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PSYC 328 (50)
Chapter 15

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PSYC 328
Blaine Ditto

PSYC328 Chapter 15 Notes WHAT ARE THE HEALTH PSYCHOLOGY PRIORITIES FOR THE FUTURE? • Helped people stop smoking, reduce consumption of high-cholesterol/high-fat foods. • Coronary heart disease and other chronic disease = show dramatic decrease. • Alcohol consumption patterns largely unchanged. • Exercise increased. • Overweight/obesity still endemic; shortly take over from smoking as major avoidable contributor to mortality. • Diabetes/high BP on rise in Canada. • Efforts to identify stronger/effective elements of behaviour-change programs to incorporate them into cost-effective interventions that reach lots of people. • Refinement/development of new psych theories needed to guide how interventions may be best implemented. • Canada: Mass consumption at community/workplace/school level. • Social Marketing: The application of marketing technologies developed in the commercial sector to the solution of social problems where the bottom line is behaviour change. Involves the analysis, planning, execution, and evalua- tion of programs designed to influence the voluntary behaviour of target audiences to improve their personal wel- fare and that of society. • Ex: ParticipACTION – best known/earliest social marking strategy. • Social Marketing: Can help raise awareness of health risks, promote advantages of healthy living, facilitate atti- tude/behaviour change. Focus on Those at Risk: • Medical research increasingly identifies genetic/behavioural risk-factors for chronic illness. • Interventions at individual/public level can be designed to help at risk people. • Studies of people at risk are useful in identifying additional risk factors for various chronic disorders. Prevention: Adolescence is a window of vulnerability for most bad health habits, and closing this window is important. • • Behavioural Immunization: Programs designed to inoculate people against adverse health habits by exposing them to mild versions of persuasive communications that try to engage them in poor health practice and giving them techniques that they can use to respond effectively to these efforts. • Already exist for smoking, drug abuse, diet/eating disorders. • Programs aimed at kids in grade 5/6 seem somewhat successful. Focus on the Elderly: • Next ten years = Will have largest elderly cohort ever seen in Canada. • Findings from Canadian Community Health Survey: consuming more fruits/veg, exercising often, lowering stress, feeling connected to community are all factors associated with overall good senior health (despite SES and health status vaariables). • These affects cumulative. • Community-based initiatives/individual interventions should focus on elderly having the highest level of functioning via programs that emphasize diet/stress management/social support/exercise/other health habits. Refocusing Health Promotion Efforts: • Refocus from mortality to morbidity. • Why? One reason = cost. • Chronic diseases expensive to treat. • Ex: RA or osteoA have low mortality impact, but major impact on functioning. Diabetes lifestyle change can have big impact on health care cost. • BC Provincial Health Officer: projected cost of health care for people with diabetes declined as a result of lifestyle changes; potential savings = ~100-200 million/year. • Implemented ActNow BC: Program designed to increase healthy lifestyles. • Addressed: Physical activity, healthy eating, healthy schools, healthy workplaces, healthy community, healthy pregnancies, tobacco control to reduce risk factors for chronic disease. Important for interventions to address more than one risk at a time. • • Ex Alberta’s Health U (activity levels, healthy eating), NFL/Labrador Go Health Wellness Plan (healthy eating, physical activity, tobacco control, injury prevention; mental health, child/youth development, environmental health, health protection). • Integrate public health promotion with individual level interventions a priority now. Promoting Resilience: • Future health promotion also should put more emphasis on positive factors that may reduce morbid/mortality. • Ex: increasing social support and a sense of connectedness to community may also add years to people’s lives, and for men in particular. • Health psycho focused most of research on risk factors for chronic illness and largely ignored positive experiences that may keep some people from developing disorders or recovering from illness. • Ex Studying how people spontaneously reduce levels of stress/seek out rest/renewal/relaxation give knowledge for effective interventions. • Can teach optimism or sense of control? Maybe. Promotion as a Part of Medical Practice: • True philosophy of health promotion cannot be adequately implemented until focus on it is important part of medi- cal practice. • Half Canadians not usually asked about health habits or assisted with goals for health. • Complementary/alternative medicine provides = potential