Module 2: Consumer Health


  • Lesson 1: Health literacy and health for all
  • Lesson 2: Types of health care professionals and facilities
  • Lesson 3: Brand name and generic medications
  • Lesson 4: Alternative medical practices
  • Lesson 5: Health fraud
  • Lesson 6: Health disparities and inequalities


Students will be able to:
  • Describe the importance of health literacy to enhancing health
  • Assess the quality of a website for health information
  • Demonstrate an ability to identify, use and critically evaluate different types of health information
  • Explain the difference between generic drugs and brand-name drugs

Lesson 1: Health Literacy

Source: Health Literacy, NNLM,

What is Health Literacy?

In the report, Healthy People 2010, the U.S. Department of Health and Human Services included improved consumer health literacy and identified health literacy as an important component of health communication, medical product safety, and oral health. Health literacy is defined in Health People 2010 as: "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."
Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.
Health literacy varies by context and setting and is not necessarily related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment. With the move towards a more "consumer-centric" health care system as part of an overall effort to improve the quality of health care and to reduce health care costs, individuals need to take an even more active role in health care related decisions. To accomplish this people need strong health information skills.

Skills Needed for Health Literacy

Patients are often faced with complex information and treatment decisions. Some of the specific tasks patients are required to carry out may include:
  • evaluating information for credibility and quality,
  • analyzing relative risks and benefits,
  • calculating dosages,
  • interpreting test results, or
  • locating health information.
In order to accomplish these tasks, individuals may need to be:
  • visually literate (able to understand graphs or other visual information),
  • computer literate (able to operate a computer),
  • information literate (able to obtain and apply relevant information), and
  • numerically or computationally literate (able to calculate or reason numerically).
Oral language skills are important as well. Patients need to articulate their health concerns and describe their symptoms accurately. They need to ask pertinent questions, and they need to understand spoken medical advice or treatment directions. In an age of shared responsibility between physician and patient for health care, patients need strong decision-making skills. With the development of the Internet as a source of health information, health literacy may also include the ability to search the Internet and evaluate websites.
ccording to the American Medical Association, poor health literacy is "a stronger predictor of a person's health than age, income, employment status, education level, and race." In Health Literacy: A Prescription to End Confusion, the Institute of Medicine reports that ninety million people in the United States, nearly half the population, have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments, and do not understand instructions like "take on an empty stomach."

Vulnerable populations include:
  • Elderly (age 65+) - Two thirds of U.S. adults age 60 and over have inadequate or marginal literacy skills, and 81% of patients age 60 and older at a public hospital could not read or understand basic materials such as prescription labels
  • Minority populations
  • Immigrant populations
  • Low income - Approximately half of Medicare/Medicaid recipients read below the fifth-grade level
  • People with chronic mental and/or physical health conditions
Reasons for limited literacy skills include:
  • Lack of educational opportunity - people with a high school education or lower
  • Learning disabilities
  • Cognitive declines in older adults
  • Use it or lose it - Reading abilities are typically three to five grade levels below the last year of school completed. Therefore, people with a high school diploma, typically read at a seventh or eighth grade reading level.

The relationship between literacy and health is complex. Literacy impacts health knowledge, health status, and access to health services. Health status is influenced by several related socioeconomic factors. Literacy impacts income level, occupation, education, housing, and access to medical care. The poor and illiterate are more likely to work under hazardous conditions or be exposed to environmental toxins.

Economic Impact of Low Health Literacy

In addition to the effects of low health literacy on the individual patient, there are economic consequences of low health literacy to society. After adjusting for health status, education level, socioeconomic status, and other demographics factors, people with low functional literacy have less ability to care for chronic conditions and use more health care services.

Learning Activity 1.1: Evaluating Legitimacy of Health-Related Websites

Why Does Health Literacy Matter?

Source: Health Literacy, Centers for Disease Control and Prevention,

Every day, people confront situations that involve life-changing decisions about their health. These decisions are made in places such as grocery and drug stores, workplaces, playgrounds, doctors' offices, clinics and hospitals, and around the kitchen table. Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions; however, research indicates that today's health information is presented in ways that are not usable by most adults. "Limited health literacy" occurs when people can't find and use the health information and services they need.
  • Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in our healthcare facilities, retail outlets, media and communities.
  • Without clear information and an understanding of the information's importance, people are more likely to skip necessary medical tests, end up in the emergency room more often, and have a harder time managing chronic diseases like diabetes or high blood pressure.

What Needs to Be Done to Improve Health Literacy?

We can do much better in designing and presenting health information and services that people can use effectively. We can build our own health literacy skills and help others—community members, health professionals, and anyone else who communicates about health—build their skills too. Every organization involved in health information and services needs its own health literacy plan to improve its organizational practices. The resources on this site will help you learn about health literacy issues, develop skills, create an action plan, and apply what you learn to create health information and services that truly make a positive difference in people's lives.

Who Does Limited Health Literacy Affect

People of all ages, races, incomes, and education levels can find it difficult to obtain, communicate, process and understand health information and services. Literacy skills are only a part of health literacy. Even people with strong reading and writing skills can face health literacy challenges when They are not familiar with medical terms or how their bodies work. They have to interpret or calculate numbers or risks that could have immediate effects on their health and safety. They are diagnosed with a serious illness and are scared or confused. They have health conditions that require complicated self-care. They are voting on a critical local issue affecting the community's health and are relying on unfamiliar technical information."

Who Does Limited Health Literacy Affect? Who is affected? Key Stakeholders

People of all ages, races, incomes, and education levels can find it difficult to obtain, communicate, process and understand health information and services. Literacy skills are only a part of health literacy. Even people with strong reading and writing skills can face health literacy challenges when -
  • They are not familiar with medical terms or how their bodies work.
  • They have to interpret or calculate numbers or risks that could have immediate effects on their health and safety.
  • They are diagnosed with a serious illness and are scared or confused. They have health conditions that require complicated self-care.
  • They are voting on a critical local issue affecting the community's health and are relying on unfamiliar technical information.

Optional Learning Activity: Watch this TED video, Dr. Ben Goldacre talks about bad science, to find out how to be a critical consumer of news reports of new health advice.

How to Read Health News

Source: How to Read Health News by Dr Alicia White, PubMed Health, "Behind the Headlines", provided by NHS Choices, England's National Health Service,

If you’ve just read a health-related headline that has caused you to spit out your morning coffee (“Coffee causes cancer” usually does the trick), it’s always best to follow the Blitz slogan: “Keep Calm and Carry On”. On reading further, you’ll often find the headline has left out something important, such as, “Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumors eventually. (Study funded by The Association of Tea Marketing)”.

The most important rule to remember is: don’t automatically believe the headline. It is there to draw you into buying the paper and reading the story. Would you read an article called, “Coffee pretty unlikely to cause cancer, but you never know”? Probably not.

To avoid spraying your newspaper with coffee in the future, you need to analyze the article to see what it says about the research it is reporting on. Consider the following questions to help you figure out which articles you’re going to believe and which you’re not.

Does the article support its claims with scientific research?

Your first concern should be the research behind the news article. If an article touts a treatment or some aspect of your lifestyle that is supposed to prevent or cause a disease, but doesn’t give any information about the scientific research behind it, then treat it with a lot of caution. The same applies to research that has yet to be published.

Is the article based on a conference abstract?

Another area for caution is if the news article is based on a conference abstract. Research presented at conferences is often at a preliminary stage and usually hasn’t been scrutinized by experts in the field. Also, conference abstracts rarely provide full details about methods, making it difficult to judge how well the research was conducted. For these reasons, articles based on conference abstracts should be no cause for alarm. Don’t panic or rush off to your doctor.

Was the research in humans?

Quite often, the “miracle cure” in the headline turns out to have only been tested on cells in the laboratory or on animals. These stories are regularly accompanied by pictures of humans, which creates the illusion that the miracle cure came from human studies. Studies in cells and animals are crucial first steps and should not be undervalued. However, many drugs that show promising results in cells in laboratories don’t work in animals, and many drugs that show promising results in animals don’t work in humans. If you read a headline about a drug or food “curing” rats, there is a chance it might cure humans in the future, but unfortunately a larger chance that it won’t. So there is no need to start eating large amounts of the “wonder food” featured in the article.

How many people did the research study include?

In general, the larger a study the more you can trust its results. Small studies may miss important differences because they lack statistical “power”, and are also more susceptible to finding things (including things that are wrong) purely by chance.

You can visualize this by thinking about tossing a coin. We know that if we toss a coin the chance of getting a head is the same as that of getting a tail – 50/50. However, if we didn’t know this and we tossed a coin four times and got three heads and one tail, we might conclude that getting heads was more likely than tails. But this chance finding would be wrong. If we tossed the coin 500 times - i.e. gave the experiment more "power" - we'd be more likely to get a heads/tails ratio close to 50/50, giving us a better idea of the true odds. When it comes to sample sizes, bigger is usually better. So when you see a study conducted in a handful of people, treat it with caution.

Did the study have a control group?

There are many different types of studies appropriate for answering different types of questions. If the question being asked is about whether a treatment or exposure has an effect or not, then the study needs to have a control group. A control group allows the researchers to compare what happens to people who have the treatment/exposure with what happens to people who don’t. If the study doesn’t have a control group, then it’s difficult to attribute results to the treatment or exposure with any level of certainty.

Also, it’s important that the control group is as similar to the treated/exposed group as possible. The best way to achieve this is to randomly assign some people to be in the treated/ exposed group and some people to be in the control group. This is what happens in a randomized controlled trial (RCT) and is why RCTs are considered the “gold standard” for testing the effects of treatments and exposures. So when reading about a drug, food or treatment that is supposed to have an effect, you want to look for evidence of a control group, and ideally, evidence that the study was an RCT. Without either, retain some healthy skepticism.

Did the study actually assess what’s in the headline?

This one is a bit tricky to explain without going into a lot of detail about things called proxy outcomes. Instead, bear in mind this key point: the research needs to have examined what is being talked about in the headline and article. (Somewhat alarmingly, this isn’t always the case.)

For example, you might read a headline that claims, “Tomatoes reduce the risk of heart attacks”. What you need to look for is evidence that the study actually looked at heart attacks. You might instead see that the study found that tomatoes reduce blood pressure. This means that someone has extrapolated that tomatoes must also have some impact on heart attacks, as high blood pressure is a risk factor for heart attacks. Sometimes these extrapolations will prove to be true, but other times they won’t. Therefore if a news story is focusing on a health outcome that was not examined by the research, treat it with a pinch of salt.

Who paid for and conducted the study?

This is a somewhat cynical point, but one that’s worth making. The majority of trials today are funded by manufacturers of the product being tested – be it a drug, vitamin cream or foodstuff. This means they have a vested interest in the results of the trial, which can potentially affect what the researchers find and report in all sorts of conscious and unconscious ways. This is not to say that all manufacturer-sponsored trials are unreliable. Many are very good. However, it’s worth seeing who funded the study to sniff out a potential conflict of interest.

