Chapter 1: Intro to Health, Wellness, and Change

Welcome to the world of health and wellness!  As you read this book, you will be taken on a learning journey that will continually ask you to reflect on your own life, your health, your wellness, your choices, and your behaviors.  Health is a topic that impacts all of us, thus this learning journey is personal to you and your life experiences.

What does Health and Wellness mean?

How have you used the word Health or Wellness in your communication with others?  The terms Health and Wellness are often used interchangeably.  What do they mean to you?

The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (illness)” and defines wellness as “the optimal state of health of individuals and groups,^[1]”  which may be expressed as “a positive approach to living.” The National Wellness Institute^[2], explains wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.”

The National Wellness Institute states that there is general agreement that:

1. Wellness is considered a conscious, self-directed and evolving process of achieving full potential.
2. Wellness is multidimensional and holistic, encompassing lifestyle, mental and spiritual well-being, and the environment.
3. Wellness is positive and affirming.

The primary difference between health and wellness is that health is your state of being, or a goal to achieve, and wellness is the active process of achieving it through growth and change.  Through wellness we hope to reach our fullest potential of health and well-being.

The Nine Dimensions of Wellness

Both health and wellness are very broad terms.  To help identify ways we can grow and change to reach our optimal health, it is helpful to view wellness in terms of the Nine Dimensions of Wellness.  The Nine Dimensions of Wellness can help to identify ways you can make wellness a part of your everyday life.

The Nine Dimensions of Wellness include: Physical, Emotional, Social, Environmental, Financial, Intellectual, Occupational, Spiritual, and Cultural.  These dimensions of wellness are not isolated, but rather are interconnected.  Problems or challenges in one dimension can impact the other, while the opposite can also be true, that by improving your health and wellness in one area can help to improve other dimensions. For example, your emotional wellness can be positively impacted through exercise (physical wellness) but negatively impacted by financial struggles that often lead to high stress.

Physical Wellness

People who are focused on improving their physical health recognize the need for regular physical activity, they choose healthy foods, go to the doctor, and get adequate sleep.  People who are physically well actively make healthy decisions on a daily basis.  This may include making a habit of exercising three to five times per week or recording their dietary intake to ensure they are receiving proper nutrition for optional health.

How would you rate your physical wellness and what behaviors could you change, or actions could you take, to positively improve your physical wellness?

Emotional Wellness

Coping effectively with life and expressing emotions in an appropriate manner are keys to emotional wellness. An emotionally well person successfully expresses and manages an entire range of feelings, including anger, doubt, hope, joy, desire, fear, and many others. People who are emotionally well maintain a high level of self-esteem. They have a positive body-image and the ability to regulate their feelings. They know where to seek support and help regarding their mental health, including but not limited to, seeking professional counseling services.

How would you rate your emotional wellness and what behaviors could you change, or actions could you take, to positively improve your emotional wellness?

Social Wellness

People who are focused on their social wellness are striving for positive relationships, developing a sense of connection, belonging, and sustained support system.  A socially well person builds healthy relationships based on interdependence, trust, and respect. Those who are socially well have a keen awareness of the feelings of others. They develop a network of friends and co-workers who share a common purpose, and who provide support and validation.

How would you rate your social wellness and what behaviors could you change, or actions could you take, to positively improve your social wellness?

Environmental Wellness

Environmental wellness includes a desire to positively impact our planet Earth and also our local community by  striving to occupy pleasant, healthy, and safe environments that support well-being and positively impact the quality of our surroundings (including protecting and preserving nature).  An environmentally well person appreciates the external cues and stimuli that an environment can provide . People who have achieved environmental wellness recognize the limits to controlling an environment and seek to understand the role an individual plays in the environment.

How would you rate your environmental wellness and what behaviors could you change, or actions could you take, to positively improve your environmental wellness?

Financial Wellness

Financial wellness refers to achieving satisfaction with current and future financial situations by handling finances wisely.  Those who are financially well are fully aware of their current financial state. They set long- and short-term goals regarding finances that will allow them to reach their personal financial goals.

How would you rate your financial wellness and what behaviors could you change, or actions could you take, to positively improve your financial wellness?

Intellectual Wellness

Intellectual wellness includes being open-minded, recognizing creative abilities, and/or finding ways to expand knowledge and skills. Those who enjoy intellectual wellness engage in lifelong learning. They seek knowledge and activities that further develop their critical thinking and heighten global awareness. They engage in activities associated with the arts, philosophy, and reasoning.

