Health Psychology 2580

1. Health Psychology 2580 Mondays 6:30 – 9:20 Instructors: Mark Vosvick, Ph.D. Amy O’Neill, B.S.

2. Today’s Agenda • Introduction- Distribute & Review Syllabus- Introduce Instructors- Randomize Students into Groups • Chapter 1- Foundations of Health Ψ- Lecture, discussion & questions- Breakout groups • Chapter 17 – Future Challenges- Lecture, discussion & questions

3. Introducing Health PsychologyChapter 1 How have views of health changed? What do you think psychology’s involvement is in health?

4. How Have Views of Health Changed? • Leading causes of death have changed from infectious diseases to those that relate to unhealthy behavior & lifestyle • Escalating cost of medical care is stimulus to educate about health-related practices that lower risk of illness • New definition of health: The presence of positive well-being, not simply the absence of disease • Questions about traditional biomedical model & advocacy for a broader perspective of health & disease

5. What Do You Think Psychology’s Involvement Is in Health? Discuss

6. Chronic Disease Major health problems in the U.S today are due to chronic diseases. What’s a basic definition of chronic disease? A disease that develops, persists or recurs over a long period of time What’s the opposite of a chronic disease? Acute

7. Chronic Disorders • Heart Disease • Cancer • Chronic Obstructive Pulmonary Disease (COPD) • Stroke

8. 20th & 21st Century Chronicities Diseases associated with individual behavior & lifestyle: All of the above have been linked to cigarette smoking, alcohol abuse, unwise eating, stress & a sedentary lifestyle

9. Deaths with Preventable Causes In 1990, more than 1 million deaths (about half the deaths in the U.S.) had preventable causes* * McGinnis & Foege, 1993

10. Ranking Complexity Looking at an entire population allows you to obtain an overview of causes of death. What’s the problem with stopping there (i.e. only looking at the general population)? Age & Race statistics may be skewed

11. Leading Causes of Death by Age • Chronic disease are reported as the leading causes of death in middle-aged & older people. • Young people (15-24) more frequently die from accidents or unintended injuries: Unintentional injuries 40% Homicide 21% Suicide 14% • For adults 25-44, HIV is the primary cause of death

12. Leading Causes of Death among Adults – U.S. 1995 15 – 24 y.o. vs 24 – 44 y.o. 10.6% Heart Disease Cancer Suicide Homicide HIV Accidents & Unintentional Injuries 3.0% 13.7% 4.7% 7.9% 13.9% 6.4% 21.2% 19.2% 1% 17.2% 40.4% 0 25 50

13. Leading Causes of Death by Race Ethnic background is also a factor in life expectancy & cause of death. Why do you think?

14. Social Class Differences Research has shown that social class differences, sometimes referred to as SES (socio-economic status) are more important in predicting health risks than ethnic differences. However, this construct is complex and includes income level, education & occupation.

15. Income Education Occupation Social Class Race Interactions Health Behaviors

16. Research Associations • Poverty is a factor in disease rates & decreased life expectancy • Disproportionate numbers of African-Americans, Latinos & Native Americans are poor • Access to medical care is a factor that makes poverty a health risk • Poverty is associated with poorer health habits Conclusion:Poverty puts poorer classes at increased risk for disease

17. Poverty & Health • Prenatal health risks • Cutbacks in federal immunization programs • Neighborhood violence • Regular health care is difficult

18. Income Level Within any income level, those at higher levels have better health & lower mortality One Hypothesis: Income is related to educational level & educational level is related to behaviors that increase health risks such as smoking, eating high-fat diets & maintaining a sedentary lifestyle.

19. Life Expectancy The 20th century witnessed a dramatic increase in life expectancy in the U.S. (from 47.3 to 76 years) What factors do you think contributed to this? • Better control of infectious diseases • Reduction of infant mortality rates • Safer drinking water & milk supplies • More efficient sewage disposal • Improved nutrition • Antibiotics • Improved medical care

20. Escalating Medical Costs • As people live to middle & old age, they tend to develop chronic diseases which often require extended (and frequently expense) medical treatment. • The cost of medical treatment is increasing much faster than inflation (a 600% increase from 1975 to 1995) • Curbing medical costs requires a greater emphasis on the early detection of disease & on changes to a healthier lifestyle & to behaviors that are preventative in nature

21. Strategy • Early detection of high blood pressure, high serum cholesterol & other precursors of heart disease allows conditions to be controlled, decreasing risk of serious disease or death • Screening for risk is preferable to remedial treatments since chronic diseases are difficult to cure & living with these diseases decreases quality of life • Maintaining health through a healthy lifestyle is even more preferable than screening So which is the best strategy? A healthy lifestyle along with early detection & reduction of health risks

22. What is Health? Discussion Two Categories: Health is an ideal state Health is a movement in a positive direction

23. Markers of Health Psychological Manifestation - A subjective feeling of well-being Social Manifestations - High levels of social productivity - Low demands on the health care system

24. Cultural Implications What does it mean to be healthy? Ancient Hebrews: a gift from God, but disease is a punishment Ancient Rome: an absence of pathogens, such as bad air or body fluids, that cause disease Early Christians: not as important as disease, which is a sign that one is chosen by God World Health Organization: A state of complete physical, mental & social well-being

25. Changing Health Models Biomedical Model- defines health as an absence of disease - diseases are caused by specific pathogens Biopsychosocial Model - defines health as a positive condition - a medical model that takes into account the patient, the social context in which he/she lives & the complementary system devised by society to deal with disruptive effects of illness