Should you “shoot the messenger”?

Overblown claims might not necessarily be due to the news reporting itself. Although journalists can sometimes misinterpret a piece of research, at other times the researchers (or other interested parties) over-extrapolate, making claims their research doesn’t support. These claims are then repeated by the journalists.

Given that erroneous claims can come from a variety of places, don’t automatically assume they come from the journalist. Instead, use the questions above to figure out for yourself what you’re going to believe and what you’re not.

Learning Activity 1.2: Health in the Headlines

Go to the Behind the Headlines service to read an unbiased and evidence-based analysis of health stories that make the news.
The service is intended for both the public and health professionals, and endeavors to:
  • explain the facts behind the headlines and give a better understanding of the science that makes the news,
  • provide an authoritative resource for doctors which they can rely on when talking to patients, and
  • become a trusted resource for journalists and others involved in the dissemination of health news.

How and Where to Find Reliable Health Information on the Internet

The Healthfinder website ( is the federal government's gateway for reliable information from U.S. government agencies and other organizations. The site displays selected resources of consumer health and human services information. These sources have been reviewed and found reliable and credible.

Health Information on the Web

Learning Activity 1.3:
  • Use this Health Website Evaluation Tool from Health on the Net Foundation to evaluate a health website of your choice.
  • Which website evaluation tool did you find most useful and why: 1) Info Literacy Wizard, or 2) Health Website Evaluation Tool from Health on the Net Foundation?

The Social Life of Health Information

Source: Summary of Findings, Pew Research Center

Where do you go for health information? According to the Pew Research Center, most people seek information from doctors, nurses, and other health professionals first but the Internet and peers are also a significant source.
The Pew Research Center conducted a telephone survey in 2010 to find out how Americans are getting their health information.

"The survey finds that, of the 74% of adults who use the internet:
  • 80% of internet users have looked online for information about any of 15 health topics such as a specific disease or treatment. This translates to 59% of all adults.
  • 34% of internet users, or 25% of adults, have read someone else’s commentary or experience about health or medical issues on an online news group, website, or blog.
  • 25% of internet users, or 19% of adults, have watched an online video about health or medical issues.
  • 24% of internet users, or 18% of adults, have consulted online reviews of particular drugs or medical treatments.
  • 18% of internet users, or 13% of adults, have gone online to find others who might have health concerns similar to theirs.
  • 16% of internet users, or 12% of adults, have consulted online rankings or reviews of doctors or other providers.
  • 15% of internet users, or 11% of adults, have consulted online rankings or reviews of hospitals or other medical facilities.
Of those who use social network sites (62% of adult internet users, or 46% of all adults):
  • 23% of social network site users, or 11% of adults, have followed their friends’ personal health experiences or updates on the site.
  • 17% of social network site users, or 8% of adults, have used social networking sites to remember or memorialize other people who suffered from a certain health condition.
  • 15% of social network site users, or 7% of adults, have gotten any health information on the sites."

Where do you go for health information? According to the Pew Research Center, most people seek information from doctors, nurses, and other health professionals first but the Internet and peers are also a significant source. For details, see the Summary of Findings.

Questions are the Answer

Source: Questions are the Answer, AHRQ,

Your health depends on good communication.
Asking questions and providing information to your doctor and other care providers can improve your care.
Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.
  • Your doctor wants your questions.
  • Doctors know a lot about a lot of things, but they don’t always know everything about you or what is best for you.
  • Your questions give your doctor and health care team important information about you, such as your most important health care concerns.
  • That is why they need you to speak up.

In this video, a patient shares why it’s important to ask questions and offer ways that you can ask questions and get your health care needs met. In these short, compelling videos, patients talk about how simple questions can help you take better care of yourself, feel better, and get the right care at the right time. Doctors and nurses talk about how your questions help them take better care of you and offer advice on how you can be an active member of your health care team and get your most pressing questions answered.

By asking questions about her medicines, this young woman got the correct diagnosis and feels better than ever.

Learning Activity 1.4: Questions for Health Care Professionals

Go to this site and use the Question Builder.
  • Create a list of questions that you can take with you whether you are getting a checkup, talking about a problem or health condition, getting a prescription, or discussing a medical test or surgery.

Contemporary Health Concern: Affordable Health Care Act

Resource:, USDHHS,

How much do you know the Affordable Health Care Act? You need to be fully informed about what it provides. Because of the Affordable Care Act, women in private plans and Medicare already have received potentially life-saving services, such as mammograms, cholesterol screenings, and flu shots at no extra cost. Effective August 1, 2012, the law builds on these benefits, requiring new, non-grandfathered private health plans to offer eight additional screenings and tests for adolescent and adult women at no extra charge. According to a new report, about 47 million women are eligible for these new additional preventive services that address their unique health care needs. These 8 New Prevention-Related Services for Women, are:

  • Well-woman visits
  • Gestational diabetes screening for pregnant women
  • Domestic and interpersonal violence screening and counseling
  • FDA-approved contraception methods, and contraceptive education and counseling
  • Breastfeeding support, supplies, and counseling
  • HPV DNA testing, for women 30 or older
  • Sexually transmitted infections counseling
  • HIV screening and counseling for sexually-active women

Furthermore, the Affordable Care Act created the new Pre-Existing Condition Insurance Plan (PCIP) program to make health insurance available to Americans denied coverage by private insurance companies because of a pre-existing condition. Coverage for people living with such conditions as diabetes, asthma, cancer, and HIV/AIDS has often been priced out of the reach of most Americans who buy their own insurance, and this has resulted in a lack of coverage for millions. The temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market.

In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through new competitive marketplaces called Exchanges, and insurers will be prohibited from charging more or denying coverage to anyone based on the state of their health.
Watch this tour of the website to find out more.

Optional Learning Activity: For those of you who are or plan to be a health care professionals ...

Lesson 2: Types of Health Care Professionals and Facilities

Types of Health Care Professionals and Facilities

Source: Types of Health Care Professionals and Facilities, NLM, NIH,

Every day, around the clock, people who work in the healthcare industry provide care for millions of people, from newborns to the very ill. In fact, the health care industry is one of largest providers of jobs in the United States. Many health jobs are in hospitals. Others are in nursing homes, doctors' offices, dentists' offices, outpatient clinics and laboratories.

Learning Activity 2.1: Health and Medical Science Careers

Explore health and medical science careers in at Interest Area (
  • Click on at least three different careers
  • Compare them in terms of how well they match your career goals.

Nature of the Industry

Source: Career Guide to Industries, 2010-11 Edition, Healthcare, Medline Plus, Bureau of Labor Statistics,

Significant Points

  • As one of the largest industries in 2008, healthcare provided 14.3 million jobs for wage and salary workers.
  • Ten of the 20 fastest growing occupations are healthcare related.
  • Healthcare will generate 3.2 million new wage and salary jobs between 2008 and 2018, more than any other industry, largely in response to rapid growth in the elderly population.
  • Most workers have jobs that require less than 4 years of college education, but health diagnosing and treating practitioners are highly educated.

Combining medical technology and the human touch, the healthcare industry diagnoses, treats, and administers care around the clock, responding to the needs of millions of people—from newborns to the terminally ill.

Industry organization

About 595,800 establishments make up the healthcare industry; they vary greatly in terms of size, staffing patterns, and organizational structures. About 76 percent of healthcare establishments are offices of physicians, dentists, or other health practitioners. Although hospitals constitute only 1 percent of all healthcare establishments, they employ 35 percent of all workers.

The healthcare industry includes establishments ranging from small-town private practices of physicians who employ only one medical assistant to busy inner-city hospitals that provide thousands of diverse jobs. In 2008, around 48 percent of non-hospital healthcare establishments employed fewer than five workers. In contrast, 72 percent of hospital employees were in establishments with more than 1,000 workers.
The healthcare industry consists of the following segments:


Hospitals provide complete medical care, ranging from diagnostic services, to surgery, to continuous nursing care. Some hospitals specialize in treatment of the mentally ill, cancer patients, or children. Hospital-based care may be on an inpatient (overnight) or outpatient basis. The mix of workers needed varies, depending on the size, geographic location, goals, philosophy, funding, organization, and management style of the institution. As hospitals work to improve efficiency, care continues to shift from an inpatient to outpatient basis whenever possible.

Nursing and residential care facilities

Nursing care facilities provide inpatient nursing, rehabilitation, and health-related personal care to those who need continuous nursing care, but do not require hospital services. Nursing aides provide the vast majority of direct care. Other facilities, such as convalescent homes, help patients who need less assistance. Residential care facilities provide around-the-clock social and personal care to children, the elderly, and others who have limited ability to care for themselves. Workers care for residents of assisted-living facilities, alcohol and drug rehabilitation centers, group homes, and halfway houses. Nursing and medical care, however, are not the main functions of establishments providing residential care, as they are in nursing care facilities.

Offices of physicians

About 36 percent of all healthcare establishments fall into this industry segment. Physicians and surgeons practice privately or in groups of practitioners who have the same or different specialties. Many physicians and surgeons prefer to join group practices because they afford backup coverage, reduce overhead expenses, and facilitate consultation with peers. Physicians and surgeons are increasingly working as salaried employees of group medical practices, clinics, or integrated health systems.

Offices of dentists

About 20 percent of healthcare establishments are dentist's offices. Most employ only a few workers, who provide preventative, cosmetic, or emergency care. Some offices specialize in a single field of dentistry, such as orthodontics or periodontics.

Home healthcare services

Skilled nursing or medical care is sometimes provided in the home, under a physician's supervision. Home healthcare services are provided mainly to the elderly. The development of in-home medical technologies, substantial cost savings, and patients' preference for care in the home have helped change this once-small segment of the industry into one of the fastest growing healthcare services.

Offices of other health practitioners

This segment of the industry includes the offices of chiropractors, optometrists, podiatrists, occupational and physical therapists, psychologists, audiologists, speech-language pathologists, dietitians, and other health practitioners. Demand for the services of this segment is related to the ability of patients to pay, either directly or through health insurance. Hospitals and nursing facilities may contract out for these services. This segment also includes the offices of practitioners of alternative medicine, such as acupuncturists, homeopaths, hypnotherapists, and naturopaths.

Ambulatory healthcare services

This segment includes outpatient care center and medical and diagnostic laboratories. These establishments are diverse including kidney dialysis centers, outpatient mental health and substance abuse centers, blood and organ banks, and medical labs that analyze blood, do diagnostic imaging, and perform other clinical tests.

Recent developments

In the rapidly changing healthcare industry, technological advances have made many new procedures and methods of diagnosis and treatment possible. Clinical developments, such as infection control, less invasive surgical techniques, advances in reproductive technology, and gene therapy for cancer treatment, continue to increase the longevity and improve the quality of life of many Americans. Advances in medical technology also have improved the survival rates of trauma victims and the severely ill, who need extensive care from therapists and social workers as well as other support personnel.