How would you rate your intellectual wellness and what behaviors could you change, or actions could you take, to positively improve your intellectual wellness?

Occupational Wellness

Occupational wellness refers to personal fulfillment and enrichment from one’s work and/or responsibilities. An occupationally well person enjoys the pursuit of a career which is fulfilling on a variety of levels. This person finds satisfaction and enrichment in work, while always in pursuit of opportunities to reach the next level of professional success.

How would you rate your occupational wellness and what behaviors could you change, or actions could you take, to positively improve your occupational wellness?

Spiritual Wellness

Spiritual wellness refers to having a sense of purpose and meaning in life, this may come from establishing peace, harmony, and balance in our lives.  People who can be described as spiritually well have identified a core set of beliefs that guide their decision making, and other faith- based endeavors. While firm in their spiritual beliefs, they understand others may have a distinctly different set of guiding principles. They recognize the relationship between spirituality and identity in all individuals.

How would you rate your spiritual wellness and what behaviors could you change, or actions could you take, to positively improve your spiritual wellness?

Cultural Wellness

Cultural wellness refers to the way you interact with others who are different from you.  This includes understanding and celebrating our differences.  Culturally well people are aware of their own cultural background, as well as the diversity and richness present in other cultural backgrounds. Cultural wellness implies understanding, awareness and intrinsic respect for aspects of diversity. A culturally well person acknowledges and accepts the impact of these aspects of diversity on sexual orientation, religion, gender, racial and ethnic backgrounds, age groups, and disabilities

How would you rate your cultural wellness and what behaviors could you change, or actions could you take, to positively improve your cultural wellness?

A Healthy Population

How long would you like to live?  What would you like to be able to do throughout life, especially into your later years? Striving for health by implementing wellness practices will impact both your quantity and quality of life.

Leading Causes of Death in the United States

Across the entire U.S. population, Cardiovascular Disease and Cancer are the top two causes of death.  However, variation exists for age and ethnicities.  For example, until age 44 the leading cause of death is unintentional injuries, then between 45-64 the leading cause of death is Cancer followed by Cardiovascular disease, and beginning at age 65 Cardiovascular Disease takes the number one rank^[3].

Table 1.1 includes the top ten causes of death for the years 1900, 1950, 2000, 2010, 2018, and 2020.   2018 was purposefully included to show the difference in causes of death pre-COVID.  In 2020, the list of the top causes shows COVID* taking the spot for the third most deaths.  As you review the data in Table 1, it is helpful to compare the leading cause of death with life expectancy. The life expectancy in 1900 was 48.3 years, by 1950 life expectancy increased to 71.1 years, and from 2010 to 2018 life expectancy remained fairly stable at 78.7 years.  From 1900 to 2000, life expectancy almost doubled and the causes of death changed from causes predominantly related to infectious diseases and sickness, to causes of death highly related to lifestyle choices, like the choice to eat a healthy diet and stay physically active.

Your Choices, Your Risk:  What is your risk factor?

Many of the risk factors for Cardiovascular Disease and Cancer are related to your lifestyle choices, thus the choices you make may impact your chances of being diagnosed with Cardiovascular Disease and Cancer. Part of learning how to take charge of your health requires understanding your risk factors for different diseases. Risk factors are things in your life that increase your chances of getting a certain disease. Some risk factors are beyond your control, you may be born with them or exposed to them through no fault of your own.

Some risk factors that you have little or no control over include your:

• Family history of a disease
• Sex/gender — male or female
• Ancestry

Some risk factors you can control include:

• What you eat
• How much physical activity you get
• Whether you use tobacco
• How much alcohol you drink
• Whether you misuse drugs
• Whether you get good sleep

You can have one risk factor for a disease or you can have many. The more risk factors you have, the more likely you are to get the disease. For example, if you eat healthy, exercise on a regular basis, and control your blood pressure, your chances of getting heart disease are less than if you are diabetic, a smoker, and inactive. To lower your risks, take small steps toward engaging in a healthy lifestyle, and you’ll see big rewards.

