Health Psychology

An Interdisciplinary Approach

Deborah Fish Ragin

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781315512273
• Edition: 3
• Topic: Psychology
• Subtopic: Emotions in Psychology
• Index: Psychology

This textbook takes a truly interdisciplinary approach to studying health psychology. It examines five systems that affect individual health outcomes: individual, family/community, social/physical environment, healthcare systems, and health policy. While grounded in psychology, it incorporates perspectives from anthropology, biology, economics, environmental studies, medicine, public health, and sociology. The social ecological perspective on health psychology creates a depth of understanding of the diverse facets of health. This text also examines health from a global perspective by exploring the impact of infectious and chronic illnesses locally, regionally and globally.

This new edition includes updated statistics and references throughout, a new chapter on psychoneuroimmunology, and significant changes and updates to the chapters on health care systems and risky health behaviors. It will be of particular interest to undergraduate students.

For additional resources, consult http://routledge.com/9781138201309, where instructors will find downloadable lecture slides, instructor manual, and testbank.

Chapter 1

An Interdisciplinary View of Health

Chapter Outline

• Opening Story: How Would You Describe Winston’s Health?
• Section I: A Brief History of Health
• Section II: Defining Health Today
• Section III: Current Views on Determinants of Health: A Health Psychology Perspective
• Personal Postscript
• Questions to Consider
• Important Terms

Chapter Objectives

After reading this chapter, you will be able to:

1. 1. Identify three ancient cultures that contributed to our current concept of determinants of health.
2. 2. Identify Hippocrates and explain the mind–body connection in health.
3. 3. Identify the role of health policy as a determinant of health in three civilizations.
4. 4. Describe how religion influenced beliefs about health and illness.
5. 5. Identify the four domains of health as defined by the American Psychological Association Division of Health Psychology.
6. 6. Identify and describe four current models of health.

Opening Story: How Would You Describe Winston’s Health?

Winston describes himself as an “average high school senior.” He is the captain of his school’s varsity baseball team, he helps coach his younger sister’s Little League softball team, he writes for his school newspaper, and he is applying to college. Yet most people who know him think Winston is exceptional. He performs all of his academic and extracurricular activities well while managing health flare-ups caused by multiple sclerosis.

Multiple sclerosis (MS) is a persistent neurological disease with episodes that can last for long periods of time. It is caused by damage to the nerve fibers in the body. The damage disrupts normal neurological functions and can cause a variety of symptoms, including fatigue, headaches, light-headedness, soreness on various parts of the body, and blurred vision (Kunz, 1982). Some people with MS also report mental and emotional problems, including mood swings or depression.

Winston was diagnosed with MS at age 16, after numerous episodes of fatigue, blurred vision, and weakness in his arms and fingers. Now, at age 18, Winston says he has learned to manage his disease. He takes medication to control the symptoms but can have occasional flare-ups. Still, Winston does not let his condition stop him from participating in the activities he enjoys. He attends every varsity baseball practice and game. When he feels unable to play, he asks the team’s designated hitter to take his place. And, when fatigued, he still cheers loudly from the dugout.

He even manages to maintain his sense of humor about his illness. Once, while warming up before a game, Winston noticed his vision was blurry. His coach insisted he rest for the first several innings. Eventually, Winston convinced the coach he was ready to return to the game. But, as he walked to the plate, he turned and jokingly asked, “Coach, which pitcher should I focus on, the one on the left or the one on the right?”

In spite of the difficulties, when asked about his health, Winston always responds the same: “I’m great. I’m doing well, and my health is excellent.”

Would you agree?

Not everyone would agree with Winston’s characterization of his health. For some, having a disease or illness is, by definition, inconsistent with being in “excellent health.” Others might label Winston’s health status as “fair” because he takes medicine for his illness and at times is unable to perform specific activities. Finally, people who consider Winston to be in “good health” may contend that even though he has a chronic illness, here meaning an illness that is persistent and that lasts over time (see Chapter 3, Global Communicable and Chronic Disease), he appears to manage well with the help of medication. In addition, he appears to be coping well emotionally. Winston’s positive attitude and his efforts to remain active would suggest, to some people, overall good health.