In addition, advances in information technology have a perceived improvement on patient care and worker efficiency. Devices such as hand-held computers are used record a patient’s medical history. Information on vital signs and orders for tests are transferred electronically to a main database; this process eliminates the need for paper and reduces recordkeeping errors. Adoption of electronic health records is, however, relatively low presently.

Cost containment also is shaping the healthcare industry, as shown by the growing emphasis on providing services on an outpatient, ambulatory basis; limiting unnecessary or low-priority services; and stressing preventive care, which reduces the potential cost of undiagnosed, untreated medical conditions. Enrollment in managed care programs—predominantly preferred provider organizations, health maintenance organizations, and hybrid plans such as point-of-service programs—continues to grow. These prepaid plans provide comprehensive coverage to members and control health insurance costs by emphasizing preventive care. Cost effectiveness also is improved with the increased use of integrated delivery systems, which combine two or more segments of the industry to increase efficiency through the streamlining of functions, primarily financial and managerial. These changes will continue to reshape not only the nature of the healthcare workforce, but also the manner in which healthcare is provided.
Various healthcare reforms are presently under consideration. These reforms may affect the number of people covered by some form of health insurance, the number of people being treated by healthcare providers, and the number and type of healthcare procedures that will be performed.

Working Conditions
Average weekly hours of nonsupervisory workers in private healthcare varied among the different segments of the industry. Workers in offices of dentists averaged only 27.4 hours per week in 2008, while those in psychiatric and substance abuse hospitals averaged 35 hours, compared with 33.6 hours for all private industry.

Many workers in the healthcare industry are on part-time schedules. Part-time workers made up about 20 percent of the healthcare workforce as a whole in 2008, but accounted for 37 percent of workers in offices of dentists and 32 percent of those in offices of other health practitioners. Many healthcare establishments operate around the clock and need staff at all hours. Shift work is common in some occupations, such as registered nurses. It is not uncommon for healthcare workers hold more than one part-time job.

In 2008, the incidence of occupational injury and illness in hospitals was higher than the average for private industry overall. Nursing care facilities had an even higher rate.
Healthcare workers involved in direct patient care must take precautions to prevent back strain from lifting patients and equipment; to minimize exposure to radiation and caustic chemicals; and to guard against infectious diseases. Home care personnel and other healthcare workers who travel as part of their job are exposed to the possibility of being injured in highway accidents.


As one of the largest industries in 2008, healthcare provided 14.3 million jobs for wage and salary workers. About 40 percent were in hospitals; another 21 percent were in nursing and residential care facilities; and 16 percent were in offices of physicians.

Occupations in the Industry

Healthcare firms employ large numbers of workers in professional and service occupations. Together, these two occupational groups account for 76 percent of jobs in the industry (table 2). The next largest share of jobs, 18 percent, is in office and administrative support. Management, business, and financial operations occupations account for only 4 percent of employment. Other occupations in healthcare made up only 2 percent of the total. Professional occupations, such as physicians and surgeons, dentists, registered nurses, social workers, and physical therapists, usually require at least a bachelor's degree in a specialized field or higher education in a specific health field, although registered nurses also may enter through associate degree or diploma programs. Professional workers often have high levels of responsibility and complex duties. In addition to providing services, these workers may supervise other workers or conduct research. Some professional occupations, such as medical and health services managers, have little to no contact with patients.
Health technologists and technicians work in many fast-growing occupations, such as medical records and health information technicians, diagnostic medical sonographers, radiologic technologists and technicians, and dental hygienists. These workers may operate medical equipment and assist health diagnosing and treating practitioners. These technologists and technicians are typically graduates of 1-year or 2-year postsecondary training programs.

Service occupations attract many workers with little or no specialized education or training. For instance, some of these workers are nursing aides, home health aides, building cleaning workers, dental assistants, medical assistants, and personal and home care aides. Nursing or home health aides provide health-related services for ill, injured, disabled, elderly, or infirm individuals either in institutions or in their homes. By providing routine personal care services, personal and home care aides help elderly, disabled, and ill persons live in their own homes instead of in an institution. With experience and, in some cases, further education and training, service workers may advance to higher-level positions or transfer to new occupations.

Each segment of the healthcare industry provides a different mix of wage and salary health-related jobs.


Hospitals employ workers with all levels of education and training, thereby providing a wider variety of opportunities than is offered by other segments of the healthcare industry. About 28 percent of hospital workers are registered nurses. Hospitals also employ many physicians and surgeons, therapists, and social workers. About 21 percent of hospital jobs are in a service occupation, such as nursing, psychiatric, and home health aides, or building cleaning workers. Hospitals also employ large numbers of office and administrative support workers.

Nursing and residential care facilities.

About 63 percent of nursing and residential care facility jobs are in service occupations, primarily nursing, psychiatric, and home health aides. Professional and administrative support occupations make up a much smaller percentage of employment in this segment, compared with other parts of the healthcare industry. Federal law requires nursing facilities to have licensed personnel on hand 24 hours a day and to maintain an appropriate level of care.

Offices of physicians.

Many of the jobs in offices of physicians are in professional and related occupations, primarily physicians, surgeons, and registered nurses. About 37 percent of all jobs, however, are in office and administrative support occupations, such as receptionists and information clerks.

Offices of dentists.

Roughly 35 percent of all jobs in this segment are in service occupations, mostly dental assistants. The typical staffing pattern in dentists' offices consists of one dentist with a support staff of dental hygienists and dental assistants. Larger practices are more likely to employ office managers and administrative support workers.

Home healthcare services.

About 59 percent of jobs in this segment are in service occupations, mostly home health aides and personal and home care aides. Nursing and therapist jobs also account for substantial shares of employment in this segment.

Offices of other health practitioners.

About 42 percent of jobs in this industry segment are professional and related occupations, including physical therapists, occupational therapists, dispensing opticians, and chiropractors. Healthcare practitioners and technical occupations and office and administrative support occupations also accounted for a significant portion of all jobs—35 percent and 31 percent, respectively.

Ambulatory healthcare services.

Outpatient care centers employed high percentages of professional and related workers like counselors and registered nurses. Medical and diagnostic laboratories predominantly employ clinical laboratory and radiological technologists and technicians. Emergency medical technicians and paramedics are also employed in ambulatory services.

Training and Advancement

A wide variety of people with various educational backgrounds are necessary for the healthcare industry to function. The healthcare industry employs some highly educated occupations that often require many years of training beyond graduate school. However, most of the occupations in the healthcare industry require less than four years of college. A variety of postsecondary programs provide specialized training for jobs in healthcare. People interested in a career as a health diagnosing and treating practitioner—such as physicians and surgeons, optometrists, physical therapists, or audiologists—should be prepared to complete graduate school coupled with many years of education and training beyond college.

A few healthcare workers need bachelor’s degrees like social workers, health service managers, and some RNs. A majority of the technologist and technician occupations require a certificate or an associate degree; these programs usually have both classroom and clinical instruction and last about 2 years. The healthcare industry also provides many job opportunities for people without specialized training beyond high school. In fact, 47 percent of workers in nursing and residential care facilities have a high school diploma or less, as do 20 percent of workers in hospitals. Some healthcare establishments provide on-the-job or classroom training, as well as continuing education. Most healthcare workers that do not have postsecondary healthcare training and work directly with patients will receive some on-the-job training. These occupations include nursing aides, orderlies, and attendants; psychiatric aides; home health aides; physical therapist aides; and EKG technicians.

Hospitals are more likely than other facilities to have the resources and incentive to provide training programs and advancement opportunities to their employees. In other segments of healthcare, the variety of positions and advancement opportunities are more limited. Larger establishments usually offer a broader range of opportunities. Some hospitals provide training or tuition assistance in return for a promise to work at their facility for a particular length of time after graduation. Nursing facilities may have similar programs. Some hospitals have cross-training programs that train their workers—through formal college programs, continuing education, or in-house training—to perform functions outside their specialties.

Persons considering careers in healthcare should have a strong desire to help others, genuine concern for the welfare of patients and clients, and an ability to deal with people of diverse backgrounds in stressful situations. Many of the healthcare jobs that are regulated by State licensure require healthcare professionals to complete continuing education at regular intervals to maintain valid licensure. Opportunities for advancement will vary depending on the occupation itself. Healthcare service assistants and aides may advance to positions with more responsibility with years of experience or additional education or training. Health technologists and technicians often advance by becoming credentialed in a specialty within their field or with additional education or training. Health professionals may advance to managerial or administrative positions.


Healthcare will generate 3.2 million new wage and salary jobs between 2008 and 2018, more than any other industry, largely in response to rapid growth in the elderly population. Ten of the twenty fastest growing occupations are related to healthcare. Many job openings should arise in all healthcare employment settings as a result of employment growth and the need to replace workers who retire or leave their jobs for other reasons.
Advances in medical technology will continue to improve the survival rate of severely ill and injured patients, who will then need extensive therapy and care. New technologies will continue to enable earlier diagnoses of many diseases which often increases the ability to treat conditions that were previously not treatable. Industry growth also will occur as a result of the shift from inpatient to less expensive outpatient and home healthcare because of improvements in diagnostic tests and surgical procedures, along with patients' desires to be treated at home.

Many of the occupations projected to grow the fastest in the economy are concentrated in the healthcare industry. For example, over the 2008-18 period, total employment of home health aides is projected to increase by 50 percent, medical assistants by 34 percent, physical therapist assistants by 33 percent, and physician assistants by 39 percent.

Rapid growth is expected for workers in occupations concentrated outside the inpatient hospital sector, such as pharmacy technicians and personal and home care aides. Because of cost pressures, many healthcare facilities will adjust their staffing patterns to reduce labor costs. Where patient care demands and regulations allow, healthcare facilities will substitute lower paid providers and will cross-train their workforces. Many facilities have cut the number of middle managers, while simultaneously creating new managerial positions as the facilities diversify. Traditional inpatient hospital positions are no longer the only option for many future healthcare workers; persons seeking a career in the field must be willing to work in various employment settings. Hospitals will be the slowest growing segment within the healthcare industry because of efforts to control hospital costs and the increasing use of outpatient clinics and other alternative care sites.

Demand for dental care will rise due to greater retention of natural teeth by middle-aged and older persons, greater awareness of the importance of dental care, and an increased ability to pay for services. Dentists will use support personnel such as dental hygienists and assistants to help meet their increased workloads.

A wealth of information on health careers and job opportunities also is available through the Internet, schools, libraries, associations, and employers.

