Health Behaviors, Lifestyle Choices, and Mental

Well-being
Health Behaviors and Lifestyle Choices
Defining Health Behaviors and Lifestyle Choices
Health behaviors
are actions individuals take that impact their overall health. These can be:
Positive: Daily activities like sleep, diet, exercise, and adhering to medical advice. They can
also include coping mechanisms.
Negative/Health Impairing: Substance abuse, engaging in risky activities.

The benefits of positive health behaviors include disease prevention and improved quality of
life.
Health behaviors can be intentional or unintentional and are often shaped by social
determinants.
Health behaviors are considered the single most influential factor in determining health, more
so than medical care or genetics.
A health lifestyle choice is a personal, conscious decision to perform a behavior that may
increase or decrease the risk of injury or disease.

Health Beliefs and Attitudes

Health beliefs
are personal convictions, cultural perceptions, and attitudes regarding health, illness, and
prevention that influence actions. They encompass what individuals believe about:
Their health conditions.
Factors contributing to health.
Causes of illness.
Ways to overcome illness.

Health attitudes refer to an individual's overall evaluation of their own health (e.g., excellent,
good, fair, poor).
Health attitudes and behaviors can be changed by altering how people think (persuasive
messages) or by changing their environment.

The Health Belief Model (HBM)

The HBM is used to predict health behavior and explain individual choices by understanding
health behaviors and guiding health promotion and disease prevention communication.
It focuses on:
Individual beliefs about health conditions.
Perceptions of personal risks.
Perceived benefits or effectiveness of a recommended health behavior.
'Cues to action' to reduce or eliminate risk.

The general belief is that individuals are more likely to adopt healthy behaviors when they are
 aware of a health threat, convinced of the action's effectiveness, and have a general health
motivation (valuing good health).

Key Constructs of the HBM

1. Perceived Susceptibility: An individual's assessment of their risk of becoming ill or
experiencing an unwanted outcome.
2. Perceived Severity: An individual's assessment of the seriousness of an illness, condition, or
unwanted outcome and its potential consequences.
3. Perceived Barriers: An individual's assessment of influences that discourage the adoption of a
promoted action or new behavior (e.g., cost, inconvenience, unpleasantness).
4. Perceived Benefits: An individual's assessment of the positive consequences of adopting the
promoted action.

Factors Influencing Adoption of Healthy Behaviors (HBM)

An individual is more likely to adopt healthy behaviors when they believe:

They are susceptible to a particular health problem.

The health problem is serious.
Preventative measures will significantly reduce the risk.
There are no significant barriers to adopting new health measures.
They have the capability to change unhealthy behavior (self-efficacy).

These factors are influenced by:

Demographic variables: Social class, living conditions, gender.

Psychosocial variables: Social support, personality traits, peer pressure.
Structural factors: Access to knowledge, evidence from similar experiences.
External cues to action: Media campaigns, health promotion messages, advice from
healthcare providers.

Limitations of HBM
While useful for predicting preventative and sick-role behaviors, HBM is not a strong predictor
of individual future behavior.
Other cognitive-altering behaviors (e.g., Cognitive-Behavior Therapy - CBT) may be needed.

Socio-cultural Factors Influencing Health Behaviors

Education: Educated individuals tend to engage in healthier activities, live longer, and often
have better-paying jobs with benefits like health insurance and healthier working conditions.
Income: Higher income is associated with healthier activities, better access to healthy foods,
safer neighborhoods, and longer life expectancy. Low-income individuals often face
challenges with unsafe housing, food insecurity, and less time for physical activity.
Housing: Poor living conditions increase the risk of developing health problems.
Access to Healthcare: Health insurance leads to more regular visits to healthcare
practitioners for screenings, preventive care, and chronic disease management.

The Social Context of Behavior Change

 When considering behavior change, it's crucial to look beyond psychological factors and
consider the social context.
The social context refers to the background of an individual's efforts to alter behavior, the
environment in which changes occur, and the role of society, government, and public
institutions.
Example: A mother's smoking might be a coping strategy to manage stress from childcare
and work, enabling her to be a more effective caregiver. This illustrates the "responsibility of
irresponsible behavior."
Behavioral change can be constrained by social circumstances and social class differences.
Promoting healthy behaviors requires examining individuals' perceptions of risk and the
context of their risk-taking behaviors.

