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- 1. MILIO’s FRAMEWORK FOR PREVENTION GROUP 1 (BAULO, BAUTISTA JR., BAYABAO, BOHARI, BOLOTO, CAIRODEN A., CAIRODEN J., CALANDADA, CALAUTO, CALI, CAMAMA)
- 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.
- 16. Thanks! ALL RIGHTS RESERVED 2023