Connect Core Concepts in Health Brief Loose Leaf Edition 15th
Connect Core Concepts in Health Brief Loose Leaf Edition 15th
Connect Core Concepts in Health Brief Loose Leaf Edition 15th
CONTENTS vii
DRINKING BEHAVIOR AND RESPONSIBILITY 262
Examine Your Drinking Behavior 263
Drink Moderately and Responsibly 263
Promote Responsible Drinking 264
Tips for Today and the Future 266
Summary 266
For More Information 266
Selected Bibliography 267
viii CONTENTS
Food Biotechnology 332 Body Fat Distribution 378
Food Allergies and Food Intolerances 332 What Is the Right Weight for You? 379
Tips for Today and the Future 333 BODY FAT AND WELLNESS 380
Summary 333 Diabetes 380
For More Information 334 Heart Disease and Other Chronic Conditions 382
Selected Bibliography 335 Problems Associated with Very Low Levels of Body Fat 382
FACTORS CONTRIBUTING TO EXCESS BODY FAT 382
13 EXERCISE FOR HEALTH AND FITNESS 342 Energy Balance 382
Genetic Factors 383
THE BENEFITS OF EXERCISE 343
Physiological Factors 383
Reduced Risk of Premature Death 343
Lifestyle Factors 385
Improved Cardiorespiratory Functioning 344
Psychosocial Factors 386
More Efficient Metabolism and Improved Cell Health 344
Environmental Factors 387
Improved Body Composition 345
Disease Prevention and Management 345 ADOPTING A HEALTHY LIFESTYLE FOR SUCCESSFUL
Improved Psychological and Emotional Wellness 346 WEIGHT MANAGEMENT 388
Improved Immune Function 347 Dietary Patterns and Eating Habits 389
Prevention of Injuries and Low-Back Pain 347 Physical Activity and Exercise 392
Improved Wellness for Life 347 Thinking and Emotions 392
Coping Strategies 392
WHAT IS PHYSICAL FITNESS? 347
Cardiorespiratory Endurance 348 APPROACHES TO OVERCOMING A WEIGHT
Muscular Strength 348 PROBLEM 392
Muscular Endurance 349 Doing It Yourself 392
Flexibility 349 Diet Books 394
Body Composition 349 Dietary Supplements and Diet Aids 395
Skill-Related Components of Fitness 349 Weight Loss Programs 396
Prescription Drugs 398
COMPONENTS OF AN ACTIVE LIFESTYLE 349
Surgery 398
Levels of Physical Activity 350
Increasing Physical Activity 350 BODY IMAGE AND EATING DISORDERS 399
Reducing Sedentary Time 351 Severe Body Image Problems 399
Eating Disorders 400
DESIGNING YOUR EXERCISE PROGRAM 353
Positive Body Image: Finding Balance 403
First Steps 353
Cardiorespiratory Endurance Exercise 357 Tips for Today and the Future 403
Exercises for Muscular Strength and Endurance 360 Summary 404
Flexibility Exercises 362 For More Information 404
Training in Specific Skills 363 Selected Bibliography 404
Putting It All Together 363
GETTING STARTED AND STAYING ON TRACK 364 PA R T F I V E
Selecting Instructors, Equipment, and Facilities 364 PROTECTING YOURSELF FROM DISEASE
Eating and Drinking for Exercise 364
Managing Your Fitness Program 366 15 CARDIOVASCULAR HEALTH 408
Tips for Today and the Future 369 THE CARDIOVASCULAR SYSTEM 409
Summary 369 The Heart 410
For More Information 370 The Blood Vessels 411
Selected Bibliography 370
RISK FACTORS FOR CARDIOVASCULAR
DISEASE 412
14 WEIGHT MANAGEMENT 374 Major Risk Factors That Can Be Changed 412
Contributing Risk Factors That Can Be Changed 418
EVALUATING BODY WEIGHT AND BODY
Major Risk Factors That Can’t Be Changed 422
COMPOSITION 375
Possible Risk Factors Currently Being Studied 423
Body Composition 376
Defining Healthy Weight, Overweight, and Obesity 376 MAJOR FORMS OF CARDIOVASCULAR DISEASE 425
Estimating Body Composition 377 Atherosclerosis 426
Body Mass Index 377 Coronary Artery Disease and Heart Attack 427
CONTENTS ix
Diagnosing Cancer 452
Treating Cancer 454
x CONTENTS
Pelvic Inflammatory Disease 514 AIR QUALITY AND POLLUTION 534
Human Papillomavirus 514 Air Quality and Smog 534
Genital Herpes 516 The Greenhouse Effect and Global Warming 535
Hepatitis B 517 Thinning of the Ozone Layer 538
Syphilis 518 Indoor Air Quality (IAQ) 538
Other Sexually Transmitted Infections 519 Preventing Air Pollution 539
WHAT YOU CAN DO ABOUT SEXUALLY TRANSMITTED WATER QUALITY AND POLLUTION 539
INFECTIONS 520 Water Contamination and Treatment 539
Education 520 Water Shortages 541
Diagnosis and Treatment 520 Sewage 541
Prevention 520 Protecting the Water Supply 541
Tips for Today and the Future 521 SOLID WASTE POLLUTION 542
Summary 522 What’s in Our Garbage? 542
For More Information 523 Disposing of Solid Waste 542
Selected Bibliography 523 Biodegradability 543
Reducing Solid Waste 544
CONTENTS xi
Natural Products 573
Manipulative and Body-Based Practices 575
Other CAM Practices 575
When Does CAM Become Conventional Medicine? 576
Evaluating Complementary and Alternative Therapies 577
Terrorism 604
Family and Intimate-Partner Violence 604 LIFE IN AN AGING AMERICA 628
Sexual Violence 607 America’s Aging Minority 628
What You Can Do about Violence 611 Family and Community Resources for Older Adults 629
Government Aid and Policies 630
PROVIDING EMERGENCY CARE 611 Changing the Public’s Idea of Aging 632
Tips for Today and the Future 613 Tips for Today and the Future 633
Summary 613 Summary 633
For More Information 614 For More Information 633
Selected Bibliography 615 Selected Bibliography 634
xii CONTENTS
COPING WITH IMMINENT DEATH 648 Changing Your Drug Habits 243
Awareness of Dying 648 Kicking the Tobacco Habit 295
The Tasks of Coping 648 Improving Your Diet by Choosing Healthy Beverages 337
Supporting a Person in the Last Phase of Life 649 Planning a Personal Exercise Program 372
The Trajectory of Dying 649 Creating a Personal Weight Management Plan 407
Reducing the Saturated and Trans Fats in Your Diet 440
COPING WITH LOSS 650
Incorporating More Fruits and Vegetables into
Experiencing Grief 650
Your Diet 470
Supporting a Grieving Person 652
Talking about Condoms and Safer Sex 525
When a Young Adult Loses a Friend 652
Adhering to Your Physician’s Instructions 585
Helping Children Cope with Loss 652
Adopting Safer Habits 616
COMING TO TERMS WITH DEATH 653
Tips for Today and the Future 654
CRITICAL CONSUMER
Summary 654
For More Information 655 Evaluating Sources of Health Information 18
