Public Health Fundamentals: Wellness, SDOH, and Policy Impacts

Posted on Jan 20, 2026 in Other university degrees and diplomas

Defining and Achieving Wellness

Wellness is the process by which health is achieved, involving choices that we make to improve or maintain health, or more broadly, improve our existence. Wellness, like health, exists across various dimensions.

Dr. Bill Hettler’s Six Dimensions of Wellness

Intellectual:

Expanding knowledge, engaging in creative and stimulating activities.

Physical:

Self-care and health-enriching behaviors.

Spiritual:

Appreciation for life and natural forces in the universe.

Emotional:

Awareness and acceptance of one’s feelings, and the ability to manage behaviors associated with those feelings.

Occupational:

Satisfaction and enrichment achieved through work, volunteering, or schooling.

Social:

Contributions to one’s community and the environment, emphasizing the connectedness between nature and others.

Public Health Components and Data Collection

Core Components of Public Health

• Research: Focuses on using the scientific method to answer research questions relevant to public health.
• Practice: Focuses on applying public health knowledge and theory to improve the health of populations.

US Census Data Limitations

The US Census only collects limited demographic and social information (e.g., sex, age, ethnicity, race, home ownership, number of people in household).

The American Community Survey (ACS) is much more expansive, collecting information on employment, education, income, and more.

Social Determinants of Health and Equity

Examples of Social Determinants of Health (SDOH)

• Access to resources to meet daily needs, educational/employment/economic opportunities, healthcare services, and transportation.
• Quality of education and job training.
• Public safety.
• Social support (material, emotional, etc.).
• Social norms and attitudes (meritocracy, discrimination, trust in systems, exposure to violence/crime/social disorder).

Contributors to Risk of Premature Death

Factors contributing to the risk of premature death include being LGBTQ+, race, gender, and housing status.

Gender Disparities in Health and Health Behaviors

• Life Expectancy: Women have higher life expectancy, while men are more likely to die of common diseases such as heart disease and cancer.
• Mental Illness Rates: Women have higher rates of internalizing disorders (e.g., depression, anxiety), while men have higher rates of externalizing disorders (e.g., substance use, antisocial personality).
• Morbidity: Women are often described as “sicker” due to increased life expectancy (leading to more chronic disease), diseases more common in women, lower social status and power, missed economic opportunities causing stress, high cost of caring, higher rates of interpersonal violence, and the stress of discrimination.

Mortality Differences Between Men and Women

Reasons why cisgender women typically live longer:

Biology:

Genetic (chromosomes), hormonal (estrogen and heart disease, testosterone and immunosuppression/prostate disease), metabolism (women have higher HDL), reproductive anatomy (site-specific disease).

Stress and Coping:

Women may be better at coping with stress (relying on family and friends more as support, potentially due to gender norms).

Behavior:

Men are traditionally involved in occupations with higher mortality, are more likely to engage in risky health behaviors (e.g., drinking, smoking), are more likely to be involved in violence and accidents, and consume more meat than women. Women consume more fruits and vegetables than men.

Mental Illness:

Women have higher rates of internalizing disorders; men have higher rates of externalizing disorders.

How Racism Impacts Health

Reporting discrimination in healthcare is associated with poorer mental health, cardiovascular disease (CVD), mortality, hypertension, lower use of lung cancer screening/pharmacy services/needed mental health care, and longer delays in filing prescriptions and getting medical care.

Reports of racism depend on race and ethnicity, as well as where one receives their usual source of health care (more reports in the Emergency Room).

Racism impacts health because it erodes trust in the healthcare system/providers, discourages repeated/regular use of health services, and acts as a chronic stressor.

Social Construction and Internalized Racism

Social Construction: Meaning placed on a thing by society. This meaning can change over time and will vary from one society to the next. That which is constructed will seem natural or real (e.g., race, gender).

Skin Whitening Cream and Health: Jones (2000) identified Level 3 = Internalized Racism, where members of minority groups accept negative messages about themselves, which may produce self-hatred. Individuals may accept that darker skin is less beautiful and begin to hate their own image, creating a desire to change.

