Social & Behavioral Aspect of Pharmacy

Measuring Health and Illness

Measures of Disease Frequency: Common Rates in Epidemiology
The most commonly used rates in epidemiology to evaluate morbidity are incidence and prevalence. These
describe the frequency of disease during a given time period. Mortality rate, also a commonly used
epidemiological rate, is a rate used to measure deaths and not morbidity.
1. Incidence Rate
a. Total new cases of specific disease during time period
b. Total population at risk during time period
c. This is the primary outcome of experimental and cohort studies. This is what it is needed for the
investigation of causal inference.
2. Prevalence Rate
a. Total new and pre-existing cases of specific disease during time period
b. Total population at risk during time period
c. This is the primary outcome of cross-sectional studies.
There can be two types of prevalence:
1. the point prevalence for the estimates at a specific time, or
2. period prevalence for the estimates within a range of time.
3. Mortality Rate
This measure describes the incidence of death/total population at a given time. Typically reported in 3 ways:
i. Crude: One overall rate; no adjustment for other factors. Insert actual (observed) mortality and population
values into numerator & denominator
ii. Cause-Specific or Group-Specific: Relevant to particular population characteristics (e.g., specific age group,
gender, ethnicity, cause of mortality). Example: infant mortality rate
iii. Adjusted: Rate that has been recalculated to adjust for difference in some population characteristic between
sample and overall population or between 2 different samples. Example: age-adjusted mortality rate because
sample has disproportionate number of old or young people.
Models of Health:
Models of health are ‘conceptual frameworks’ or ways of thinking about health. Models of health and health
promotion including:
a. Biomedical model of health:
Biomedical Model of Health focuses on the physical or biological aspects of disease and illness. It is a medical
model of care practised by doctors and/or health professional and is associated with the diagnosis, cure and
treatment of disease.
Advantages
1. It creates advances in technology and research
2. Without this model of health there would be little known about how to treat and diagnose illnesses
3. Many common problems can be effectively treated
4. Diseases that would otherwise develop and cause considerable illness or death can be stopped.
5. Extends life expectancy
6. Improves quality of life
7. Can be successful in returning someone back to good health.
Disadvantages:
1. Relies on professional health workers and technology and is therefore costly
2. Professionals with specialist knowledge needed are expensive to train.
3. Technology, equipment and technological developments expensive
4. Doesn’t promote good health / narrow view of health. Doesn’t encourage people to live healthy lives as they
are treated to fix problems as they arise. The focus is on the condition and not the determinants that caused it.
Not every condition can be treated.
b. Social model of health:
The Social Model of Health goes beyond the focus of lifestyles and behavior and accepts the need for social
change to provide prerequisites for health
5 Key Principles:
1. Addresses the broader determinants of health
2. Reduce social inequities
3. Empower individuals and communities
4. Access to health care
5. Inter-Sectorial collaboration
Advantages:
1. Less costly to prevent the disease before it happens
2. Encourages individuals to take responsibility and lead healthier lifestyles => improve quality of life
3. Community approach involving all levels of government, non-government organisations
4. Increase economic development of the country as the population is in good health and lead productive lives
Disadvantages:
1. Lack of education for the whole population, some people don’t get or understand the message
2. Population not motivated e.g. suntans, smoking, overweight.
3. Not believing it will happen to them
4. Changing lifestyles is very hard
5. Not all diseases can be prevented
c. The Ottawa Charter for Health Promotion:
The Determinants of Model Health:
Many factors combine together to affect the health of individuals and communities. Whether people are healthy
or not, is determined by their circumstances and environment. To a large extent, factors such as where we live,
the state of our environment, genetics, our income and education level, and our relationships with friends and
family all have considerable impacts on health, whereas the more commonly considered factors such as access
and use of health care services often have less of an impact.
The determinants of health include:
1. the social and economic environment,
2. the physical environment, and
3. the person’s individual characteristics and behaviors.

These determinants—or things that make people healthy or not—include the above factors, and many others:
a. Income and social status - higher income and social status are linked to better health. The greater the gap
between the richest and poorest people, the greater the differences in health.
b. Education – low education levels are linked with poor health, more stress and lower self-confidence.
c. Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all
contribute to good health.
d. Employment and working conditions – people in employment are healthier, particularly those who have more
control over their working conditions
e. Social support networks – greater support from families, friends and communities is linked to better health.
F. Culture - customs and traditions, and the beliefs of the family and community all affect health.
g. Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing
certain illnesses. Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and
how we deal with life’s stresses and challenges all affect health.
h. Health services - access and use of services that prevent and treat disease influences health
i. Gender - Men and women suffer from different types of diseases at different ages.

Social and Behavioral Health:

The ultimate goal of public health is to achieve and sustain healthy populations and environments. In order to
reach this goal, however, we must be able to understand the role of behavior and social factors and how they
contribute to public health solutions and policies. The study of social and behavioral health sciences involves
how human behavior affects human interaction, decision making, and group processes.
Social and behavioral health sciences involve:
a. Understanding the psychosocial, behavioral, community, and societal influences on the health of a specific
population, including those who are disadvantaged
b. Creating interventions that eliminate specific barriers to health across the lifespan
c. Understanding how biological factors influence health, illness, and recovery
d. Identifying risk factors that result in adverse health outcomes and strategies for promoting health and
preventing disease.