Healthy by Design: ACHA-NCHA and the Ecological Approach

1. Healthy by Design: ACHA-NCHA and the Ecological Approach KAREN S MOSES Director, ASU Wellness and Health Promotion karen.moses@asu.edu December 2006

2. What is Health? • A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. • Health is instrumental in a person’s ability to lead a socially and economically productive life. • Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The Definition has not been amended since 1948.

3. What is Health? • Health is the capacity of individuals and communities to reach their potential. It is not solely a biomedical quality measured through clinical indicators. • Health transcends individual factors and includes cultural, institutional, socioeconomic, and political influences. NASPA Health in Higher Education Knowledge Community

4. Health • Influences academic, personal and professional potential. • Is multidimensional. • Is influenced by interrelated variables. • Occurs within complex systems. • Requires complex strategies.

5. Ecological Approach • Expands responsibility for health beyond the individual to the community and environment. • Calls for community leadership to improve health.

6. Multiple Dimensions

7. Interrelatedness • An action aimed at one variable will have side effects and long-term repercussions.   

8. Systemic Influence Person Community People Institution Place

9. Complexity • The existence of many interdependent variables in a given system.  • The more variables and the greater their interdependence, the greater that system's complexity.  • Great complexity places high demands on a planner's capacities to gather information, integrate findings, and design effective actions.

11. Framework for Planning Problem Identification Problem Analysis Goals/Objectives Information Gathering Model Formation Prediction & Extrapolation Select Strategies Implement Evaluate & Revise

12. Common Mistakes • Acting without prior analysis of the situation. • Failing to anticipate side effects and long-term repercussions. • Assuming that the absence of immediately obvious negative effects means that correct measures have been taken. • Over-involvement in "projects" can blind planners to emerging needs and changes in the situation. • Cynical reactions.

13. Variables within systems move "on their own".  • Requires: • Knowing current status. • Accurately predicting changes over time. • Predicting how actions will influence the situation. • How variables in the system are related. • How variables in the system influence each other. • If X increases, then Y will increase.

14. “It is usually wise when correcting a deficiency to consider it within the context of its system. If we don’t, we may treat only the symptoms and not the source of the trouble. We may also overlook the unpleasant side effects of our actions and do more harm than good in the long run. Considering the system means more than simply acknowledging the existence of many variables. It means recognizing the different ways the variables can affect one another and themselves.” Deitrich Dorner in The Logic of Failure

15. Interrelationships • Positive feedback • Negative feedback • Buffer • Critical indicator

16. Systemic Plans Person Community People Institution Place

17. People • Representative • Information • Leadership • Integrated • Spheres of Influence • Big picture

18. Good (more successful) planners are initially more cautious about acting, and try to secure a solid base of information. But too much information can lead to indecision and delay planning and action.

19. The more we know, the more clearly we realize what we don’t know.

20. We must learn to think in terms of systems. We must learn that in complex systems we cannot do only one thing. Whether we want it to or not, any step we take will affect many other things. We must learn to cope with side effects, and understand that the effects of our decisions may turn up in places we never expected to see them surface.

21. Planning Questions • Partners? • Issues to address? • Size • Significance • Potential to intervene • Resources required • Relevance? • Campus values/mission? • Student success? • Student health/safety? • Influences? • Individual / Interpersonal / Institutional / Societal

22. World Nation UNIVERSITY GET OUT OF YOUR COMFORT ZONE State Risk Management Benefits Office Community STUDENTAFFAIRS Academic Senate Public Safety STUDENTS Res Halls Judicial Affairs Employee Wellness Student Involvement Faculty HEALTH CENTER Dining Physicians Counseling Nurses HEALTH PROMOTION President’s Office StudentGov Research Projects/ Centers CAREER Admissions Pharmacy Lab Human Resources Training Recreation Complex Multicultural center Dietitian Colleges/ Areas of study Involved: Disabled Ethnic/Racial International Gender GLBTQ Age Calendar Orientation Disability Resources Entertainment/ Public Events Facility Management (Grounds, Building) Athletics

23. Using ACHA-NCHA Results for Ecological Planning • Evidence based problem identification • Population wide • Subgroup specific • Problem analysis/ Information gathering / Model formation • Related issues • Significance • Setting Goals / Objectives • Prediction and Extrapolation • Evaluate: System wide outcomes/trends • Building a Case

