HLTH 2000 Exam 2: Chapter 13

List of Leading Actual Causes of Death in the US

1) Tobacco 2) Poor Diet and Physical Inactivity 3) Misuse of Alcohol 4) Microbial Agents 5) Toxic Agents 6) Firearms 7) Sexual Behavior 8) Motor Vehicles 9) Illicit Drug Use

Advertising

An extension of the educational approach to changing behavior is the use of advertising to reinforce the public health message. Most people are subjected to large doses of media messages promoting unhealthy behavior. The occasional public service announcements meant to convey countervailing messages are feeble weapons in the battle for public health. Recently there have been efforts to develop more effective approaches to conveying public health messages in the media.

Regulation: 19th Century and Venereal Diseases

Another hot issue in the 19th century, both in Britain and the US, was the control of venereal diseases. In Britain, a series of Contagious Diseases Act were passed in the 1860s and 1870s, providing for compulsory medical examinations of known and suspected prostitutes and detention of those found to carry disease. Such laws were justified by arguing that venereal diseases were a national defense issue. Proponents also argued that irresponsible men, infected by prostitutes, carried diseases home to their innocent wives. In the US, most states adopted laws that required couples to be certified free of disease before they could obtain a marriage license.

Social Norms Approach

Another variation on health education that has become popular with college administrators to curb high-risk student drinking is the social norms approach. This approach is based on an influential study from the 1980s, which surveyed students about their perception of the frequency and amount of drinking among their peers. It turned out that students generally believed that other students drank more than they actually did. The remedy to the misperception that "everyone is doing it" is to advertise the actual norms on campus.

Last Leading Actual Causes of Death in the US: Firearms, Sexual Behavior, Motor Vehicles, and Illicit Drug Use

Firearms, sexual behavior, motor vehicles, and the illicit use of drugs round out the list. The authors, recognizing that some deaths may have multiple causes, choose what they believe to be the most significant.

1964 Surgeon General's Report

For example, the 1964 surgeon general's reported called Smoking and Health, the first authoritative statement from the federal government that smoking caused cancer and other life-threatening diseases, had a significant impact on the prevalence of smoking in the US.

Leading Actual Causes of Death (Non-genetic)

In 1990, a group of public health experts from the Centers for Disease Control and Prevention (CDC) decided that they should look at the data in a different way. They observed that the leading causes were not, in fact, root causes but were merely the diagnoses identified at the time of death. These diseases result from a combination of inborn (largely genetic) and external factors. They came up with a list of nongenetic factors that they called the leading actual causes of death. These factors are highly significant for public health because they are preventable causes of death and disability and because they provide targets for public health intervention.

Regulation: 20th Century and AIDS

Many of the themes that occurred in the debates over venereal disease control have recurred today in debates about AIDS prevention. In fact, two states passed laws in the 1980s requiring premarital screening for HIV infection. However, these laws were soon repealed. The conflict between, on the one hand, the protection of the privacy and freedom of the infected individual and, on the other hand, the protection of the health of potential "innocent" victims is the same with AIDS as it was with syphilis. However, the political power of gay men was much stronger than was the power of prostitutes in the 19th century. The gay community fought against many proposals designed to prevent the spread of the virus.

Third Leading Actual Cause of Death in the US: Misuse of Alcohol

Misuse of alcohol was listed as the third actual cause of death. Alcohol consumption by people under 21 is associated with many health and social problems.

Friedman and Bennett: Prohibition Debate

The debate about Prohibition resurfaces occasionally in the context of illegal drugs. In an exchange of letters published in the Wall Street Journal in 1989, two prominent conservatives debated whether the war on drugs was doing more harm than good. The economist Milton Friedman argued that the illegality drives up the price of the drugs, providing a financial incentive to drug dealers, causing desperate addicts to commit crimes to pay for their addiction, and corrupting law enforcement officials tempted by bribery. Opposing this view was William Bennett. Bennett admitted that the war on drugs is costly, but argued that the cost of not enforcing laws against drugs would be higher.

