Towards an overall model

April, 2013

Modeling Decisions

Outcome (What are we explaining?)• General (e.g., longevity) vs. specific (e.g., MI)?• Incidence vs. progression or survival?

(i.e., absolute or relative?) • Outcomes or distribution of outcomes? (Individual vs. societal?)

Population (Whom are we considering?)• Overall average tendencies, or particular sub-groups?• Local or universal? Current patterns or historical trends?

Perspective (Why?)• All factors or a simplified model? How distilled?• Prediction vs. explanation?

Form (How?)• Mathematical or compositional?• Organic or structural? Next

Diseasemanagementbehaviors

Seema Nagpal, PhD thesis, 2011

Social Support Back

Family

Neighborhood

National

Global Factors

Determinants at higher level

influence health at lower level

∑

Explanations:Reasons lookoutwards (the

“Why?” questions)

Analysis:Mechanisms look

inwards (the “How?” questions)

∑∑

∑ Health statusand risk factors at lower levels

aggregate to higher levels

Physical Emotio

nal

SocialSpiritu

al

The Person

Back

PopulationIncidence

Individual risk categoriesLow High

High

D

RF

Causes of cases vs. Population Rates

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Elements of a ‘model’

• Elements & links; is this sufficient?

• Magnitude & pattern of influence

• Layering of influences

• Historical: time dimension & external influences

• Model vs. Framework

Lalonde

Selye

IOTF

Minard

Next

Frank-Etches

Health

Health CareOrganization

HumanBiology

Environment

Lifestyle

Lalonde’s Health Field Concept Back

Theory of Planned Behaviour

AttitudesAttitudes

Subjective Subjective NormsNorms

Perceived Perceived BehaviouraBehavioura

l Controll Control

BehaviouraBehavioural Intentionl Intention BehaviourBehaviour

Ajzen & Madden, (1986), Journal of Experimental Social Psychology, 22, 453

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Alarm Resistance Exhaustion

Selye’s conception of generalized reaction:initial fall in performance during alarm phasefollowed by heightened vigilance during resistance phase, leading to precipitous fallas body becomes exhausted.

Selye’s notion of optimal levelof stress: too little impairs performance(‘rust out’); we operate at peak under optimal stress, but canwear out with prolonged stress.Note similar findings for anxiety.

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Charles Joseph Minard’s 1869 diagram of Napoleon’s Russian campaign of 1812-13

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John Frank

Vera Etches

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Globalinfluences

Societal processes

Individualactions

Biologicalprocesses

Healthoutcomes,

e,g.:

Structural Starting-Point for our Overall Model

Overallmortality

CVD,cancer

Mental health

Obesity

QoL