1. 1 Health Psychology Chapter 17: Future Challenges Mansfield University Dr. Craig, Instructor

2. Where do we go from here? §Helpful to look at changes in recent past to point us to the future l well-being - a personal responsibility, medical professionals just one piece of the health puzzle l declining mortality for Heart Disease & Cancer l increasing amounts of unhealthy behaviors in places  physical activity, diet, smoking, STDs etc. §Goal Setting for future Health l Healthy People 2000 & 2010 3 Major Goals, 22 priority Areas, 300 objectives within priority areas.

3. Healthy People- Goal #1 HEALTHY §Goal #1: INCREASE HEALTHY LIFE SPAN §We know people on average are living a bit longer l but are they living “better”. l Dead or Alive-- too simplistic Well-year” §“Well-year” - one year of completely well life, free of dysfunction, symptoms or health related problems” Health Expectancy”- §“Health Expectancy”- time a person is free from disability

4. 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  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…  fewer doctors visits, medications, emergency room trips Old need not be synonymous with frail/sick

5. Healthy People: Goal #2 §Goal #2: REDUCE HEALTH DISPARITIES l focus on meeting general standards for all, instead of targeting groups §Social & Economic Factors underlie much of group differences l education, income, occupational status, ethnic background §African Americans l life expectancy, infant mortality, homicides, CVD deaths, cancer, TB & diabetes all much worse than any other ethnic group.

6. Health Disparities.. cont §African Americans l poorer medical treatment, less health education, discriminatory provision of health care (e.g.) l even poor whites fare better..  Less likely to live in “poverty areas” with the deficiencies that that entails (medical assessability, good grocery markets, safety issues etc.) §Native Americans l all-cause mortality, infectious disease, infant mortality than groups (other than African-Americans) l lack of access to medical care l higher health risk taking behaviors l SES explains part, but not all of the equation

7. Disparities… cont. §Issues for Hispanic Americans (non-Cuban) l lower insurance coverage rates l poorer accessibility to physicians l greater smoking, hypertension & obesity l 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 l less than 12 years… all kinds of problematic behavior

8. Goal#3: Increasing Access to Preventative Svcs §Primary Prevention Services l encourage life style changes l frequently targets those at risk l 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 future disease.--- therefore cost-benefit ratio improved radon/lead testing; genetic screening; hypertension, cholesterol screening, mammography & HIV screening

9. 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

10. 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 specialization imp §Also, specialization imp. often in form of Post-Doc

11. Health Psychology: A Collaborative Profession §Health Psychologist- works in variety of work settings often as part of a team l universities teaching & research often involves other health professionals l HMOs/ hospitals testing, research, rehab, treatment, policy prevention work for HMOs l 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”.

12. Future Challenges: Changing Profile of Illness etc §Heart Disease vs. Cancer l both declining in 90’s, but HD more rapidly l figure 17.1 & 17.2- if trend continues greater emphasis on psychology of cancer will emerge l Cancer leading cause of prematurely death (40- 65) 37% of deaths in women compared to 22% for CVD men also §Reduction of Unintentional Injuries- l car accidents, seatbelt use; domestic injury, computer injury etc. §Aging l new issues emerge as population ages cost-benefit of treatment

13. Future Challenges: Aging etc. §Aging (continued) l new emphasis on well-year approach, and maintaining health l health care policy shifts toward prevention? §Infectious Illness l Tuberculosis & treatment resistant strains l “Medication Communication”- getting people to take all medicines properly---> tough to do sometimes l Iatrogenic Infection §Controlling & justifying costs of a health psychologist l US spending more than anywhere else in the world and is not in the top 10 for lowest mortality/disease rates l downstream & upstream programs that save