Optional Reading: Information on the following occupations may be found in the 2010-11 edition of the Occupational Outlook Handbook:

Health Facilities

Source:Health Facilities, National Library of Medicine, NIH,

Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers and specialized care centers, such as birthing centers and psychiatric care centers.
When you choose a health facility, you might want to consider
  • How close it is
  • Whether your health insurance will pay for services there
  • Whether your health care provider can treat you there
  • The quality of the facility
Quality is important. Some facilities do a better job than others. One way to learn about the quality of a facility is to look at report cards developed by state and consumer groups.

Look for a hospital that:
  • Is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
  • Is rated highly by the State and by consumer groups or other organizations.
  • Has a lot of experience and success in treating your condition.
  • Monitors quality of care and works to improve quality.
In choosing a nursing home or other long-term care facility, look for one that:
  • Has been found by State agencies and other groups to provide quality care.
  • Provides a level of care, including staff and services, that will meet your needs.

Learning Activity 2.2: Find a suitable hospital for you and your family.
  1. Go to Hospital Compare -
  2. Type in your zip code.
  3. Select three nearby hospitals to compare.
  4. Consider which one of these hospitals would you prefer to use.

Lesson 3: Brand Name and Generic Medications

Brand Name and Generic Medications

Source:Medicines, NLM, NIH,

You may need to take medicines every day, or only once in a while. Either way, you want to make sure that the medicines are safe and will help you get better. In the United States, the Food and Drug Administration is in charge of assuring the safety and effectiveness of both prescription and over-the-counter medicines.
Even safe drugs can cause unwanted side effects or interactions with food or other medicines you may be taking. They may not be safe during pregnancy. To reduce the risk of reactions and make sure that you get better, it is important for you to take your medicines correctly.

Understanding Generic Drugs

Source:Understanding Generic Drugs, FDA,

Generic drugs are important options that allow greater access to health care for all Americans. They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
Health care professionals and consumers can be assured that FDA approved generic drug products have met the same rigid standards as the innovator drug. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand-name drugs. And, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.

Generic Drugs: Questions and Answers

Source: Consumer Questions and Answers, FDA,

What are generic drugs?

A generic drug is identical -- or bioequivalent -- to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price. According to the Congressional Budget Office, generic drugs save consumers an estimated $8 to $10 billion a year at retail pharmacies. Even more billions are saved when hospitals use generics.

Learning Activity 3.1: Generic equivalents for brand-name drug

1. Find out if there is a generic equivalent for a brand-name drug that you or someone you know uses.
  • Use Drugs@FDA, a catalog of FDA-approved drug products, as well as drug labeling.
2. You can also search for generic equivalents by using the "Electronic Orange Book."
  • Search by proprietary "brand" name," then search again by using the active ingredient name.
  • If other manufacturers are listed besides the "brand name" manufacturer when searching by the "active ingredient," they are the generic product manufacturers.

Are generic drugs as effective as brand-name drugs?
Yes. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken and the way it should be used.
FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs.
Not every brand-name drug has a generic drug. When new drugs are first made they have drug patents. Most drug patents are protected for 20 years. The patent, which protects the company that made the drug first, doesn't allow anyone else to make and sell the drug. When the patent expires, other drug companies can start selling a generic version of the drug. But, first, they must test the drug and the FDA must approve it.
Creating a drug costs lots of money. Since generic drug makers do not develop a drug from scratch, the costs to bring the drug to market are less; therefore, generic drugs are usually less expensive than brand-name drugs. But, generic drug makers must show that their product performs in the same way as the brand-name drug.

How are generic drugs approved?

Drug companies must submit an abbreviated new drug application (ANDA) for approval to market a generic product. The Drug Price Competition and Patent Term Restoration Act of 1984, more commonly known as the Hatch-Waxman Act, made ANDAs possible by creating a compromise in the drug industry. Generic drug companies gained greater access to the market for prescription drugs, and innovator companies gained restoration of patent life of their products lost during FDA's approval process.
New drugs, like other new products, are developed under patent protection. The patent protects the investment in the drug's development by giving the company the sole right to sell the drug while the patent is in effect. When patents or other periods of exclusivity expire, manufacturers can apply to the FDA to sell generic versions.
The ANDA process does not require the drug sponsor to repeat costly animal and clinical research on ingredients or dosage forms already approved for safety and effectiveness. This applies to drugs first marketed after 1962.

What standards do generic drugs have to meet?

Health professionals and consumers can be assured that FDA approved generic drugs have met the same rigid standards as the innovator drug. To gain FDA approval, a generic drug must:
  • contain the same active ingredients as the innovator drug(inactive ingredients may vary)
  • be identical in strength, dosage form, and route of administration
  • have the same use indications
  • be bioequivalent
  • meet the same batch requirements for identity, strength, purity, and quality
  • be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator products

Learning Activity 3.2:
  • Watch this brief video, The Over-the-Counter Drug Facts Label video, about how to safely use an over-the-counter medicine.
    • Why is it important to follow the label's information?
  • Watch this video titled: Avoid Drug Interactions
    • Get helpful tips to avoid the three main types of interactions: drugs with food and beverages, drugs with dietary supplements, and drugs with other drugs.
  • Watch this video from the U.S. Food and Drug Administration (FDA) Office of Women's Health titled: Use Medicines Wisely

Lesson 4: Alternative Medical Practices

Alternative Medical Practices

Source: Alternative Medical Practices, NIH: National Center for Complementary and Alternative Medicine,

Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard care. Standard care is what medical doctors, doctors of osteopathy and allied health professionals, such as registered nurses and physical therapists, practice. Alternative medicine means treatments that you use instead of standard ones. Complementary medicine means nonstandard treatments that you use along with standard ones. Examples of CAM therapies are acupuncture, chiropractic and herbal medicines.
The claims that CAM treatment providers make about their benefits can sound promising. However, researchers do not know how safe many CAM treatments are or how well they work. Studies are underway to determine the safety and usefulness of many CAM practices.

What Is Complementary and Alternative Medicine?

Source:What Is Complementary and Alternative Medicine? NCCAM, NIH,
Many Americans use complementary and alternative medicine (CAM) in pursuit of health and well-being. The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, showed that approximately 38 percent of adults use CAM.
Defining CAM
Defining CAM is difficult, because the field is very broad and constantly changing. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over time, become widely accepted.
"Complementary medicine" refers to use of CAM together with conventional medicine, such as using acupuncture in addition to usual care to help lessen pain. Most use of CAM by Americans is complementary. "Alternative medicine" refers to use of CAM in place of conventional medicine. "Integrative medicine" combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.

Types of CAM

CAM practices are often grouped into broad categories, such as natural products, mind and body medicine, and manipulative and body-based practices. Although these categories are not formally defined, they are useful for discussing CAM practices. Some CAM practices may fit into more than one category.

Natural Products

This area of CAM includes use of a variety of herbal medicines (also known as botanicals), vitamins, minerals, and other "natural products." Many are sold over the counter as dietary supplements. (Some uses of dietary supplements—e.g., taking a multivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health—are not thought of as CAM.)
CAM "natural products" also include probiotics—live microorganisms (usually bacteria) that are similar to microorganisms normally found in the human digestive tract and that may have beneficial effects. Probiotics are available in foods (e.g., yogurts) or as dietary supplements. They are not the same thing as prebiotics — nondigestible food ingredients that selectively stimulate the growth and/or activity of microorganisms already present in the body.
Interest in and use of CAM natural products have grown considerably in the past few decades. The 2007 NHIS found that 17.7 percent of American adults had used a nonvitamin/nonmineral natural product. These products were the most popular form of CAM among both adults and children. The most commonly used product among adults was fish oil/omega 3s (reported by 37.4 percent of all adults who said they used natural products); popular products for children included echinacea (37.2 percent) and fish oil/omega 3s (30.5 percent).

Mind and Body Medicine

Mind and body practices focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health. Many CAM practices embody this concept—in different ways.
  • Meditation techniques include specific postures, focused attention, or an open attitude toward distractions. People use meditation to increase calmness and relaxation, improve psychological balance, cope with illness, or enhance overall health and well-being.
  • The various styles of yoga used for health purposes typically combine physical postures, breathing techniques, and meditation or relaxation. People use yoga as part of a general health regimen, and also for a variety of health conditions.
  • Acupuncture is a family of procedures involving the stimulation of specific points on the body using a variety of techniques, such as penetrating the skin with needles that are then manipulated by hand or by electrical stimulation. It is one of the key components of traditional Chinese medicine, and is among the oldest healing practices in the world.
Other examples of mind and body practices include deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, qi gong, and tai chi.
Historical note: The concept that the mind is important in the treatment of illness is integral to the healing approaches of traditional Chinese medicine and Ayurvedic medicine, dating back more than 2,000 years. Hippocrates also noted the moral and spiritual aspects of healing and believed that treatment could occur only with consideration of attitude, environmental influences, and natural remedies.
Current use: Several mind and body approaches ranked among the top 10 CAM practices reported by adults in the 2007 NHIS. For example, the survey found that 12.7 percent of adults had used deep-breathing exercises, 9.4 percent had practiced meditation, and 6.1 percent had practiced yoga; use of these three CAM practices had increased significantly since the previous (2002) NHIS. Progressive relaxation and guided imagery were also among the top 10 CAM therapies for adults; deep breathing and yoga ranked high among children. Acupuncture had been used by 1.4 percent of adults and 0.2 percent of children.
Acupuncture is considered to be a part of mind and body medicine, but it is also a component of energy medicine, manipulative and body-based practices, and traditional Chinese medicine.

Learning Activity 4.1: Watch this video: What Happens during an Acupuncture Session?" [2 min 43 sec]

Manipulative and Body-Based Practices

Manipulative and body-based practices focus primarily on the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems. Two commonly used therapies fall within this category:
  • Spinal manipulation is performed by chiropractors and by other health care professionals such as physical therapists, osteopathic physicians, and some conventional medical doctors. Practitioners use their hands or a device to apply a controlled force to a joint of the spine, moving it beyond its passive range of motion; the amount of force applied depends on the form of manipulation used. Spinal manipulation is among the treatment options used by people with low-back pain - a very common condition that can be difficult to treat.
  • The term massage therapy encompasses many different techniques. In general, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body. People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general well-being.

Other CAM Practices

CAM also encompasses movement therapies—a broad range of Eastern and Western movement-based approaches used to promote physical, mental, emotional, and spiritual well-being. Examples include Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration. According to the 2007 NHIS, 1.5 percent of adults and 0.4 percent of children used movement therapies.
Practices of traditional healers can also be considered a form of CAM. Traditional healers use methods based on indigenous theories, beliefs, and experiences handed down from generation to generation. A familiar example in the United States is the Native American healer/medicine man. The 2007 NHIS found that 0.4 percent of adults and 1.1 percent of children had used a traditional healer (usage varied for the seven specific types of healers identified in the survey).

