Health Psychology

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Health Psychology

• Lecture 1

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Lecturer

• Andy Keen, Health Psychologist
• Based _at_ RACH ARI
• Best to contact by email
• Andrew.Keen_at_arh.grampian.scot.nhs.uk
• Available _at_ end of lectures

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Lectures

• Available on Psychology website
• Main text (Carlson et al, 2004) is of limited
  relevance
• Further reading from listed texts
• No exam questions on material not covered in
  lecture notes

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Further Reading

• Ogden, J. (2004). Health Psychology A Textbook.
• Sarafino, E.P. (2001). Health Psychology
  Biopsychosocial Interactions.
• Sheridan, C.L Radimacher, S.A (1992). Health
  Psychology Challenging the Biomedical Model.
• Many other textbooks in the QML MSL
• References given in each lecture if appropriate

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Course Aims

• Gain a broad idea about the concerns of health
  psychology
• Develop knowledge of a small number of specific
  topics in the field of health psychology
• Appreciate that a range of factors contribute to
  health status, recovery from illness how
  effectively people deal with chronic illness

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Foci of Lectures

• Predominantly illness not health related
• Mostly at individual not population level
• Reflect my knowledge interests rather than
  health psychology as a whole

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Topics

• Lecture 1 Introduction Public Health
• Lecture 2 Stress, Coping Illness
• Lecture 3 Doctor - Patient Communication
• Lecture 4 Pain
• Lecture 5 Diabetes
• Lecture 6 Paediatric Health Psychology

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Today

• Aims
• Understand some basic concepts in health
  psychology
• Appreciate some issues in public health such as
  variations in health illness across time
  regions

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Field of Health Psychology

• Application of psychological principles to
  health, illness the health care system
• Understanding improving health outcomes
• Relatively new discipline
• Broad scope
• Research
  Interventions
• Population-level
  Individual
• Prevention
  Treatment of ill

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Typical Questions

• What causes illness / health?
• Why do some patients have better QoL than others
  with similar disease?
• Whats the best way to improve health outcomes
  QoL for those who are ill (e.g. rehab, self
  care)?
• What are the most effective ways of improving
  public health (clinical cost)?

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Biopsychosocial Approach

• Illness, effects of illness, recovery QoL are
  not caused solely by biological processes
• Rather, combination of inter-related systems
  biological, psychological social
• Central to health psychology
• Integrative systems not separate holistic
• In opposition to traditional medical view

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Psychological Behaviour Beliefs Thoughts Emotion
Stress Coping

• Biological
• Viruses
• Bacteria
• Lesions
• Genes

Social Relationships Class Culture Employment
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Heart Attack
Smoking Social class
Atherosclerosis Narrowing hardening of arteries
Genes
HDL LDL cholesterol balance
HDL returns cholesterol to liver
LDL carries cholesterol to cells
Exercising Health fitness are important
Low fat diet Mood
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Influences on Health
Living working conditions
Individual lifestyle factors
Social Community
Socioeconomic, cultural environmental conditions
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Health Inequalities

• Influence of macro factors group differences
• Foci of public health research policy
• Discuss three aspects
• Life expectancy
• Excess deaths
• Cause of death

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Life Expectancy

• Expected average number of years of life
• Significant increase in west only in last 100 ys
• USA 1900 47 ys 1985 74.7 ys
• Little change in life span (maximum age)
• More people survive childhood

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Life Expectancy in the UK
80 Life Expectancy 60 40
1900 1950
2000 Date
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Variation in Life Expectancy Across Counties

• Japan 81.9 years Sierra Leone 34.0 (WHO,
  2004)

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Cause of Death
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Cause of Death Eng Wales
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Health Inequality UK Scottish Male Infant
Deaths (/100k)

• Most Affluent 10
• Least Affluent 10
• Ratio

1991-93 615.69 1042.36 1.69
1999-01 426.58 784.23 1.84

• Increasing in some areas Blackburn, Preston
  etc.

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Health Inequality - Excess Deaths

• Rates controlled for age average 0
• Rates for adults dropping overall
• Large variation across country, however
• Glasgow 66 gt likely to die prematurely than
  those in Dorset
• Worst (Salford, Greenock, Oldham) 3rd gt than
  national average

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UK Excess Deaths
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Health Behaviours

• Generally, behaviours related to health-status
• Kasl Cobb (1966)
• Health behaviours prevent disease (e.g. diet)
• Illness behaviours seeking remedy (see dr)
• Sick-role behaviour getting well (rest, med.)
• Matarazzo (1984)
• Health impairing (smoking, high fat diet)
• Health protective (brush teeth, attn screening)

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Impact of Health Behaviours

• Estimated 50 of mortality due to behaviour
• Seven behaviours relate to health status
• 1. Sleeping 7-8 hours per day
• 2. Having breakfast every day
• 3. Not smoking
• 4. Rarely eating between meals
• 5. Being near ideal weight
• 6. Moderate or no alcohol intake
• 7. Taking regular exercise

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Smoking

• Main reason for health inequalities (DoH)
• 5th most v 5th least deprived ratio (Sco) - males
  1.89 1 females 2.551
• Linked to many illnesses CHD cancers COPD
• Doll et al (2005) - 50 year study (N34.5k)
• Lifelong smokers died 10 years before
  non-smokers
• Stopping earlier greater gains (603 3010)

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Peto et al (1994) Of 1000 20 year olds who smoke
regularly
250
493
Cigarettes (35-69) Murdered Cigarettes
70 RTA Other
1
250
6
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Smoking Cessation

• Important area of Govt NHS Plan
• Nicotine replacement therapy OR 1.5-2.0
• Physician advice OR 1.74
• Individual counselling OR 1.62
• Media campaigns few appear to work
• 90 stop with no help
• 10-20 success _at_ 1 year 3-5 continual

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Lung Cancer

• Prognosis not good
• Approx. 15 incurable/inoperable _at_ dx
• 20 survival rate _at_ 1 year
• 10 survival rate _at_ 5 years
• Similar variation to mortality with wealth

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Lung Cancer Rates By Deprivation
Deprivation Category
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Political Context

• NHS cost 65.4bn in 2003
• 2/3 costs are on staff
• 4.4bn on negligence costs (2001) rising
• Costs are rising at above inflation levels
• Govt committed to various health targets
• Match EU mean (8) Fra 9.6 Ger 10.7

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UK Financial Commitment on Health
2003/4 4-5 5-6 6-7 7-8
2003/4 4-5 5-6 6-7 7-8 8-9 Year
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Summary

• Health psychology is a broad approach to health
  illness, considers many factors important
• There are significant differences in the health
  of people throughout the world and within the UK
• These can be illustrated by broad indicators such
  as life expectancy, excess deaths childhood
  death rates
• The provision of health care occurs in a
  political context

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The End