Understanding Homelessness and Its Health Impact

Causes of Homelessness

The most common reason is mental health; the second most common is interpersonal conflict. Ultimately, the likelihood of experiencing homelessness among youth is influenced by:

• Family may kick them out (due to pregnancy, drug use, being LGBTQ+).
• Teen may want to leave/flee the home (due to abuse, having a partner, wanting to be independent).
• Family may be missing or gone (e.g., incarcerated, passed away/died).
• Homes may be destroyed (due to crime, natural disasters, etc.).
• Household economic conditions may change (parents separate, guardians lose jobs, larger economic downturn).
• Aging out of foster care.
• Having to choose between getting housing and separating family or staying together.
• Youth dealing with untreated or unmanaged mental illness.

Recent Trends in US Homelessness

Homelessness is a growing issue in the US. According to HUD in 2024, 771,480 people in the US experienced at least one night of homelessness. Most people experiencing homelessness are individuals. Estimates are higher in the South and West, and lower in the North and East.

Between 2007 and 2024, there has been a 19.2% increase in the number of people experiencing homelessness. This increase has been larger among sheltered people. Homelessness is an increasing issue across all age groups (almost 150,000 children experienced a night of homelessness in the past year). Other sources, such as Covenant House, place the number of youth experiencing homelessness as far higher (4 million+).

Defining Homelessness (HUD Categories)

The Department of Housing and Development (HUD) defines homelessness in the US using four categories:

1. Literally Homeless: Lacks a fixed, regular, and adequate nighttime residence. This includes one of three scenarios: primary nighttime residence not meant for human habitation, shelter for temporary living arrangement, or living in the current place for less than 90 days and living in a shelter or somewhere not meant for human habitation prior to living in the current institution.
2. Imminent Risk of Homelessness: Will imminently lose primary nighttime residence, provided that: residence will be lost within 14 days of the date of application for homeless assistance, no subsequent residence has been identified, and lacking resources and support networks to obtain other permanent housing.
3. Homeless Under Other Federal Statuses: Unaccompanied youth under 25 or families with children and youth who do not otherwise qualify as homeless who: are defined as homeless under other listed federal statuses, have not had lease, ownership, or interest in permanent housing in the 60 days prior to homeless assistance application, have experienced persistent instability as measured by 2+ moves in the last 60 days, and can be expected to continue in such status for an extended period of time due to special needs or barriers.
4. Fleeing or Attempting to Flee Domestic Violence: Fleeing or attempting to flee domestic violence, has no other residence, and lacks resources or support networks to obtain permanent housing.

Impact of Homelessness on Health

• Limited Resources: Resources used to stay healthy are limited (food, water, heating/cooling, healthcare, shelter).
• Exposure to Hazards: Exposure to the elements, weather, unsafe/unsanitary conditions that can cause illness/injury, lack of resources in temporary housing, and infectious diseases in crowded housing settings.
• Violence Exposure: Others may attack, harass, or harm you because you are experiencing homelessness, potentially including lethal violence.
• Stress: Homelessness is a stressful experience. Prolonged stress is detrimental to health, making existing conditions worse and contributing to new ones. Some cope with stress in unhealthy ways (e.g., substance use, risky sexual behaviors).
• Stigma: Homelessness is stigmatized, often viewed as a personal failing or a choice. Perceiving stigma is associated with poor physical and mental health. Stigma causes people to hide or deny experiences of homelessness, potentially avoiding support services or seeking shelter in more dangerous places.
• Health as a Cause: Health might cause housing loss. Medical debt is a common reason for bankruptcy. Health issues (mental illness, substance abuse disorder) and disability can make it harder to keep a home due to limited employment, support, or discrimination.

Covenant House

Covenant House is an organization that provides services and shelter to youth experiencing homelessness.

Program Planning, Communication, and Research Methods

Group Formation Stages

The Storming Stage (2nd Stage) is the stage of group formation characterized by a clash between expectations and reality.

The “Mobilize” Step of MAP-IT

Mobilize individuals and organizations that care about the health of your community into a coalition.