Unrealistic Optimism (Optimistic Bias)

Individuals tend to believe their chances of experiencing negative events are minimal and
their chances of positive events are higher.
This bias is often based on the belief that past exemption from health concerns will continue,
supported by:
Personal actions (preventative health).
Psychological attributes (being health-conscious, resilient).

Individuals are unlikely to engage in health-protective behaviors unless they perceive

themselves as susceptible, often ignoring environmental or hereditary risk factors.

The Power of the Medical Profession

Medicine: Medical Care or Social Control?
Medical Care: The core function is to diagnose, treat, and prevent diseases and injuries to
improve individual and community health (e.g., vaccinations, organ transplants, treating
ailments).
Social Control: Medicine has the power to define "normal" and "abnormal," "healthy" and
"unhealthy," influencing societal perceptions and expectations.

The Power of Medical Judgment

Medical power can be viewed positively (curing, caring) based on professional judgment and
specialist knowledge (clinical autonomy or "doctor knows best").
However, some medical decisions can have negative effects, based on assumptions, lack of
clear evidence, or misdiagnosis, leading to clinical iatrogenesis (medical harm or doctor-
caused illness).
Medical nemesis occurs when harm caused by medicine requires further medical
intervention, leading to more harm.
Examples of iatrogenesis include healthcare-acquired infections, surgical infections, adverse
drug reactions, and wrong-site surgeries.

Medical Power and Life/Death Decisions

Medical power includes making life and death decisions (e.g., euthanasia, termination of
pregnancy for medical reasons).
This raises ethical issues regarding the decision to end life and the diagnostic process itself.
Medicalization vs. De-medicalization
Medicalization:
The process by which a condition or behavior becomes defined as a medical problem
requiring a medical solution.
Examples: Social conditions (sin, crime) redefined as medical problems (ADHD,
homosexuality, shyness, heavy drinking). Natural processes (aging, menstruation,
menopause, balding) also medicalized.
Medicalization often occurs when organized social groups with vested interests (including
doctors seeking to increase power, practice scope, and income) convince others of a new
definition.
Example: Pediatricians shifting focus from serious childhood illnesses to minor ones and
expanding practices to include behavioral concerns, parenting issues, etc., to maintain
their market.
Lay groups (e.g., Alcoholics Anonymous) can also drive medicalization to reduce stigma
or seek more humanitarian control.
The pharmaceutical industry has an economic interest in medicalization when drugs can
provide a treatment.
Example: The medicalization of "short stature" through the promotion and mass
marketing of human growth hormone (HGH), even for children with no underlying
disease other than shortness.

Consequences of Medicalization
1. Social Status: Defining a condition as an illness doesn't always improve the social status of
sufferers (e.g., excessive alcohol use continues to face stigma).
2. Expertise of Doctors: Once medicalized, doctors become the primary experts, increasing their
power at the expense of other groups (parents, teachers, patients).
3. Medical Treatment as the Only Response:
Medical treatment becomes the default solution, potentially overshadowing social, political, or
personal approaches.
Example: Medicalizing woman battering focuses on individual treatment rather than
addressing societal power structures.
Forced medical interventions (e.g., forced cesarean deliveries) highlight how
medicalization can override patient autonomy, even when medical judgment is fallible.

4. Expanded Medical Control: Medicalization expands the range of life experiences under
medical control (e.g., fetal alcohol syndrome, advocating for involuntary hospitalization for
pregnant women who drink). It can also lead to discrimination (e.g., employers discriminating
against smokers or overweight individuals). This diminishes the power of other social
authorities.
5. Focus on Individual Problems: Medicalization can lead to a focus on individual issues,
neglecting underlying psychological, social, lifestyle, or political factors (e.g., medicalizing
woman battering over addressing male power and female subordination).
Demedicalization:
The reverse process where conditions previously considered medical are re-evaluated as
normal or social.
Example: Masturbation is now considered a normal part of human sexuality, though
 excessive use can still be problematic. Homosexuality has been de-pathologized.
Lobbying by lay groups and a proliferation of resources teaching self-care contribute to
de-medicalization.

ICD Codes: The International Classification of Diseases (ICD) managed by the WHO
standardizes diagnoses. It can reflect evolving social norms by moving conditions between
disease categories, "Z-codes" (factors influencing health status), or removing them. The
increasing focus on Social Determinants of Health (SDOH) has led to more "Z-codes."

