(W1) Ch1 -HMP

Explaining health behavior

life expectancy vs health life expectancy

health life: life expectancy in good health without disability or illness

after 65 only about 50% of one’s remaining years are lived in health

decline in mortality: why?

in developed countries mainly because of immunisation programmes, social and environmental changes in healthcare, mortality rates since 1950 have declined by 25%

causes of mortality

changed

less due to infections, more due to vascular diseases

alzheimer and dementia

fewer due to congenital malformations, HIV, diarrhoea, and more due to diabetes

behavior and health

40% of cancer deaths are attributable to behavior

higher cancer incidence (added cases in an interval) in men due to lifestyle factors, higher incidence also due to living longer

awareness of behavioral risks

grows and behavior changes are made alongside advances in the medical field

decline in heart disease, cancer and respiratory disease deaths

What is health?

concept comes drom the word wholeness

history of health

stone age: trephination (holes in skull to release evil spirits)

1000-300BC: disease as a punishment from god

similar beliefs remain in some cultures today

understanding beliefs is important in understanding indiv responses to illness

Mind-Body relationship

body= physical aspects of humans formed of molecular, genetic, biological, biochemical and measurable components that enable the machine to work, incl physical brain

mind= non-physical entity, reflecting our consciousness, thoughts and emotions that have no physical properties per se

dualistic thinking

mind and boy as separate

either influencing the other

mind body history: humours

Hippocrates (400BC):

• 4 humors (yellow bile, phlegm, blood and black bile) healthy if in balance

• humors linked to personality

• theory was that the body affects the mind

Galen (150AD):

• same view as hippocrates,

• physical and pathological cause to disease,

• added that individual temperaments could contribute to the experience of specific illnesses

18th century:

• failed to find evidence to support humors theory but the idea of connection between body and mind remained

Early Middle Ages (400-500)

• health linked faith and spirituality

Renaissance (1300-1500):

• Individual thinking became popular

• Led to the scientific revolution in 1600

• explanation of illness increasingly organic or physiological

illness aetiology

cause of a disease

René Descartes’ dualism

• mind and body are separate

• mind exists but is non-material

• mind is independent if body which is material

• mind controls body from pineal gland

• soul leaves body when it dies so research on corpses was possible

  → 1700-1900 research on anatomy was done and disease was found to be in cells not humours

René Descartes: mechanistic view

• body is a machine only understandable in terms of its constituent parts

• reductionist: behavior can be reduced to the level of organ or physical function

biomedical model

• diseases and symptoms have an underlying physiological explanation

• mind is considered part of the material body given that it is part of the brain

• mental processes may be mapped through physical neural processes of the brain

monist materialism integrated into biomedical model

non physical mind cannot be studied separately from the physical brain supported by the huge growth in neuopsychology and brain imaging

behaviorism

monistic

emphasozed objectifiable actions and the enviro factors that shape action or behavior

humanism

=approach emphasizes the inner feelings and needs of individuals

only by understanding unique human experience we can understand indiv beh

we seek evidence to understand human experience

growth in neuroscience shows that materialism prevails

biomedical model of illness

health = absence of disease

direct causal rel betw illness, symptoms, an underlying pathology, and the degree of adaption

reflected in WHO ICIDH

biomedical perspective on disablity

impairment

=structural abnormality of the body such as losses at the level of a persons organs tissues or appearance

leads to disability

=not being able to function as “a normal human being”

leads to handicap

= experiencing difficulties in fulfilling their normal social rules

criticism of biomedical model

• highly mechanistic view of our body which allows little room for subjectivity

• reductionist

• unanswered questions:

  • how do you medically explain unexplained symptoms?

  • how do you explain that people w the same disease have different reactions to it?

  • is it better to change the individual or the environment? (eg cochlear implant)

challenging dualism and the emergence of (bio)psychosocial models of health and illness»

• objective aetiology but subjective response

• freud redefined mind body problem as one of consciousness and believed in existence of uncoscious mind

• pioneered much work into unconscious conflict personality and illness ultimately leading to development of the field of psychosomatic medicine

• psychology: social and psyh factors are imp to consider in the medical world eg phantom pain/ placebo effect

• indiv context and subjectivity in terms of beliefs, expectations, and emotions interact w bodily reactions to play imp role in illness or stress experience

• shifts in thinking → health psychology which adopts biopsychosocial perspective on health, illness, and disability

BIOPSYCHOSOCIAL MODEL OF ILLNESS»

