risky allele OR are exposed to SDP, but
not both, risk of ADHD is much lower.
This information has obvious application in the field of public health, and international health. When we seek to promote healthy behavior change, or even just to understand the root causes of a health problem in a given community, it is vital to remember that there is more at play than the choices people make. I think it is quite common for public health professionals to understand that environmental limitations such as socioeconomic status and education can negatively impact health behaviors, but biology must not be counted out. The unfortunate thing is that this can be hard to change; as epigenetics research shows, we are not entirely in control of our gene expression but are at the mercy of environmental exposure, prenatal care, and even behavior of the generations that came before us. Ideally, we need to be able to communicate to people that their behaviors are not only affecting them but also their descendants for generations to come. More realistically, we can recognize that genetics and environment do not only independently impact our health but also influence each other, so any particular health concern we seek to attend to as international health officials requires careful analysis and deep understanding of all contributing factors.
This information has obvious application in the field of public health, and international health. When we seek to promote healthy behavior change, or even just to understand the root causes of a health problem in a given community, it is vital to remember that there is more at play than the choices people make. I think it is quite common for public health professionals to understand that environmental limitations such as socioeconomic status and education can negatively impact health behaviors, but biology must not be counted out. The unfortunate thing is that this can be hard to change; as epigenetics research shows, we are not entirely in control of our gene expression but are at the mercy of environmental exposure, prenatal care, and even behavior of the generations that came before us. Ideally, we need to be able to communicate to people that their behaviors are not only affecting them but also their descendants for generations to come. More realistically, we can recognize that genetics and environment do not only independently impact our health but also influence each other, so any particular health concern we seek to attend to as international health officials requires careful analysis and deep understanding of all contributing factors.
Friday, November 18, 2016
Perceived Barriers and Facilitators to Mental Health Help-Seeking
I am pleasantly surprised at how exposed I have been to mental health issues
in public health this semester; it is a topic that we have discussed almost
every class, Lala’s point of interest, my group’s final paper project, and an
area I will soon be working in. I think
a large part of why we discuss mental health in public health is because there
are a lot of perceived barriers to seeking mental health care due to stigma
that varies from country to country and even town to town.
Gulliver, Griffiths, and Christensen (2010) looked at perceived barrier
and facilitators to mental health help-seeking in young people globally. The statistics they found are not surprising
to what we already know: only 18% of 12-17 year olds in Germany with
diagnosable anxiety disorders utilized mental health care; only 34% of 15-16
year olds in Norway with high levels of depression and anxiety symptoms sought
professional mental health care in the previous year; and only 25% of children
4-17 with a diagnosable mental disorder had utilized mental health services six
months prior to the survey. Key barriers
that they found in their review included the following: stigma surrounding
mental illness (10 studies); confidentiality/trust (6); unable to identify
symptoms of mental illness (5); concerns about the mental health provider (5);
and reliance on self/do not want help (5); among others (see Table 1 of
reference). I have included a picture of
the top rated barriers they found in quantitative studies (Table 3). Curiously, they also looked at key
facilitator themes to seeking mental health services: positive past experiences
with help-seeking, social support/help from others, confidentiality/trust in
mental health provider, among others (see Table 2 in reference).
Studies
like this are crucial because they help health care professionals fix the right
problems: the first step to solving an issue is to (1) talk with the people
your intervention affects and (2) ask questions ask questions ask
questions. I also think that Lala’s
article on reflexivity that we read a few weeks could come into play perfectly
with this topic. Stigma has
unfortunately portrayed mental illnesses harshly and creates judgements in all
of us. With mental health especially it
is important to address your own judgements and thoughts, put them aside, and
focus on the issue and people. On a
global scale, these judgements can vary widely.
Again, before we plan an intervention it is important to talk with the
people of the area we are working in, and realize that what worked for one
country/town may not work for another.
Slowly but surely, I think we can defeat the barriers to mental health
help-seeking.
Reference
Gulliver,
A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and
facilitators to mental health help-seeking in young people: A systematic
review. BioMed Central Psychiatry, 10(1),
1.
Personality Traits and Health
Personality traits and health have long had an interesting and complex
relationship. Physicians and researchers
have looked at how one influences the other.
The most common study is how personalities affect health. It could be argued that health status can
change personality as well, but there is little to no research done on this
yet. Shifren and Bauserman make the
connection between personality traits leading to lifestyle choices (1996). Individuals who have high scores in expressive
and instrumental traits are more likely to have better health behaviors. These include the use of more safety
precautions and are less likely to smoke tobacco products. It has also been shown that people who do not
ask for medical assistance during ailments or injury are more likely to be
susceptible to preventable illness and death.
In a more recent article, Bogg and Roberts evaluated personality traits
as a psychological construct (2013).
Much of their research showed conscientiousness as an influential
personality trait on health. Conscientiousness
is the personality trait related to being vigilant or careful. People ranked with more conscientiousness
personalities lived longer and had less disease risk. These include indicators of pathology for
diabetes, ulcers, strokes, high blood pressure, tuberculosis, and skin
problems. The most recent studies have
been focusing on conscientiousness personalities and the handling of stress
(Bogg & Roberts, 2013). As we have
discussed in previous conversations, stress can cause a tremendous number of
health problems. More conscientiousness
leads to better coping and adaptive strategies for stress. Because this is a fairly recent line of
research, the correlation between health-related outcomes and conscientiousness
for stress is lacking. This being said,
the initial findings warrant further attention.
The future of health and personality traits, at least according to Bogg
and Roberts, is to co-develop health behaviors and conscientiousness. The researchers believe that this will reduce
the amount of morbidity and eventually mortality experienced by populations.
- Bogg, T., & Roberts, B. W. (2013). The case for conscientiousness: Evidence and implications for a personality trait marker of health and longevity. Annals of Behavioral Medicine, 45(3), 278-88. doi:http://dx.doi.org.ezproxy.lib.purdue.edu/10.1007/s12160-012-9454-6
- Shifren, K., & Bauserman, R. L. (1996). The relationship between instrumental and expressive traits, health behaviors, and perceived physical health. Sex Roles, 34(11-12), 841-864. Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/225375107?accountid=13360
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