Basic Concepts in Health Psychology and Education for Health

Course Overview and Bibliography

The course titled Health Psychology (13023014) is part of the $\text{3rd Grade}$ of Early Childhood Education at the University for the academic year $2025\text{-}2026$. It is taught by Professor Alfonso Montilla. The primary objectives of this first block include understanding the historical evolution of the concept of health, analyzing the mind-body connection, evaluating the biomedical and biopsychosocial models, and understanding the role of behavior in health. Furthermore, the course aims to differentiate Health Psychology from related disciplines and analyze factors that influence health behaviors, particularly in the context of an educator's role.

The bibliography for this section includes foundational works such as Manual de psicolog3a de la salud by Amigo ($2015\text{-}2023$, editions $4\text{-}5$), specifically the chapters on health psychology and beliefs about health and behavior change. Other key texts include Psicolog3a de la Salud by Morrison and Bennet ($2008$), and Psicolog3a de la salud y de la calidad de vida by Le3n, Medina, and Barriga ($2004$).

The Concept of Health and its Social Construction

Health is a term used by most people, yet it holds various meanings depending on personal or family situations, society, historical moments, and age. It is considered a social construction. Health Psychology emerged when it became clear that health is not merely the absence of disease or the act of curing an organism. Bauman ($1961$) categorized health into three dimensions: a general sense of well-being (feelings), the absence of disease symptoms (symptom orientation), and performance, which refers to what a person in good physical shape can do. Herlitz ($1973$) described social representations of health through three verbs: Being (if I am not sick, I am healthy), Having (a positive resource or reserve), and Doing (physical capacity or functionality).

In a $1990$ survey of $9,000$ people conducted by Blaxter, several health categories were identified: health as not being sick (absence of symptoms/doctor visits), health as a reserve (resilience based on family strength), health as behavior (self-care, exercise), health as fitness and vitality (energy), health as psychosocial well-being (mental balance and social satisfaction), and health as function (the ability to act without feeling incapacitated). Thus, subjective perception is critical, often measured by asking how a person rates their health generally (e.g., Excellent to Poor) or compared to the previous year.

From the perspective of Health Psychology, the relationship between behavior and health is paramount. The individual takes an active role in preventing disease, promoting well-being, and adapting to illness. Health is seen as both a personal right and a responsibility that must be promoted by society through interdisciplinary tasks. The World Health Organization (WHO) defined health in $1948$ as a "complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity." Salleras ($1985$) updated this to emphasize achieving the highest possible level of functioning allowed by the social factors in which the individual and community are immersed.

Historical Evolution: Holistic vs. Dualistic Visions

Through history, the understanding of health has oscillated between holistic and dualistic views. The holistic vision treats the human being as an inseparable whole, emphasizing prevention and an active role for the individual, common in ancient civilizations and the modern biopsychosocial model. The dualistic vision divides the human being, emphasizes treatment, and assigns a passive role to the individual, as seen in the biomedical model.

In Ancient Greece, Hippocrates proposed that health was the result of harmony within oneself and with the exterior; behavior and personality were seen as causes of disharmony. Galen later associated fluid imbalances with personality and disease (temperaments). Ancient Chinese medicine also held a holistic view, where illness arose from a rupture in the balance of forces (cold vs. heat, yin and yang), influenced by emotions and diet. In the Middle Ages, the vision shifted towards dualism (eternal spirit vs. finite body) under the Church's influence, where disease was viewed as sin and healing required faith and repentance.

During the Renaissance, Descartes solidified dualism. He viewed the body as a physical machine (finite) and the mind as a spiritual entity (abstract) that do not affect each other, except through the pineal gland. This led to the biomedical model, which views illness as a mechanical failure or a biochemical reaction. This model successfully controlled contagious diseases and reduced mortality through surgery and drugs, but it carries significant limitations.

The Biomedical Model vs. The Biopsychosocial Model

The Biomedical Model is characterized by biological reductionism, where diseases are seen solely as physical or chemical reactions. It ignores personal and social factors, such as treatment adherence or emotional responses. It treats the human as a passive object. For example, cancer is seen as purely physical; while it may cause unhappiness, the patient's mood is not considered to affect the course of the disease. George Engel ($1977$) criticized this model for being insufficient. He noted that diagnosis depends on patient reports and clinical skill, and the model ignores the influence of stressful life events. It is categorical (one is either sick or healthy), whereas chronic issues like chronic pain or "white coat hypertension" (where blood pressure rises only in medical settings) require a more nuanced view.

The Biopsocial Model, also proposed by Engel ($1977$), suggests that health and disease are determined by a combination of biological, psychological, and social factors. It is a holistic, bidirectional model where "there are no diseases, only sick people" (Claude Bernard). It emphasizes personal responsibility, lifestyle, treatment adherence, and the mind-body interaction. Variables such as self-efficacy, coping strategies, resilience, mood, and social support are crucial. This model is essential for addressing Non-Communicable Diseases (NCDs), which are chronic conditions like cardiovascular disease, cancer, chronic respiratory diseases, and diabetes.

