Introduction to Health Psychology PDF

Introduction to Health Psychology CPS2819 Week #2 Dr. Aristea Ladas  Part I: The Background of Health Psychology  Question What does the term “health” mean to you? Health is popularly defined in terms of absence of disease, but it should be viewed as an illness – wellness con...

Introduction to Health Psychology CPS2819 Week #2 Dr. Aristea Ladas  Part I: The Background of Health Psychology  Question What does the term “health” mean to you? Health is popularly defined in terms of absence of disease, but it should be viewed as an illness – wellness continuum “Health” according to the World Health Organization (WHO): “A complete state of physical, mental and social well-being, not merely the absence of disease or infirmity” The Biomedical Model What causes illness? Diseases invade the body from the outside (e.g. viruses, bacteria), or they have a genetic basis Who is responsible for illness? Individuals are seen as victims, not responsible for their illness How should illness be treated? Vaccination, surgery, medical treatments (e.g. chemo, radiotherapy), antibiotics Aim to change one’s physical state Who is responsible for treatment? The medical profession Illness in ancient times ▪ A supernatural thing (a whim of the gods, a punishment, a possession by demons.) ▪ Hippocrates (the Father of medicine): Understanding illness as a natural, rational, observable thing – predictable thing propelled by natural causes – illness as a process of imbalance, not invasion – The body: a microcosm of the universe at large, whose equilibrium depended on four elements – earth, air, fire, and water. A system of 4 fluid “humours”: black bile, yellow bile, phlegm and blood. Balance= health, imbalance = illness 5 Illness in ancient times (cont.) ▪ Set “the cognitive foundation on which scientific medicine was built” writes Yale historian Frank M. Snowden ▪ “if disease is postulated as caused by gods, or demons, then scientific progress is impossible. If it is attributed to a hypothetical humor, the theory can be tested and improved.” (Winslow, epidemiologist in 1940s) 6  The Biomedical Model What is the relationship between health and illness? Qualitatively different: You are either healthy or ill, there is nothing in between What is the relationship between the mind and the body? Function independently: The mind–body split; the mind is not capable of influencing one’s physical state, it is abstract and relates to feelings & thoughts What is the role of psychology in health and illness? Illness may have psychological consequences (e.g. negative mood), but not psychological causes  th Changes in the 20 Century Scientists and medical professionals started challenging some of these traditional assumptions of the biomedical model An increasingly important role was placed on psychology in terms of health & illness: A different perspective on the mind–body relationship This has led to the development of several new scientific fields (e.g. psychosomatic medicine, behavioural health), including health psychology  What is Health Psychology? What causes illness? A combination of biological, psychological (e.g. behaviours, cognitions, emotions) and social factors (e.g. employment, class, ethnicity, social norms) Who is responsible for illness? The individual is not a passive victim How should illness be treated? Not just the physical symptoms, but the whole person Who is responsible for treatment? The individual is also partly responsible  What is Health Psychology? What is the relationship between health and illness? Not qualitatively different, but rather exist on a continuum What is the relationship between the mind and the body? The mind and body interact A holistic (whole-person) approach to health What is the role of psychology in health and illness? Psychological factors are not only a consequence, but can also contribute to health and illness  The Focus of Health Psychology 1) The Biopsychosocial Model 2) Health as a continuum 3) Direct & indirect pathways to health 4) Variability in health and illness  Discussion: Try to give an example of how you think bio-psycho-social factors might interact, and influence our health and illness  1. The Biopsychosocial Model This model integrates psychology (“psycho”) and the environment (“social”) into the traditional biomedical (“bio”) model of health and illness  2. Health–Illness Continuum Psychological factors impact health at all stages of the continuum: – Illness onset: Beliefs, behaviour, stress – Help-seeking: Social norms, illness cognitions, symptom perception – Illness adaptation: Coping, pain, social support – Illness progression: Stress, adherence to treatment, behaviour – Illness outcomes: Quality of life, longevity, reoccurrence  3. Direct & Indirect Pathways Direct pathway: Psychological factors affect physiology: – E.g. acute or chronic stress: Coronary heart disease, stroke, cancer, immune system deficiencies, etc... Indirect pathway: Psychological factors affect behaviour, which then affects physiology: – Smoking, drinking, drug abuse – Diet, exercise, sleep – Sexual behaviours Direct Pathway Indirect Pathway  4. Variability in Health & Illness a) Geographical location b) Socioeconomic status (SES) c) Gender d) Time There is also variability between people: – Two people both know that smoking is bad, but only one quits – Two women both find a lump in their breast, but only one goes to the doctor  The Aims of Health Psychology 1. Understand, develop & test new theories: – Why do people engage in unhealthy behaviours even when they know the risks? – Does stress cause illness? – Do certain behaviours cause illness? – How do people cope with chronic illness? 