Some CAM practices involve manipulation of various energy fields to affect health. Such fields may be characterized as veritable (measurable) or putative (yet to be measured). Practices based on veritable forms of energy include those involving electromagnetic fields (e.g., magnet therapy and light therapy). Practices based on putative energy fields (also called biofields) generally reflect the concept that human beings are infused with subtle forms of energy; qi gong, Reiki, and healing touch are examples of such practices. The 2007 NHIS found relatively low use of putative energy therapies. Only 0.5 percent of adults and 0.2 percent of children had used energy healing/Reiki (the survey defined energy healing as the channeling of healing energy through the hands of a practitioner into the client's body).
Finally, whole medical systems, which are complete systems of theory and practice that have evolved over time in different cultures and apart from conventional or Western medicine, may be considered CAM. Examples of ancient whole medical systems include Ayurvedic medicine and traditional Chinese medicine. More modern systems that have developed in the past few centuries include homeopathy and naturopathy. The 2007 NHIS asked about the use of Ayurveda, homeopathy, and naturopathy. Although relatively few respondents said they had used Ayurveda or naturopathy, homeopathy ranked 10th in usage among adults (1.8 percent) and 5th among children (1.3 percent).

Learning Activity 4.2: Watch this video about Tai Chi and Qi Gong.

Lesson 5: Health Fraud

Health Fraud

Source: Health Fraud,NLM, NIH, MedlinePlus,

You have probably seen ads for miracle cures - a supplement to cure cancer, a diet to cure diabetes. But remember - if it sounds too good to be true, then it probably is. Health fraud involves selling drugs, devices, foods or cosmetics that have not been proven effective. At best, these scams don't work. At worst, they're dangerous. They also waste money, and they might keep you from getting the treatment you really need. Health scams often target older people. Most victims in the United States are older than 65.

To protect yourself -
  • Question claims of miracle cures or breakthroughs
  • Know that newspapers, magazines, and radio and TV stations do not have to make sure that the ads they run are true
  • Find out about products before you buy them
  • Don't let salespeople force you into making snap decisions
  • Check with your doctor before taking products

Learning Activity 5.1: Watch these short videos by the U.S. Food and Drug Administration:
What are the red flags that should make you suspicious about health product or treatment claims?

Miracle Health Claims: Add a Dose of Skepticism

Source:Medical Health Claims, FTC,

People spend billions of dollars a year on health-related products and treatments that not only are unproven and often useless, but also sometimes are dangerous. The products promise quick cures and easy solutions for a variety of problems, from obesity and arthritis to cancer and AIDS. But the "cures" don't deliver, and people who buy them are cheated out of their money, their time, and even their health. That's why it's important to learn how to evaluate claims for products related to your health.

Are You a Target for Health Fraudsters?

You’ve seen miracle claims for products related to health. It’s no wonder. People spend billions of dollars a year on fraudulently marketed health-related products and treatments that not only are unproven and often useless, but sometimes also are dangerous.
Health fraud trades on false hope. It promises quick cures and easy solutions for a variety of problems, from obesity and arthritis to cancer and AIDS. But the “cures” don’t deliver. Instead, people who buy them are cheated out of their money, their time, and even their health. Fraudulently marketed health products can have dangerous interactions with medicines people are already taking, and can keep them from getting a proper diagnosis and treatment from their own health care professional. Many unapproved treatments are expensive, too, and rarely covered by health insurance.
Health fraudsters often target people who are overweight, have serious conditions like cancer, or conditions without a cure, like:
  • multiple sclerosis
  • diabetes
  • Alzheimer's disease
  • arthritis
The Federal Trade Commission (FTC), the nation’s consumer protection agency, and the Food and Drug Administration (FDA) say it's important to learn how to evaluate health claims, especially if you have a serious condition.


If you or someone you love has cancer, you may be curious about supposed “miracle” cancer-fighting products — like pills, powders, and herbs — that you’ve seen advertised or heard about from family and friends. Scammers take advantage of the feelings that can accompany a diagnosis of cancer. They promote unproven — and potentially dangerous — substances like black salve, essiac tea, or laetrile with claims that the products are both “natural” and effective. But “natural” doesn’t mean either safe or effective, especially when it comes to using these products for cancer. In fact, a product that is labeled “natural” can be more than ineffective: it can be downright harmful. What’s more, stopping or delaying proven treatment can have serious consequences.
The truth is that no single device, remedy, or treatment can treat all types of cancer. All cancers are different, and no one treatment works for every cancer or every body. Even two people with the same diagnosis may need different treatments. That’s one more reason to be skeptical of websites, magazines, and brochures with ads for products that claim to treat cancer, and to decide on treatments with your health professional.
People with cancer who want to try an experimental treatment should enroll in a legitimate clinical study. The FDA reviews clinical study designs to help ensure that patients are not subjected to unreasonable risks.

OPTIONAL Learning Activity: CURE-ious? Ask. Cancer Treatment Scams
Microsite with important information about cancer treatment scams. Includes tips on questions to ask, how to spot a scam, how to file a complaint and resources for patients and their families. Includes a 90 second video, "Anatomy of a Cancer Treatment Scam.”
Source: Curious, FTC,


Although proven treatments can extend and improve the quality of life for people with AIDS, so far there is no cure for the disease. If you’ve been diagnosed with HIV, the virus that causes AIDS, you may be tempted to try untested drugs or treatments. But trying unproven products or treatments — like electrical and magnetic devices and so-called herbal cures — can be dangerous, especially if it means a delay in seeking medical care.
For example, the herb St. John's Wort has been promoted as a safe treatment for HIV. But there’s no evidence that it is effective in treating HIV; in fact, studies have shown that it interferes with medicines prescribed for HIV.
You also may have considered home test kits. But claims for these products could be misleading. Safe, reliable HIV testing can be done only through a medical professional or a clinic, or through the Home Access Express HIV-1 Test System, the only FDA-approved system for home use.


There’s no shortage of people selling unproven arthritis remedies, which include thousands of dietary supplements and so-called natural cures like mussel extract, desiccated liver pills, shark cartilage, CMO (cetylmyristoleate), honey and vinegar mixtures, and gimmicks like magnets and copper bracelets. But these remedies aren’t backed adequately by science to demonstrate relief.

Avoiding Shady Sellers and Practitioners

It's easy to see why some people believe product claims, especially when successful treatments seem elusive. But pressure to decide on-the-spot about trying an untested product or treatment is a sure sign of a fraud. Ask for more information and consult a knowledgeable doctor, pharmacist, or other health care professional. Promoters of legitimate health care products don’t object to your seeking additional information — in fact, most welcome it.
The same goes if you’re considering a clinic that requires you to travel and stay far from home for treatment: check it out with your regular doctor. Although some clinics offer effective treatments, others:
  • Prescribe untested, unapproved, ineffective, and possibly dangerous "cures"
  • Employ health care providers that may not be licensed or have other appropriate credentials
For information about a particular hospital, clinic, or treatment center contact the state or local health authorities where the facility is located. If the facility is in a foreign country, contact that government's health authority to see that the facility is properly licensed and equipped to handle the procedures involved.
The FTC works to prevent fraudulent, deceptive and unfair business practices in the marketplace and to provide information to help consumers spot, stop and avoid them.

Beware of Health Scams

Source: Beware of Health Scams, NIA,

You see the ads everywhere these days — “Smart Drugs” for long life or “Arthritis Aches and Pains Disappear Like Magic!” or even statements claiming, “This treatment cured my cancer in 1 week.” It’s easy to understand the appeal of these promises. But there is still plenty of truth to the old saying, “If it sounds too good to be true, it probably is!”

Health scams and the marketing of unproven cures have been around for many years. Today, there are more ways than ever to sell these untested products. In addition to TV, radio, magazines, newspapers, infomercials, mail, telemarketing, and even word-of-mouth, these products are now offered over the Internet—with websites describing miracle cures and emails telling stories of overnight magic. Sadly, older people are often the target of such scams.

The problem is serious. Untested remedies may be harmful. They may get in the way of medicines prescribed by your doctor. They may also waste money. And, sometimes, using these products keeps people from getting the medical treatment they need.

False Hopes
Why do people fall for these sales pitches? Unproven remedies promise false hope. They offer cures that appear to be painless or quick. At best, these treatments are worthless. At worst, they are dangerous. Health scams prey on people who are frightened or in pain. Living with a chronic health problem is hard. It’s easy to see why people might fall for a false promise of a quick and painless cure. The best way for scientists to find out if a treatment works is through a clinical trial.
These scams usually target diseases that have no cures, like diabetes, arthritis, and Alzheimer’s disease.

You may see ads for:
  • Anti-aging medications.
    • Our culture places great value on staying young, but aging is normal. Despite claims about pills or treatments that lead to endless youth, no treatments have been proven to slow or reverse the aging process. Eating a healthy diet, getting regular exercise, and not smoking are proven ways to help prevent some of the diseases that occur with age. In other words, making healthy lifestyle choices offers you the best chance of aging well.
  • Arthritis remedies.
    • Unproven arthritis remedies can be easy to fall for because symptoms of arthritis tend to come and go. You may believe the remedy you are using is making you feel better when, in fact, it is just the normal ebb and flow of your symptoms. You may see claims that so-called treatments with magnets, copper bracelets, chemicals, special diets, radiation, and other products cure arthritis. This is highly unlikely. Ads where people say they have been cured do not prove that a product works. Some of these products could hurt you, aren’t likely to help, and are often costly. There is no cure for most forms of arthritis. Rest, exercise, heat, and some drugs help many people control their symptoms. Don’t trust ads where people say they have been cured. This kind of statement probably doesn’t tell the whole story. If you are thinking about any new treatment, such as diet, a device, or another arthritis product, talk with your doctor first.
  • Cancer cures.
    • Scam artists prey on a fear of cancer. They promote treatments with no proven value—for example, a diet dangerously low in protein or drugs such as laetrile. Remember: there is no one treatment that cures all types of cancer. By using unproven methods, people with cancer may lose valuable time and the chance to benefit from a proven, effective treatment. This delay may lessen the chance of controlling or curing the disease.
  • Memory aids.
    • Many people worry about losing their memory as they age. They may wrongly believe false promises that unproven treatments can help them keep or improve their memory. So-called smart pills, removal of amalgam dental fillings, and certain brain retraining exercises are some examples of untested approaches.
  • Dietary supplements.
    • Americans spend billions of dollars each year on dietary supplements. These supplements are sold over-the-counter and include vitamins and minerals, amino acids, herbs, and enzymes. Most dietary supplements do not undergo government testing or review before they are put on the market. While some vitamins may be helpful, supplements may be bad for people taking certain medicines or with some medical conditions. Be wary of claims that a supplement can shrink tumors, solve impotence, or cure Alzheimer’s disease. Talk to your doctor before starting any supplement.
  • Health insurance.
    • Some companies target people who are unable to get health insurance. They offer coverage that promises more than it intends to deliver. When you think about buying health insurance, remember to find out if the company and agent are licensed in your State.