24. Description ASU NCHA 2000 ASU NCHA 2002 ASU NCHA 2004 ASU NCHA 2006 National NCHA 2005 Had 5 or more drinks in a sitting in the last two weeks 33.9 40.8 31.3 28.4 39.9 Had 5 or more drinks the last time you “partied”/socialized. 37.0 42.3 31.6 28.1 40.2 Think the typical ASU student had 5 or more drinks last time 67.7 69.9 64.9 62.4 Combined, never used alcohol + have used, but not in the last 30 days. 39.4 29.9 34.0 33.9 12.2 Problem Identification—Population Wide

25. Problem Identification—Subgroup Specific • Gender • Class • Sexual orientation • Ethnic minority identity • International status • Disabled • Living arrangements

26. Description ASU 2004 n=738 ASU 2004 On campus n=104 ASU 2004 Off campus n=431 ASU 2004 Parents house n=128 Had 5 or more drinks in a sitting in the last two weeks 31.3 44.0 39.0 18.5 Had 5 or more drinks the last time you “partied”/socialized. 31.6 48.0 37.5 24.8 Think the typical ASU student had 5 or more drinks last time 64.9 76.0 72.3 57.3 Combined, never used alcohol + have used, but not in the last 30 days. 34.0 30.0 29.3 51.6 Affected academic performance. 8.3 6.3 4.8 3.6 Est BAC 0.08 or higher 29.7 46.0 37.0 25.6 Received alcohol/drug use prevention 21.0 42.0 23.1 16.7 Problem Identification—Subgroup Specific

27. Problem Identification—Subgroup Specific

28. Problem Analysis—Related Issues • Alcohol • Stress • BMI

29. Alcohol use is related to… • Academic impediments • Symptoms of depression • Illegal drug use • Tobacco use • Number of sex partners • Condom use • Sexually transmitted infections • Sexual violence • Abusive relationships • Dieting ASU ACHA-NCHA 2004 data (n=738)

30. Stress is related to… • Depression • Perceptions about weight • Weight loss attempts • Illness • Alcohol/drug use • Sex ASU ACHA-NCHA 2002 data (n=1,149)

31. High BMI is related to… • High blood pressure • High cholesterol • Back pain ASU ACHA-NCHA 2004 data (n=738)

32. Rank Order Condition/Experience Performance affected by population Experienced this by population Experienced this by performance affected 1 Attention Deficit 8.4 15.5 54.2 2 Depression/Anxiety/SAD 15.1 28.3 53.4 3 Learning Disability 2.6 5.4 48.2 4 Other 7.7 17.6 43.8 5 Sleep Difficulty 24.7 61.4 40.2 6 Stress 31.7 80.8 39.2 7 Mono 1.0 2.6 38.5 8 Relationship difficulty 15.5 45.1 34.4 9 Death of friend/ family 8.4 25.3 33.2 10 URI 25.9 83.5 31.0 Problem Analysis—Significance

33. Building a Case • For your spheres of influence • Internal Team • Wellness Partners • Student Government • Student Affairs • Academic Affairs • Administrators • Community • For your funding partners

34. System Wide Outcomes/Trends • Trends to follow • Appropriate change in direction

35. To produce positive outcomes at the population level requires complex, integrated strategies that will have impact over time.

36. Campus Health Concerns

37. Environmental InfluencesNegative Place People Institution Community

38. Environmental InfluencesPositive Place People Institution Community

39. Challenges • Training needs. • Campus investment in individual methods. • Change is slow. • Examples limited. • Campus commitment to health promotion. • Involve the campus community. • Provide training opportunities.

40. Resources • NASPA— www.naspa.org • Health in Higher Education Knowledge Community • Health Education Leadership Program • Leadership for a Healthy Campus • www.naspa.org/help/archives/docs/EcologyBooklet.pdf • US Department of Education Higher Education Center— www.higheredcenter.org • Environmental Management booklet • http://www.higheredcenter.org/framework/ • Dorner, D. (1996) The Logic of Failure: Recognizing and Avoiding Error in Complex Situations. New York: Metropolitan Books.