2. Put the theory into practice: – Target and change “unhealthy” beliefs & cognitions – Promote healthy behaviour change – Prevent illness onset  To Conclude Health psychology challenges the traditional biomedical approach, and emphasizes the role of psychology in the cause, progression and outcomes of health & illness Focuses on: – The biopsychosocial model – Health–illness continuum – Direct and indirect pathways – Variability in health Aims to: – Develop & test new theories – Put theories into practice  Part II: Variability in Health  Health Inequalities Worldwide Health and illness are not constant, they vary across a number of key dimensions: 1. Geographical location 2. SES 3. Gender 4. Time  1. Geographical Location The prevalence of a range of diseases & their mortality rates vary enormously between countries: – Highest death rates in Eastern Europe, Russia, and Central Africa – Lowest death rates in the Middle East, North Africa, and Central America Death Rates per 1,000 (2019)  Geographical Location Childhood mortality rates also vary significantly between countries: – Highest in Africa and South-Central Asia – Lowest in Europe, Canada, and Australia However, childhood mortality rates have fallen universally Child Mortality Rates per 1,000 (2014)  Geographical Location There are also geographical differences in specific diseases: – E.g. HIV/AIDS highest in Africa and the Americas Geographical differences within continents: – E.g. lung cancer highest in Hungary, Serbia and Greece; lowest in Sweden and Portugal (2018) There can also be variation within a country (e.g. mortality rates higher in northern England), and even within a city (e.g. mortality rates higher in east London) Global Prevalence of HIV (2017)  2. SES With low SES comes an increase in: – Communicable conditions (e.g. infections, viruses, bacteria) – Maternal & perinatal conditions – Nutritional deficiencies With high SES comes an increase in: – Non-communicable conditions (e.g. diabetes, cancer, diseases of the heart) With middle SES comes an increase in: – Deaths by injury and/or accidents Premature Mortality (< 75) Worldwide  SES There is also SES-related variation in specific health conditions, such as: Lung cancer: – Highest in low SES group – True for both men & women Diabetes & obesity: – Highest in low SES group – BUT True only for women – For men highest in the middle SES group Lung Cancer Rates by Gender and SES Diabetes Rates by Gender and SES  3. Gender On average, women tend to live 3-4 years longer than men (globally) However, this gap is gradually closing  Gender MacIntyre et al. (1996) Gender differences in a range of illnesses  Gender MacIntyre et al. (1996) Gender differences in physical symptoms  Gender So it seems that women suffer from more illnesses & experience more physical symptoms, and yet they live longer? Men are less likely to report having symptoms, have overall less contact with the health care services, and on average tend to lead more unhealthy lifestyles: – Less likely to have seen a doctor in the last 12 months – Have fewer hospital admissions – Less likely to have a screening test, or a general health check-up – More likely to smoke, drink, have poor diets  “Men are more likely to smoke, drink excessively and be overweight. They are also less likely to seek medical help early, and if diagnosed with a disease, they are more likely to be non-adherent to treatment. On top of all that, men are more likely to take life-threatening risks and to die in car accidents, brawls or gun fights.” Dr. Perminder Sachdev Professor of Neuropsychiatry at the University of New South Wales in Australia  Why Does This Variability Exist? The most commonly used explanations focus on 3 key factors: 1. Medical interventions 2. The environment 3. Behaviour 1. Medical Interventions Availability and cost of medication Training & expertise of health professionals Access to health care (e.g. distance needed to travel, free access to services, health insurance) Antiretroviral medication for HIV/AIDS: – Western world Chronic illness; normal life expectancy – Africa Acute terminal illness; low life expectancy MIs could explain variations in child mortality as well – Is a medical professional present at birth? Births Attended by Skilled Health Professionals  However... Decline over time in mortality from tuberculosis (McKeown, 1979): So, other variables play an important role as well (e.g. improved nutrition, better hygiene, contraception)  2. Environment Food availability & hygiene – 10% of population consume food irrigated by wastewater Sanitation facilities (WHO, 2017): – 55% not using safe sanitation facilities – 2 billion do not have basic sanitation facilities (e.g., toilets, latrines) – 700 million still defecate in the open – Sanitation is lowest in Africa, Middle East, South Asia Access to clean water: – In 2019 1 in 3 people do not have access to safe drinking water (highest in Africa & South Asia)  Environment However, even in developed countries, where basic medical & sanitation facilities are available: Easy (and very cheap!) access to unhealthy foods Harsh work environments and schedules Sedentary lifestyles Cars (almost a necessity)  3. Behaviour Even when medication, health care, sanitation facilities & clean water are available The individual is ultimately the one that has to choose to be healthy – Do I really need to go to the doctor? – I don’t want to take this medication for a week... – I don’t care about washing my hands after going to the bathroom, and then eating a sandwich... – Should I be partying and drinking all weekend, and then going to my Health Psychology class on Monday morning?  Behaviour & Longevity Most common causes of death in Europe & US Chronic health conditions (e.g. cardiovascular diseases, cancer, diabetes; account for 60-75%) Belloc & Breslow (1972) 7 key behaviours that are related to good health and high life expectancy: 1. Sleeping 7-8 hours a day 2. Having breakfast every day 3. Not smoking 4. Rarely eating between meals 5. Being near or at prescribed weight 6. Moderate or no use of alcohol 7. Regular exercise  Behaviour & Mortality On the opposite side of the spectrum… Death from all causes is significantly related to these 4 behaviours (Khaw et al., 2008): – Smoking – Not being physically active – Drinking more than moderate amounts of alcohol – Not eating five or more portions of fruit and vegetables per day 75% of all cancer-related deaths are associated with these behaviours...  To Conclude Health and illness vary along 4 key dimensions: – Geographical location – SES – Gender – Time These variations can be explained by 3 main factors: – Medical interventions – The environment – Behaviour QUESTIONS