26. Major Trends in Health Care  Chronic diseases have replaced infectious diseases as the leading cause of death & disability  Increase in chronic disease has resulted in an increase in medical costs  Definition of health is changing from ‘the absence of disease’ to a ‘state of positive well-being’  Emergence of the biopsychosocial model of health

27. Psychology & Health Since most chronic diseases stem at least partly from individual behavior, psychology (otherwise known as the science of behavior) has become involved in health care Major contributions: techniques for changing behaviors implicated in chronic diseases, relieving pain, reducing stress, improving adherence & help in living with chronic illness

28. Psychology in Medical Settings In the 1940’s medical training limited psychological factors to how they related to disease In the 1960’s behavioral science became a part of the curriculum in most medical schools By the 1990’s, MD’s no longer thought of health psychologists as stats consultants, test administrators or therapists with skills limited to psychosomatic illness.

29. Psychosomatic Medicine Psychosomatic medicine is concerned with the emotional & psychological components of physical diseases & the psychological & somatic factors that interact to produce disease

30. Early Research 1932 – Cannon observed that physiological changes accompany emotion* This research demonstrated that emotion could cause physiological changes which might be related to the development of physical disease * Kimball, 1981

31. 1943 – Dunbar developed the notion that habitual responses, which people exhibit as part of their personalities, are related to specific diseases – i.e. a relationship between personality & disease 1950 – Alexander saw psychosomatic disorders as resting on a link between personal conflicts & specific disease. He believed some people were more vulnerable to effects of stress on organ systems and would develop a disease to which they were most vulnerable

32. Terminology By the 1970’s the emphasis shifted away from specific diseases & the term psychosomatic was no longer applied to diseases but to an approach to the the study & treatment of disease. The psychosomatic approach describes illness as complex & that the single-factor pathogen model is no longer viable

33. Psychosomatic medicine started as a reform movement in medicine but was not entirely successful in emphasizing the psychological & social components of somatic disease. Behavioral medicine has subsumed the original objectives of the psychosomatic movement.

34. Behavioral Medicine 1977 – a conference at Yale University led to the definition of a new field, behavioral medicine, defined as ‘ the interdisciplinary field concerned with the development & integration of behavioral & biomedical science knowledge & techniques relevant to health & illness & the application of this knowledge & these techniques to prevention, diagnosis, treatment & rehabilitation

35. Goals of Behavioral Medicine Designed to integrate medicine & the various behavioral sciences, the goals include:  Improved prevention  Diagnosis  Treatment  Rehabilitation B-Med attempts to use psychology & the behavioral sciences along with medicine to promote health & treat disease

36. Behavioral Health Behavioral health emerged about the same time as B-Med and emphasized the enhancement of health & prevention of disease in healthy people rather than the Dx & treatment of disorders in sick people. Behavioral health is an interdisciplinary subspecialty in B-Med specifically concerned with the maintenance of health & the prevention of illness & dysfunction in currently healthy people.

37. Behavioral Health Topics Topics included within behavioral health:  Injury Prevention  Cigarette Smoking  Alcohol Use  Dieting  Exercise Focus is on individual responsibility for health & wellness rather than physician dx, treatment or rehabilitation

38. Health Psychology Related to both B-Med and behavioral health is a discipline within the field of psychology called Health Psychology, the branch of psychology that concerns individual behaviors & lifestyles affecting a person’s physical health.

39. Health Ψ Contributions Health psychology contributes to:  The enhancement of health  The prevention & treatment of disease  The identification of health risk factors  The improvement of the health care system  The shaping of public opinion with regard to health

40. Specifically, Health Psychology involves the application of psychological priniciples to such physical health areas as: lowering high blood pressure controlling cholesterol managing stress alleviating pain stopping smoking moderating risky behaviors encouraging regular exercise encouraging regular medical/dental exams encouraging safer behaviors

41. Additionally, health psychology helps to identify conditions that that affect health, diagnose & treat certain chronic diseases & modify the behavioral factors involved in physiological & psychological rehabilitation.

42. History of HealthΨ 1973 – the Board of Scientific Affairs of the APA appointed a task force to study the potential for psychology’s role in health research. 1978 – APA established Division 38, Health Psychology 1982 – the journal Health Psychology began publication

43. Group Exercise

44. Future Challenges Chapter 17 Looking Toward the Future

45. Healthy People 2000 Three broad goals, 22 priority areas & 300 main objectives Broad Goals: • Increasing the span of healthy life • Reducing health disparities • Increasing access to preventive services

46. Increasing the Span of Healthy Life Well-year - the equivalent of a year of completely well life, free of dysfunction, symptoms & health related problems Health expectancy - the period of life a person spends free from disability

47. Reducing Health Disparities Healthy People 2000 - a plan to reduce ethnic & socioeconomic disparities by targeting minority groups separate from general population Healthy People 2010 - emphasis shifted away from targeting special groups toward high standards of improved health for everyone

48. Factors Contributing to Disparity • Education • Income • Occupational Status • Ethnic Background Complex interactions between these, which complicates interpretation of reasons for disparities

49. Example of Disparity African Americans, compared to European Americans: - have shorter life expectancy - higher infant mortality rate - more homicide deaths - increased cardiovascular disease rates - higher cancer mortality - more tuberculosis - more diabetes

50. Native Americans Low economic status & lack of access to medical care affect Native Americans at least as strongly as African Americans. - shorter life expectancy - higher mortality rate - higher infant mortality - higher rates of infectious illness