Sociology of Mental Health and Illness

Defining Mental Health and Illness
World Health Organization (WHO) Definition of Mental Health: "A state of well-being in which
the individual realizes his or her own abilities, can cope with the normal stresses of life, can
work productively and fruitfully, and can contribute to his or her community."
Mental Disorder/Illness (WHO): A clinically significant disturbance in an individual's cognition,
emotional regulation, or behavior, usually associated with distress or impairment in daily life.
Sociological Perspective: Behavior is labeled mental illness when it violates social norms
(cognitive, performance, or feeling norms). Sociologists question the medicalization of
natural life processes, even while acknowledging distress.

The Rosenhan Experiment (1973)

Experiment: Seven individuals (including David Rosenhan) faked auditory hallucinations
("voices") to gain admission to psychiatric hospitals. Once admitted, they acted normally.
Findings:
All participants were diagnosed with mental illness (schizophrenia in remission) and
admitted.
Hospital staff did not detect the "pseudo-patients."
Real patients often recognized the pseudo-patients as sane.
The second part of the experiment, where staff were challenged to identify pseudo-
patients, led to many genuine patients being misidentified.

Conclusion: The experiment demonstrated the subjective nature of psychiatric diagnoses and
their susceptibility to social expectations and the labeling process within institutions. Staff
expectations influenced their interpretations of patient behavior.

Challenges with Mental Health Diagnoses

Unlike many medical conditions, mental disorders lack clear biological diagnostic markers.
Diagnoses are based on clinical and societal observations of behavior, primarily using tools
like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and ICD (International
Classification of Diseases).
Cultural Issues:
Cultural context significantly influences:
The manifestation and expression of distress.
Acceptable and adaptive forms of emotional expression.
The continuum from normal to deviant behavior.
Impact of Culture on Mental Health
Symptom Presentation: Culture affects whether emotional problems are expressed physically
(somatization), spiritually, or psychologically. Non-Western cultures may express distress as
physical pain.
Communication and Language Barriers: Difficulty explaining symptoms or understanding
instructions can lead to misdiagnosis and treatment errors. Culturally competent and
linguistically accessible services are crucial.
Stigma and Help-Seeking: Mental health challenges can be viewed as shameful, a sign of
weakness, or a moral failing, leading to reluctance to seek professional help. Cultural beliefs
about spiritual causes (witchcraft, evil spirits) also influence help-seeking.
Gender Roles: Cultural norms may discourage men from seeking help or expressing
vulnerability.
Treatment Interventions: Cultural beliefs influence treatment preferences and the role of
family in decision-making.

History and Treatment of Mental Illness

Historically, behaviors deviating from norms were explained as eccentricity, sin, taboo
violation, or the work of spirits/witches.
Treatments involved religious or spiritual practices (prayer, exorcism) and sometimes brutal
physical interventions (bloodletting, purging, killing).
The rise of capitalism weakened informal social controls, making it difficult for families to
care for relatives with mental illness due to work demands and migration.
This led to the development of formal institutions ("madhouses," asylums) by the 18th
century.
Patients were often housed with other marginalized groups, under deplorable conditions.
Early beliefs held mental illness as genetic, incurable, and requiring control rather than
treatment, leading to incarceration and mistreatment.

The Rise and Decline of Moral Treatment

Moral Treatment: Reformers advocated for kindness, sensitivity, opportunities for work, and
the belief that mental illness was curable, influenced by physical and psychological stressors.
This approach involved closing brutal institutions and providing facilities with exercise and
daylight.
By the 20th century, doctors gained control, and care shifted from laypeople to medical
professionals.
Moral treatment declined as mental hospitals grew, making institutionalization easier.

Institutionalization and Deinstitutionalization

Institutionalization: Confining individuals in mental hospitals could lead to a self-fulfilling
prophecy, segregation from society, damaged self-image, a loss of identity
(depersonalization), and powerlessness.
Deinstitutionalization (1970s onwards): A shift from inpatient to outpatient care, generally
improving the quality of life for many.
Biochemical Focus (1980s): Psychiatrists emphasized biochemical, neurological, or genetic
causes, often overlooking social factors. Media and pharmaceutical companies promoted
mental illness as a biological problem, sometimes with limited evidence.
The Experience of Mental Illness
Symptom Interpretation: Symptoms are open to various interpretations. Labels like "mad,"
"psycho," or "schizo" are applied when alternative interpretations fail.
Self-Labelling: Individuals often label themselves as mentally healthy, referring to issues as
"problems" rather than "illness" and offering alternative explanations to reject medical/
psychiatric diagnoses.
Labelling by Others: Families may deny problems, offer alternative explanations, or reluctantly
label members. Getting consent for treatment can be difficult.
Medical Labelling: The medical model assumes treatment helps, and patients are brought for
care because they need it. Crisis situations can make diagnosis easier but may overlook
context.
Post-Diagnosis Experience: Individuals labeled mentally ill may face fear, rejection, or
support.