People with a family health history of chronic disease may have the most to gain from making lifestyle changes. You can’t change your genes, but you can change behaviors that affect your health, such as smoking, inactivity, and poor eating habits. In many cases, making these changes can reduce your risk of disease even if the disease runs in your family. Another change you can make is to have screening tests, such as mammograms and colorectal cancer screening. These screening tests help detect disease early. People who have a family health history of a chronic disease may benefit the most from screening tests that look for risk factors or early signs of disease. Finding disease early, before symptoms appear, can mean better health in the long run.

Healthy People

We want people to be healthy.  A healthy population is a nations greatest resource, it means a productive population, a prosperous population, and a healthy economy. Your individual commitment to striving for personal wellness may contribute to our national goals for a healthy population!

Every decade since 1980, the U.S. Department of Health and Human Services (HHS) has published healthy goals for our U.S. population called the Healthy People initiative.  Healthy People 2030 is the 5th iteration of the Healthy People initiative.  The Healthy People initiative is designed to guide national health promotion and disease prevention efforts to improve the health of the nation.

The 2030 broad goals for this decade include the following:

• Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death.
• Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.
• Create social, physical, and economic environments that promote attaining full potential for health and well-being for all.
• Promote healthy development, healthy behaviors and well-being across all life stages.
• Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.

The five broad goals are further divided into over 400 objectives: 355 core objectives, 115 developmental objectives and 40 newly added research objectives.  The science-based objectives include targets to monitor progress and motivate action.  The Healthy People 2030 objectives were carefully chosen based on national data.  The goal is to work together as a nation to achieve the achieve the objectives and goals to hopefully improve health and well-being nationwide.

Health Literacy

The internet brought us the ability to have a wealth of information at our fingertips.  Have you ever felt sick and googled your symptoms to try to self-diagnose your sickness?  Have you been scrolling through your social media and an article popped up promising a cure to obesity with just one simple pill?

With so much information available to us, it is imperative that we understand how to critically evaluate information we see or hear.  The need to be critical consumers of information is reflected in the Healthy People broad goal to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.”  We need to increase our health literacy.

The CDC defines personal health literacy as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others^[7]. We must be critical consumers of information which starts with evaluating the source of the information.

Evaluating and Finding Health Information

One strategy for assessing a website is to use the CRAAP^[8] method which stands for Currency, Relevance, Authority, Accuracy, and Purpose.

As you read information critically, ask yourself the following questions:

Currency: The timeliness of the information.

• When was the information published or posted?
• Has the information been revised or updated?
• Does your topic of interest require current information, or will older sources work as well?
• Are the links functional?

Relevance: The importance of the information for your needs.

• Does the information relate to your topic or answer your question?
• Who is the intended audience?
• Is the information at an appropriate level (i.e. not too elementary or advanced for your needs)?
• Have you looked at a variety of sources before determining this is one you will use?
• Would you be comfortable citing this source in a research paper?

Authority: The source of the information.

• Who is the author/publisher/source/sponsor?
• What are the author’s credentials or organizational affiliations?
• Is the author qualified to write on the topic?
• Is there contact information, such as a publisher or email address?
• Does the URL reveal anything about the author or source? examples: .com .edu .gov .org .net

Accuracy: The reliability, truthfulness and correctness of the content.

• Where does the information come from?
• Is the information supported by evidence?
• Has the information been reviewed or refereed?
• Can you verify any of the information in another source or from personal knowledge?
• Does the language or tone seem unbiased and free of emotion?
• Are there spelling, grammar or typographical errors?

Purpose: The reason the information exists.

• What is the purpose of the information? Is it to inform, teach, sell, entertain or persuade?
• Do the authors/sponsors make their intentions or purpose clear?
• Is the information fact, opinion or propaganda?
• Does the point of view appear objective and impartial?
• Are there political, ideological, cultural, religious, institutional or personal biases?

Taking Charge of your health:  Making Healthy Changes

The choices you make each day can impact your quality and quantity of life.  At the beginning of this chapter you were invited to reflect on your health across the Nine Dimensions of Wellness by giving yourself a score from 1-10 that would reflect your health in each dimension from low to high.  You were also invited to identify possible behaviors you could change that would positively impact your health in each dimension.  This is a very helpful activity for helping you to identify what you can do to stay healthy throughout life.  The first step in any behavior change is to recognize what you can and should change.

Are you ready to change your behaviors?

You may be able to quickly identify behaviors your could change to increase your wellness, but you might not be able to quickly begin implementing the change.  Are you ready to change your unhealthy behaviors?

