Abstract
Behavioral epidemiology constitutes a series of practices that gather data on behavioral-related factors related to disease spreading and affecting communities and populations. Healthcare managers are in a position to utilize that data to inform their decision-making in day-to-day tasks as well as interventions. They can use it strategically to inform the scope, the goals, and the use of resources to achieve specific results. At the same time, the political dimension, presence of different stakeholders, resource limits, and personal biases prevent decision-makers from using it to one’s full potential.
Introduction
Epidemiology is a useful tool for healthcare managers to be implemented in the decision-making process. It allows making healthcare decisions based on the real needs of the population, and adjust medical services accordingly. Therefore, healthcare management and epidemiology go hand in hand. The information provided by epidemiological studies could and should be used to allocate resources, assign priorities and objectives, and guide interventions as well as everyday experiences. Behavioral epidemiology is a subset of epidemiology that has to do with health habits that can either promote healthy or unhealthy behavior, or undermine it. It allows connecting the behaviors of people with the pattern of distribution of diseases ranging from obesity to the more recent epidemic of COVID-19.
At the same time, despite the usefulness of epidemiology to healthcare management, the latter does not fully realize the necessity of it for effective healthcare administration. Epidemiology has been in place since at least the 1970s, and despite almost 50 years had passed; its use started to gain traction only after the early 2000s, and had been recently increased due to the pandemic. Before that, leaders and administrators took strategic and operational decisions without proper guidance of the data behind the real picture of health of the population, using frameworks and ideas not thoroughly backed by epidemiological research. The lack of behavioral epidemiological data may explain why, for example, obesity programs have not reached any modicum of lasting success in the USA. “God gives wisdom generously to all” (James 1:5). Therefore, it would be unchristian to deny the wisdom behavioral epidemiology offers, to make healthcare-related management decision. This paper will evaluate the biblical foundations for using epidemiology, its role in relation to that of a healthcare manager, applications to strategic planning, and currently known issues in its implementation.
Biblical Foundation for the Topic
The popular opinion is that the Bible and Christianity in general oppose many practices imposed by modern medicine. There are enclaves of people who, for one reason or another, refuse specific treatments for religious purposes or, like Followers of Christ, deny the access to medicine altogether in favor of faith-based practices (Whitt, 2019). When it comes to behavioral epidemiology, however, it could not be further from the truth. In fact, the first examples of it could be found in the Old Testament itself (Hollman, 2020). Examples of these include the avoidance of unclean meat, provided by creatures that eat dead meat or serve as “cleaners” of the land and ocean, thus more likely to be filled with impurities and cause various diseases (Leviticus 11:11).
Based on this notion, it could be observed that Christianity actually promoted healthy living through behavioral means, essentially acknowledging the existence and usefulness of the concept in order to ensure better health. By ensuring that people ate only healthy foods in moderation, God takes care of his children and ensures their happiness and longevity (Farhan, 2018). The current endemic of obesity that swipes the world right now is, in part, due to the consumption of unhealthy meats. Pork, for example, has been warned against in the Bible, as God forbade Moses and his followers to eat it, as the creature “parts the hoof but does not chew the cud” (Leviticus 11:27). Therefore, it was prohibited from consumption by good Christians. Indeed, pork meat is filled with unhealthy fats and has more calories than chicken meat or fish. Excluding it from consumption would greatly help against obesity, thus proving that the Bible understands its epidemiology.
Another connection between biblical laws and theses and behavioral epidemiology could be found in Corinthians 1:7, which addresses the virtues of monogamy from a clinical perspective. God says that a man should have only one wife, and a woman – only one husband (Corinthians 1:7). From a behavioral epidemiology point of view, it is an excellent suggestion, as having stable sexual partners and not engaging in polygamy helps prevent transmittable sexual diseases. Doing so prevents having them spread among the populace. In addition, responsible behavior like that is beneficial to promoting social health and ensuring that children have parents (Dave & Keller, 2019). In contrast, sexual frivolity without protection is likely to result in unwanted pregnancies, incomplete families, and other social determinants prerequisite to bad health.
Based on these observations it could be seen that the Bible is approving of utilizing behavioral interventions against well-known diseases, and expresses awareness of epidemiology as a concept. While God’s word predates the concept of healthcare management as a dedicated profession, it speaks extensively about community leadership and one’s role in maintaining it. Bible says the following: “there may be no division in the body, but that the members may have the same care for one another. If one member suffers, all suffer together” (Corinthians 1:10). Thus, the role of a healthcare manager, in relation to behavioral epidemiology is to acknowledge the unhealthy behaviors and rectify them in accordance to best medical practices and the implicit support from God. The relationship between the two, thus, is not opposing, as the popular stigma suggests, but rather mutually supportive in seeking new ways of improving communities and the flock.