Selected Bibliography 655 Choosing and Evaluating Mental Health Professionals 82
Sex Enhancement Products 127
Obtaining a Contraceptive from a Health Clinic or
APPENDIXES Physician 150
Home Pregnancy Tests 192
A NUTRITION RESOURCES 657
Choosing a Drug Treatment Program 239
b A SELF-CARE GUIDE FOR COMMON MEDICAL Alcohol Advertising 265
PROBLEMS 658 Tobacco Advertising 277
Using Food Labels 326
Using Dietary Supplement Labels 328
Index 665 What to Wear 365
Evaluating Fat and Sugar Substitutes 391
Are All Calories and Dietary Patterns Equal for
BOXES Weight Loss? 394
ASSESS YOURSELF Avoiding Cancer Quackery 455
Wellness: Evaluate Your Lifestyle 16 Sunscreens and Sun-Protective Clothing 463
The Perceived Stress Scale 30 Preventing and Treating the Common Cold 489
Are You Suffering from a Mood Disorder? 73 Tattoos and Body Piercing 492
Are You Emotionally Intelligent? 93 Getting an HIV Test 508
Which Contraceptive Method Is Right for You and Your Endocrine Disruption: A “New” Toxic Threat 547
Partner? 166 Avoiding Health Fraud and Quackery 570
Creating a Family Health Tree 189 Choosing a Health Insurance Plan 581
Is Internet Use a Problem for You? 219 Choosing a Place to Live 631
Do You Have a Problem with Alcohol? 264 A Consumer Guide to Funerals 647
Tobacco Use Disorder: Are You Hooked? 274
Your Diet versus MyPlate Recommendations 321
DIVERSITY MATTERS
The 1.5-Mile Run–Walk Test 367
What Triggers Your Eating? 386 Moving toward Health Equity 12
Anger, Hostility, and Heart Disease 421 Diverse Populations, Discrimination, and Stress 40
Are You at Risk for CVD? 436 Ethnicity, Culture, and Psychological Health 70
What’s Your UV Risk? 461 Marriage Equality 103
Do Your Attitudes and Behaviors Put You at Risk for Genital Alteration 116
STIs? 522 Barriers to Contraceptive Use 164
Environmental Health Checklist 529 The Adoption Option 175
Exploring What You Know about CAM 578 Abortion around the World 179
Are You an Aggressive Driver? 594 Ethnicity and Genetic Disease 187
Drug Use and Race/Ethnicity 237
Metabolizing Alcohol: Our Bodies Work Differently 247
BEHAVIOR CHANGE STRATEGY Ethnic Foods 316
Behavior Change Contract 27 Overweight and Obesity among U.S. Ethnic Populations 385
Taking Control of Your Sleep 56 Gender, Race/Ethnicity, and Cardiovascular Disease 424
Dealing with Social Anxiety 86 Race/Ethnicity, Poverty, and Cancer 446
CONTENTS xiii
Poverty, Ethnicity, and Asthma 479 Warning Signs and Symptoms of Heart Attack, Stroke, or
HIV/AIDS around the World 504 Cardiac Arrest 428
Poverty, Gender, and Environmental Health 545 Testicle Self-Examination 464
Health Care Visits and Gender 565 Preventing STIs 512
Injuries among Young Men 589 Don’t Wait—Early Treatment of STIs Really Matters 521
Why Do Women Live Longer? 627 High-Efficiency Lighting 540
Evaluating Health News 562
Head Injuries in Contact Sports 597
TAKE CHARGE Repetitive Strain Injury 600
Financial Wellness 5 Recognizing the Potential for Abusiveness in a Partner 605
Life Expectancy and the Obesity Epidemic 8 Preventing Date Rape 609
Mindfulness Meditation 45 Can Exercise Delay the Effects of Aging? 621
Digital Devices: Help or Harm for a Good Night’s Coping with Grief 651
Sleep? 50 Surviving the Violent Death of a Loved One 653
Overcoming Insomnia 52
Realistic Self-Talk 65
Does Exercise Improve Mental Health 79 WELLNESS ON CAMPUS
Guidelines for Effective Communication 97 Wellness Matters for College Students 14
Strategies of Strong Families 108 Coping with News of Traumatic Events 41
Communicating about Sexuality 137 Deliberate Self-Harm 77
Talking with a Partner about Contraception 165 Hooking Up 100
Physical Activity during Pregnancy 202 Questions to Ask Before Engaging in a Sexual
If Someone You Know Has a Drug Problem . . . 240 Relationship 133
Dealing with an Alcohol Emergency 250 Contraception Use and Pregnancy among College
Avoiding ETS 287 Students 144
Strategies to Quit Smoking 292 Drug Use among College Students 222
Fats and Health 302 Alcoholic Energy Drinks: The Dangers of Being “Drunk and
Choosing More Whole-Grain Foods 305 Wide Awake” 252
Eating for Healthy Bones 310 Peer Pressure and College Binge Drinking 258
Positive Changes to Meet the Dietary Guidelines 315 Eating Strategies for College Students 324
Judging Portion Sizes 319 The Freshman 15: Fact or Myth? 389
Safe Food Handling 330 Meningococcal Meningitis and College Students 485
Making Time for Physical Activity 352 The Riskiest Sexual Behavior Is Becoming More
Move More, Sit Less 353 Common 506
Interval Training: Pros and Cons 355 College Students and STIs 515
Determine Your Target Heart Rate 357 Creating Your Own Health Record 566
Lifestyle Strategies for Successful Weight Management 393 Cell Phones and Distracted Driving 593
If Someone You Know Has an Eating Disorder . . . 402 Staying Safe on Campus 612
xiv CONTENTS
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P R E FAC E xv
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xvi P R E F A C E
PROVEN, SCIENCE-BASED CONTENT
McGraw-Hill’s digital teaching and learning tools are built on the solid foundation of
Connect Core Concepts in Health’s authoritative, science-based content. Connect
Core Concepts in Health is written by experts who work and teach in the fields of
exercise science, medicine, physical education, and health education. Connect Core
Concepts in Health provides accurate, reliable, current information on key health and
wellness topics, while also addressing issues related to mind–body health, research,
diversity, and consumer health. The pedagogical program for the 15th edition main-
tains important features on behavior change, personal reflection, critical thinking, and
other key content and skills.
Assess Yourself features provide assessments Ask Yourself: Questions for Critical
for students to use in analyzing their own health Thinking and Reflection encourage critical
and health-related behaviors. reflection on students’ own health-related
behaviors.
