51331_PAHO_CVRr2 4/10/03 12:07 AM Page 1 PAHO Scientific and Technical Publication No. 590 Pan American Health Organization BUILDING BETTER HEALTH: A Handbook of Behavioral Change Building Better Health: A Handbook of Behavioral Change is a one-of-a-kind manual for communities to reduce disease, disability, and premature death throughout the life cycle. It blends proven disease prevention strategies with practical behavioral science principles and methods to create a handy guide that health workers at all levels can use in planning and operating local and regional health programs. David Jenkins is an internationally known health worker, researcher and Professor of Preventive Medicine and Community Health, of Epidemiology, and of Psychiatry.
He has been a consultant to the World Health Organization, the Pan American Health Organization, and WHO Regional Offices for Europe, the Eastern Mediterranean, and the Western Pacific. Jenkins’ text is lively, enthusiastic, accessible—and anchored in solid science. Wherever in the world health workers fight against disease and disability, this Handbook will become an essential tool. It will be especially useful in the battle against the rising tide of chronic degenerative diseases, lifestyle related diseases, major depression, injuries, and violence.
David Jenkins It is a tour de force. It is succinct, based on science, but understandable; it is enthusiastic; the behavioral change section is outstanding; the relevance to lesser developed countries is clear throughout. Formerly Associate Director for Disease Prevention National Institutes of Health United States Department of Health & Human Services Dr. Jenkins’s book is a one-of-a-kind example of a successful blend of biomedical and behavioral sciences.
It has two outstanding pluses: first, the information in it can be interpreted within a theoretical context and, because of that, it can be applied to similar conditions that are not specifically covered in the book; second, the information in this book will have a very long useful life. Miguel Álvarez, Ph. BUILDING BETTER Professor, National Institute of Neurology and Neurosciences Havana, Cuba Among [the Handbook’s] many strengths is its emphasis on the inseparable nature of the human HEALTH condition. All disorders, and therefore their prevention, must take into account their biological, psychosocial, and community setting….
The unity of health and behavior, and the carryover of this theme to prevention, is a most important concept for the developing and the developed worlds. This book will be a useful guide for all who work at preventing illness and disability throughout the world. Robert Haggerty Professor and Chair Emeritus, Department of Pediatrics, University of Rochester School of Medicine and Dentistry A Handbook of Behavioral Change Sci. 590 Pan American Health Organization Regional Office of the World Health Organization ISBN 92-75-11590-7 51331_p001_018_r2 4/9/03 5:52 PM Page i BUILDING BETTER H E A LT H A HANDBOOK OF BEHAVIORAL CHANGE C.
David Jenkins, Ph. Professor of Preventive Medicine and Community Health, Epidemiology, and Psychiatry Scientific and Technical Publication No. 590 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-third Street, N. 2003 51331_p001_018_r1 4/7/03 1:40 PM Page ii PAHO HQ Library Cataloguing-in-Publication Data Jenkins, C.
David Building better health: a handbook for behavioral change Washington D. Pan American Health Organization 1. EDUCATION, PUBLIC HEALTH PROFESSIONAL 4. BEHAVIORAL MEDICINE-education 5.
MANUALS NLM WA590.J52b 2003 The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Publications Program, Pan American Health Organization, Washington, D., which will be glad to provide the latest information on any changes made to the text, plans for new edi- tions, and reprints and translations already available. © Pan American Health Organization, 2003 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved.
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in pref- erence to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. 51331_p001_018_r1 4/7/03 1:40 PM Page iii Table of Contents Prologue.
General Principles of Health Promotion and Disease Prevention. 3 Human and Economic Values of Prevention. 3 Disease Prevention and Health Promotion. 6 Three Levels of Prevention.
8 The Actual Causes of Death. 8 Box: The Ten “True” Leading Causes of Death. 8 The Next Step Needed to Advance “Health for All”. Principles of Community Health Intervention.