Key actions include:

• Brainstorming potential partners (who is essential, who has the knowledge/expertise).
• Recruiting coalition members.
• Creating a vision for the coalition (what are you trying to accomplish and why).
• Considering what you might want coalition partners to do and how the coalition might be organized (organizational structures: egalitarian, hierarchical, free-wheeling).

Identifying the Best Health Problem to Tackle

The best health problem to tackle when working with a community is one identified by the community using a program with participation and development of communities that can better evaluate and solve health and social problems (Community-Based Participatory Research).

Interference in Health Communication

Interference in health communication comes from:

• Competing Messages: Messages from people who want to produce the same behavior change, messages from people who want to prevent behavior change, or messages that have nothing to do with the behavior change in question.
• Distractions in the Environment.
• Physical Barriers: E.g., rain makes it hard to see a billboard, or poor reception makes it hard to hear a radio or TV advertisement.

Identifying SMART Objectives

Specific:

What exactly are we going to do for whom? (Answers the “what” and “how” of your project. Objectives should be detailed enough that someone else can read them and come to your intended understanding.)

Measurable:

Baselines and change from baseline must be something that can be measured. (Allows us to determine if expectations have been met and if our intervention worked. Measures can be based on single items or scores on scales. Coincides with two-sided vs. one-sided tests in statistics.)

Attainable:

Realistic given the science, money, and time. (Determines if what is being proposed is doable in light of budget, scope of problem, time frame, expertise, etc.)

Relevant:

Feeds into the overall goal of our intervention. (Allows us to determine if what is being proposed should be done, why it should be done, and if this objective obtains the sought-after health impact.)

Time Bound:

By when will this objective be accomplished? (Allows us to determine when the proposed work will be done. Dates should be as specific as possible.)

Identifying Double-Barreled Questions

A double-barreled question includes two questions in one statement. This is a huge problem when no additional context is given. Examples:

• Does your mother know you skipped class today?
• Does your insurance cover all of your medications?

Disadvantages of Open-Ended Questions

• May get blank or nonsensical responses.
• Data from questions does not readily lend itself to “statistics” as we know them (e.g., calculating mean responses regularly).
• If statistics are desired, responses must be analyzed for themes and variables created to capture information (formal qualitative analysis).
• Takes more time and effort to summarize this data.

Health Policy and Economic Factors

How Policy Impacts Health

All policies impact health through direct or indirect effects!

Main ways policy impacts health:

• Public goods (infrastructure).
• Natural resources.
• Requirements and mandates to protect people (encourage/discourage certain actions and behaviors).
• Direct support (financial, insurance, and housing assistance).
• Creating opportunities (higher education, job training, tax breaks).

Health In All Policies (HIAP)

HIAP is the idea that health should be taken into consideration in the policymaking process. Policies should only be pursued if they have a neutral or beneficial impact on health. How this materializes depends on the context.

Elements of HIAP (American Public Health Association):

• Promote health, equity, and sustainability.
• Support intersectional collaboration.
• Benefit multiple partners.
• Engage stakeholders.
• Create structural or process change.

Indirect impacts of policy include altering the distribution of resources, raising awareness through discussion, and competing policies forcing prioritization of certain issues.

The Pink Tax

The Pink Tax refers to the extra money women and girls pay for comparable goods and services compared to men (price discrimination). A 2015 study found that women pay an annual “pink tax” of $1,351 for the same services as men. Specific findings included:

• 7% more for toys and accessories.
• 4% more for children’s clothing.
• 8% more for adult clothing.
• 13% more for personal care products.
• 8% more for senior/home healthcare products.

Increasing LGBTQ+ Identification

The increasing percentage of Americans identifying as LGBTQ+ is attributed to increased acceptability and survivorship bias (LGBTQ+ individuals were historically less likely to survive to old age).

Protecting Data Confidentiality

To protect the confidentiality of collected data:

• Do not collect information you do not need, particularly if it is sensitive or private.
• Do not collect sensitive information in public or in a way that lets others know what information is being collected, if possible.
• Store data securely (secure cabinet, encrypted machine).
• Remove identifiable information (like names) and replace it with a study ID number.
• Destroy data/data collection instruments after you no longer need them.