Health Psychology 2580
Mondays 6:30 – 9:20
Instructors: Mark Vosvick, Ph.D.
Amy O’Neill, B.S.
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
Introducing Health Psychology
Chapter 1
How have views of health changed?
What do you think psychology’s
involvement is in health?
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
What Do You Think Psychology’s
Involvement Is in Health?
Discuss
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
Chronic Disorders
• Heart Disease
• Cancer
• Chronic Obstructive Pulmonary Disease
(COPD)
• Stroke
20th & 21st Century Chronicities
Diseases associated with individual
behavior & lifestyle:
Cardiovascular Disease
(stroke)
Cancer
COPD (emphysema &
chronic bronchitis)
Diabetes
Unintentional Injuries
Cirrhosis of the Liver
HIV
Suicide
All of the above have been linked to cigarette smoking,
alcohol abuse, unwise eating, stress & a sedentary lifestyle
Deaths with Preventable Causes
In 1990, more than 1 million deaths
(about half the deaths in the U.S.) had
preventable causes*
Tobacco
400,000 Deaths
19%
Diet & Physical
Inactivity
Alcohol, firearms,
sexual behaviors,
motor vehicles &
illicit drugs
300,000
14%
200,000
9%
* McGinnis & Foege, 1993
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
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
Leading Causes of Death among Adults – U.S. 1995
15 – 24 y.o. vs 24 – 44 y.o.
10.6%
Heart
Disease
3.0%
13.7%
Cancer
4.7%
7.9%
Suicide
13.9%
6.4%
Homicide
19.2%
HIV
Accidents &
Unintentional
Injuries
21.2%
1%
17.2%
40.4%
0
25
50
Leading Causes of Death by Race
Ethnic background is also a factor in life
expectancy & cause of death.
Why do you think?
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.
Interactions
Income
Education
Social Class
Health
Behaviors
Occupation
Race
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
Poverty & Health
• Prenatal health risks
• Cutbacks in federal immunization
programs
• Neighborhood violence
• Regular health care is difficult
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.
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?
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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
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
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
What is Health?
Discussion
Two Categories:
Health is an ideal state
Health is a movement in a positive
direction
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
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
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
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
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
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.
Psychosomatic Medicine
Psychosomatic medicine is concerned
with the emotional & psychological
components of physical diseases & the
psychological & somatic factors that
interact to produce disease
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
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
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
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.
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
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
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.
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
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.
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
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
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.
History of Health Ψ
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
Group Exercise
Future Challenges
Chapter 17
Looking Toward the Future
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
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
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
Factors Contributing to Disparity
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Education
Income
Occupational Status
Ethnic Background
Complex interactions between these,
which complicates interpretation of
reasons for disparities
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
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
Latino/Hispanic Americans
Many Latino’s/Hispanic Americans also
experience low socioeconomic status &
poor education but not all groups are
equally affected & their health & longevity
tend to vary accordingly.
This group fares about the same or better
than European Americans on health &
mortality measures
- lower death rates
Curiously
Low death rates (specifically due to heart
disease, stroke & lung cancer) among
Latino/Hispanic Americans is puzzling,
given the high rates of smoking, obesity &
hypertension in this group.
Hypothesis?
A lag during transition from adopting U.S.
lifestyle behaviors to the development of
associated chronic diseases
Asian Americans
Asian Americans who adopt U.S. lifestyle
behaviors that increase their risk,
however this group still has a more
favorable health status & life expectancy
than other ethnic groups.
- lower infant mortality
- longer life expectancy
- lower lung & breast cancer deaths
- lower cardiovascular death rates
Increasing Access to Preventive Services
Primary Prevention
- consists of immunizations & programs that
encourage lifestyle changes
- encouragement to quit smoking, eat
properly, exercise & moderate drinking
- usually a good bargain (i.e. cost effective)
with few risks
Secondary Prevention
- screening people at risk for developing a
disease in order to find problems in their
early & more treatable stages.
- costly
Profession of Health Psychology
Goal of Health Psych:
Translate knowledge into action
Four Major Contributions:
- accumulate more information on behaviors
& lifestyles vis a vis health & illness
- promote & maintain health
- contribute to the prevention & treatment of
disease
- help to formulate health policy & promote
the health care system
Psychology’s historical involvement in
changing human behavior positions it to:
- help people eliminate unhealthy practices
- support their attempts to incorporate
healthy behaviors into an ongoing lifestyle
Challenges include:
Asthma
 Arthritis
 Alzheimer’s
 AIDS
 Cancer
 Stress
 Diabetes
 Headaches
 Cardiovascular disease
Employment Opportunities
Since the early 1980’s, employment
opportunities for health psychologists
have increased
Positions include
Faculty appointments in universities &
medical schools, postdoctoral research
fellowships, predoctoral internships,
employment in hospitals, clinics, private
practices, HMO’s & pain clinics
Training
Health Psychologists now receive a solid core
of graduate training in areas such as:
-biological bases of behavior, health & disease
-cognitive & affective bases of behavior, health
& disease
- social bases of health & disease
- psychological bases of health & disease,
focusing on individual differences
- advanced research, methodology & statistics
- psychological & mental health measurement
Work Settings
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Universities
Hospitals
Clinics
HMO’s
Private Practice
Center for Disease Control (CDC)
National Institute of Health (NIH)
A Day in the Life of…
Health Psychologists:
- Teach
- Conduct research
- Provide service to individual patients &
agencies
Much of the work is collaborative,
frequently working with teams of health
professionals including physicians,
nurses, physical therapists & counselors
Services Include
• Alternatives to pharmacological
treatment
– Biofeedback instead of analgesic drugs for
headache patients
• Primary treatment for physical disorders
that respond favorably to behavioral
interventions (chronic pain & GI
problems)
Services Continued
• Traditional psychological services for
hospitalized patients (i.e. cardiac or
cancer patients)
• Help to improve adherence to medical
regimines (including drugs)
• Provide assessments
Future Challenges
• Changing patterns of illness
• Escalating cost of health care
Changing Profile of Disease
Trend shifts from Cardiovascular Disease
(CVD) to Cancer
• Focus has been on CVD, with the
development of behavioral interventions
for reducing cholesterol, lowering blood
pressure, encouraging exercise &
promoting heart-healthy behavior
• An expectation that deaths from cancer
will surpass CVD
• The prominence of cancer as a cause of
death among young & middle-aged
adults
– Children & adults from 50 – 65 show a
greater tendency to die from cancer
– Cancer accounts for more premature death
than CVD
• The leading cause of death in young &
middle-aged women
– 37% of deaths in women btwn ages 15 &
64 (only 22% for CVD)
• Reducing unintentional injuries – the
leading cause of death for young people
btwn ages 15 & 24. Leading killers:
- motor vehicle crashes
- intentional violence
- suicide
• Aging of the U.S. population. After 65,
many people develop chronic illnesses
& suffer from chronic pain
Controlling Health Care Costs
• Health Care Costs in the U.S. have
escalated at a higher rate than inflation
& other costs of living
Contributors to increase:
– Proliferation of hospitals
– Growth of technology
– Large proportion of MD’s are specialists
– Growing Administrative costs