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Health Impact Pyramid Framework Research Paper on Global Health: Mental

Health

Heather Stalters

Delaware Technical Community College

NUR 310: Global Health

Dr. Paula Mundell

December 06, 2020

Health Impact Pyramid Framework Research Paper on Global Health: Mental Health

Abstract

Health is the state of well-being of an individual. It involves the physical, social,

mental, and spiritual state of the individual. Mental health focuses on the state of mental well-

being of an individual. The key determinants of mental health are biological factors, family

history, environment, and life experiences. Culture, education, socio-economic status, and health

care access all impact how mental health is perceived and treated. This paper focuses on the 5-

tier Health Impact Pyramid (HIP) and how interventions with the greatest potential impact can be

implemented.

Introduction

Mental health is comprised of the emotional, social, and psychological well-being of a

person that affects how they act and feel. According to research in 2017, a study estimated that

792 million people or 1 in 10 people, globally, lived with mental health disorder (Ritchie &

Roser, 2018). The most prevalent mental health disorders being anxiety disorders and

depression. Depression affected 264 million people globally in 2017 (Ritchie & Roser, 2018).

The top three countries with the highest rates of depression are China, India, and United States

(Depression rates by country 2020, 2020). In 2019, WHO introduced the WHO Special initiative

for Mental Health (2019-2023): Universal Health Coverage for Mental Health (Mental Health,

n.d.). This initiative ensures universal mental health care in 12 priority countries. Many factors

can affect how a person views and deals with mental health. Education, religion, cultural beliefs

and practices, socio-economic status all play a critical role in how mental health is perceived and

treated. This paper applies to the Health Impact Pyramid (HIP) model, to analyze the proper

tools and interventions to achieve good mental health for people globally.
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The Health Impact Pyramid

The Health Impact Pyramid is a 5-tier pyramid that depicts the influence of the public

health interventions aimed at providing a framework to improve health. The base of the pyramid

provides interventions that address the socio-economic determinants of health. In ascending

order, the next level addresses the changing of context so that individuals’ default decisions are

made healthy. This is followed by long-lasting protective interventions, clinical interventions,

then counseling and health education at the peak of the pyramid as shown in figure 1 of this

page. The HIP utilizes a framework of interventions that are applied to health priorities such as

global mental health.

Socio-economic Factors and Their Impact on Mental Health

Reduction of poverty and having improved education are the major social determinants of

public health both within and across countries. Factors such as attainment of low education,

poverty, lack of sanitation, and deprivation lead to exposure to various environmental hazards.

Children raised in such environments are highly exposed to unhealthy food, use of drugs and

alcohol as well as dangerous chemicals and toxins such as lead or pollution. These exposures

can lead to depression and cardiovascular and cancer-related disease. These factors can

contribute to mental illness.  Limited resources and supports, community violence, vandalism
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and crime, substance use, unstable housing, unemployment, and food insecurity contribute to

high rates of caregiver stress and depression in poverty-impacted communities (Acri, et al.,

2017).

While, developed countries such as the United States (U.S.) have a much better

infrastructure to support improved mental health, the U.S. has the third highest rated of

depression in the world (Depression rates by country 2020, 2020). One theory as to why the

U.S. and other rich countries have such high depression rates is due to the culture of working too

much, stress, lack of community, and too much screen time or social media. All these factors

can contribute to depression.

Changing the Context to Encourage Healthy Decisions

This is the second tier of the HIP where individuals make default healthy decisions.

These interventions may include choosing to avoid products that may lead to exposure to lead,

asbestos, and other elements that may contribute to mental illness when consumed either

knowingly or unknowingly. Choosing to eat healthy, fresh food as opposed to processed foods

with food dye and refined sugars plays a huge factor in mental health. Other interventions that

may result in a healthier mind set are increasing physical activities and exercise. Being outside

has many benefits, vitamin D can not only boost your immune system but also help improve

depression (Penckofer, et al, 2010). Overall, healthy food and opportunities to make healthier

choices need to be made more readily available to people.

Long-Lasting Protective Interventions

This is the third tier of the HIP interventions aimed at reaching people collectively. Most

countries must allocate more resources to mental illness and care to achieve adequate mental
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health care services for long term solutions. Working proactively to provide mental health

services to the population can prevent depression and anxiety in the long term.