Socio-cultural Context of Mental Health in Namibia

Mental disorders are a significant global burden.
In Namibia, over 25% of the population is affected, with common conditions including
depression, anxiety, substance abuse, and trauma-related disorders. High suicide rates and
HIV-related neurocognitive disorders are also concerns.
Key Factors:
Socio-economic Factors: Poverty, inequality, and unemployment contribute to stress and
anxiety.
High Suicide Rates: Namibia has one of the highest rates globally.
Stigma and Culture: Cultural beliefs and stigma are major barriers to seeking treatment,
leading to isolation and delayed care. Mental illness is often a taboo topic.
Limited Services: Mental health services are scarce, especially in rural areas.
Traditional/Religious Approaches: Some consult churches or traditional healers,
sometimes undervaluing Western therapeutic approaches. Traditional healers are seen by
some as having unique skills to diagnose and treat mental illness.

Impact of Family on Mental Well-being

Family provides vital physical and emotional support, fostering resilience, meaning, purpose,
self-esteem, and self-worth.
Families promote healthy interactions, effective coping mechanisms, and conflict resolution.

Social Stressors and Mental Health

Poverty, unemployment, suicide, domestic violence, substance abuse, and relationship issues
significantly impact mental health, especially among youth.
Domestic Violence: Reinforced by cultural norms protecting abusers and discouraging
women from reporting to avoid shame.
Youth Unemployment: Creates a lack of purpose, stress, reduced motivation, and stigma,
compounded by the financial and emotional strain of job searching.

Mental Health Facilities in Namibia

African countries, including Namibia, dedicate minimal budget to mental health care, leading
to under-resourced systems.
 Namibia has only two state mental health units (Windhoek Central Hospital and Oshakati
intermediate hospital), offering limited inpatient and outpatient services.
Scarcity of trained professionals (psychiatrists, psychologists) in the public sector, with many
in private practice, limits access for those who cannot afford private care.
Stigma, social exclusion, and discrimination compound these issues, often negating the
positive effects of treatment.

Mental Health Amongst Medical Students

Medical students globally report high rates of depression, anxiety, and burnout, often
exceeding the general population.
This is attributed to academic demands, exposure to patient suffering, and personal/
organizational stressors.
They are less likely to seek treatment due to time constraints, confidentiality fears, stigma,
cost, and academic concerns.

Sources of Modern Illness, Premature Death, and

the Nature of Diseases
General Information for Namibia
Namibia is an upper-middle-income country with a population of just over 3 million.
Average life expectancy is 65.8 years.
Major Causes of Morbidity and Premature Death:
Communicable Diseases: Primarily HIV/AIDS, which has been the leading cause of death
since 1996.
Non-Communicable Diseases (NCDs): A growing concern, contributing significantly to
deaths.

Main Types and Causes of Disease and Death

1. Poverty and Malnutrition:
Primary cause of low life expectancy.
Damages the immune system, increasing susceptibility to illness.
Contributes to infant and maternal mortality.
Leads to brain damage (iodine deficiency), blindness (vitamin A deficiency), and mental
retardation (anemia). High prevalence among children under 5.

2. Cardiovascular Diseases (CVD):

Diseases of the heart and blood vessels (heart muscle diseases, stroke, heart attacks,
heart failure).
A leading cause of death globally, projected to increase in low- and middle-income
countries.
Risk Factors: Age, genetics, lifestyle (BMI, diet, inactivity), geographical location (access to
healthcare), unemployment, stress, social isolation.

3. Cancer:
 The second leading cause of death after heart disease globally.
An emerging public health problem in Africa, often diagnosed at advanced stages due to
lack of screening, awareness, and stigma.
Most diagnosed cancers in Namibia: breast cancer, Kaposi Sarcoma, cervical, prostate, and
lip/oral cavity cancers.
Requires early detection, quality treatment, survivorship care, financial resources, and
social support.

