Public health theory links ... helpful for social and behavioral students (and everyone else!)

I'm a big advocate of using theory to create public health programs, instead of just trusting your "gut." Too many public health practitioners, who are poorly trained in theory and evidence-based approaches, put together programs like this: FocusDriven that are largely designed to appeal to our emotions and fear of physical injury. Although I suppose these worked at one time, campaigns such as these slip out of our conciousness the minute we navigate to a different page.

With that in mind, I've found some really awesome articles that summarize public health theories relating to behavior change, and I'm going to share them here! Get stoked!

• This article from the National Institutes of Health relates specifically to cancer, but the information can be generalized to most public health practice. This is probably the most practically applicable document I've seen that relates to public health theory.
• Here is a file that summarizes public health theory nicely, including some that you usually don't see, such as Protection Motivation Theory and the Elaboration Likelihood Model.
• Finally, it's important to recognize that different populations require different theoretical models to inspire interventions. Children are a particularly relevant group because their cognitive abilities differ greatly from those of adults. This article explains a child-specific model that can be used to spark behavior change.

Again, it's important that public health professionals adhere to existing scientific knowledge in crafting campaigns and interventions. Otherwise, taxpayer money and funds from private enterprise are essentially discarded as they are applied to feel-good efforts that really don't fix anything.

I'm continually shocked at the inability of our health community to lay proper foundations for research and intervention. Perhaps this is because many of us in this field are poorly educated about public health, considering the current clinical focus of medical technology today. It's clear that a paradigm shift must occur that stresses true evidence basis instead of self-serving, happiness-inducing, ineffective programming.

This means that we, as public health professionals, must acquire enough knowledge to recognize when something is a bunch of horse hockey. Learn your statistical measures. Understand what total crap looks like. Sources will tell you that D.A.R.E. is an effective program, for example ... but if you actually READ the studies, the evidence for this suddenly vanishes.

Think critically, people.

Borderline personality disorder ... mental health in sports news? Yes, we're excited!

So, I'm hanging out with my S.O. yesterday, and I see him reading some sports news. Meh, no big deal, I think ... I'm not usually excited by A&M's football prospects or which hitter has the best RBI. But then, out of the blue ... a public health article sprouts up in the sporting world that has nothing to do with performance-enhancing drugs or nasty ACL injuries. Yep, it made for a great Sunday.

Here's the scoop: Miami Dolphins wide receiver Brandon Marshall went public with his diagnosis of Borderline Personality Disorder (article here). For those of you who aren't mental health experts, Borderline Personality Disorder (BPD) is characterized by the following:

1) frantic efforts to avoid real or imagined abandonment

2) a pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3) identity disturbance: markedly and persistent unstable self-image or sense of self

4) impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)

5) recurrent suicidal behavior, gestures or threats, or self-mutilating behavior

6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

7) chronic feelings of emptiness

8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9) transient, stress related paranoia or severe dissociative symptoms

(More information from a DSM summary here)

The most important part of this whole situation is that Marshall is making his struggles with BPD public. BPD may not be on many people's radars as far as important mental health issues go, but that doesn't matter. What excites me abot this article is that a ridiculously successful (Pro Bowl anyone?) professional athlete is unabashedly admitting to a relatively severe mental illness.

The message? It can happen to anyone.

As more and more people come forward to share their struggles with mental illness, the stigma and hype surrounding such conditions will begin to wane. This is why I am always so forward about my struggles with depression and an eating disorder; by making these things a secret, I would be playing into the social expectations of guilt and embarrassment about my mental health. I'm so happy to see high-profile folks like this coming forward to help fight for the cause.

I do feel terribly sorry for Marshall; even with practically unlimited resources, he's continued to struggle with this difficult condition. This article, however, highlights another important point about mental illness that we can scarcely afford to forget:

A man with nearly unlimited resources at his disposal still struggled immensely with mental illness.

Not only do mental illnesses not discriminate ... they also require specific, individualized treatment plans and a lot of dedication to overcome.

This is particularly salient in light of the recent health care reforms, which have re-opened the debate about insurers' responsibility to those of us who suffer from mental illness. If recovery is even difficult for a man with access to so much care, what can we expect for those with health disparities? The dearth of mental health services for all Americans is inexcusable; although the physical maladies may present themselves with more clarity, mental illnesses are also fatal diseases. We can't ignore the implications that mental illnesses have for overall improvement of care.

So, a big THANK YOU to Brandon Marshall for "coming out" as someone with a mental illness! Here's to shattering more norms!

More smoking, more eating = less economic burden?

Smokers, obese save us money!

So, in addition to the above picture of the ubiquitous headless fatty, I bring you one of the most controversial articles I've read all year. I tell all kinds of people about this study, but no one seems to believe me, and they also think I've lost my mind and/or soul when I bring up this important point:

Healthy people cost the healthcare system more money than chubbies/smokers do.

"How can this be?" you might ask. I was with you at first. I used to vilify people for making bad health decisions because I thought I'd end up paying thousands of dollars to fix their medical problems. I resented diabetes, lung cancer, hypertension, COPD and the whole panoply of medical conditions that accompany obesity and smoking. 

Consider this ... if you're eating healthy, exercising, and living to a ripe old age of, say, 90, you're ruining it for the rest of us. Would you rather pay for 2 years of cancer treatment (and die at, what, 65?), or 15 years of Medicare-sponsored assisted living expenses?

Our profession ostensibly strives to overcome health problems to improve the quality of life rather than simply its duration, which is the only argument I really have against allowing people to kill themselves earlier so we can reap economic gain. That, in itself, should be the fundamental tenet of public health, not saving the almighty dollar. Still, information like this is hard to ignore; again, as public health professionals, how are we supposed to "sell" improvements in health when they might actually harm society? Great question.

Articles like the link above provide us with stimulating information that ought to fuel our continuous debate about how to best spend our public health dollars. When it comes down to it, we really do have to think in economic terms; although it may seem cold, would you rather save 400 people with a guardrail (for example) or one child who needs a liver transplant (thus condemning 400 people to death)?

Economically, I'd go for the former, despite the plight of the kid tugging at my heart strings. But then everyone looks at you as though you shot their dog, accuses you of being heartless, and spends the money on the sick child anyway.

I feel very clinical and almost ... Third Reich-ish ... when speaking like this, but this is just another example of humans failing to examine facts and make decisions based on reality. I'm guilty of choosing with my gut more often than not, but when we're dealing with population-based health measures, that's a dangerous way of doing things.

Our responsibility is to serve the best interests of the general populace; can we do this best by saving money, or by lengthening lives?