REVISED PSYC 304 TIMETABLE

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• REVISED PSYC 304 TIMETABLE
• Thursday 30th Aug 0745 Health Psyc 1 GCL
• Mon 3rd Sept 0840 Health Psyc 2 GCL
• Tues 4th Sept 1125 Health Psyc 3 GCL
• Tues 4th Sept 1220 Health Psyc 4 GCL
• Wed 5th Sept 1505 Eating Disorder MK
• Thurs 6th Sept 0745 TEST
• Mon 10th Sept 0840 Eating Disorder MK
• Tues 11th Sept 1125 Suicide MK
• Tues 11th Sept 1220 Suicide MK
• Thurs 13th Sept 0745 Health Psyc 5 GCL/ZE
• Mon 17th Sept 0840 Health Psyc 6 GCL/ZE
• Tues 18th Sept 1125 Health Psyc 7 CR
• Tues 18th Sept 1220 Health Psyc 8 CR

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Health Psychol Reading

• Marks Murray Health Psychol.
• (Ch 1 2)
• Heist Brannon Health Psychol.
• (Ch 1)
• Strobe Social Psychology Health
• (Ch 2)
• Gatchel Baum Health Psychol
• (Ch 6)

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HEALTH PSYCHOLOGY

• Introduction to history,
• theory and practice.

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1. Introduction and definition

• APA Division 38 the aggregate of the specific
  educational, scientific and professional
  contributions of the discipline of psychology to
  the promotion and maintenance of health, the
  prevention and treatment of illness, and the
  identification of etiologic and diagnostic
  correlates of health, illness and related
  dysfunction (Matarazzo, 1980) plus the
  contribution to the health care system and to
  health policy formation

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1. Introduction contd

• 5 components of APA definition
• Public Health Health Psychology
• Emergence of HP APA 1978
• a) changes in the epidemiology of health and
  disease
• b) new modes of conceptualization about health
  and disease.

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Changing epidemiology of health2.1. Changing
patterns of disease

• different types of disease
• diseases of poverty
• diseases of industrialization
• diseases related to social instability
• Epidemiology shift 1st to 3rd types disease
• Shift from acute to chronic disease
• Acute disease
• Chronic disease

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2.1. Changing patterns of disease contd

• USA as example 1900-1983
• conquest of infectious diseases
• importance of antibiotics
• clean water, sanitation, nutrition
• improved medical technology
• all ? decreases diseases of poverty -
  infectious/communicable disease
• increase in diseases of industrialization -
  disease of lifestyle

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Causes of death in USA
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2.1. Changing patterns of disease contd

• clear implications of the shift for the
  behavioural sciences
• behavioural factors as pathogens in causation
  implications for prevention
• long-term nature of chronic disease chronic
  treatment concern with quality of life

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2.1. Changing patterns of disease contd

• Epidemiology of disease in RSA
• Causes of death in RSA - 1997-2001
• Mortality in RSA
• Neoplasm mortality proportions
• Chronic disease in RSA

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Mortality in SA 1990-2000 (Statistics SA)

• Poor registration of deaths in SA
• Many causes death unknown
• Better estimates for women
• Improves from 54 (1990) to 89 (2000)
• Significant increase in death rates of women
  1995-2000
• 350 increase death women 25-29 y between
  1990-2000

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Mortality in SA 1990-2000 (Statistics SA)

• Death of men 1985
• - mainly violence
• - gradual increase to death from HIV
• - both behaviourally related
• By 2000 20 total deaths from HIV
• - 40 of deaths in age 15-49 HIV
• An epidemic of violent deaths is being replaced
  by an even worse AIDS epidemic.

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Deaths in SA 2001
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Cancer Deaths RSA
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Chronic Illness by Race in SA ()

• Afr. Col. Ind. Wt. Total
• Hypertension 9 11 11 11 9
• Arthritis 9 9 15 9 9
• Asthma 5 6 7 8 5
• CHD 4 3 4 3 4
• Diabetes 2 3 7 2 2
• Epilepsy 1 4 1 2 1
• Cancer 0 0 1 2 1

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2.1. Changing patterns of disease contd

• 2001 S A Health Review A recent review of the
  health of youth argues that gender based
  violence, sexual risk taking, excessive alcohol
  consumption, and high levels of general violence
  are the most important causal factors impact upon
  the health of the nations youth. (P.13)

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2.1. Changing patterns of disease contd