P R E F A C E xvii
WHAT’S NEW IN CONNECT CORE
CONCEPTS IN HEALTH, 15TH EDITION?
xviii P R E FAC E
∙ Updated Diversity Matters feature: Diverse Populations, Chapter 7: Abortion
Discrimination, and Stress; updated Wellness on ∙ Updated statistics on pregnancy, birth, and abortion rates
Campus feature: Coping with News of Traumatic ∙ New information about the history of abortion, safety
Events; updated Take Charge feature: Mindfulness of abortions, and medical versus aspiration abortion
Meditation ∙ Updated information on personal considerations for
men about abortion, legal restrictions and state-specific
Chapter 3: Psychological Health
requirements for abortion, and the public debate about
∙ Updated information on psychological defense mech
abortion
anisms; mood disorders; professional help; and warning
signs, risk factors, and preventive factors related to Chapter 8: Pregnancy and Childbirth
suicide ∙ New coverage related to the Zika virus
∙ Updated Diversity Matters feature: Ethnicity, Culture, ∙ Updated statistics on the average age of first-time
and Psychological Health and updated Wellness on mothers in the United States; costs of raising a child;
Campus feature: Deliberate Self-Harm infertility; fetal alcohol syndrome; depression during
∙ New and updated statistics on the prevalence of selected pregnancy; hospital versus at-home births in the United
psychological disorders among Americans, on suicide States; breastfeeding; and premature births, low birth
methods, and on the prevalence of suicidal thoughts weight, and infant mortality
∙ Updated information on the second trimester of preg-
Chapter 4: Intimate Relationships and Communication
nancy and on avoiding drugs and other environmental
∙ Updated information on gender roles, sexual orienta-
hazards
tion, and gender identity in relationships
∙ Updated Critical Consumer feature: Home Pregnancy
∙ New and updated statistics on marital status; median
Tests and Take Charge feature: Physical Activity
age of marriage; married women in the labor force; and
during Pregnancy
Americans’ attitudes toward gay relationships, online
Chapter 9: Drug Use and Addiction
dating, cohabitation, and single-parent families
∙ New information on Internet gaming disorder
∙ Updated information on digital communication and
∙ Updated statistics on drug overdose deaths, nonmedical
social networks and on strategies of strong families
∙ Updated Wellness On Campus feature: Hooking Up and drug use among Americans, heroin use and deaths, use
of opioid painkillers and correlation with heroin use,
updated Diversity Matters feature: Marriage Equality
psychoactive drugs and their potential for substance
Chapter 5: Sex and Your Body disorder and addiction, sex and drug use, drug use among
∙ Updated Diversity Matters feature: Genital Alteration college students, workplace drug testing, and state and
∙ Updated information on differentiation of an embryo, federal prison inmates serving time for drug offenses
intersex, gender roles, sexual orientation, gender ∙ Updated information on diagnosing drug use and
identity, commercial sex, and treatments for female addiction; risk factors for drug use and addiction;
hypoactive sexual desire disorder commonly misused drugs and their effects; and
Chapter 6: Contraception marijuana legalization, medical uses for marijuana, and
∙ Updated information on modern versus traditional long-term effects of using marijuana
contraception ∙ Updated Diversity Matters feature: Drug Use and
∙ New figure on women’s use of contraception and its Race/ Ethnicity
effectiveness Chapter 10: Alcohol: The Most Popular Drug
∙ Updated statistics on the rate of unintended ∙ New information about alcohol absorption
pregnancies and contraceptive use worldwide ∙ Updated information on the possible health benefits of
∙ Updated Critical Consumer feature: Obtaining a alcohol
Contraceptive from a Health Clinic or Physician ∙ Updated Wellness on Campus features: Alcoholic
and Diversity Matters feature: Barriers to Energy Drinks: The Dangers of Being “Drunk and Wide
Contraceptive Use Awake”; and Peer Pressure and College Binge Drinking
P R E FAC E xix
∙ Updated statistics on alcohol use disorder and suicide; c ommon over-the-counter weight loss pills, and pre-
drunk driving; binge drinking and heavy alcohol use; scription weight loss drugs
fetal alcohol syndrome; arrests for drug and alcohol- ∙ New information on gut microbiota, eating disorders,
related offenses; and the contribution of alcohol use to and positive body image
murders, assaults, and rapes ∙ Updated statistics on the prevalence of obesity in
America and on the amount of money spent on weight
Chapter 11: Tobacco Use
loss efforts per year in America
∙ New and updated information on e-cigarettes, tobacco
∙ Updated Wellness on Campus feature: The Freshman
additives, tolerance and withdrawal, and economic
15: Myth or Fact?; Critical Consumer feature: Evaluat-
costs of cigarettes
ing Fat and Sugar Substitutes; Take Charge feature:
∙ Updated statistics on annual deaths from tobacco-
Lifestyle Strategies for Successful Weight Manage-
related causes, deaths among nonsmokers due to
ment; and Critical Consumer feature: Are All Calories
environmental tobacco smoke, demographics of smokers,
and Dietary Patterns Equal for Weight Loss?
American teen smokers, quitting smoking, total health
care costs of smoking, and state rates of smoking Chapter 15: Cardiovascular Health
∙ Updated Critical Consumer feature: Tobacco Advertising ∙ New information on treatments for high blood pressure,
medications for high cholesterol, and e-cigarettes and
Chapter 12: Nutrition Basics
their relationship to cardiovascular d isease
∙ New section on the Dietary Guidelines for Americans
∙ Updated statistics on the prevalence of overall
2015–2020
cardiovascular disease, high cholesterol, diabetes and
∙ Updated information on added sugars, dietary fat, e nergy
prediabetes, heart attack and stroke deaths, recurrent heart
needs, building and supporting healthy eating patterns,
attacks, heart failure, and cardiovascular disease deaths
how the U.S. diet compares to recommendations, the
attributed to smoking and environmental tobacco smoke
DASH eating plan, biotech crops, and food safety
∙ New information on calorie labeling for restaurants and Chapter 16: Cancer
vending machines ∙ New information on genomic research
∙ Updated information on the Social-Ecological Model ∙ Updated information on early detection of cancer, foods
for food and physical activity decisions that increase risk of colorectal cancer, recommendations
∙ New Take Charge feature: Positive Changes to Meet for mammography, skin cancer treatments, biological
Dietary Guidelines; updated Take Charge feature: Fats therapies/immunotherapy, and cancer vaccines
and Health; and updated Critical Consumer feature: ∙ Updated statistics on the number of annual cancer cases
Using Food Labels and deaths; five-year survival rates; and cancer deaths
Chapter 13: Exercise for Health and Fitness caused by poor diet, exercise habits, obesity, and smoking
∙ New information on the health benefits of exercise, the Chapter 17: Immunity and Infection
risks of sedentary time, core training, and managing ∙ New coverage of Zika disease, new information on
athletic injuries climate change and allergies
∙ New Take Action feature: Move More, Sit Less and up- ∙ Updated information on HPV, Ebola, West Nile virus,
dated Critical Consumer feature: What to Wear E. coli, and hantavirus
∙ Updated information on target heart rate range, core ∙ Updated information on immunization