How Can You Protect Yourself From Health Scams?

Be wary. Question what you see or hear in ads or on the Internet. Newspapers, magazines, radio, and TV stations do not always check to make sure the claims in their ads are true. Find out about a product before you buy. Don’t let a salesperson talk you into making a snap decision. Check with your healthcare provider first.
  • Promise a quick or painless cure
  • Claim the product is made from a special, secret, or ancient formula
  • Offer products and services only by mail or from one company
  • Use statements or unproven case histories from so-called satisfied patients
  • Claim to be a cure for a wide range of ailments
  • Claim to cure a disease (such as arthritis or Alzheimer’s disease) that hasn’t been cured by medical science
  • Promise a no-risk, money-back guarantee
  • Offer an additional “free” gift or a larger amount of the product as a “special promotion”
  • Require advance payment and claim there is a limited supply of the product

Learning Activity 5.2: Watch this video - Navigate Safely - A Video Guide by the Health On the Net Foundation (HON)

Lesson 6: Health Disparities and Inequalities

Health Disparity

Source: Health Disparities, Centers for Disease Control and Prevention,

Despite prevention efforts, some groups of people are affected by HIV/AIDS, viral hepatitis, STDs, and TB more than other groups of people. The occurrence of these diseases at greater levels among certain population groups more than among others is often referred to as a health disparity. Differences may occur by gender, race or ethnicity, education, income, disability, geographic location and sexual orientation among others. Social determinants of health like poverty, unequal access to health care, lack of education, stigma, and racism are linked to health disparities.

Health in the United States is a complex and often contradictory issue. One the one hand, as one of the wealthiest nations, the United States fares well in health comparisons with the rest of the world. However, the United States also lags behind almost every industrialized country in terms of providing care to all its citizens. The following sections look at different aspects of health in America.

Health by Race and Ethnicity

Source: OpenStax College. 2012. Health in the United States. Connexions, May 18, 2012.

When looking at the social epidemiology of the United States, it is hard to miss the disparities among races. The discrepancy between black and white Americans shows the gap clearly; IN 2008, the average life expectancy for white males was approximately five years longer than for black males: 75.9 compared to 70.9. An even stronger disparity was found in 2007: the infant mortality rate for blacks was nearly twice that of whites at 13.2 compared to 5.6 per 1,000 live births (U.S. Census Bureau 2011). According to a report from the Henry J. Kaiser Foundation (2007), African Americans also have higher incidence of several other diseases and causes of mortality, from cancer to heart disease to diabetes. In a similar vein, it is important to note that ethnic minorities, including Mexican Americans and Native Americans, also have higher rates of these diseases and causes of mortality than whites. Lisa Berkman (2009) notes that this gap started to narrow during the Civil Rights movement in the 1960s, but it began widening again in the early 1980s.

What accounts for these perpetual disparities in health among different ethnic groups? Much of the answer lies in the level of health care that these groups receive. The National Healthcare Disparities Report (2010) shows that even after adjusting for insurance differences, racial and ethnic minority groups receive poorer quality of care and less access to care than dominant groups. The Report identified these racial inequalities in care: Black Americans, American Indians, and Alaskan Natives received inferior care than Caucasian Americans for about 40 percent of measures Asian ethnicities received inferior care for about 20 percent of measures Among whites, Hispanic whites received 60 percent inferior care of measures compared to non-Hispanic whites (Agency for Health Research and Quality 2010). When considering access to care, the figures were comparable.

Health by Socioeconomic Status

Discussions of health by race and ethnicity often overlap with discussions of health by socioeconomic status, since the two concepts are intertwined in the United States. As the Agency for Health Research and Quality (2010) notes, “racial and ethnic minorities are more likely than non-Hispanic whites to be poor or near poor,” so many of the data pertaining to subordinate groups is also likely to be pertinent to low socioeconomic groups. Marilyn Winkleby and her research associates (1992) state that “one of the strongest and most consistent predictors of a person's morbidity and mortality experience is that person's socioeconomic status (SES). This finding persists across all diseases with few exceptions, continues throughout the entire lifespan, and extends across numerous risk factors for disease.”It is important to remember that economics are only part of the SES picture; research suggests that education also plays an important role. Phelan and Link (2003) note that many behavior-influenced diseases like lung cancer (from smoking), coronary artery disease (from poor eating and exercise habits), and AIDS initially were widespread across SES groups. However, once information linking habits to disease was disseminated, these diseases decreased in high SES groups and increased in low SES groups. This illustrates the important role of education initiatives regarding a given disease, as well as possible inequalities in how those initiatives effectively reach different SES groups.

Health by Gender

Women are affected adversely both by unequal access to and institutionalized sexism in the health care industry. According a recent report from the Kaiser Family Foundation, women experienced a decline in their ability to see needed specialists between 2001 and 2008. In 2008, one quarter of females questioned the quality of her health care (Ranji and Salganico 2011). In this report, we also see the explanatory value of intersection theory. Feminist sociologist Patricia Hill Collins developed this theory, which suggests we cannot separate the effects of race, class, gender, sexual orientation, and other attributes. Further examination of the lack of confidence in the health care system by women, as identified in the Kaiser study, found, for example, women categorized as low income were more likely (32 percent compared to 23 percent) to express concerns about health care quality, illustrating the multiple layers of disadvantage caused by race and sex.

We can see an example of institutionalized sexism in the way that women are more likely than men to be diagnosed with certain kinds of mental disorders. Psychologist Dana Becker notes that 75 percent of all diagnoses of Borderline Personality Disorder (BPD) are for women according to the Diagnostic Statistical Manual of Mental Disorders. This diagnosis is characterized by instability of identity, of mood, and of behavior, and Becker argues that it has been used as a catch-all diagnosis for too many women. She further decries the pejorative connotation of the diagnosis, saying that it predisposes many people, both within and outside of the profession of psychotherapy, against women who have been so diagnosed (Becker).
Many critics also point to the medicalization of women’s issues as an example of institutionalized sexism. Medicalization refers to the process by which previously normal aspects of life are redefined as deviant and needing medical attention to remedy. Historically and contemporaneously, many aspects of women’s lives have been medicalized, including menstruation, pre-menstrual syndrome, pregnancy, childbirth, and menopause.

The medicalization of pregnancy and childbirth has been particularly contentious in recent decades, with many women opting against the medical process and choosing a more natural childbirth. Fox and Worts (1999) find that all women experience pain and anxiety during the birth process, but that social support relieves both as effectively as medical support. In other words, medical interventions are no more effective than social ones at helping with the difficulties of pain and childbirth. Fox and Worts further found that women with supportive partners ended up with less medical intervention and fewer cases of postpartum depression. Of course, access to quality birth care outside of the standard medical models may not be readily available to women of all social classes.


Despite generally good health in the U.S. compared with less-developed countries, America is still facing challenging issues such as a prevalence of obesity and diabetes. Moreover, Americans of historically disadvantaged racial groups, ethnicities, socioeconomic status, and gender experience lower levels of health care. Mental health and disability are health issues that are significantly impacted by social norms.

What factors contribute to the disparities in health among racial, ethnic, and gender groups in the United States?

Learning Activity 6.1: Use the chart at Health Disparities to find out about specific health disparities in California and one other state of your choice.
  • How do they compare?
  • Which has the greatest disparities?

Resource: Health Status 2020,

How to Define and Measure Health Disparities

Source: How to understand, define, and measure health disparity, by John Lynch and Sam Harper, OpenMichigan, Lecture 1, Part 1, 2005, CC-BY

Healthy People 2010 is a statement of objectives published by the United States Department of Health and Human Services. Recognized as one of the most important public health documents in the nation, it states the overarching national goals for public health to be achieved by the year 2010.

The first goal is “to help individuals of all ages increase life expectancy and improve their quality of life.

The second goal is “to eliminate health disparities among segments of the population, including differences according to gender, race or ethnicity, education or income, disability, geographic location or sexual orientation.”
In other words, there would be no health disparity between or among groups within these social categories of gender, race/ethnicity, education, income, disability, geography or sexual orientation. So as you can see, health disparities are high on the public health agenda.
  • How do we know a disparity exists?
  • How can disparity be depicted?

As another example, here we see infant mortality rates among African-Americans and whites across regions of the U.S.

There is a black/white difference in infant mortality in the U.S. Additionally, the difference varies by region of the country, so both a race/ethnic and geographic disparity exist.

Recently, efforts to monitor health disparities have grown significantly. We have already talked about the Healthy People 2010 goals, but there are others worth noting. The National Center for Health Statistics is currently producing a handbook to measure health disparities. There are also various initiatives across the National Institutes of Health. The National Cancer Institute, in particular, has a major initiative on health disparities.
The Health Resources and Services Administration, the Institute of Medicine, and many other bodies have produced documents and sponsored conferences and workshops focused on reducing or eliminating health disparities in the U.S. In addition to these, there are many Healthy People 2010 efforts at the state level, such as Michigan’s task force on health disparities.

The language of health disparities is varied, and different terms are used in different parts of the world. In the United States we usually talk about “disparities.” In England they sometimes use the word “variations” Throughout Europe they talk about “inequalities” in health. You will also see the term “inequities” being used; specifically, you will hear it in the phrase: “inequities in health.” We can think about disparities, variations and inequalities as being very similar terms; whereas, the term “inequity” implies something different. We’ll explore that distinction in a moment. But for now, you can think about inequalities, variations, or disparities or inequities in health according to gender, race/ethnicity, socioeconomic position, and geography. Note that these are some of the social categories that are reflected in HP 2010 Goal #2.

Now let’s consider the word “disparity.”

The dictionary defines disparity as a difference, which means two quantities are not equal. We have a mathematical symbol for that. It is very easy to decide when two things are not equal. We can easily say that a rate in Group A is not the same as—or is not equal to—a rate in Group B. This provides a workable definition of health disparity that we will use from this point forward. According to this simple definition, a disparity is just a difference. In this sense, the word disparity has the same meaning as the word inequality— two quantities are not equal.

Now that we’ve defined disparity, let’s move on to the next step—understanding what the inequalities in health are based upon. Inequalities in health are based on observed differences or disparities in health. For example to conclude whether “poor people die younger than rich people,” we simply compare death rates in the two groups and we find out whether they are the same. If they are different, then an inequality exists—a disparity exists. Infants born into a low social class have lower birth weight. Smokers get more lung cancer than non-smokers. Women live longer than men. These statements can be made from simple, unambiguous observations of the relevant data.

When we begin to discuss inequities in health, things get a little more complicated. Deciding if something is an “inequity” means we have to make an ethical judgment about the fairness of the health differences we observe. This extends beyond recognizing that things are different. You need to get to the point of thinking,

  • “It is true poor people die younger than rich people, but should they – is it fair?
  • Should infants born into a low social class have a lower birth weight?
  • Should smokers get more lung cancer?
  • Should women live longer than men?”

