Transcript Health Psychology - Mansfield University of Pennsylvania

Health Psychology
Chapter 17:
Future Challenges
Mansfield University
Dr. Craig, Instructor
1
Where do we go from here?
 Helpful to look at changes in recent past to point us to
the future
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well-being - a personal responsibility, medical
professionals just one piece of the health puzzle
declining mortality for Heart Disease & Cancer
increasing amounts of unhealthy behaviors in places
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physical activity, diet, smoking, STDs etc.
 Goal Setting for future Health
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Healthy People 2000 & 2010
• 3 Major Goals, 22 priority Areas, 300 objectives within
priority areas.
Healthy People- Goal #1
 Goal #1: INCREASE HEALTHY LIFE SPAN
 We know people on average are living a bit longer
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but are they living “better”.
Dead or Alive-- too simplistic
 “Well-year” - one year of completely well life, free
of dysfunction, symptoms or health related problems”
 “Health Expectancy”- time a person is free from
disability
Longevity, Health and Wellness
 Concepts like WY and HE refocus effort toward
building quality of life, not necessarily longevity.
• Therefore reallocation of attention to issues that may not
threaten life but impact quality of life
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e.g., movement disorders, chronic pain, respiratory disorder
vs. cancer, HD, accidents, suicide etc.
 May be cost-effective for elderly
• WY and HE refocuses attention on prevention and
building health into old age…
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fewer doctors visits, medications, emergency room trips
• Old need not be synonymous with frail/sick
Healthy People: Goal #2
 Goal #2: REDUCE HEALTH DISPARITIES
 focus on meeting general standards for all, instead
of targeting groups
 Social & Economic Factors underlie much of group
differences
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education, income, occupational status, ethnic
background
 African Americans
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life expectancy, infant mortality, homicides, CVD
deaths, cancer, TB & diabetes all much worse than
any other ethnic group.
Health Disparities.. cont
 African Americans
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poorer medical treatment, less health education,
discriminatory provision of health care (e.g.)
even poor whites fare better..
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Less likely to live in “poverty areas” with the deficiencies
that that entails (medical assessability, good grocery
markets, safety issues etc.)
 Native Americans
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all-cause mortality, infectious disease, infant mortality
than groups (other than African-Americans)
lack of access to medical care
higher health risk taking behaviors
SES explains part, but not all of the equation
Disparities… cont.
 Issues for Hispanic Americans (non-Cuban)
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lower insurance coverage rates
poorer accessibility to physicians
greater smoking, hypertension & obesity
Still fare BETTER than Eur-Amer IN ALL-CAUSE
MORTALITY
• why? Immigrants not fully adopt all the unhealthy
behaviors available to them in the US
 Education
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less than 12 years… all kinds of problematic behavior
Goal#3: Increasing Access to Preventative Svcs
 Primary Prevention Services
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encourage life style changes
frequently targets those at risk
low cost (relative to disease treatment)
• smoking cessation, stress management, physical activity
groups
• immunization
 Secondary Prevention
• public screening for disease prior to development
• more costly
• may (like prim. Prevent) add well-years as well as reduce
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future disease.--- therefore cost-benefit ratio improved
radon/lead testing; genetic screening; hypertension,
cholesterol screening, mammography & HIV screening
The Work of Health Psychologists
 Many directions between and within disease
conditions and health behaviors
 1. Gathering data on behavior/lifestyle & how they
relate to health (up & down)
• tradition scientific inquiry, frequently basic science
 2. Promotion & Maintenance of health (down)
• program engendering health, stoking importance of
lifestyle changes
 3. Prevention (up) & Treatment(down) of disease
• programs designed to eliminate/reduce specific disease
 4. Formulate/Shape policy in health/health care (up)
• political & business sector effects that change
Training in Health Psychology
 1. Biological bases of behavior/health
 2. Cognitive-Affective affector of health
• (emotion, attitudes,)
 3. Social basis for disease/poor health
 Individual Differences & health
• personality, sex
 4. Advanced Research Methods & Statistical Analysis
 5. Measurement of health & psychology
 6. Interdisciplinary Collaboration
 7. Ethical & Professional Issues
 Also, specialization imp. often in form of Post-Doc
Health Psychology: A Collaborative Profession
 Health Psychologist- works in variety of work
settings often as part of a team
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universities
• teaching & research often involves other health
professionals
HMOs/ hospitals
• testing, research, rehab, treatment, policy
• prevention work for HMOs
Federal Government: CDC, NIH
• research & treatment)
 Note that all of except perhaps teaching at universities,
the HP is working in an area that has been historically
someone else’s “turf”.
Future Challenges: Changing Profile of Illness etc
 Heart Disease vs. Cancer
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both declining in 90’s, but HD more rapidly
figure 17.1 & 17.2- if trend continues greater emphasis
on psychology of cancer will emerge
Cancer leading cause of prematurely death (40- 65)
• 37% of deaths in women compared to 22% for CVD
• men also
 Reduction of Unintentional Injuries
car accidents, seatbelt use; domestic injury, computer
injury etc.
 Aging
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new issues emerge as population ages
• cost-benefit of treatment
Future Challenges: Aging etc.
 Aging (continued)
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new emphasis on well-year approach, and maintaining
health
health care policy shifts toward prevention?
 Infectious Illness
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Tuberculosis & treatment resistant strains
“Medication Communication”- getting people to take all
medicines properly---> tough to do sometimes
Iatrogenic Infection
 Controlling & justifying costs of a health psychologist
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US spending more than anywhere else in the world and is
not in the top 10 for lowest mortality/disease rates
downstream & upstream programs that save