muscles, and differences in muscular strength between recommendations, vaccination efficacy and rates, and
sexes deaths due to infectious diseases worldwide
Chapter 14: Weight Management ∙ Updated statistics on the H5N1 virus, tuberculosis,
∙ Updated information on energy intake, dietary patterns, polio, tickborne infections, pertussis, HPV vaccination,
and sleep as lifestyle factors for weight management and antibiotic resistance
∙ Updated information on environmental factors in ∙ Updated Diversity Matters feature: Poverty, Ethnicity,
weight management, safety and effectiveness of and Asthma
xx P R E F A C E
Chapter 18: Sexually Transmitted Infections ∙ Updated Critical Consumer feature: Health Care
∙ Updated information on HIV diagnosis and treatment Reform with the ACA
∙ Updated information and statistics on hepatitis B,
syphilis, and trichomoniasis Chapter 21: Personal Safety
∙ Updated Diversity Matters feature: HIV/AIDS around ∙ New information on head injuries in contact sport
the World; Wellness on Campus feature: The Riskiest ∙ New and updated information on preventing
Sexual Behavior Is Becoming More Common; and acquaintance rape
Critical Consumer feature: Getting an HIV Test ∙ Updated Wellness on Campus feature: Cell Phones and
∙ Updated statistics on new STI cases; direct medical costs Distracted Driving and Diversity Matters feature:
of STIs; number of Americans living with HIV; Injuries among Young Men
percentage of HIV-infected Americans who do not know ∙ New and updated statistics on deaths and costs of
of their infections; and rates of chlamydia, gonorrhea, injuries, leading causes of deaths from unintentional
human papillomavirus, genital herpes, and syphilis injuries, deaths from motor vehicle crashes in the
United States, use of seat belts, bicycle helmet laws,
Chapter 19: Environmental Health
pedestrian injuries, gun ownership, sexual assaults,
∙ New information on pesticides, preventing air and
arrests, and violent crimes
chemical pollution, the 2015 UN Climate Change
Conference, and the effects on children whose mothers Chapter 22: Aging: A Vital Process
were exposed to air pollution while pregnant ∙ Updated statistics and information on the number of
∙ Updated information on carbon dioxide levels in the
older Americans, life expectancy, poverty rates, living
atmosphere, climate change, and the hole in the ozone arrangements of people 65 and older, and Social
layer Security benefits
∙ Updated statistics on world population growth, energy
consumption of selected countries, renewable energy Chapter 23: Dying and Death
use, deaths from air pollution per year, and trash and ∙ Updated information on defining and learning about
compost generated in America death, physician-assisted death and voluntary active
Chapter 20: Conventional and Complementary Medicine euthanasia, the shortage of organs among some racial
∙ New information on integrative health, evaluating or ethnic groups, autopsies, and helping children cope
complementary and alternative therapies, and with loss
acupuncture ∙ Updated Critical Consumer feature: A Consumer’s
∙ Updated statistics on the number of Americans using Guide to Funerals
complementary and alternative therapies ∙ New Take Charge feature: Surviving the Violent Death
∙ New information on types of research studies, the of a Loved One
placebo effect, recognized medical specialties, ∙ Updated statistics on people who die in hospice and on
choosing a specialist, and key concepts in health care people waiting for an organ transplant and the number
insurance coverage of people who die waiting for one
P R E F A C E xxi
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such as readings, articles, cases, videos, and more. access the entire library of McGraw-Hill instructional re-
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Experience how McGraw-Hill Education’s Create empowers
INSTRUCTOR RESOURCES
you to teach your students your way: Instructor resources available through Connect for Connect
http://www.mcgrawhillcreate.com. Core Concepts in Health include a Course Integrator Guide,
Test Bank, Image Bank, and PowerPoint presentations for
each chapter. A static PDF version of the interactive Wellness
Worksheets offered in Connect is also available.
xxii P R E F A C E
ACKNOWLEDGMENTS
Connect Core Concepts in Health, 15th edition, has bene- Kim McMahon, MS, RD, LD
fited from the thoughtful commentary, expert knowledge, Benedictine University and Logan College
and helpful suggestions of many people. We are deeply Weight Management
grateful for their participation in this project. Jonathan Schwartz, MD
Stanford University School of Medicine
Academic Contributors Cardiovascular Health
Steve Flowers, MA, LMFT
Somasundaram Subramaniam, MD, MS
Mindfulness Based Stress Reduction Program at Enloe
Swedish Cancer Institute
Medical Center
Cancer
Stress: The Constant Challenge
Martha Zuniga, PhD
Heidi Roth, MD
University of California—Santa Cruz
University of North Carolina–Chapel Hill
Immunity and Infection
Sleep Medicine
Candice J. McNeil, MD, MPH
Michael Joshua Ostacher, MD, MPH, MMSc
Wake Forest University Health Sciences
Stanford University School of Medicine
Sexually Transmitted Infections
Psychological Health
Robert Jarski, PhD, PA
Inge Hansen, PsyD
School of Health Sciences, Oakland University
Stanford University
Conventional and Complementary Medicine
Intimate Relationships and Communication
Christine Labuski, PhD Marcia Seyler, MPhil
Virginia Polytechnic Institute and State University Aging: A Vital Process
Sex and Your Body Nancy Kemp, MD, MA
Kamilee Christenson, MD Green Valley Hospice
Stanford University Dying and Death
Contraception
Anna Altshuler, MD, MPH Academic Advisors and Reviewers
California Pacific Medical Center for the 15th Edition
Abortion Ronald Baldwin, Beaufort County Community College
Kathy Bingham, Antelope Valley College
Jeroen Vanderhoeven, MD
Mia M. Botkin, Moreno Valley College
Swedish Medical Center
Paula Congleton, Santa Barbara City College
Pregnancy and Childbirth
Wendy Frappier, Minnesota State University Moorhead
Chwen-Yuen Angie Chen, MD, FACP, FASAM James Metcalf, George Mason University
Internal and Addiction Medicine, Stanford University Kristin Newton, Gardner-Webb University
Drug Use and Addiction Jodi Rees, Indiana State University
Johanna Rochester, PhD Scott Rogers, College of Southern Idaho
The Endocrine Disruption Exchange Richard Scheidt, Fresno City College
Tobacco Use Carol Sloan, Henry Ford College
Environmental Health Teresa K. Snow, Georgia Institute of Technology
Susan Stockton, University of Central Missouri
Melissa Bernstein, PhD, RD, LD B. Denise Stokich, University of Nevada, Reno
Rosalind Franklin University of Medicine and Science Robert O. Walsh, Utah Valley University
Nutrition Basics Heidi Wiedenfeld, Texas Tech University
Tom Fahey, EdD
California State University–Chico
Exercise for Health and Fitness
P R E FAC E xxiii
CHAPTER
Taking Charge
of Your Health 1
T
he next time you ask someone, “How are you?” person’s body or mind and to the presence or absence of ill-
and you get the automatic response “Fine,” be ness or injury. Wellness expands this idea of good health to
grateful. If that person had told you how he or include living a rich, meaningful, and energetic life. Beyond
she actually felt—physically, emotionally, men- the simple presence or absence of disease, wellness can refer
tally—you might wish you had never asked. to optimal health and vitality—to living life to its fullest.