= posits that diseases and symptoms can be explained by a combo of physical, social, cultural and psychological factors

employed in several allied health professions as well as in health psychology

WHO ICIDH → WHO ICF

someone with an impairment does not have ti have a disability / handicap

eg a parlympian performs above average in sports while having an impairment in the medical sense

the new model acknowledges that there are enviro and personal factors that influence whether someone has a disability or handicap

INDIVIDUAL, CULTURAL AND LIFESPAN PERSPECTIVES ON HEALTH»

views on health have changed over time

18th century: health as egalitarian ideal to be strived for and potentially under individuals control

mid 20th century: linked to fitness to work and doctors declared if someone could adopt the “sick role”

Lay theories of health

1. considered as a general sense of wellbeing

2. identified with the absence of symptoms of disease

3. seen in the things that a person who is physically fit is able to do

Bauman”s definition of health

1. feeling

2. symptom orientation

3. performance

what is seen as healthy depends on one’s own health status

healthy people rate subjective health looking at health behavior

health behavior

behavior performed by an individual regardless of health status as means of protecting, promoting or maintaining health

Bennett: definition of health

health is sth you are, have and do

the average person does not think of health as sth you have

health and liefstyle survey: what do people think about health?

15% could not think of someone who is very healhy

10% could not think of what is is like to be healthy themselves

• young men: health as sth that is always the case

• older women: don’t remember what it’s like to be healthy

categories of health emerged:

• health as not ill: no symptoms

• health as reserve: come from strong family, quick surgery recovery

• as behavior: usually applied to others

• as physical fitness and vitality: used more often by younger respondents, more referring to male (feeling fit), when referring to females “ feeling full of energy”

• as psychosocial wellbeing: health defined in terms of a persons mental state

• as function: idea of health as the ability to perform ones duties or meet role expectations

psychosocial wellbeing approach

merges psychological approach (more individual/ micro) with a social approach (macro/ community/interaction)

health is a relative state of being, depending on frame of reference

WHO definition of health

“state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”

this allows inclusion of lifestyles, behaviors and socio-economic as well as cultural influences on health

CROSS CULTURAL PERSPECTIVES ON HEALTH »

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medicalized vs naturalized

e.g. pregnancy is medicalized in western cultures while it is naturalized in developing regions

stigma

stigma of physical disability, mentall illness or dementia in some cultures can lead to lower social standing of the family

can influence health seeking and disclosure

holistic view

“wholeness”

concerned w whole human being and its wellebing rather than addressing the purely physical or observable

some african cultures, eastern, and aboriginal cultures use this approach

westerners often divide betw mind, bpdy and soul for treatment allocation

spiritual wellbeing

gained credence in many QOL meaures

negative supernatural forces sometimes get the blame for illness and disability

beliefs about punishment for past life sins can have an impact on those living with illness or those caring for them

collectivist approach

community and family work together for the wellbeing of all

disadvantage of stigma because of lack of contribution to society

individualistic approach

responsibility on the individual and emphasis on rights above duties

behavior often driven by individual needs instead of community needs → eg lack of mask wearing during pandemic, ignorance of passive smoke

social exclusion

poor health can lead to social exclusionL

LIFESPAN, AGEING, AND BELIEFS ABT HEALTH AND ILLNESS»

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developmental theories

1. learning: relatively permanent change in knowledge, skill, or ability of experience

2. Experience: what we do see hear feel think

3. maturation: thought, behav or physical growth attributed to a genetically determined sequence of development and agening rather than to experience

piaget: cognitive developmental stages

1. sensorimotor stage (0-2y): understanding the world through sensation and movement but the absence of symbolic thoughts

2. preoperational (2-7y): symbolic thought develops → imagination and intellectual development through simple logical thinking, play, and language, egocentrism

3. concrete operational (7-11y): logical thought develops, can perform mental operations and manipulate objects to enable problem solving, others perspectives can be understood

4. formal operational (12 to adulthood): abstract thought and imagination develop as does deductive reasoning, metacognition and introspection, not everyone reaches this level

Erikson: 8 major life stages

each stage varies across dimensions incl.:

cognitive and intellectual functioning: understanding health instructions

language and communication skills: social development, expressing problems

understanding an illness and seeking help

healthcare and maintenance behavior: assessed risk

all of these are imp to health psychologists and impairments need to be adjusted to

Bibace and Walsh: illness concept of children at diff stages of cogn-develop model»