• General conclusions about SA
• Major importance of behaviour implicated in
  deaths, esp violence and HIV/AIDS
• Behavioural factors in some of most important
  chronic diseases e.g. hypertension
• Behavioural factors in health of youth
• Also evidence of other infectious diseases
  related to poverty
• Epidemiological trap of RSA

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2.1. Changing patterns of disease contd

• General conclusions about behavioural factors in
  changing epidemiology of disease
• Emergence of health psychology
• Acknowledge that greatest predictors of poor
  health are poverty, gender (women), race (black)

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2.1. Changing patterns of disease contd

• World Health Organization (WHO)
• Top 10 risks to health
• behaviour related unsafe sex, high BP,
  tobacco use, alcohol use, high cholesterol,
  obesity
• socio-economic unsafe water, sanitation,
  hygiene indoor smoke from solid fuel,
• combined iron deficiency, underweight

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2.2. Escalating cost medical care.

• Health care systems in economic crisis
• Cheaper to be healthy than sick
• Implications for disease prevention

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2.3. Commoditization of health

• Emergence of health and disease prevention as
  marketable commodities
• Especially around stress
• Marks Murray criticism --
• Strong individual focus factors in individual
  control
• Less applicable to poorer people.
• Focus on personal control may make their
  situation worse
• Much HP as middle class oriented

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Reconceptualizing health disease

• 3.1. Changing conceptions of health
• Traditionally defined in biomedical terms
• Health no longer absence of disease
• WHO 1946 "...a state of complete physical, mental
  and social well-being and...not merely the
  absence of disease or infirmity
• Mixed response to definition

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3.1. Changing conceptions of health contd.

• Health is not an objective or essentialist
  phenomenon, but that it is socially constructed
• Health - a function of social, cultural, economic
  and political factors
• Quality of life in health care especially in
  chronic disease.

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3.2. Reservations about the biomedical approach

• Biomedical model (BMM) traditional medical
  theory, research and practice
• Disturbed biology single cause explanations
• Limitations and weaknesses of BMM
• Failure to recognize non-biological factors
• Health care system seeking help for non medical
  problems
• Quality of life

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3.2. Reservations about the biomedical approach

• Emergence of new health paradigms
• Alternate health industry
• Psychological understandings of these developments

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3.3. Emergence of the biopsychosocial approach

• Engel (1977) BPS model
• General systems theory (GST)
• Biological elements necessary, but seldom
  sufficient for disease
• Complex interaction of biological, psychological,
  social and environmental variables.
• e.g. psycho-neuro-immunology

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3.3. Emergence of the biopsychosocial approach
contd

• "...the biopsychosocial model proposes that a
  medical diagnosis should always consider the
  interaction of biological, psychological and
  social factors in order to assess a person's
  health, and to make recommendations for
  treatment. (Therefore) "it stipulates common
  theories and research designs, facilitates
  interdisciplinary thinking and research, and
  encourages greater synthesis among numerous
  variables" so that it "has the potential to
  establish a more effective, multi- cause,
  multi-effect approach to health and illness
  (Schwartz, 1982, p.1049)".

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3.3. Emergence of the biopsychosocial approach
contd

• Interactive rather than dualistic thought.
• Impact of multiple variables on health.
• Broader approach to medical research, training
  and practice.
• e.g. chronic pain HIV/AIDS

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Critical psychologys critique of health
psychology.

• HP has been portrayed as an alternative to the
  dominant biomedical approach
• Critics HP as subservient to BMM
• Psychological theorizing appropriates medical
  definitions for its understanding of health and
  illness (Stam, 2005, p.16)
• Need for a reflexive stance and alternate modes
  of theorizing.

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Critical psychologys critique of health
psychology.

• The BPS model provided psychology with a useful
  theoretical device for the appropriation of a set
  of topics in health and illness into
  psychological practice and theory.....(Rather
  than) challenging the biomedical dominance of
  definitions of health and illness (it) ensures
  psychological research will take bio-medicine for
  granted (Stam, p.20).

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Critical psychologys critique of health
psychology.

• HP has a major contribution.
• Need a critical distance from the discourse of
  biomedicine (p.23).
• Including and especially to the definitions of
  desirable outcomes in medicine.
• Stam (2005) definition and criteria of health
  are decided by the health care system, with
  little attention to the voices of users or
  sufferers.
• Feministic critique masculine domination

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