Your friend might be one of the too many people who live Although we use the words health and wellness interchange-
most of their lives feeling no better than just all right, or so- ably, they differ in two important ways:
so, or downright miserable. Some do not even know what ∙ Health—or some aspects of it—can be determined or
optimal wellness is. How many people do you know who influenced by factors beyond your control, such as your
feel great most of the time? Do you? genes, age, and family history. Consider, for example, a
50-year-old man with a strong family history of early heart
disease. This factor increases this man’s risk of having a
WELLNESS AS A HEALTH GOAL heart attack at an earlier age than might be expected.
Generations of people have viewed good health simply as ∙ Wellness is determined largely by the decisions you
the absence of disease, and that view largely prevails today. make about how you live. That same 50-year-old man can
The word health typically refers to the overall condition of a reduce his risk of an early heart attack by eating sensibly,
exercising, and having regular screening tests. Even if he
develops heart disease, he may still live a long, rich, mean-
health The overall condition of body or mind T ERMS ingful life. These factors suggest he should choose not
and the presence or absence of illness or injury. only to care for himself physically but also to maintain a
T ERMS
positive outlook, enjoy his relationships with others, chal-
wellness Optimal health and vitality, encompassing all the
dimensions of well-being. lenge himself intellectually, and nurture other aspects of
his life.
2 CHAPTER 1 TA K I N G C H A R G E O F YO U R H E A LT H
FIGURE 1.1 The wellness continuum.
Low level Physical, mental, Change High level The concept of wellness includes vitality in
of wellness emotional symptoms and growth of wellness a number of interrelated dimensions, all of
which contribute to wellness.
INTELLE SS
CTU NAL LNE
AL E RSPOH WEL WE
EMOTIO
NA RP YS WELLNE LL
L TE IC SS NE
IN WE A SS
CU L LN L
LTU ESS
EN RA WELLNESS
VIR L A L S
L U S S W S
O N M E N TA S P IRI T W E LL NE ELL N E W
ELL
O C C UPATI O N AL W E L LN ESS NES
S
FIN A
N CIAL
Wellness, therefore, involves conscious decisions that affect acceptance is your personal satisfaction with yourself—it
risk factors that contribute to disease or injury. We cannot might exclude society’s expectations—whereas self-esteem
control risk factors such as age and family history, but we relates to the way you think others perceive you; self-confi-
can control lifestyle behaviors. dence can be a part of both acceptance and esteem. Achiev-
ing emotional wellness means finding solutions to emotional
problems, with professional help if necessary.
Dimensions of Wellness
Intellectual Wellness Those who enjoy intellectual
The process of achieving wellness is continuing and
wellness continually challenge their minds. An active mind
dynamic (Figure 1.1), involving change and growth. Well-
is essential to wellness because it detects problems, finds
ness is not static. The encouraging aspect of wellness is
solutions, and directs behavior. Throughout their lifetimes
that you can actively pursue it. Here are nine dimensions of
people who enjoy intellectual wellness never stop learning.
wellness:
Often they discover new things about themselves.
∙ Physical ∙ Spiritual
∙ Emotional ∙ Environmental Interpersonal Wellness Satisfying and supportive re-
lationships are important to physical and emotional well-
∙ Intellectual ∙ Financial ness. Learning good communication skills, developing the
∙ Interpersonal ∙ Occupational capacity for intimacy, and cultivating a supportive network
∙ Cultural are all important to interpersonal (or social) wellness. Social
wellness requires participating in and contributing to your
These dimensions are interrelated and may affect each
community and to society.
other, as the following sections explain. Figure 1.2 lists spe-
cific qualities and behaviors associated with each d imension. Cultural Wellness Cultural wellness refers to the way
you interact with others who are different from you in terms
Physical Wellness Your physical wellness includes not
of ethnicity, religion, gender, sexual orientation, age, and
just your body’s overall condition and the absence of disease
customs (practices). It involves creating relationships with
but also your fitness level and your ability to care for your-
others and suspending judgment on others’ behavior until
self. The higher your fitness level, the higher your level of
you have lived with them or “walked in their shoes.” It also
physical wellness. Similarly, as you develop the ability to
includes accepting, valuing, and even celebrating the differ-
take care of your own physical needs, you ensure greater
ent cultural ways people interact in the world. The extent to
physical wellness. The decisions you make now, and the
which you maintain and value cultural identities is one mea-
habits you develop over your lifetime, will determine the
sure of cultural wellness.
length and quality of your life.
Emotional Wellness Trust, self-confidence, optimism, Spiritual Wellness To enjoy spiritual wellness is to
possess a set of guiding beliefs, principles, or values that
satisfying relationships, and self-esteem are some of the
give meaning and purpose to your life, especially in difficult
qualities of emotional wellness. Emotional wellness is dy-
times. The spiritually well person focuses on the positive
namic and involves the ups and downs of living. No one can
achieve an emotional “high” all the time. Emotional well-
ness fluctuates with your intellectual, physical, spiritual, TER MS
risk factor A condition that increases your
cultural, and interpersonal health. Maintaining emotional chances of disease or injury.
wellness requires exploring thoughts and feelings. Self- TER M
W E L L N E S S as a H E A L T H G O A L 3
PHYSICAL WELLNESS EMOTIONAL WELLNESS INTELLECTUAL WELLNESS
• Eating well • Optimism • Openness to new ideas
• Exercising • Trust • Capacity to question
• Avoiding harmful habits • Self-esteem • Ability to think critically
• Practicing safer sex • Self-acceptance • Motivation to master new skills
• Recognizing symptoms of disease • Self-confidence • Sense of humor
• Getting regular checkups • Ability to understand and accept • Creativity
• Avoiding injuries one’s feelings • Curiosity
• Ability to share feelings with others • Lifelong learning
FI GURE 1 . 2 Qualities and behaviors associated with the dimensions of wellness. Carefully review each dimension and consider
your personal wellness strengths and weaknesses.
aspects of life and finds spirituality to be an antidote for a way that gives you peace of mind. It includes balancing
negative feelings such as cynicism, anger, and pessimism. your income and expenses, staying out of debt, saving for the
Organized religions help many people develop spiritual future, and understanding your emotions about money. See
health. Religion, however, is not the only source or form of the “Financial Wellness” box.
spiritual wellness. Many people find meaning and purpose
in their lives through their loved ones or on their own— Occupational Wellness Occupational wellness refers
through nature, art, meditation, or good works. to the level of happiness and fulfillment you gain through
your work. Although high salaries and prestigious titles are
Environmental Wellness Your environmental wellness gratifying, they alone may not bring about occupational
is defined by the livability of your surroundings. Personal wellness. An occupationally well person enjoys his or her
health depends on the health of the planet—from the safety of work, feels a connection with others in the workplace, and
the food supply to the degree of violence in society. Your phys- takes advantage of the opportunities to learn and be chal-
ical environment can support your wellness or diminish it. To lenged. Another important aspect of occupational wellness
improve your environmental wellness, you can learn about and is recognition from managers and colleagues. An ideal job
protect yourself against hazards in your surroundings and work draws on your interests and passions, as well as your voca-
to make your world a cleaner and safer place. tional skills, and allows you to feel that you are making a
contribution in your everyday work.