11 Box: Puzzles to Solve for Building Better Health. 11 Strategies for Identifying Causes. 13 Social/economic Level. 14 Cultural/ideological Level.
15 Using the Epidemiologic Triangle in Prevention Programs. 17 Multiple Contributing Causes. 18 Selecting Which Conditions to Prevent. 19 Selecting the Target Populations to Receive Help.
21 Working with the Whole Community or Only with the High-risk Group. 24 The Prevention Paradox. 27 Specifying the Changes in Behaviors and Environments Required to Reach the Health Goals. I M P R O V I N G H E A LT H T H R O U G H O U T THE LIFE CYCLE 3.
Infants and Children Up to 14 Years Old. 33 Risk Factors for Low Birthweight, Fetal Anomalies, and Infant Deaths. 36 Social Risk Factors. 36 Personal Biological Factors.
36 TA B L E O F C O N T E N T S iii 51331_p001_018_r1 4/7/03 1:40 PM Page iv Personal Behavioral Factors. 37 Psychological Risk Factors. 37 Screening Pregnant Women. 38 Box: Screening Checklist for Pregnant Women.
38 From Birth through Age 4 Years. 39 Prevention and Early Detection of Developmental Problems. 42 Screening Checklist for Newborns. 42 Preventing Postnatal Disabilities.
43 Reducing Sudden Infant Death Syndrome (SIDS). 44 Predisposing and Precipitating Risk Factors for SIDS. 46 Increasing Immunization Coverage. 47 Reducing Respiratory Diseases.
48 Controlling Diarrheal Diseases. 52 Oral Rehydration—How to Do It. 52 Reducing Rates of Unintentional Injuries. 53 Preventing Impact Injuries to Children Inside Motor Vehicles.
56 Preventing Impact Injuries to Children Outside of Motor Vehicles. 56 Preventing Impact Injuries to Children on Playground Equipment or Climbing. 57 Preventing Injuries on Household Stairs and Windows. 57 Preventing Burn Injuries.
59 Preventing Cuts and Lacerations. 61 Dealing with Insect and Animal Bites. 61 Preventing Strangulation/Choking. 62 Preventing Firearm Injuries.
63 Child Abuse and Neglect. 64 Prevalence and Severity of the Problem. 65 Cross-cultural Considerations. 66 Clinical Signs of Child Abuse.
66 Box: The Explanation. 67 Box: Professionals’ Checklist for Questionable Injuries. 68 Box: Checklist of Signs of Possible Neglect for Health Professionals. 69 Secondary Prevention of Abuse and Neglect.
70 Primary Prevention of Child Abuse and Neglect. 70 Screening Summary from Birth to Age 4 Years. 73 Box: Screening Checklist from Birth to Age 4 Years. 74 iv BUILDING BETTER HEALTH 51331_p001_018_r1 4/7/03 1:40 PM Page v From Ages 5 through 14 Years.
75 Major Health Problems. 75 Health Promotion Opportunities. 76 Box: Screening Checklist for ages 5 to 14. Adolescents and Young Adults 15–24 Years Old.
79 Nurturing the Seeds for a Healthy Future. 79 Major Health Problems at Ages 15–24. 81 Morbidity and Disability. 83 Box: Two Common Dynamics of Weight-losing Eating Disorders.
90 Psychosocial Foundations of Most Health Problems at These Ages 93 Conveying Learning and Values to Overcome Health Vulnerabilities. 95 Box: How to Develop Systematic Health Programs for Youth. 96 Box: Useful Principles Taken from Studies of Youth and Adult Learning Which Have Cross Cultural Value. 97 Protective Factor: Promote the “Universal Vaccine”.
97 Box: Screening Checklist for Ages 15 to 24 Years: by Interview and Observation. 105 Inquiry Topics from the “Youth Risk Behavior Survey”. The Prime of Life: Ages 25 to 64 Years. 109 The Growing Importance of Adult Health.
