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 PsychologyChapter 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)

Unintentional Injuries

Diabetes Suicide

Cirrhosis of the Liver HIV

All of the above have been linked to cigarette smoking, alcohol abuse, unwise eating, stress & a sedentary lifestyle

Deaths with Preventable CausesIn 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

300,000 14%

Alcohol, firearms, sexual behaviors, motor vehicles & illicit drugs

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. 199515 – 24 y.o. vs 24 – 44 y.o.

Heart Disease

Cancer

Suicide

Homicide

HIV

Accidents &UnintentionalInjuries

0 5025

10.6%3.0%

13.7%4.7%

7.9%13.9%

6.4%21.2%

19.2%1%

17.2%40.4%

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.

HealthBehaviors

Interactions

Income

Education

Occupation

Social Class

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 increasedrisk 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 ExpectancyThe 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

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 punishmentAncient Rome: an absence of pathogens, such as bad air or body fluids, that cause diseaseEarly Christians: not as important as disease, which is a sign that one is chosen by GodWorld Health Organization: A state of complete physical, mental & social well-being

Changing Health ModelsBiomedical 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 & HealthSince 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 MedicineDesigned to integrate medicine & the various behavioral sciences, the goals include:

Improved prevention

Diagnosis

Treatment

RehabilitationB-Med attempts to use psychology & the behavioral sciences along with medicine to promote health & treat disease

Behavioral HealthBehavioral 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 TopicsTopics 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 pressurecontrolling cholesterolmanaging stressalleviating painstopping smokingmoderating risky behaviorsencouraging regular exerciseencouraging regular medical/dental examsencouraging 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 DisparitiesHealthy 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

• 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 AmericansMany 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

CuriouslyLow 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 AmericansAsian 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 PsychologyGoal of Health Psych:

Translate knowledge into actionFour 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 OpportunitiesSince the early 1980’s, employment opportunities for health psychologists have increasedPositions includeFaculty appointments in universities & medical schools, postdoctoral research fellowships, predoctoral internships, employment in hospitals, clinics, private practices, HMO’s & pain clinics

TrainingHealth 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

• 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 DiseaseTrend 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 livingContributors to increase:– Proliferation of hospitals– Growth of technology– Large proportion of MD’s are specialists– Growing Administrative costs