Financial Wellness Financial wellness refers to your
ability to live within your means and manage your money in
New Opportunities for Taking Charge
morbidity rate The relative incidence of disease T ERMS Wellness is a fairly new concept. One hundred and fifty
among a population. years ago, Americans considered themselves lucky just to
T ERMS
survive to adulthood. A boy born in 1850, for example, could
mortality rate The number of deaths in a population in a
given period; usually expressed as a ratio, such as 75 deaths expect to live only about 38 years and a girl, 40 years. Mor-
per 1000 members of the population. bidity and mortality rates (rates of illness and death, re-
infectious disease A disease that can spread from person to
spectively) from common infectious diseases (such as
person, caused by microorganisms such as bacteria and viruses. pneumonia, tuberculosis, and diarrhea) were much higher
than Americans experience today.
4 CHAPTER 1 TA K I N G C H A R G E O F YO U R H E A LT H
TAKE CHARGE
Financial Wellness
Researchers surveyed nearly 90,000 college students about of students surveyed feel they have all the in-
their financial behaviors and attitudes. According to results formation needed to pay off their loans. Work
released in 2016, a large percentage of students feel less with your lender and make sure you know
prepared to manage their money than to handle almost any how to access your balance, when to start re-
other aspect of college life. They also express distress over payment, how to make payments, what your
their current and future financial decisions. Front and center in repayment plan options are, and what to do if you have trou-
their minds is how to manage student loan debt. Financial ble making payments. Information on managing federal stu-
wellness means having a healthy relationship with money. dent loans is available from https://studentaid.ed.gov/sa/.
Here are strategies for establishing that relationship: If you have credit card debt, stop using your cards and
start paying them off. If you can’t pay the whole balance, try to
Follow a Budget pay more than the minimum payment each month. It can take
A budget is a way of tracking where your money goes and a very long time to pay off a loan by making only the minimum
making sure you’re spending it on the things that are most payments. For example, paying off a credit card balance of
important to you. To start one, list your monthly income and $2000 at 10% interest with monthly payments of $20 would
expenditures. If you aren’t sure where you spend your money, take 203 months—nearly 17 years. Check out an online credit
track your expenses for a few weeks or a month. Then orga- card calculator like http://money.cnn.com/calculator/pf/debt
nize them into categories, such as housing, food, transporta- -free/. If you carry a balance and incur finance charges, you
tion, entertainment, services, personal care, clothes, books are paying back much more than your initial loan.
and school supplies, health care, credit card and loan pay-
ments, and miscellaneous. Knowing where your money goes Start Saving
is the first step in gaining control of it. If you start saving early, the same miracle of compound inter-
Now total your income and expenditures and examine est that locks you into years of credit card debt can work to
your spending patterns. Use this information to set guidelines your benefit (for an online compound interest calculator, visit
and goals for yourself. If your expenses exceed your income, http://www.interestcalc.org). Experts recommend “paying
identify ways to make some cuts. For example, if you spend yourself first” every month—that is, putting some money into
money going out at night, consider less expensive options savings before you pay your bills. You may want to save for a
like having a weekly game night with friends or organizing an large purchase, or you may even be looking ahead to retire-
occasional potluck. ment. If you work for a company with a 401(k) retirement plan,
contribute as much as you can every pay period.
Be Wary of Credit Cards
Students have easy access to credit but little training in fi- Become Financially Literate
nances. The percentage of students who have access to credit Most Americans have not received any basic financial train-
cards has increased from 28% in 2012 to 41% in 2015. This ing. For this reason, the U.S. government has established the
increase in credit card use has also correlated with an increase Financial Literacy and Education Commission (MyMoney.gov)
in paying credit card bills late, paying only the minimum to help Americans learn how to save, invest, and manage
amount, and having larger total outstanding credit balances. money better. Developing lifelong financial skills should begin
Shifting away from using credit cards and toward using in early adulthood, during the college years, if not earlier, as
debit cards is a good strategy for staying out of debt. Familiar- money-management experience appears to have a more di-
ity with financial terminology helps as well. Basic financial lit- rect effect on financial knowledge than does education. For
eracy with regard to credit cards involves understanding example, when tested on their basic financial literacy, stu-
terms like APR (annual percentage rate—the interest you’re dents who had checking accounts had higher scores than
charged on your balance), credit limit (the maximum amount those who did not.
you can borrow), minimum monthly payment (the smallest
payment your creditor will accept each month), grace period SOURCES: Smith, C., and G. A. Barboza. 2013. The role of trans-generational
(the number of days you have to pay your bill before interest financial knowledge and self-reported financial literacy on borrowing prac-
or penalties are charged), and over-the-limit and late fees (the tices and debt accumulation of college students. Social Science Research
amounts you’ll be charged if you go over your credit limit or Network (http://ssrn.com/abstract=2342168); Plymouth State University.
your payment is late). 2013. Student Monetary Awareness and Responsibility Today! (http://www
.plymouth.edu/office/financial-aid/smart/); U.S. Financial Literacy and Educa-
Manage Your Debt tion Commission. 2013. MyMoney.gov (http://www.mymoney.gov);
Sparshott, J. 2015. Congratulations, Class of 2015. You’re the most
A 2015 study indicated that graduating college students of- indebted ever (for now). Wall Street Journal, May 8, 2015 (http://blogs.wsj
ten had debts of $35,000—and this amount is expected to .com/economics/2015/05/08/congratulations-class-of-2015-youre-the
rise. When it comes to student loans, having a direct, personal -most-indebted-ever-for-now/); EverFi. 2016. Money Matters on Campus:
plan for repayment can save time and money, reduce stress, Examining Financial Attitudes and Behaviors of Two-Year and Four-Year
and help you prepare for the future. However, only about 10% College Students (www.moneymattersoncampus.org).
W E L L N E S S as a H E A L T H G O A L 5
Control of Recognition of Affordable Care Act
infectious Safer tobacco use as a Implementation
Vaccinations diseases workplaces health hazard
for childhood 77.9 78.8
diseases 75.4 76.9
73.7
Fluoridation of 69.7 70.8
drinking water 68.2
62.9
59.7
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2014
Year
FI GURE 1 . 3 Public health, life expectancy, and quality of life. Public health achievements during the 20th century are credited with
adding more than 25 years to life expectancy for Americans, greatly improving quality of life, and dramatically reducing deaths from infectious
diseases. Public health improvements continue into the 21st century, including greater roadway safety and a steep decline in childhood lead
poisoning. In 2013, the government mandated that all Americans be covered by health insurance, a protection already long established in most
other industrialized countries.