109 Major Causes of Death. 113 Major Causes of Disability. 114 Special Issues for Women. 116 Special Issues for Men.
117 Avenues for Reaching Adults with Preventive Programs. 119 Screening by Interview. 121 Use of Other Mood Altering Substances. 122 Social and Emotional Well-being.
122 Risks of Motor Vehicle Trauma or Injury. 123 Risks of Occupational Injury. 124 Social Support Network. 124 Health Problems in Other Family Members.
125 TA B L E O F C O N T E N T S v 51331_p001_018_r1 4/7/03 1:40 PM Page vi Screening by Observation. 125 Appearance and Behavior. 125 Clinical and Laboratory Screens and Prophylaxes. 126 Height and Weight Measurement.
126 Blood Pressure Measurement. 127 Sexually Transmitted Infections. 127 Ischemic Heart Disease. The Older Years: 65 to 100.
129 Health Goals for the Later Years. 129 Major Health Problems at These Ages. 131 General Systemic Diseases and Disabilities. 132 Box: Leading Noncommunicable Disease Causes of Disability Worldwide.
132 Risk Factors for Major Causes of Death and Disability. 132 Protective Factors for Major Causes of Death and Disability. 135 Preserving Physical and Mental Functioning. 136 Protective Factors for Mental Abilities.
137 Treating Pain and Suffering. 137 Box: Action Checklist for General Preventive Measures for Ages 65 Years and Older. 138 Community Action for Older Citizens. Brain and Behavioral Disorders.
143 Disabilities of Brain and Behavior. 143 Who is Vulnerable?. 145 Teasing Out the Causes of Brain and Behavioral Disorders. 147 Box: Sources that Influence the Risk of Brain and Behavioral Disorders.
148 Eleven Crossroads where Risk and Protective Factors Meet. 150 Genetic Strengths and Vulnerabilities. 150 The Intrauterine Environment. 151 vi BUILDING BETTER HEALTH 51331_p001_018_r1 4/7/03 1:40 PM Page vii The Perinatal Experience.
151 Coping with Chronic Illness or Injury Disability. 152 Box: How to Cope with the Risks of Chronic Illness or Disability. 152 Temperament and Adaptability. 153 Ability to Learn.
155 Family and Social Context. 157 Box: The “Good Behavior Game”. 158 Attachment to Parents and Mentors. 159 Summing up the Crossroads.
160 Restructuring Treatment Systems. 160 Recognizing and Dealing with Depression. 161 Signs and Symptoms. 162 The Bright Side: Secondary Prevention through Early Treatment.
163 Alcohol Abuse and Dependence. 168 Protective Factors and Interventions. 168 Conduct Disorders/Delinquency. 170 Emergence of Signs.
172 Positive Behavioral and Mental Health. 174 At the Individual Level. 174 Within the Self. 174 In Relationships with Others.
175 At the Family Level. 176 Self-acceptance, Self-esteem, Realism, Efficacy. 176 Continuity of Satisfying, Trusting, and Caring Relationships. 176 Coping with Life Responsibly and Productively.
176 At the Community Level. 176 Self-acceptance, Self-esteem, Effectiveness. 176 Relations with Other Groups. Diseases of the Heart and Blood Vessels.
179 Inflammatory Heart Diseases. 181 Box: Primary Prevention of Chagas’ Disease. 182 Rheumatic Heart Disease. 183 TA B L E O F C O N T E N T S vii 51331_p001_018_r1 4/7/03 1:40 PM Page viii Pulmonary Heart Disease.
183 Box: Prevention of Rheumatic Heart Disease. 185 Nutritional Heart Diseases. 186 Hypertension and Hypertensive Heart Disease. 191 Ischemic Heart Disease.
195 Cerebrovascular Diseases—“Stroke”. 197 Box: Warning Signals of Transient Ischemic Attacks. 201 Digestive System Cancers. 204 Cancers of the Colon and Rectum.
206 Cancers of the Oral Cavity, Esophagus, Larynx, and Pharynx. 208 Cancer of the Liver .