Statistics show that NCDs killed at least $43\,\text{million}$ people in $2021$, representing $75\%$ of global deaths. Furthermore, $18\,\text{million}$ people died from NCDs before age $70$ in $2021$. Factors like tobacco use, physical inactivity, unhealthy diets, alcohol abuse, and air pollution increase NCD risk. The biopsychosocial approach requires intervention at individual, group, and social levels across different disciplines (medicine, psychology, sociology) and at different stages (before, during, and after illness).

The Emergence and Definition of Health Psychology

Health Psychology emerged in the $1980s$ following a shift in the $1950s$ from infectious diseases to chronic diseases associated with industrial lifestyle. In $1982$, the National Academy of Science's Institute of Medicine attributed $50\%$ of mortality among the top ten causes of death in the US to "lifestyle." Matarazzo ($1980$) defined Health Psychology as the sum of professional, scientific, and educational contributions of psychology for promoting health, preventing and treating disease, identifying etiologies, and improving the healthcare system.

There are four main lines of work: $1.$ Promotion and maintenance of health (e.g., establishing healthy habits). $2.$ Prevention and treatment of illness (e.g., modifying unhealthy habits). $3.$ Identification of etiologic and diagnostic correlates (e.g., studying behavioral causes). $4.$ Improvement of the healthcare system and health policy formulation.

Prevention is categorized by evolution (Fielding, $1978$): Primary (preventing onset in healthy people), Secondary (stopping progress after it starts), and Tertiary (rehabilitation to avoid relapse). It is also categorized by target population (Mrazek and Haggerty, $1994$): Universal (general population), Selective (risk groups), and Indicated (high-risk individuals with some symptoms).

Related Disciplines and Health Behavior

Health Psychology differs from other fields:

• Psychosomatic Medicine: Historically focuses on how psychological conflicts cause physical ailments (e.g., asthma, ulcers).
• Medical Psychology: Uses psychological techniques for medical practice, often subordinate to medicine.
• Behavioral Medicine: An interdisciplinary field applying behavior modification and functional analysis to treatment.
• Clinical Psychology: Primarily focused on mental rather than physical health.

Health behavior is defined as activities undertaken to prevent or detect disease or improve well-being (Kasl and Cobb, $1966$; Conner, $2002$). These consist of behavioral pathogens (risk behaviors) and behavioral immunogens (protective behaviors). Matarazzo ($1980$) listed key protective behaviors: sleeping $7\text{--}8\,\text{hours}$, eating breakfast daily, not snacking between three meals, maintaining normal weight, regular exercise, moderate or no alcohol, no smoking, seeking healthcare, treatment adherence, and safety behaviors.

Taylor ($1999$) noted that health behaviors are unstable and independent. This is due to situational specificity (e.g., drinking only on weekends), individual differences (e.g., one person drinks for social anxiety, another for euphoria), and behavioral/personal evolution over the life cycle (e.g., brushing teeth starts to avoid punishment but becomes an automated habit for well-being).

Determinants and Obstacles to Health Behavior

Determinants of health behavior include:

• Social Context: Influence from family, peers, and teachers through social learning (Bandura). For instance, parental habits often predict youth alcohol consumption.
• Emotional States: Stress and anxiety can trigger smoking or poor diet, while well-being favors healthy habits.
• Beliefs about Health: Low perception of vulnerability or the "optimistic bias" can prevent action. "Risk compensation" occurs when someone uses one good habit (gym) to justify a bad one (smoking), resolving cognitive dissonance.
• Symptom Perception: The perceived gravity of a symptom often dictates the duration of a habit change.

Obstacles to prevention include cultural values that equate a "good life" with unhealthy habits (success, comfort, thrill-seeking). Our culture often promotes a passive role and reliance on medicine. Furthermore, healthy habits usually require delayed gratification and more effort compared to the immediate gratification of unhealthy ones. The health system itself is often more curative than preventative, and clinical psychology has historically focused on private, individual mental health intervention rather than collective programs in schools or workplaces.

Salutogenesis: Aaron Antonovsky

Aaron Antonovsky developed the paradigm of Salutogenesis after studying Holocaust survivors, wondering why some remained healthy despite extreme trauma. He viewed health and disease as a continuum rather than a dichotomy. Key concepts include General Resistance Resources (GRRs) like money, knowledge, ego strength, and social support.

The core of his theory is the Sense of Coherence (SOC), which has three components: Comprehensibility (cognitive understanding of one's life), Manageability (instrumental ability to use resources), and Meaningfulness (the motivational belief that life's challenges are worthy of investment). SOC typically stabilizes by age $30$. Antonovsky used the "river of life" metaphor: instead of just rescuing people from the water (pathogenesis), we should teach them to swim well so the current does not sweep them away.