SOU RCE S:Kochanek, K.D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4); Centers for Disease Control and Prevention. 2011. Ten
great public health achievements—United States, 2001–2010. MMWR 60(19): 619–623; Centers for Disease Control and Prevention. 1999. Ten great public health
achievements—United States, 1900–1999. MMWR 48(50): 1141.
By 1980, life expectancy nearly doubled, due largely to The good news is that people have some control over
the development of vaccines and antibiotics to fight infec- whether they develop chronic diseases. People make choices
tions, and to public health measures such as water purifica- every day that increase or decrease their risks for such dis-
tion and sewage treatment to improve living conditions eases. For example, each of us can take personal responsibil-
(Figure 1.3). But even though life expectancy has increased, ity for lifestyle choices regarding smoking, diet, exercise,
poor health will limit most Americans’ activities during the and alcohol use. Table 1.2 shows the estimated number of
last 15% of their lives, resulting in some sort of impaired annual deaths tied to selected underlying causes. For exam-
life (Figure 1.4). Today a different set of diseases has ple, the estimated 90,000 deaths tied to alcohol includes
emerged as our major health threat: Heart disease, cancer, deaths due directly to alcohol poisoning as well as a propor-
and chronic lower respiratory diseases are now the three tion of deaths from causes such as liver cancer and injuries.
leading causes of death for Americans (Table 1.1). An obe- Similarly, sexual behavior is linked to a proportion of all
sity epidemic, beginning in the late 1970s, has also spurred
predictions that American life e xpectancy will decline within
the next several decades (see box “Life Expectancy and the
Obesity Epidemic” on p. 8). Obesity and poor eating habits Healthy life
can lead to all of the major chronic diseases. 69.0
6 CHAPTER 1 TA K I N G C H A R G E O F YO U R H E A LT H
V I TA L S TAT I S T I C S
Table 1.1 Leading Causes of Death in the United States, 2013
SOURCE: Kochanek, K. D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4).
V I TA L S TAT I S T I C S
Table 1.2 Key Contributors to Deaths among Americans
ESTIMATED NUMBER OF DEATHS PER YEAR PERCENTAGE OF TOTAL DEATHS PER YEAR
Tobacco 480,000 18.3
Diet/activity patterns (obesity)* 400,000 15.2
Alcohol consumption 90,000 3.4
Microbial agents** 80,000 3.0
Firearms 30,000 1.1
Illicit drug use*** 25,000+ 1.0
Motor vehicles 20,000 0.8
Sexual behavior**** 15,000 0.6
*The number of deaths due to obesity is an area of ongoing controversy and research. Recent estimates have ranged from 112,000 to 400,000.
**Microbial agents include bacterial and viral infections, such as influenza, pneumonia, and hepatitis. Infections transmitted sexually are counted in the “sexual
behavior” category, including a proportion of deaths related to hepatitis, which can be transmitted both sexually and nonsexually.
***Drug overdose deaths have increased rapidly in recent years, making it likely that this estimate will rise.
****Estimated deaths linked to sexual behavior includes deaths from cervical cancer and sexually acquired HIV, hepatitis B, and hepatitis C.
SOURCE S: Kochanek, K. D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4), National Research Council, Institute of Medicine.
2015. Measuring the Risks and Causes of Premature Death: Summary of Workshops. Washington, DC: National Academies Press; Stahre, M., et al. 2014.
Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Preventing Chronic Disease: Research, Practice,
and Policy 11: 130293; U.S. Department of Health and Human Services. 2014. The Health Consequences of Smoking—50 Years of Progress: A Report of the
Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
W E L L N E S S as a H E A L T H G O A L 7
TAKE CHARGE
Life Expectancy and the Obesity Epidemic
Life expectancy consistently increased each • Fund strategies to promote physical activity by creat-
decade in the United States since 1900 (see ing more walkable communities, parks, and recreational
Figure 1.3). But is this trend continuing? Will facilities.
children today live longer and healthier lives • Train health professionals to provide nutrition and exercise
than their parents? The upward trend has
counseling, and mandate health insurance coverage for treat-
slowed, and some researchers point to the significant in-
ment of obesity as a chronic condition.
crease in obesity among Americans as a potential cause. Ac-
cording to estimates released in 2016, 35% of American men • Promote expansion of worksite programs for improving
and 40% of American women are obese. The problem isn’t diet and physical activity habits.
confined to the United States: The World Health Organization
estimates that 2 billion adults worldwide are overweight • Encourage increased public investment in obesity-related
or obese. research.
Along with increases in obesity come increased rates
In addition to indirectly supporting these actions, you can
of diabetes, chronic liver disease, heart disease, stroke,
directly do the following:
and other chronic diseases that are leading causes of
death. Of course, medical interventions for these condi- • Analyze your own food choices, and make appropriate
tions have improved over time, lessening the impact of changes. Nutrition is discussed in detail in Chapter 12, but
obesity to date. Still, medical treatments may be reaching you can start by shifting away from consuming foods high in
their limits in preventing early deaths related to obesity. sugar and refined grains.
Moreover, people are becoming obese at earlier ages,
exposing them to the adverse effects of excess body fat • Be more physically active. Take the stairs rather than the
over a longer period of time. The magnitude of the obesity elevator, ride a bike instead of driving a car, and reduce your
problem has brought predictions that an overall decline in overall sedentary time.
life expectancy will take place in the United States by the
mid-21st century.
• Educate yourself about current recommendations and ar-
What can be done? For an individual, body composition eas of debate in nutrition.
is influenced by a complex interplay of personal factors, in- • Speak out, vote, and become an advocate for healthy
cluding heredity, metabolic rate, hormones, age, and d ietary changes in your community.
and activity habits. But many outside forces—social, cultural,
and economic—shape our behavior, and some experts rec- See Chapters 12–14 for more on nutrition, exercise, and
ommend viewing obesity as a public health problem that weight management.
requires an urgent and coordinated public health response.
A response in health care technology such as gastric b ypass
surgery, medications, and early screening for obesity- SOURCES: Flegal, K. M., et al. 2016. Trends in obesity among adults in
related diseases has helped in the past, but if obesity trends the United States, 2005–2014. JAMA 315(21): 2284–2291. Ludwig,
persist, especially among children, average life spans may D. S. 2016. Lifespan weighed down by diet. JAMA (published online
April 4, 2016, DOI: 10.1001/jama.2016.3829); Olshansky, S. J., et al.
begin to decrease.
2005. A potential decline in life expectancy in the United States in the
What actions might be taken? Suggestions from health
21st century. New England Journal of Medicine 352(11): 1138–1145;
promotion advocates include the following: National Center for Health Statistics. 2016. Health, United States,
• Change food pricing to promote healthful options; for ex- 2015: With Special Feature on Racial and Ethnic Health Disparities.