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sensorimotor:

difficult to determine due to lack of language

concrete operational

logical thinking but lack of distinction betw body and mind

explanation of disease is more concrete and based on cause-effect:

contamination = idea that bacteria and own behavior can cause disease

internalisation = illness in your body, and we know this leads to symptoms

children can be encouraged to take personal control over their illness or treatment

adolescence and formal operational thought

puberty begins and in early adolescnce (11-13y) indivs prepare for incr autonomy, independence and peers are starting to become more important than parents, much of life’s health damaging behaviors eg smoking start

illness concept: explanation of disease is abstract, usually explained based on the interaction betw person and environment

physiological: they understand what happens in the body

psychophysiological: >14 y: understand that mind and body interact eg role of stress (however many people of all ages fail to reach this understanding and think more simply about it)

early adulthood (17-40y)

developing independence, maturation, and responsibility

new perspectives come from experience and are applied

often apply to protective behaviors for health reasons

middle age (40-60)

period of doubt and anxiety and change due to empty nest syndrome and physical changes

noticing physical changes can be a motivation to start living healthye

elderly (60+)

people are getting older, more old people

health care will become more important

oldest (80+)

period of limitations and dependency

studies children adolescents dimensions of health (severity, control)

adolescents experience more control over illness and understand that some things are necessary but they will not cooperate if it gets in the way of goals or peer approval

how children communicate their symtpoms, how they act, and how much responsibility they feel for the disease depends on cogn develop as well as experience and knowledge

communication about health should be age appropriate

self concetpt

relatively stable through life

many elderly expect to have poor health so less efoort staying heathy

old people underestimate their physical abilities: sport is possible and beneficial

successful ageing

bowling and iliffe: 5 models of successful ageing

1. biomedical: physical and psychiatric functioning

2. broader biomedical: as above and social participation and activity

3. social functioning: based on nature and frequencyy of social functioning and networks, social support is assessed

4. psychological resources: based on personal characteristics of optimism and self efficacy and on sense of purpose, coping and problem solving, self confidence and self worth

5. lay model: all of above and socioecnomic factors

Lay model = best predictor of good QOL, followed by broader biomedical model

WHAT IS HEALTH PSY?»

psychology = scientific study of mental and behavioral functioning

limited in that not all behavior are observable (thoughts)

we rely on self reports

aims to describe, explain, predict and intervene to control or modify beh and mental processes from language, memory, attention, perception to emotions, social beh and health beh

empiricism = school of thought that states all knowledge can be obtained through experience

what connects psy to health?

health psychology integrated many cognitive, developmental and social theories and applies solely to health, illness and healthcare

main goals seek to develop understanding of biopsychosocial factors involved in:

• promotion and maintenance of health

• improving healthcare systems and health policy

• the causes of illness eg vulnerability and risk factors

  • the prevention and management of illness

health psy and other fields»

adopted and adapted many models and theories frm other fields eg social psy, behaviorsm, clinical psy, cogn psy

psychosomatic medicine:

• 1930s developed

• initially domain of psychoanalysts

• certain personalities = more susceptible to disease (eg hostility and heart disease)

• until 1960 mainly psychoanalytic (suppressed emotions triggering migraine or asthma)

• psychogenic diseases (w no physical expl) were often written off as psychosomatic

behavioral medicine

behavior comes through conditioning

operant conditioning applied to rehabilitation and treatment and prevention

e.g. biofeedback works on operant conditioing principles

medical psy

definition differs

NL: professional working in a medical setting who has completed a psych degree and health psychology masters training followed by a two year internship for generalist practicioner certification, or clinical psychologist training m

medical sociology

health and illness are viewed in a broad social and political context

clinical psy

mental health and diagnosis and treatment of mental health problems

health psy

considers biological, social and psych factors inv in aetiology, prevention or treatment of physical illness as well as in promotion and maintenance of health

Heman: biopsychosocial model of health

some critics argue too individualized but there has been progress on this by incl socioeconimc factors and emphasizing the human exists in a social context

Lehman’s biopsychosocial model of health

micrsystem: immediate direct contacts sucg as family, friends, classmates, colleagues

mesosystem: aspects of the microsys interconnect, such as communications betw family members and a health care professional

macrosys: one’s wider setting incl socioeconimc, enviro, cultural factors that frame the structures and rels betw all other sys

exosystem: individuals are affected by systems they are not part of such as media coverage, their partners workplace policies