Fifth Leading Actual Cause of Death in the US: Toxic Agents

The fact that toxic agents are listed fifth as an actual cause of death is evidence of successes in environmental health. The list's authors call this figure the most uncertain; environmental threats may actually belong farther up the list.

Prohibition

The most ambitious attempt by the US government to regulate the behavior of its citizens was Prohibition, passed by a constitutional amendment in 1919 that was repealed 14 years later. The movement to legally ban alcohol became a moral crusade in the late 19th century, with prohibitionists blaming alcohol for all the ills of society. However, it was also true that flouting of the law became socially acceptable, and organized crime flourished. Common wisdom holds that Prohibition was a failure, but today's society treats "recreational" drugs in much the same way that the Eighteenth Amendment treated alcohol. In fact, the Prohibition approach to regulating behavior appears to have mixed results, combining success and failure in a complex way.

Regulation

The regulatory approach is clearly warranted when its intent is to restrain people from harming others. Most states have laws concerning alcohol and tobacco use aimed at protecting the public. The greatest controversy about governmental attempts to regulate behavior arises when these efforts are perceived as interfering with a mature individual's freedom to take risks with his or her own health.

Education and Eating

Most simply, education informs the public about healthy and unhealthy behaviors. Many people who are concerned about their health and that of their families do in fact adjust their behavior in accordance with new information. The focus of government educational programs on nutrition has shifted to the prevention of the major killers—cancer, cardiovascular disease, and diabetes, which tend to be associated with nutritional excesses. There is evidence that Americans have responded to the message that they should cut down on fat in their diet and that this behavior may have helped bring down the high rates of hear disease over the past 30 years. Results of the efforts to modify dietary and smoking behaviors, while showing some success, also illustrate the limitations of the educational approach. The impact of both messages has been limited. Information on healthful eating habits has traditionally been provided by the federal government. The educational process was furthered by Food and Drug Administration (FDA) requirements for labeling of prepared foods, which must accurately identify the percentage of the daily value provided by each serving.

Fourth Leading Actual Cause of Death in the US: Microbial Agents

Number four on the list—microbial agents—encompasses the top three killers of 1900.

Second Leading Actual Cause of Death in the US: Poor Diet and Physical Inactivity

Poor diet and physical inactivity are listed as the second most important actual cause of death. These two factors are closely related to each other, with overeating and inactivity combining to lead to obesity.

Schools and Health Education

Schools are naturally a prime site for health education programs. The goal is to teach children from an early age how to live healthy lives. Studies have shown that school education programs are effective in teaching children the facts about health and safety. It is less clear, however, that they actually influence young people to behave in healthier ways.

Sex Education

Sex education in the schools is highly controversial. Opponents have argued for years that teaching young people about sex encourages them to indulge in immoral behavior. Many proponents of explicit education about safe sex argue that young people have sex no matter what they are taught and that they should be informed about how to protect themselves. Opponents argue that condoms are only partially effective in preventing pregnancy and sexually transmitted diseases and that young people should be taught that they can protect themselves only by abstinence. In fact, a number of studies have shown that students who have received comprehensive sex education in school delay initiation of sex, reduce the number of partners, and are more likely to use contraception when they do have sex. Nevertheless, the controversy continues in many communities.

Prevention of the Leading Actual Causes of Death in the US

These nine actual causes of death account for approximately 50% of all deaths in the US. The other half includes genetic factors, which were specifically excluded from the analysis, and other less clearly identifiable causes. The nine identified factors are of particular public health significant because they cause premature deaths; they are often preceded by impaired quality of life; and many could be prevented by public health measures. In trying to prevent premature death and disability, public health must focus on these nine factors. Two of them—microbial agents and toxic agents—have traditionally been public health issues. The other seven are rooted in the behavioral choices of individuals. This is the biggest challenge now faced by public health. There are two obvious approaches that the government has traditionally taken to promote healthy behavior: education and regulation.

Leading Actual Cause of Death in the US: Tobacco

Tobacco was found to be the leading actual cause of death in the US.