venue for health behaviour change. • Holistic health associated with CAM care/longer consultation times = facilitate healthy lifestyle change. • Study: CAM care helped with smoking cessation, improved diet, increase exercise. • Study: Social Cognitive Theory and Self=Determination Theory; CAM providers encourage/support autonomous health behaviour change and increase self-efficacy/responsibility for health. • Annual physical should have a review of health issues/habits that someone can focus on might help. • Doctors persuasive in helping too. SES and Health Disparities: • Biggest risk factor for early disease/disability/death is low SES. • Lower class = experience more intense stressors, has cumulative toll on health risks. • Higher income = have more resources, lower risks. • Low SES effects for men and women and all age levels, but effect narrows toward end of life. • Low SES = lower sense of mastery, self esteem, social support. • LSES 3x more likely to have diabetes. • Mortality earlier for LSES for things that both upper/lower get. • Target interventions to people with LSES. • Ethnic differences bleak; ½ non-reserve Aboriginal report good health, gap widens as older groups and more pro- nounced for women. • Aboriginal report: more arthritis, hypertension, asthma, 2x more diabetes. • 7 men, 5 women fewer years for Aboriginal. • Injury/suicide rates 4x higher for Aboriginal. Social Change to Improve Health: • Individual change must couple with social change. • Access to health care not good in Canada compared to other countries. • Large disparity in living conditions for Canadians. • Social conditions tied to development of coronary heart disease, indicators of allostatic load. • Policy of health therefore has to address social conditions too not just individual risk. Gender and Health: • Women live on average 7 yrs longer. • Women sick more than men. • Women have greater chronic illness; usually older with no one to assist. More women referred to long-term-care or nursing homes once they suffer a chronic illness or serious health condition. • Diverse women = diverse healthcare needs. • Women may respond different to drugs. • Women may have different risk factors for major disease. • Women’s risk for coronary heart disease increase greatly after menopause. • Symptoms of heart disease different for women. • Violence against women should be top priority to improve women health. WHERE IS STRESS RESEARCH HEADED? • Low control, high demands, little chance for social support = job characteristics tied to stress. • Able to develop occupational interventions. • Job insecurity = nothing to do about it. • Instead maybe help people learn to cope = good area of study. • Women must take care of aging parents more than men. • Canadian female population under lots of stress, patterns may also increase in other countries too. • Additional health/mental health consequences, effective solutions to this, not yet developed. Advances in Stress Management: • In theory: knowledge of how people adjust successfully to stress can be translated into interventions to help those coping poorly. • Advances come from neurophysiology of stress; links between stress and corticosteroid functioning, temperamen- tal differences in sympathetic NS activity, factors influences release of endogenous opioid peptides and links to IS including inflammatory response. • Role of stress in pain experience; neuromatrix theory of pain – may provide chance for research into stress man- agement for managing pain. • Having social support network is recognized as a social determinant of health in Canada. • Fostering social support systems and social connectedness among Canadians to offset trends that isolate people will likely be important for future. • Self-help groups, increasingly popular for giving social support; delivery of Internet-mediated social support for fu- ture too. WHAT IS THE FUTURE OF HEALTH SERVICES? • 3 Main goals: 1. Improve access to needed health care. 2. Improve quality of care. 3. Narrow health inequality gap by addressing health care needs of Aboriginal people and with LSES. Improving Access to Health Care: • Health care provider shortage that began in mid 1990s. • Poorest physician-to-patient ratios in developed nations. • Canadians most likely to have wait times, difficulty getting after-hours care, wait times for elective surgery. • Nursing shortage, wait time for specialists/diagnostics/cardiac/cancer-care. • Solutions: • Easing restrictions on foreign doctors. • Easing restrictions on practice and improving number of graduating doctors. • Increase availability of telehealth technology. • Training/integration of physician assistants. • Also: Implement interprofessional teams (include 3+ doctors/nurses/nurse practitioners, social workers, psycholo- gists) to collaborate to deliver primary care services and share patient. May be good for chronic or emergency. May also achieve goal of provide health giving promotion/disease prevention services during firs
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