Hyattsville, MD: National Center for Health Statistics; International
ample, tax sugary beverages and offer incentives to farmers
Food Policy Research Institute. 2016. Global Nutrition Report 2016:
and food manufacturers to produce and market affordable
From Promise to Impact: Ending Malnutrition by 2030. Washington,
healthy choices and smaller portion sizes. DC: International Food Policy Research Institute; U.S. Department of
• Limit advertising of unhealthy foods targeting children. Agriculture. 2015. Scientific Report of the 2015 Dietary Guidelines
Advisory Committee (http://www.health.gov/dietaryguidelines
• Require daily physical education classes in schools. /2015-scientific-report).
deaths from HIV/AIDS and cervical cancer. As Table 1.2 the leading cause of death is unintentional injuries (acci-
makes clear, lifestyle factors contribute to many deaths in the dents), with the greatest number of deaths linked to car
United States. crashes (Table 1.3). Factors that influence wellness, includ-
The need to make good choices is especially true for teens ing the choices we can all make to promote it, are discussed
and young adults. For Americans aged 15–24, for example, later in this chapter.
8 CHAPTER 1 TA K I N G C H A R G E O F YO U R H E A LT H
V I TA L S TAT I S T I C S
Table 1.3 Leading Causes of Death among Americans Aged 15–24, 2014
SOURCE: Kochanek, K. D., et al. 2016. Deaths: Final data for 2014. National Vital Statistics Reports 65(4).
Coverage
Ask Yourself ∙ Health plans can no longer deny or limit benefits due
to a preexisting condition.
QUESTIONS FOR CRITICAL THINKING AND REFLECTION
∙ If you are under 26, you may be eligible to be covered
How often do you feel exuberant? Vital? Joyful? What makes you
feel that way? Conversely, how often do you feel downhearted,
under your parent’s health plan.
de-energized, or depressed? What makes you feel that way? Have ∙ Insurers can no longer cancel your coverage because of
you ever thought about how you might increase experiences of honest mistakes in your application.
vitality and decrease experiences of discouragement? ∙ If your plan denies payment, you are guaranteed the
right to appeal.
Costs
PROMOTING NATIONAL HEALTH ∙ Lifetime dollar limits are not permitted on most
benefits you receive.
Wellness is a personal concern, but the U.S. government has ∙ Insurance companies must now publicly justify rate
financial and humanitarian interests in it, too. A healthy hikes.
population is the nation’s source of vitality, creativity, and
∙ Your premium dollars must be spent primarily on
wealth. Poor health drains the nation’s resources and raises
health care costs for all. The primary health promotion health care—not administrative costs.
strategies at the government and community levels are pub- Care
lic health policies and agencies that identify and discourage
∙ Recommended preventive health services are covered
unhealthy and high-risk behaviors and that encourage and
provide incentives for positive health behaviors. At the fed- with no copayment.
eral level in the United States, the National Institutes of ∙ From your plan’s network, you can choose the primary
Health (NIH) and the Centers for Disease Control and Pre- care doctor you want.
vention (CDC) are charged with promoting the public’s ∙ You can seek emergency care at a hospital outside your
health. These and other agencies translate research results health plan’s network.
into interventions and communicate research findings to
health care providers and the public. There are also health Finding a Plan Under the ACA, health insurance market
promotion agencies and programs at the state, community, places, also called health exchanges, facilitate the purchase
workplace, and college levels. Take advantage of health pro- of health insurance in every state. The health exchanges
motion resources at all levels that are available to you. provide a selection of government-regulated health care
plans that students and others may choose from. Those who
are below income requirements are eligible for federal help
The Affordable Care Act with the premiums.
The Affordable Care Act (ACA), also called “Obamacare,”
was signed into law on March 23, 2010, and upheld by the
health promotion The process of enabling TER MS
Supreme Court in 2012 and 2015. The new law requires people to increase control over their health and its
most people to obtain health insurance or pay a federal pen- determinants, and thereby improve their health. TER M
alty. Here is a brief summary of the new law:
Benefits to College Students The ACA permits stu- In a shift from the past, Healthy People 2020 emphasizes
dents to stay on their parents’ health insurance plans until the importance of health determinants—factors that affect
age 26—even if they are married or have coverage through the health of individuals, demographic groups, or entire pop-
an employer. Students not on their parents’ plans who do not ulations. Health determinants are social (including factors
want to purchase insurance through their schools can do so such as ethnicity, education level, or economic status) and
through a health insurance marketplace. environmental (including natural and human-made environ-
If you’re under 30, you have the option of buying a “cata- ments). Thus one goal is to improve living conditions in
strophic” health plan. Such plans tend to have low premiums ways that reduce the impact of negative health determinants.
but require you to pay all medical costs up to a certain amount, Examples of individual health-promotion goals from
usually several thousand dollars. The insurance company Healthy People 2020, along with estimates of how well
would pay for essential health benefits over that amount. Americans are tracking toward achieving those goals, appear
Students whose income is below a certain level may qual- in Table 1.4.
ify for Medicaid. Check with your state. Individuals with
nonimmigrant status, which includes worker visas and stu-
dent visas, qualify for insurance coverage through the ex-
Health Issues for Diverse Populations
changes. You can browse plans and apply for coverage at We all need to exercise, eat well, manage stress, and culti-
HealthCare.gov. vate positive relationships. We also need to protect ourselves
from disease and injuries. But some of our differences—
both as individuals and as members of groups—have impor-
The Healthy People Initiative tant implications for wellness. These differences can be
The national Healthy People initiative aims to prevent dis- biological (determined genetically) or cultural (acquired as
ease and improve Americans’ quality of life. Healthy People patterns of behavior through daily interactions with family,
reports, published each decade since 1980, set national community, and society); many health conditions are a func-
health goals based on 10-year agendas. The initiative’s most tion of biology and culture combined.
recent iteration, Healthy People 2020, was released to the As described in the previous section, eliminating health
public in 2010 and envisions “a society in which all people disparities is a major focus of Healthy People 2020. But not
live long, healthy lives” and proposes the eventual achieve- all health differences between groups are considered health
ment of the following broad national health objectives: disparities, which are those differences linked with social,
economic, and/or environmental disadvantage. They affect
∙ Eliminate preventable disease, disability, injury, and groups who have systematically experienced greater obsta-
premature death. cles to health based on characteristics that are historically
∙ Achieve health equity, eliminate disparities, and im- linked to exclusion or discrimination. For example, the fact
prove the health of all groups. that women have a higher rate of breast cancer than men is a
∙ Create social and physical environments that promote health difference but is not considered a disparity. In con-
good health for all. trast, the higher death rates from breast cancer for black
women compared with non-Hispanic white women is con-
∙ Promote healthy development and healthy behaviors
sidered a health disparity.
across every stage of life.
You share patterns of influences with certain others, and
information about those groups can help you identify areas
that may be of concern to you and your family. Healthy Peo-
health disparity A health difference linked to T ERMS
social, economic, or environmental disadvantage that
ple 2020 tracks health status and behaviors in relation to a
adversely affects a group of people. number of demographic dimensions, including sex and gen-
T ERMS
der, race and ethnicity, income and educational attainment,
10 CHAPTER 1 TA K I N G C H A R G E O F YO U R H E A LT H
Another random document with
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.