What explains the diverse opinions about Winston’s health? Different theories about what constitutes health, which are shaped in part by historical and cultural factors is one explanation. We introduce some of these theories in this chapter and return to them throughout the book. Briefly, some people believe that health is determined by a person’s physiological state, here meaning a person’s ability to physically perform his or her daily functions without limitations, restrictions, or impediments. Such beliefs may derive from theories that propose that an individual’s health is defined by the presence or absence of disease, dysfunction, or other abnormal biological changes in the body (see Chapter 6, Emotional Health and Well-Being) (Wade & Halligan, 2004). Others believe that health is defined not only by a person’s physical functional status but also by that person’s attitude about the illness and his or her overall mental and emotional state. For these people, health is a holistic concept. We define holistic health as a state of being influenced by physiological, psychological, emotional, and social factors. Hippocrates, a Greek physician and philosopher, is often credited as the first to acknowledge the connection between emotions and health (Salovey, Rothman, Detweiler, & Steward, 2000). Yet, we will see here and in Chapter 6 (Emotional Health and Well-Being) that many other cultures also believed that physical health was integrally linked to emotional and mental health. In fact, a review of the history of health will reveal that health is an evolving concept that has been shaped over time by science, culture, and history (Boddington, 2009).

For the moment, Winston’s characterization of his own health appears to be consistent with the holistic definition. When describing his health, he considers his physiological condition, including his ability to perform tasks (especially favorite activities such as baseball), his psychological and emotional state and his level of satisfaction with his life. Using this holistic definition, it may be easy to see why Winston describes his health as excellent.

History shows that for centuries scholars have identified a host of different primary or contributing factors that influence health outcomes. We call these factors determinants of health. We will see that some determinants are universal, while others appear to be specific to a culture or time.

Psychologists who adhere to a holistic model identify four health determinants: physiological, psychological, emotional and social. But we will also see in this chapter that the proponents of the social ecological model contend that five determinants impact health. They include individual physiology and behaviors (such as diet, exercise, and use of alcohol), family and cultural traditions (diet, social customs, and belief systems), physical environmental conditions (such as clean water and safe neighborhoods), health systems (health care delivery organizations), and health policies (regulations that promote or protect the health of communities). Some even include a sixth determinant: spiritual well-being. Although we explore the social ecological model later in the chapter, for the moment it is important to note that it is perhaps the only model that specifically names health systems and health policy as health determinants, factors that were also introduced by earlier civilizations as important to health outcomes.

Which model best characterizes Winston’s views? Recall that in the opening story, we noted that Winston’s concept of health was consistent with a holistic health perspective. He assessed his physical, psychological, emotional, and social well-being, all of which he believed were excellent.

In this chapter, we will begin our overview of health and well-being by exploring health determinants identified in earlier civilizations, such as those in the Indus Valley and ancient China, Egypt, and Greece. As we progress forward in time, we will compare these early beliefs with the healing practices of Native American and southern African cultures in which botany, here meaning the study of plants and plant life, were important to their health practices. We conclude the historical review by examining the impact of spiritual beliefs on health in Western Europe during the Middle Ages and afterward during the Renaissance.

In Section II, we review three of the current models used by health psychologists: the biopsychosocial model, the wellness model, and the social ecological model. All three and others are explored in greater depth in Chapter 6, Emotional Health and Well-Being. Here, however, we focus on these three models to complete the historical timeline of the definitions and determinants of health.

Finally, in Section III, we review current research that explores the role of biological (physiological), social (including family and community), and environmental factors, as well as health systems and the health policies on individual health outcomes. In other words, we review the research that lends credence to the social ecological model. We then explore the contributions of health psychologists in explaining and changing individual health outcomes.

After reading this chapter, you will be able to summarize the changes over time and across cultures in the concepts and determinants of health. You will be able to compare and contrast the earlier views of health with current and modern concepts and to describe the research that supports or refutes the current perspectives.

Section I. A Brief History of Health

It is tempting to think that our current beliefs about health reflect new knowledge, based partly on new research findings. But history shows us that early civilizations, beginning in the third century BCE (Before Common Era), pioneered some of the “modern” concepts of health that we embrace today. From written records, public works (infrastructure), and even art, we can glimpse the health beliefs and practices of these civilizations and link them to the health outcomes of their populations.

Health Practices in Early Civilizations

UNDERSTANDING HEALTH THROUGH HEALTH POLICY There are many health behaviors that we take for granted. For example, most people today accept that clean water and sanitation are essential to prevent illness and to maintain good physiological health. But did you know that the Egyptian and Indian civilizations also considered clean water and sanitation important health determinants? The notions of health in these civilizations may differ, but both cultures established and maintained public water delivery systems that enhanced the health of their populations.

For example, archeological records from the Indus Valley region in the second millennium before the Common Era (2000 BCE) revealed evidence of bathrooms and sophisticated public and private drainage systems, as shown in Figure 1.1. Located in an area known presently as Pakistan, the Indus Valley civilization consisted of more than 100 well-ordered and structured towns and villages that appeared to be administered by ...