The Stages of Change, also called the Transtheoretical model of behavior change, was developed by Prochaska and DiClemente to help understand the stages a person goes through when trying to make changes in their life.  It assesses an individual’s readiness to implement a healthier behavior, and provides insight into the decision-making process that leads to action.  The five stages include: precontemplation, contemplation, preparation, action, and maintenance.  You might not go through the stages linearly, rather you might find yourself moving between them, and regressing.  For example, you might first believe you are in the Preparation Stage and then realize you are actually in the Contemplation stage.  Or you might jump into the Action stage beginning the change, and then discontinue with your plan stepping back into the Preparation or Contemplation stage.

As you review the five stages of the Stages of Change, along with characteristics and strategies^[9],   think about a behavior you’d like to change and identify which stage you are currently in and what you could do to move to the next stage:

Precontemplation Stage (not ready to change): 

People in the precontemplation stage are not intending to take action in the foreseeable future, are not interested in getting help, and can be unaware or do not believe that their behavior is problematic.

• Characteristics: Ignoring or ignorance of the problem, or denying the problem exists.
• Strategies to move to next stage:  Identify the risks to your life if you do not change and take time to analyze or rethink your behaviors and action.

Contemplation Stage (getting ready to change):

People in the contemplation stage are beginning to recognize that their behavior is problematic, be more aware of the consequences of their behavior, and start to look at the pros and cons of either continuing or changing their behavior.  They be more accepting or receptive to information about their unhealthy behavior and more open to learn about ways they could change.

• Characteristics:  Being doubtful or ambivalence of the change, or having conflicted emotions about the change.
• Strategies to move to next stage:  Make a list of the pros and cons of changing your behavior, identify barriers to changing and strategies you could use to overcome the barriers, lastly look for resources that could help you make the change.

Preparation Stage (ready to change):

People in the Preparation stage are intending to take action in the immediate future, they are committed to making changes, and may begin taking small steps toward behavior change by researching to find resources or strategies to help them with their change.  This stage likely includes the development of a behavior change plan.

• Characteristics:  Experimenting with small changes and collecting information about the change.
• Strategies to move to next stage:  Write down your goals, prepare a plan of action, and make a list of motivating statements.

Action Stage (actively changing):

People in the action stage believe they can change and are actively changing their behaviors.  They are open to help, seek support, and work to overcome barriers to stay committed.

• • Characteristics:  Direct action toward goal.
  • Strategies to move to next stage:  Reward your successes and seek out social support.

Maintenance Stage (maintain change):

People in the  maintenance stage have been able to sustain action for at least six months and are working to prevent relapse into previous unhealthy behaviors.

• • Characteristics:  Maintenance of the new behavior and avoiding temptations.
  • Strategies to prevent relapse: Developing positive coping strategies for overcoming temptations and remember to continue to reward yourself.

Making the Change with SMART Goal Setting

Have you ever tried to change your behaviors?  Maybe you set a New Years Resolution?  How did it go?

If you have been successful at changing your behaviors it is highly likely that you followed a very specific plan.  If you haven’t been successfully, you likely followed a path similar to what many people do around January first each year which is make broad statements such as “I am going to lose weight this year” or “this is the year I am going to work out” or “I am going to get healthy.”  Each of these statements have a good intent, but are lacking an actual goal or target to achieve. It is like saying you are taking a vacation but haven’t made any plans, haven’t decided where to go, or how you will get there.

Setting SMART goals can help you to have a better chance at being successful with behavior change by giving you direction and a target to achieve.  SMART stands for Specific, Measurable, Attainable/Achievable, Realistic, Time-oriented.

Setting a SMART goal requires the goal setter to think about the factors involved in achieving their goal. Defining each of the five characteristics can help to define a pathway to reaching the goal. The more well-defined that pathway becomes, the easier it is to follow.

Specific

Create a goal that has a focused and clear path for what you actually need to do. The goal needs to be concrete, detailed, and well defined so that you know where you are going and what to expect when you arrive.   What do you want to accomplish? Why have you set this goal?

Measurable

Create a goal that provides means of measurement and comparison by using numbers and quantities, this enables you to track your progress. Including measurement lets you know whether or not you have met your goal. How will you measure your progress? How will you know when you have successfully achieved your goal?