Individuals should be encouraged to practice mental health activities which include

cognitive behavioral therapy, meditation or mindfulness, and psychotherapy worksheets (Riopel,

2020). These are long term mental wellness activities that have positive effects on people’s

health and provide a sense of inner peace.

Clinical Interventions

These are interventions at the fourth level of the HIP and represent the prevention of

diseases that are likely to cause depression, stress, and anxiety. It involves clinical care services

that prolong life and reduce disability among people although the interventions are limited by

unpredictable adherence and lack of access. Nonadherence is a major problem especially with

psychiatric medications because the person may start to feel better and think they do not need the

medication anymore. Many side effects are associated with psychiatric medications which make

it difficult for some patients to stay compliant (Velligan, et al, 2017).

There are unmet treatment needs for severe mental illness in both less developed and

undeveloped countries. There must be urgent agenda to develop more effective, affordable, and

safer treatment strategies that incorporate a more integrated mental healthcare model in which

medical and mental illness are addressed in one clinic (Lake & Turner, 2017). This is

accomplished by implementing changes in physician practices and incentives to support the

prevention and management of all diseases and activities likely to cause stress and depression.

Counseling and Educational Interventions

These are part of the fifth tier of the pyramid and represent interventions aimed at health

education and counseling. Nurses at this level are tasked to improve patients’ health through
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recommendations and encourage preventative services like counseling, screening, and

medication. The nurses’ recommendations and preventative care are about increasing physical

activities and improved diet, avoiding drug abuse, controlling existing diseases, and moderating

alcohol use. These will lead to good physical health therefore preventing stress, depression, and

anxiety that may cause mental illness. Their preventative care involves a range of techniques

that include identification, education, prevention, and treatment of diseases in populations across

the globe based on their position in health care facilities.

The change of behavior theory that is most employed in healthcare is the Health Belief

Model (HBM). It asserts that for people to have a behavior change, they have to feel vulnerable

to the health risk, understand possible severe consequences, and feel that they can take action to

reduce or prevent the risk with no barriers at an affordable cost (Jones et al., 2015). Once this

model is understood by the general public, then the change in their behavior to avoid stress and

depression can help reduce mental illness. Counseling and clinical health education are always

helpful among teenagers especially in high schools to help them manage stress and depression

that may arise as they associate with others and changes to life.

Recommendations

Having gone through the interventions of the HIP and their impact on mental health,

there are still other interventions that can be put into place to effectively curb this global

problem. All medical practitioners should encourage an increase in professional, political, and

social awareness of the importance of prevention of mental illness. Countries should encourage

interventions for each growth stage to minimize risk factors impact. Nurses in all clinical care

facilities should be encouraged to provide education on healthy lifestyles that include exercise,

good nutrition, healthy stress management. School-based interventions that target children and
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parents to help them curtail stress and depression would be beneficial. In summary, all mental

health interventions should involve all experts that include therapists, psychiatrists, social

workers, and psychologists working together as a team to help manage mental health.

Discussion

There are many factors that contribute to a countries approach and treatment of

mental illness. Aside from access and resource availability, culture plays a significant role.

Health beliefs are largely influenced by the culture of a particular set of people (Nielsen-

Bohlman, 2004). This is especially true of mental illness due to the stigmatization and negative

beliefs associated with mental illness. It is important that health professionals work to educate

and change beliefs about mental illness. Complementary health care is health care that is not

part of standard health care. This is widely influenced by cultural beliefs. Some people in India

and China do not believe in western medicine. Such people tend to use complementary health

therapies, some of which are dangerous. Use of herbs, hypnosis, and many other methods are

being used to treat mental health. Integrative health care is where complementary medicine is

combined with standard medicine. A good example of this is acupuncture, which is common in

Chinese medicine. This is the use of needles in therapy. In China and some parts of India, it is

widely used in the treatment of the mentally ill.

One of the ways that we can work to normalize mental health care is by integrating

mental health care into conventional health care. Starting a dialogue early on in an individual’s

life will help normalize and make them more open to discussion of mental health. Nurses can

play a significant role in getting the ball rolling in that regard.

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