Here are questions for you to think about:
  • Are all health inequalities, also health inequities?
  • In other words, are all the observed health differences among social groups unfair?
  • Are health inequalities always health inequities?

Public health scientists can measure differences or inequalities or disparities in health. We can measure differences in health status between groups. However, as you have just seen, we require some process of social and political discourse to assess which disparities—which differences—are unjust and intolerable in our society. Which disparities are unfair and thus require priority policy attention? As you will see, one of the challenges in addressing health disparities lies in moving beyond the drawing board. Different endeavors to reduce health disparities have frameworks and approaches that complicate interpretation. Next we will discuss some examples of how the conceptualization of health disparity differs.
  • …the National Institutes of Health (NIH) Strategic Plan to Reduce and Ultimately Eliminate Health Disparities—the plan that guides NIH research—defines health disparities in this way: It says, “health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” Note that this definition is very similar to the one we agreed upon earlier—a disparity is a difference.
  • By contrast, the Act that actually set up some of these research endeavors—the Minority Health and Health Disparities Research and Education Act of 2000 - states: “A population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population.”

Comparing the two definitions for disparity, you may note that the first one just says that disparity is a difference, without indicating from where the difference should be measured. The second definition, on the other hand, says that a disparity has to be significant when compared to the general population.

Former U.S. Surgeon General, David Satcher, has written about the importance of disparities, and he offers a third perspective. He argues that we must eliminate disparities in health. The central part of his statement is the aim “to eliminate, not just reduce, some of the health disparities between majority and minority populations.”

How does this statement differ from the earlier definitions?

Dr. Satcher explains that the disparity of concern exists between the majority and the minority populations. The previous definition we saw stated that differences should be compared to the general population, not to the majority population.

As you can see, differences in language reflect different understandings about 1) which elements are most important in assessing the extent of health disparity and 2) which groups are of concern.

Learning Activity 6.2: How Health is Impacted by Race and Class
  1. Go to the Unnatural Causes website at, then
  2. Click on each of the photos to read about how health is impacted by race and class.

The Culture of Poverty

Source: AFMC Primer on Population Health,The Association of Faculties of Medicine of Canada, CC-BY-NC-SA,

Socio-economic status influences most aspects of health, but the nature of that influence is complex and varied. Nonetheless, there are some consistencies that may be relevant for the clinician to note. The term culture of poverty describes certain characteristics of behavior and outlook that may be seen among people who are living in socially disadvantaged conditions. Here are some thoughts to bear in mind when communicating with people living in poverty:
  1. People lower in the social hierarchy have the same diseases as anyone else, but tend to have more of them.
  2. When you are poor and sick the future looks bleak, and so you try to ignore it, to live in the present, and plan only in the short term.
  3. When a person with few choices is trying to survive from day to day, long-term health is less of a priority than getting through today.
  4. Behaviors that may seem irresponsible to people who are not members of the culture often have a different meaning to people in marginal situations. For instance, adolescent pregnancy may offer a route to self-esteem. Substance abuse may be an antidote to reality. Both, ultimately, serve to maintain poverty, but recognize item 3, above.
  5. A person living in poverty may not be able to follow the doctor’s advice; he may not have the time, the money, or the opportunities that the doctor probably takes for granted. A poor person may not have a drug plan, so may not be able to afford the antibiotic you just prescribed.
  6. Do not confuse schooling with intelligence. Many people with little formal schooling have no difficulty understanding new concepts when they are properly explained.

California Profile

Source: Chart Book Data,

California has some of the lowest rates of death due to various causes including deaths from cancer and deaths due to unintentional injuries. The state ranks among those with the highest rates of deaths due to influenza and pneumonia, and diabetes-related causes, with substantially higher rates of diabetes-related deaths among the black and Hispanic populations. Rates of high blood pressure and obesity are higher for the black, Hispanic and American Indian/Alaskan Native (AI/AN) populations in the state as compared with the white and Asian/Pacific Islander populations. It is one of the states in which all population groups have achieved the Healthy People 2020 target for percentages of population with no leisure-time physical activity.
California ranks among the states with low proportions of current smokers and high percentages of residents who eat five or more fruits and vegetables per day. California ranks in the lower range of states for health insurance coverage, and the rate of coverage for the state’s large Hispanic population is notably lower than for other population groups.

Learning Activity 6.3: Health and Location

Optional Learning Activity: Healthier Community, Neighborhood or Campus

  • Watch Video Excerpts from Unnatural Causes –
  • What can be done to create a neighborhood that promotes rather than destroys health?
  • Consider your own neighborhood and answer the questions below:
    • What does this neighborhood look like?
    • What are the strengths of this neighborhood?
    • What actions could be taken to sustain those strengths?
    • Who can help you and others take those actions?
    • What things in this neighborhood need to be improved to reduce chronic stress, give residents better access to healthy choices, and/or give people a greater control over their lives? Be as specific as possible.
    • What actions could be taken to make those improvements?

Complementary and Alternative Medicine Online Continuing Education Series

  1. Ten Years of Research on Complementary and Alternative Medicine: Promising Ideas from Outside the Mainstream
  2. Herbs and Other Dietary Supplements
  3. Mind-Body Medicine
  4. Acupuncture: An Evidence-Based Assessment
  5. Manipulative and Body-Based Therapies: Chiropractic and Spinal Manipulation
  6. CAM and Aging
  7. Integrative Medicine
  8. Health and Spirituality
  9. Studying the Effects of Natural Products
  10. Neurobiological Correlates of Acupuncture

Each lecture includes:

  • A video lecture by one author, including the transcript
  • A question and answer transcript
  • An optional online test
  • Additional resource links

Optional: Health Inequalities and BehaviorComplete an online course for health care professionals: Roots of Health Inequity

This course contains five units that present different aspects of social justice as it relates to public health. Each unit provides an in-depth look at a specific topic by using interactive maps and timelines, slideshows, resource libraries, videos and interviews with practitioners. In 2009, the National Association of County and City Public Health Officials received a two-year grant from the National Center for Minority Health and Health Disparities at the National Institutes of Health to create this educational website to help public health practitioners recognize and act more effectively on the social injustices at the root of health inequity.

Source: Roots of Health Inequality,

Watch this video about the Immigrant Paradox

Source: Unnatural Causes, Episode 3 Becoming American,

Wealth and health are tightly linked in the United States. As immigrants remain in the country, as they "become American," their socioeconomic status becomes increasingly relevant to their health status. For those who experience discrimination, low wages, unstable employment, and other stressors, this relationship may erode the health advantage they enjoyed upon arrival in the country.

Watch this video - How Class Works

Consider what we know from research about disease and illness patterns among groups with lower income, more stress, and less control of their lives. Consider how investment decisions in neighborhoods, over transportation, school facilities, parks, location of grocery stores, quality of affordable housing, etc. influenced by powerful interests, affect the quality of life for large segments of the population.

Watch this video - Determinants of Health: A Framework for Reaching Healthy People 2020 Goals

Income and Life Expectancy

If you are curious about the relationship between income and life expectancy, take a look at a video clip of a BBC documentary about Income and Life Expectancy. What does it Tell Us About Us

Determinants of Human Behavior in Health

Source: Health Education, Advocacy and Community Mobilization Module, CC-BY-NC-SA,

Before identifying the various determinants of human behavior, you should consider the following four types of assessment: social diagnosis, epidemiological diagnosis, educational diagnosis, and environmental and behavioral diagnosis. Below is a brief description of each of these phases of assessment.

Social diagnosis

The focus of social diagnosis is to identify and evaluate the social problems which impact on the quality of life within your population. Doing a ‘social diagnosis’ will help you to gain an understanding of the social problems which affect the quality of life of people in your community, and how local people see those problems. This understanding is followed by the establishment of a link between the social problems and specific health problems that will become the focus of your health education activities.
Methods used for social diagnosis may be one or more of the following: community forums, focus groups, surveys and interviews.
An example of a social diagnosis would be that in a community the quality of life of the people may be very low as a result of poverty, malnutrition and the poor quality of drinking water.

Epidemiological diagnosis

Epidemiological diagnosis will help you to determine the specific health issues that affect the people in your community. The focus of this phase is to identify both the health problems and the non-health factors which are associated with a poor quality of life. Describing these health problems can help establish a relationship between health problems and the quality of life. It can also lead to the setting of priorities which will guide your health education programs and show you how to best use your resources.
An example would be that in your community the specific health problems that have resulted in poor quality of life. These may be malaria, HIV/AIDS, TB, malnutrition and others. At this phase you will identify which ones are the most important ones.

Educational diagnosis

This phase of assessment pinpoints the factors that must be changed to initiate and maintain behavioral change. Educational diagnosis looks at the specific features that hinder or promote behavior related to the health issues that are important in your community. An example would be to identify why people are behaving in a way that is dangerous to their life? As you will see later in the study session there are a number of ways of examining these sorts of questions as they relate to predisposing, enabling and reinforcing factors.

Environmental and behavioral diagnosis

Environmental diagnosis is a parallel analysis of factors in the social and physical environment that could be linked to health problems.
Behavioral diagnosis is the analysis of behavioral links to the health problems that are identified in the epidemiological or social diagnosis.
This phase focuses on the systematic identification of health practices or behaviors which cause health problems in your community. If you take the example of HIV/AIDS, once you reach this stage your focus will be to examine why people in your community are highly affected by HIV/AIDS. Is it because of their behaviors — or is it due to other environmental factors such as lack of HIV prevention and counseling services? At this stage you need to be able to identify the factors — and as in many societies the most important factor responsible for higher level of HIV/AIDS in your community may be high-risk sexual behaviors.
  • Read again the list of different diagnoses that precede and underpin preventive health education work. Of these various processes which one do you think you are most likely to need to consult with other health colleagues over?
  • As a health worker you are likely to undertake social diagnosis, behavioral diagnosis and education diagnosis yourself. You will also collect some statistical data yourself, from your own community. But you are likely to depend at least as much if not more on statistics from other colleagues. The reason for this is that epidemiological data has to be collected from large numbers of people in order to be able to see trends, and looking at a small sample from your community may not enable to you understand what happens at the level of a whole population.

Factors affecting behavior

Predisposing factors are those characteristics of a person or population that motivate behavior before the occurrence of that behavior. Peoples’ knowledge, beliefs, values and attitudes are predisposing factors and always affect the way they behave. Predisposing factors are motivational factors subject to change through direct communication or education. All of these can be seen as targets for change in health promotion or other public health interventions. We will look at each of them in turn.


Knowledge is usually needed but is not enough on its own for individuals or groups to change their behavior. At least some awareness of health needs and behavior that would address that need is required. Usually, however, for behavior change some additional motivation is required.