Attainable/Achievable

Make sure that your goal is within your capabilities and not too far out of reach. For example, if you have not been physically active for a number of years, it would be highly unlikely that you would be able to achieve a goal of running a marathon within the next month.  Your goal must be feasible and easy to put into action.  Do you have the skills, abilities, or time needed to achieve your goal?

Realistic/Relevant

When deciding on your goal considers constraints such as resources, personnel, and cost. Try to ensure that your goal is something you will be able to continue doing and incorporate as part of your regular routine/lifestyle. For example, if you made a goal to kayak 2 times each week, but don’t have the financial resources to purchase or rent the equipment, no way to transport it, or are not close enough to a body of water in which to partake in kayaking, then this is not going to be feasible. Why do want to achieve the goal?  Is your goal in line with your lifestyle?

Time-Oriented/Time-Bound/Timely

A time frame helps to set boundaries around the objective. Give yourself a target date or deadline in which the goal needs to be met.  This will keep you on track and motivated to reach the goal, while also evaluating your progress. What is your timeline to change?

Moving from Broad to SMART Goals

Here’s are examples of changing from a vague goal to a SMART goal:

• Change “I will workout” to “I will engage in 30 minutes of aerobic physical activity 5 days a week for the next 4 weeks.”
• Change “I will lose weight” to “I will lose weight by tracking my calories every day for the next 2 months and reducing my calorie intake by 10% each week beginning week 1 with 2,000 calories/day intake, week 2 calorie intake 1,800 calories/day, week 3 calorie intake 1,620 calories/day, etc.”
• Change “I will be happier” to “I will increase my happiness by incorporating positive affirmations into my daily life. For the next two months I will begin week 1 with choosing one positive affirmation that I will repeat to myself five times a day.  Each subsequent week I will add another affirmation so that by week 8 I am repeating 8 positive affirmations five times a day.”
• Change “I will go to the gym” to “I will increase my physical activity by doing cardio and weight training at the gym four times a week for the next 10 weeks. I will track my progress by keeping a workout log. I will increase cardio time and weight training reps/sets each week by 5-10%”

Increase Your Opportunity for Successful Change

Behavior change is hard for many reasons.  Here are some strategies to help increase your chances of successfully achieving your health and wellness goals.

Set approach goals instead of avoidance goals^[10]

Approach goals are goals where you are taking actions to meet a desired outcome, whereas avoidance goals are focused on not taking actions.  Research has shown that we are more successful when we set approach goals rather than avoidance goals.  For example, rather than setting an avoidance goal such as “I will not drink soda” the focus could be “I will drink water instead of soda.”

Set mastery (learning) goals instead of performance goals^[11]

A performance goal might be to lose 20 pounds, whereas a mastery (learning) goal would focus on the actions you are taking to lose weight, such as focusing on your nutrition or exercise. A mastery skill involves increasing existing abilities or learning new skills. Performance goals may be less effective than mastery goals.  It is ok to set a performance goal, but it should always be accompanied by a mastery goal.

Find Your Why

Take a moment to think about why you want to change.  How will this change make your life better?  How will this change help you feel better, have better relationships with yourself and others, or help your family or friends?  You might like to refer to this as finding or discovering your why.

Your Daily Action Plan

If you think about your SMART goal as your destination, how will you get there and what are the directions or what route will you take?  Developing an action plan is a helpful strategy to increase your motivation.  An action plan specifies the what (always a behavior), how much, how often, and usually when (which days and times), in other words it is the steps by which the SMART goal will be achieved.  Your action plan provides you with your goal for each day allowing you to focus on your day-to-day actions rather than just on your long term goal.  This allows you to be successful each day that you complete your stated actions in your action plan.

Boost Your Self Efficacy

Implementing a carefully and thoughtfully crafted action plan  can help to improve health and build your  self efficacy^[12].  Self-Efficacy is the confidence in one’s ability to achieve a specific goal, it is the belief in oneself that you can do it.  Implementing and meeting the goals of your action plan is a great strategy for building your self-efficacy, which in turn builds your motivation to change.

A Positive Mindset

Having a positive mindset can also help to increase your self-efficacy.  This might include focusing on positive self-talk whereby purposefully telling yourself that you can complete your goals.  A positive mindset may also take the form of finding enjoyment in your changes.  When the thought of your change brings you enjoyment, you are more likely to engage in the behavior change and stick to it^[13].