2. WHO IS
NANCY MILIO?
Nancy Rosalia Milio, Ph.D., FAPHA, FAAN
is Professor Emeritus of Nursing and
Professor Emeritus of Health Policy and
Administration, School of Public Health,
University of North Carolina at Chapel Hill.
She is a leader in public health policy and
education, who originated the notion of
healthy public policy which addresses the
effects of all areas of public policy on health
and has been adopted internationally,
including the World Health Organization.
3. OVERVIEW OF MILIO’S FRAMEWORK
FOR PREVENTION
• Milio (1976) proposed that health deficits often result from an
imbalance between a population’s health needs and its health
sustaining resources.
• She stated that diseases associated with excess occurred in affluent
societies (obesity) and diseases that result from inadequacies in food,
shelter and water afflict the poor. Therefore, poor people in affluent
societies experience the least desirable cambination of factors.
• Personal and societal resoures affect the range of health promoting or
health damaging choices available to individuals. Personal resources
include the individual’s awareness, knowledge, and health beliefs.
Money and time are also personal resources.
4. • She proposed that most human beings make the easiest choices
available to them most of the time. Health promoting choices must be
more readily available and less costly than health damaging options for
individuals to gain health.
• This theory is broader than the HBM, it includes economic, political,
and environmental health determinants rather than just the individual’s
perceptions.
• This theory encourages the nurse to understand health behaviors in
the context of their societal milieu.
5. DEFINITION OF MILIO’S FRAMEWORK
FOR PREVENTION
• Milio stated that behavioral
patterns of the populations- and
individuals who make up
population- are a result of
habitual selection from limoted
choices.
• She challenged the common
notion that a main determinant
for unhealthnful behavioral
choice is lack of knowledge.
• A framework for prevention that
includes concepts of
community-oriented,
population-focused care.
• Milio’s framework described
sometimes neglected role of
community health nursing to
examine the determinants of a
community’s health and attempt
to influence those determinants
through public policy.
7. 1. Population Health
results from deprivation
and excess of critical
health resources.
• E.g., Individuals and families living in poverty have poorer health status
compared with middle and upper class individuals and families.
8. 2. Behaviors of populations result from
selection from limited choices; these arise
from actual and perceived options
available a well as beliefs and
expectations resulting from socialization,
education and experience.
• E.g., Positive and Negative lifestyle choices (example: smoking,
alcohol use, safe sex practices, regular exercise, diet/nutrition, seatbelt
use) are strongly dependent on culture, socioeconomic status, and
educational level.
9. 2. Behaviors of populations result from
selection from limited choices; these arise
from actual and perceived options
available a well as beliefs and
expectations resulting from socialization,
education and experience.
• E.g., Positive and Negative lifestyle choices (example: smoking,
alcohol use, safe sex practices, regular exercise, diet/nutrition, seatbelt
use) are strongly dependent on culture, socioeconomic status, and
educational level.
10. 3. Organizational decisions and policies
(both governmental and
nongovernmental) dictate many of the
options available to individuals and
populations, and influence choices.
• E.g., Health insurance coverage and availability are largely determined
and financed by federal and state governments (like Medicare and
Medicaid) and employers (like private insurance): the source and
funding of insurance very strongly influence health provider choices
and services.
11. 4. Individual choices related to health-
promoting or health-damaging behaviors
is influenced by efforts to maximize
valued resources.
• E.g., Choices and behaviors of individuals are strongly influenced by
desires, values, and beliefs. For example, the use of barrier protection
during sex by adolescents is often dependent on peer pressure and the
need for acceptance, love, and belonging.
12. 5. Alteration in patterns of behavior
resulting from decision making of
significant number of people in a
population can result in social change.
• E.g., Some behaviors such as tobacco use have become difficult to
maintain in many settings or situations in response to organizational
and public policy mandates.
13. 6. Without concurrent availability of
alternative health-promoting options for
investment of personal resources, health
education will be largely ineffective in
changing behavior patterns.
• E.g., Addressing persistent health problems (like overweight and
obesity) is hindered because most people are very aware of what
causes the problem, but are reluctant to make reluctant lifestyle
changes to prevent or reverse the condition. Often “new” information
(like a new diet) or resources (like a new medication) can assist in
attracting attention and directing positive behavior changes.
14. MILIO’S PROPOSITIONS OF
FRAMEWORK FOR PREVENTION
1. Population Health results from deprivation and excess of critical health resources.
2. Behaviors of populations result from selection from limited choices; these arise
from actual and perceived options available a well as beliefs and expectations
resulting from socialization, education and experience.
3. Organizational decisions and policies (both governmental and nongovernmental)
dictate many of the options available to individuals and populations, and influence
choices.
4. Individual choices related to health-promoting or health-damaging behaviors is
influenced by efforts to maximize valued resources.
5. Alteration in patterns of behavior resulting from decision making of significant
number of people in a population can result in social change.
6. Without concurrent availability of alternative health-promoting options for
investment of personal resources, health education will be largely ineffective in
changing behavior patterns.
15. Personal Behavior patterns are not simply “free” choices
of “lifestyle” that are isolated from their personal and
economic context. Lifestyles are patterns of choices
made from available alternatives according to people’s
socioeconomic circumstances and how easily they are
able to choose some over others.