Discussion of the Role of the Healthcare Manager
While doctors, nurses, and related personnel provide direct healthcare services to persons and communities, healthcare managers take care of administrative tasks. They manage schedules, budgeting, and resources, without directly engaging with patients (Brauer et al., 2019). From a biblical perspective, their role is that of a leader, who “each has received a gift, use it to serve one another, as good stewards of God’s varied grace” (Peter 4:10). However, by nature of their trade they do not have the same experiences as nurses and doctors do. The latter cannot have an objective picture of what is going on in the community, as they are limited to their own perspectives and experiences. Epidemiology is the blanket of data that shows what is going on not with individual persons or groups of people, but large communities as a whole (Brauer et al., 2019). By utilizing epidemiological data, healthcare managers can understand the current developments, predict future motions, distribute resources, and prepare accordingly. If such an individual can be compared to a shepherd, then epidemiology serves as a weather broadcast to decide where to move the herd.
Healthcare managers are, thus, identified as the decision-makers that can allocate effort and resources to tackling specific problems. Behavioral epidemiology, as a subset of epidemiology, is relevant to the process since it concerns various types of behaviors that can either increase or decrease the amount of effort necessary for engaging a specific healthcare problem (Brauer et al., 2019). Predisposition towards obesity, for example, is present as a genetic anomaly in a very small number of people (Chooi et al., 2019). In the majority of cases, however, it is a result of negative behaviors ranging from unhealthy eating to a sedentary lifestyle to a lack of meaningful exercise and diet balancing. In parts of the world that do not endorse the eating of high-calorie foods (such as the Middle East), this problem is less prevalent than in other places (Albataineh et al., 2019). The issues of unprotected sex, the surge of AIDS, HIV, and other STDs is resurging, partly because of the failure of the society to live in accordance with Biblical ideals (Dale & Keller, 2019). This brings the role of a healthcare manager to in a different light in relation to the facility and the community.
Healthcare managers are intended to be the role models and the speakers for public health. Since they have access to epidemiological data and can utilize their facilities to gather such, they are more aware of the issues than anyone else. In addition, they have access to medical literature and evidence-based practices that could be implemented on the community scale (Tate et al., 2019). They can work with doctors on their propositions for interventions, initiate some themselves, and act as advocates for healthcare when in contact with governments, agencies, civilian authorities, and community managers. They serve as an important joining point between these different stakeholders, which puts them in a unique position to head and direct interventions. Knowing what to do and where to go, which is the kind of information epidemiology provides to decision-makers, and lends itself to strategic planning, that will be described below.
Application in Strategic Planning
There are numerous applications of behavioral epidemiology to strategic planning. The first application is in defining health policies as something that goes beyond services. They allow formulating goals as well as terms on which they can be achieved. This goes beyond the scope of services as well as resources that need to be mobilized to achieve the results (Abel-Smith, 2018). As a result, the objectives of policies become measurable as to their effect on the population. For example, an obesity-related program would result in numerous metric changes, from the overall BMI to a decrease in pre-diabetic patients within a community (Blüher, 2019). The objective is difficult in that it has to account for persons’ often spontaneous behavior.
Epidemiological data can be used in these situations to provide a set of acceptable criteria for priorities, describe the state of health, and evolution of problems. It allows for the evaluation of responsiveness of different targets to the intervention. Other behavioral data includes psychological, cultural, and social variables (Abel-Smith, 2018). These can be gathered using quantitative methods and effectively shape the relationships between therapists, services, and patient outcomes.
On a regional and municipal strategic levels, health systems prefer a collective approach to individual health problems. Institutional and professional interventions focusing on individual case-by-case scenario often do not have access to relevant epidemiological data but may contribute to the gathering of it and creating a larger picture. Population approaches, on the other hand, require such data to start. Therefore, without epidemiological data, a scale approach cannot be utilized, unless the intervention is doomed to wander in the dark or address health problems to which there is little to no epidemiological data currently available. The usual sources of behavioral data include managers, professionals, and representatives of the population that could be considered reliable enough to serve as valid examples of what is currently going on in the community.