4. Obesity:
Abnormal or excessive fat accumulation impairing health.
Contributes to CVD, diabetes, and musculoskeletal disorders.
Alleviation: Supportive environments promoting healthy dietary choices and regular
physical activity.

5. Infectious and Parasitic Diseases:

HIV/AIDS: Kills more people than any other infectious disease, especially in less developed
nations. Heterosexual intercourse is the major transmission mode; mother-to-child
transmission has declined due to ARVs. Life expectancy has increased but remains below
50-60 years in some regions. Migration and transactional relationships increase risk.
Tuberculosis (TB): An ancient disease caused by Mycobacterium tuberculosis. Affects
millions annually, more adults than children, more men than women.
Diarrheal Diseases: The second leading cause of death in children under five. Caused by
bacteria, viruses, and parasites spread through contaminated water or food. Leads to
dehydration, electrolyte imbalance, and malnutrition. Common where sanitation, hygiene,
and safe water are lacking.

6. Infant and Maternal Mortality:

Infant Mortality: Higher in less developed nations due to respiratory and diarrheal diseases.
Influenced by women's status (underfed, overworked mothers, closely spaced births) and
infant formula marketing. Breastfeeding is crucial for survival.
Maternal Mortality: Primary cause of death among women of reproductive age. Causes
include lack of prenatal care, severe bleeding, infections, uncontrolled high blood pressure
(pre-eclampsia/eclampsia), unsafe abortions, and inadequate family planning. Has
declined due to fewer births, increased education, income, and skilled birth attendants.

7. Respiratory Diseases:
A major cause of death globally. Caused by infections, smoking, secondhand smoke, air
pollutants, and cooking fires.
Includes asthma, COPD, pneumonia, and lung cancer.

Other Social Causes of Illness and Premature Deaths

Violence and Injuries: Intentional (domestic violence, self-harm) and unintentional (road
accidents, poison, falls). Males aged 20-29 are particularly at risk for MVAs.
Illegal Drugs: Common drugs in Namibia include cannabis, Mandrax, cocaine, and
methamphetamine. Drug use can lead to overdose, suicide, injuries, unsafe sexual practices
(increasing HIV risk), and birth defects.
Sexual Behavior: Risk of HIV/AIDS, unwanted pregnancies, unsafe abortions, and
abandonment of children. Teenage pregnancies are a significant issue.
Occupational Hazards and Environmental Pollutants.
Medical and Medication Errors:
 Preventable deaths caused by errors despite healthcare professionals' best efforts. Often a
result of systemic challenges rather than solely individual blame.
Challenges: Inconsistent medication stocking, lack of equipment, similar drug names,
failure to identify fatalities, fear of malpractice claims.
Reporting: Limited reported cases of medical negligence and adverse drug reactions in
Namibia, likely an underestimation.
Examples: Dangerous drug interactions, wrong medication/dose, unnecessary surgery,
misdiagnosis, surgical instruments left in patients.

Social Stress
Definition: Stress can refer to situations that cause anxiety, the resulting emotions, or the
bodily changes in response.
Types: Acute (death of a loved one) or chronic (social isolation, poverty, low self-esteem).
Cumulative Stress: The combined effect of acute and chronic stresses, a strong predictor of
ill-health.
Fight-or-Flight Response: The body's acute stress response, useful for immediate threats but
can wear out the body with prolonged activation, leading to chronic illness.
Impact of Stress: Prolonged stress can encourage unhealthy behaviors. The impact depends
on the nature of the stress (fateful loss, physical exhaustion, disruption of social support) and
how individuals appraise and cope with it.
Chronic Stress (especially poverty): Diminishes the ability to ward off infections and
depression.
Coping: Effective coping and appraisal are influenced by social resources (funds, friends,
learned coping mechanisms like alcohol use).

Social Networks
Definition: Webs of social relationships (friends, family, colleagues) that link people. Often
homogeneous.
Impact on Health:
Provide social support (emotional and practical resources).
Offer assistance with tasks, finances, and health-related information.
Expose individuals to social norms (e.g., smoking vs. non-smoking groups).

Disadvantaged individuals may have less ability to avoid stress or recover from illness due to
weaker social networks. Support operates at individual and societal levels.