Beliefs are convictions that something is real or true. Statements of belief about health include such negative comments as, ‘I don’t believe that exercising daily will improve my health’. More positive health beliefs might include statements such as, ‘If I use an insecticide treated bed net at night I will probably not get malaria.
Often a potent motivator related to beliefs is fear. Fear combines an element of belief with an element of anxiety. The anxiety results from beliefs about the severity of the health threat and one’s susceptibility to it, along with a feeling of hopelessness or helplessness to do anything about the threat.


Values are the moral and ethical reasons or justifications that people use to justify their actions. They determine whether people consider various health-related behaviors to be right or wrong. Similar values tend to be held by people who share generation, geography, history or ethnicity. Values are considered to be more entrenched and thus less open to change than beliefs or attitudes. Of interest is the fact that people often hold conflicting values. For example, a teenage male may place a high value on living a long life; at the same time, he may engage in risky behaviors such as drinking alcohol. Health promotion programs often seek to help people see the conflicts in their values, or between their values and their behavior.


Attitudes are relatively constant feelings directed toward something or someone that contains a judgment about whether that something or someone is good or bad. Attitudes can always be categorized as positive or negative. For example, a woman may feel that using contraception is unacceptable. Attitudes differ from beliefs in that they always include some evaluation of the person, object or action.


The most important predisposing factor for self-regulating one’s behavior is seen to be self-efficacy, that is the person’s perception of how successful he or she can be in performing a particular behavior. Self-efficacy is learning why particular behaviors are harmful or helpful. It includes learning how to modify one’s behavior, which is a prerequisite for being able to undertake or maintain behaviors that are good for your health. Health education and behavioral change programs help a person to bring the performance of a particular behavior under his or her self-control.
  • Make a list of some health beliefs that you think that some people in your own community have which affect the way they behave — in other words beliefs which pre-dispose them to have certain health behaviors.
  • Of course beliefs can cover a huge range. They could equally be ‘I don’t believe that smoking harms my health’ through to ‘I do believe that smoking harms my health’. The same may be true of people’s beliefs about exercise, alcohol and so on. The important thing is that beliefs don’t always coincide with facts. For example the evidence is that smoking does harm health. But many people believe that it doesn’t affect their health.

Enabling factors

Enabling factors are factors that make it possible (or easier) for individuals or populations to change their behavior or their environment. Enabling factors include resources, conditions of living, social support and the development of certain skills.
Among the factors that influence use of health services are two categories of enabling resources: community-enabling resources (health personnel and facilities must be available), and personal or family-enabling resources (people must know how to access and use the services and have the means to get to them).
Enabling factors refer to characteristics of the environment that facilitate or impede healthy behavior. They also include the skills and resources required to attain a behavior. For example enabling factors for a mother to give oral rehydration salts to her child with diarrhea include having time, a suitable container and the salt solution itself.


A person or population may need to employ a number of skills to carry out all the tasks involved in changing their behavior. For some positive health behaviors it might be necessary to learn new skills. For example if a breast feeding mother is not well trained on positioning and attachment of her baby she may have difficulty in properly breastfeeding her child. Similarly, if the mother is not well trained at a later stage on the preparation of complementary feeding, the child may not get the nutrition they require

Healthcare resources

A number of healthcare resources may also need to be in place if an individual or population is to make and sustain a particular health-related behavior change. The availability, accessibility and affordability of these resources may either enable or hinder undertaking a particular behavior. For example, in a given health post the lack of availability of the family planning method of choice for a mother may discourage her from utilization of the service in the future.
Changing behavior may also be easier if other aspects of one’s environment are supportive of that change. For example policy initiatives or even laws might be in place that create a positive atmosphere for change.
  • From your experience as an educator or receiver of health education make a list of some of the enabling skills and enabling resources you have seen or experienced that support health education.
  • Enabling factors make it possible (or easier) for individuals or populations to change their health-related behavior. Enabling skills, of course, include making sure people know how to do things.

Reinforcing Factors

Reinforcing factors are the positive or negative influences or feedback from others that encourage or discourage health-related behavior change. The most important reinforcing factors are usually related to social influences from family, peers, teachers or employers.

Social influence

Social influence is the positive or negative influence from those influential people around us that might encourage or discourage us from performing certain health-related behaviors. For example a mother who is planning to start family planning (FP) might be influenced by negative attitudes from her peer group and think, ‘Most of my friends do not use FP methods and I may lose friends in the neighborhood if I use the methods’. She might also be influenced by her family: ‘My family members do not all support the idea of using FP methods, especially my husband and my mother-in-law. They would really be mad at me if I use FP’. She may also be aware that her community society or culture generally may not be supportive: ‘Everyone in our community is against FP and it is seen as a sin in our society.
An individual’s behavior and health-related decision making — such as choice of diet, condom use, quitting smoking and drinking, etc. — might very well be dependent on the social networks and organizations they relate to. Peer group, family, school and workplace are all important influences when people make up their minds about their individual health-related behavior.
  • Choose either smoking or alcohol use among young men and think about some of the reinforcing factors, or reinforcing people, that might encourage them to stay smoking or give up smoking or alcohol.
  • Reinforcing factors are the positive or negative influences or feedback from others that encourage or discourage the behavior change. The most important reinforcers in a given community include family, peers, teachers and employers. In the case of young men, their own peer group may be the strongest reinforcer to stay smoking or using alcohol. They may think they look grown up, or that others will think they look childish if they don’t smoke or drink a lot. But perhaps employers may say that it is not professional to smoke or teachers may say it is childish to smoke.

Optional: Medicalization of Sleeplessness

Source: OpenStax College. Health in the United States. Connexions, May 18, 2012. Photo: Courtesy of Wikimedia Commons

But is insomnia a disease that should be cured with medication?

How is your “sleep hygiene?” Sleep hygiene refers to the lifestyle and sleep habits that contribute to sleeplessness. Bad habits that can lead to sleeplessness include inconsistent bedtimes, lack of exercise, late-night employment, napping during the day, and sleep environments that include noise, lights, or screen time (National Institutes of Health 2011a).
According to the National Institute of Health, examining sleep hygiene is the first step in trying to solve a problem with sleeplessness.
For many Americans, however, making changes in sleep hygiene does not seem to be enough. According to a 2006 report from the Institute of Medicine, sleeplessness is an underrecognized public health problem affecting up to 70 million people. It is interesting to note that in the months (or years) after this report was released, advertising by the pharmaceutical companies behind Ambien, Lunesta, and Sepracor (three sleep aids) averaged $188 million weekly promoting these drugs (Gellene 2009).

According to a study in the American Journal of Public Health (2011), prescriptions for sleep medications increased dramatically from 1993 to 2007. While complaints of sleeplessness during doctor’s office visits more than doubled during this time, insomnia diagnoses increased more than sevenfold, from about 840,000 to 6.1 million. The authors of the study conclude that sleeplessness has been medicalized as insomnia, and that “insomnia may be a public health concern, but potential overtreatment with marginally effective, expensive medications with nontrivial side effects raises definite population health concerns” (Moloney, Konrad, and Zimmer 2011). Indeed, a study published in 2004 in the Archives of Internal Medicine shows that cognitive behavioral therapy, not medication, was the most effective sleep intervention (Jacobs, Pace-Schott, Stickgold, and Otto 2004).
A century ago, people who couldn’t sleep were told to count sheep. Now, they pop a pill, and all those pills add up to a very lucrative market for the pharmaceutical industry.
  • Is this industry behind the medicalization of sleeplessness, or are they just responding to a need?
  • What else do we tend to medicalize?

Optional: American Health Care

Source: OpenStax College.Comparative Health and Medicine. Connexions, July 16, 2012.

United States health care coverage can broadly be divided into two main categories: public health care (government-funded) and private health care (privately funded). The two main publicly funded health care programs are Medicare, which provides health services to people over 65 years old as well as people who meet other standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements. Other government-funded programs include service agencies focused on Native Americans (the Indian Health Service), Veterans (the Veterans Health Administration), and children (the Children’s Health Insurance Program).

A controversial issue in 2011 was a proposed constitutional amendment requiring a balanced federal budget, which would almost certainly require billions of dollars in cuts to these programs. As discussed below, the United States already has a significant problem with lack of health care coverage for many individuals; if these budget cuts pass, the already heavily burdened programs are sure to suffer, and so are the people they serve (Kogan 2011).The U.S. Census (2011) divides private insurance into employment-based insurance and direct-purchase insurance. Employment-based insurance is health plan coverage that is provided in whole or in part by an employer or union; it can cover just the employee, or the employee and his or her family. Direct purchase insurance is coverage that an individual buys directly from a private company.With all these insurance options, insurance coverage must be almost universal, right? Unfortunately, the U.S. Census Current Population Survey of 2010 and 2011 shows that 16 percent of Americans have no health insurance at all. Equally alarming, a study by the Commonwealth Fund shows that in 2010, 81 million adults were either uninsured or underinsured; that is, people who pay at least ten percent of their income on health care costs not covered by insurance or, for low-income adults, those whose medical expenses or deductibles are at least five percent of their income (Schoen, Doty, Robertson, and Collins 2011).
The Commonwealth study further reports that while underinsurance has historically been an issue that low-income families faced, today it is affecting middle-income families more and more.Why are so many people uninsured or underinsured? Skyrocketing health care costs are part of the issue. Many people cannot afford private health insurance, but their income level is not low enough to meet eligibility standards for government supported insurance. Further, even for those who are eligible for Medicaid, the program is less than perfect. Many physicians refuse to accept Medicaid patients, citing low payments and extensive paperwork (Washington University Center for Health Policy N.d.)

Health care in the United States is a complex issue, and it will only get more so with the continued enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. This Act, sometimes called “ObamaCare” for its most noted advocate, President Barack Obama, represents large-scale federal reform of the United States’ health care system. Most of the provisions of the Act will take effect by 2014, but some were effective immediately on passage. The PPACA aims to address some of the biggest flaws of the current health care system. It expands eligibility to programs like Medicaid and CHIP, helps guarantee insurance coverage for people with pre-existing conditions, and establishes regulations to make sure that the premium funds collected by insurers and care providers go directly to medical care. It also includes an individual mandate, which requires everyone to have insurance coverage by 2014 or pay a penalty. A series of provisions, including significant subsidies, are intended to address the discrepancies in income that are currently contributing to high rates of uninsurance and underinsurance. Many Americans worry that governmental oversight of health care represents a federal overstepping of constitutional guarantees of individual freedom. Others welcome a program that they believe will make health care accessible and affordable to everyone.

The PPACA has been incredibly contentious. Private insurance companies have been among the strongest opponents of the law. But many Americans are also concerned that the PPACA will actually result in their medical bills increasing. In particular, some people oppose the individual mandate on the grounds that the federal government should not require them to have health care. A coalition of 26 states and the National Federation of Independent Businesses brought suit against the federal government, citing a violation of state sovereignty and concerns about costs of administering the program.

Contemporary Health Issues

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