The strategic uses of epidemiological data lead to a more equitable redistribution of various resources available to the manager. If one particular subset of disease is a lot more prevalent than the other, it would be prudent to focus more on the ones that are affecting the most people. For example, COVID-19 vaccines have shown to be effective in reducing or outright negating the effects of the virus, while the data on the wearing of masks is inconclusive – there is no direct link between the epidemiology of the disease and the wearing of masks (Brüssow& Zuber, 2022). Based on these findings, it might be more pressing to ensure total vaccination before enforcing the masks regime. Indeed, in many areas of the US and the world wearing them changed from mandatory to optional. On the other hand, some populations may be more exposed to certain conditions than others. In that case the allocation of resources should be based not on sensibility and equality, but rather on equity (Babor et al., 2019). Needs-based frameworks usually operate with an emphasis on disenfranchised and minority groups.
Finally, epidemiological data is invaluable to strategic planning in order to differentiate between interventions that work and those that do not. In the majority of cases, the resources available to spare would be limited. Limitations can be on equipment, materials, time, or personnel. When selecting different interventions that address different parts of the epidemiological program, a healthcare manager has to look for what works the best. For example, an intervention aiming to change the behaviors of the population to eat healthier is likely to prevail on the collective level to the highly-individualistic operational solution, which deals with obesity at a great cost without removing the causes (Suksatan&Posai, 2020). Thus, it is possible to see how epidemiological data is applied at a scope, strategy, distribution, and resource levels.
Currently Known Issues
Despite the fact that behavioral epidemiology is both a useful and a God-ordained tool to be used in medicine, there are various gaps between itself and healthcare managers. The first issue comes from the relative novelty of applying policies that were based on epidemiological rather than political concern. Goals are usually formulated by peoples’ demands rather than objective healthcare needs, and it is hard for these goals and objectives to align (Dorsey et al., 2020). The US healthcare system is making an effort to make that coordination happen, but progress is still slow, as the demand is formed by other forces (Dorsey et al., 2020). Therefore, the political dimension is clearly present in utilizing data.
The other issue lies in the misuse of the resource allocation for different needs. The people responsible may twist the needs data to accomplish their own agendas, exacerbating the need despite the epidemiological data saying otherwise. Decision-makers may have a commitment to various entities to prioritize them and their needs, making objective use of resources and the data difficult (Smithard and Haslam, 2021). It is the reason why epidemiologists and healthcare managers have to be not only decision-makers but also advocates, and convince the population that the specified course of action is what they need, rather than the other way around.
Even when the political will and the stakeholders are behind a particular intervention, the lack of epidemiological data presents a big issue for healthcare managers. In some areas, it is hard to collect, making educated solutions difficult. In other areas, the data is not of a quantitative nature – biases are present and determining the right course of action is hard. Finally, the nature of some issues makes the collection of said data hard to achieve. Subjects like sexual violence, child molestation, drug abuse, emotional abuse, and others are difficult to talk about or to quantify (Oram, 2019). As a result, the interventions often have to take risks, often to acquire the epidemiological data required, for future use.
Finally, there is the issue of personal bias of decision-makers. Epidemiological data is often unclear and offers conflicting evidence based on the methodology, mistakes made during collection and the general data flow inputs. Managers are often responsible for under-utilizing epidemiological data when it does not fall into their preconceptions of what is or is not good information (Briere et al., 2018). They question the validity of numerators and denominators, the credibility of collection tools, and the quality of scientific analysis. The very definition of epidemiology makes the analysis harder, as the status quo to which the data is compared to vary from one case to another. There is a perception that diseases themselves are social constructs, as is evidenced by fat acceptance movements in the US, which advocate and propagate for obesity as the new norm rather than an unhealthy anomaly (Smith, 2018). Such motions make the use of epidemiological data a perceptions-charged question.
There are numerous other issues that arrive from the use of epidemiological data in decision-making, but it varies from case to case. Sometimes, the ones outlined are isolated, other times they are together. The more of these issues arise – the harder it is to implement the data to policies and day-to-day applications. A healthcare manager has to be mindful of these matters when working with behavioral epidemiologic data.
Conclusions
Behavioral epidemiology is a useful tool for providing data for healthcare managers. Its use is ordained by the Bible and supported both in word and spirit by various chapters of the Holy Text. It is important in strategic planning when formulating objectives, assigning resources, and determining the proper framework to achieving success. The role of the healthcare manager is intrinsically connected with the concepts of epidemiology and the data it provides. At the same time, engaging in the use of that data can be met with difficulties. Some of the most important barriers to implementing epidemiological data include politics, biases, and the influence of various different parties vying for attention, among others. A healthcare manager must utilize the benefits offered by epidemiology without being blind to data’s shortcomings.
Ultimately, utilizing data is better than not doing so and having no guidance whatsoever. They have to become shepherds of the communities they attend to, and act as both professionals and advocates for policies that need to be implemented, and interventions these communities require. With God’s help and direct encouragement, the mission of medicine may continue unhindered, despite the odds.
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