Sociology Focus
Author: Mediha Din

How We Make Health Decisions

Every season of the hit T.V. show Dancing with the Stars, fans tune in to see famous faces learning complicated routines. Over the past few years, it seems that fans and the media are intrigued with more than just the fox-trot, merengue, and the waltz. There is also a growing fascination with the physical transformation of some of the stars. Watching many of the celebrities lose weight has become one of the major highlights of the show. Americans are often fascinated with stories of celebrities improving their health. Sociologists are interested in what it takes for a person to make the decision to improve their health and actually follow through with that decision.

This season, the Dancing With The Stars winner and Glee actress Amber Riley has had countless interviews that focused on her health and weight as much as her winning dancing moves (‘Dancing With the Stars’ Champ Amber Riley Talks Winning and Weight Loss). Riley discusses how one of her main motivations for participating in the show was to improve her health, not to win. “When we first started, that wasn’t the goal — it really wasn’t,” she told Us Weekly. “I was like, ‘OK, this will be cool. It’ll be great exercise, I’ll gain confidence, and I’ll learn dances’.”

The Health Belief Model in Sociology can help explain what motivates some people to take charge of their health, and what prevents others from doing the same. According to this model, there are four conditions that must be met in order to take care of your own health.

1. You must believe you are at risk.

Throughout my college life, I did not accept my strong family history of heart disease. I ate McDonalds for breakfast, Burger King for lunch, and Taco Bell or Pizza Hut for dinner on a near-daily basis. Seriously. I knew I had a high risk for heart disease because both my maternal and paternal grandfathers died of heart attacks at an early age. I knew high blood pressure and high cholesterol plagued many of my family members. Yet I still did not accept that I personally was at risk.

This is partly because my poor eating habits did not cause me to become very overweight (possibly due to age, metabolism, luck). In our society we often assume that someone who is overweight has poor lifestyle habits, and someone who is slim is healthy. We forget that the person who may seem to be at an unhealthy weight may exercise regularly and eat healthy food, while the person who is slimmer may suffer from anorexia, bulimia, drug addiction, or avoid exercise and healthy foods.

2.You must believe the risk is serious.

Even though I knew my risk factors, I did not initially take them very seriously. Perhaps because one of my grandfathers passed before I was born, and the other shortly after, the risks did not feel as immediate. It was not until after college, when close members of my family had to go through heart bypass surgeries and spend long periods of time in the hospital that I began to accept the severity of the situation. Seeing pain and suffering of patients that you care about firsthand has a strong impact. For me, seeing my grandmother’s scar from heart surgery is a moment I will never forget. I actually passed out in the hospital when I saw her. Visiting my uncle who spent months in the hospital and hearing him describe the misery of breathing tubes after he finally returned home was another unforgettable memory. It began to sink in for me that poor eating habits could easily mean the same for me one day. I knew that I didn’t want to spend the later years of my life in and out of the hospital. The loss quality of life began to be a serious concern.

3. You must believe that prevention will change your risk significantly

Sociology in Focus author Nathan Palmer’s piece If It’s Hard to Change, Hardly Anyone Ever Will connects to this concept. My family members and friends were great examples for me here. I saw those that were active and making positive changes in their eating habits getting results. One of my best friends committed to taking high intensity cardio classes, weight training, and eating clean. She slowly but surely got to a healthy weight and was taken off of her medication for high blood pressure. My cousin reduced his high cholesterol after 6 months by reducing portion sizes, starting yoga, and bicycling. It was clear to me that positives changes would indeed yield positive results.

4. You must believe you can overcome the financial, emotional, or physical barriers you face.

Our jobs and schooling are unfortunately some of our biggest obstacles when it comes to health. In the past most Americans worked in agriculture. Our days spent on the farm were extremely physically active. Today, most of us sit all day at a desk in the office or at school. After sitting all day, we come home too tired to cook a healthy meal. For myself, as for many others, even after my undergraduate degree, I worked a full-time job, came home for an hour to rest, and then headed back out to take night classes for my Master’s degree. Snickers ice cream bars and Red Bulls became my strange form of sustenance. However, at the same time I was eating anything offered in a vending machine, I saw my great friend Tiffany begin working out and taking charge of her health. She also is a teacher and was juggling a lot at the time, but managed to lose 128 pounds. She improved her health drastically. If she was able to overcome the financial, emotional, and physical obstacles she faced, I knew I could do the same.

I also saw my friend Joanne using technology to overcome some of her obstacles. She used the free cell phone applications MyFitnessPal to track calories, Couch to 5k to become a runner for the first time in her life, and Runstastic to keep track of her pace and push herself further. She posted about her workouts on her Facebook page to get encouragement from friends as well as accountability for herself. She taught herself weight training routines as well as how to cook healthy meals on a budget by following YouTube fitness channels such as LeanSecrets. Tiffany and Joanne made it clear to me that that even with lots of challenges such as busy schedules or financial restraints, health could and should be made into a priority. I changed my eating habits (eliminated the fast foods and increased my green vegetable intake 3-fold) and made outdoor exercise (especially running and bicycling) a big part of my life.

Angelina Jolie as an Example of the Health Belief Model

Recently Angelina Jolie was in the news because she had made the decision to have both of her breasts removed in a double mastectomy after learning that the probability of her developing breast cancer was very high. To wrap up this discussion let’s apply the Health Belief Model to what we know about her decision making process from the news coverage. Note: Health decisions are deeply personal and often private matters. We can’t be sure this is exactly how her decision making process went, but based on the news coverage, we can roughly estimate it might have gone like this.

  1. You must believe you are at risk: The Hollywood superstar lost her mother to ovarian cancer and knew she herself carried the gene, BRCA1, which sharply increases the risk of developing breast cancer and ovarian cancer.
  2. You must believe the risk is serious. Her doctors estimated that her risk of breast cancer was 87%.
  3. You must believe prevention will change your risk: She made the decision to have a major surgery: a preventative double mastectomy, which lowered her risk to 5%, as her doctors had predicted.
  4. You must believe you can overcome the financial, emotional, or physical barriers. Jolie had the finances for the procedure. In an article she wrote for the New York Times, she also describes knowing that her family would be there to help her emotionally throughout her treatment.

Dig Deeper:

  1. One barrier that Americans face when trying to get healthy is misleading advertising. Products that are unhealthy are often labeled in a deceptive manner. Find and describe 3 examples of unhealthy foods or beverages that are advertised or labeled in a misleading way.
  2. What are other financial, emotional, or physical barriers that may prevent someone from improving their health?
  3. Some cities make it easier for citizens to be healthy. Clean air, walkability, and availability of fresh produce are some of the factors that promote healthy lifestyles. Read about the Happiest and Healthiest Cities in America and America’s Top 20 Healthiest Cities.What other factors make these cities so health-friendly?
  4. Apply the 4 conditions of the Health Belief Model to a health situation you are familiar with (some examples: quitting smoking, limiting restaurant meals, eating organic produce, avoiding artificial sweeteners).
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