Behavior AND Health: Learning Outcomes

01-Introduction
19 February 2013
2nd Sem. 2012-2012
PKK 3304 BEHAVIOR AND HEALTH

Assoc. Prof. Dr. Zaitun Yassin Department of Nutrition & Dietetics Faculty of Medicine & Health Sciences Universiti Putra Malaysia
Learning Outcomes
At the end of the lecture students will be able to: Determine his or her health behavior Discuss the historical perspective of health and behavior Compare the traditional and expended model of disease process Define the terms behavioral medicine and health psychology
Introduction
Behavior has long been identified as an important factor in determining health Technological, engineering and biomedical remedies have tried to disprove it Legal and regulatory approaches have tried to control it and protect people from other peoples behaviors These strategies have alternately declared their victories, only to find behavior breaking out somewhere else as a cause of ill-health
(Green & Simons-Morton , Oxford Textbook of Public Health, 1991)
Historical Perspectives
Ancient writers adopted a holistic approach to health Hippocrates: Health depends on a state of equilibrium among the various internal factors which govern the operation of the body and the mind; the equilibrium in turn is reached only when man lives in harmony with his external environment.
[Cited in Dubos, 1959, The mirage of health, p. 114]
17th19th Centuries: Emergence of reductionist perspectives Newton, Decartes
Secrets of health and disease could be understood solely in terms of physical
Kochs postulates were firmly entrenched by the end of the 19th century: Etiological micro-organism must be present in every case of the disease The micro-organism is not found in any other disease The isolated microbe reproduces the disease when administered to a new host
illness
End of the 19th Century:
Established that micro-organisms cause diseases; pathogenic effects can be avoided/reversed using antitoxins, vaccines Cholera, diphtheria, leprosy, malaria, staphylococcus, tetanus, tuberculosis
5
01-Introduction
19 February 2013
Traditional medical model of disease process

Exposure to pathogen Treatment Recovery Physiological & biochemical mechanisms Disease state Chronic state Death
As the 20th century unfolded, it became obvious that few diseases satisfied Kochs postulates completely Example: In the case of TB, the ability of the TB bacillus to infect the host depends on multiple variables, including: host nutrition, actions of leukocytes, and responses of body tissues to counteract the bacillus at the site of infection
McKinlay & McKinlay (1997) Concluded that only 3.5% of the total decline in mortality since 1900 could be attributed to medical interventions Argued that changes in the environmental conditions (e.g. improved nutrition, improved hygiene), not control of diseasecausing micro-organisms, were most responsible for dramatic improvement in public health that occurred during 1900 1950
[Source: McKinlay & McKinlay, Milbank Quarterly, 55, 405-28.]
Relations between cause of death and behavioral risk factors

Behavioral factors (BF) can be found for
almost any disease, either through: a causal risk factor that is behavioral (e.g., unsafe driving, intoxicated activities) BF that influence physiological risk factors (e.g., high fat diet, smoking, physical inactivity) BF that influence treatment and prognosis (delay in health seeking behaviour, noncompliance with treatment regimens)
Definitions & Approaches

Biopsychosocial approach to health
Good/poor health is caused by dynamic interactions among many factors Biological (e.g. genetic, cellular factors) Psychological (e.g. coping & immune function) Sociological (e.g. government policies, social support) From an epidemiological perspective: focus on behavioral risk factors brings host & environmental factors to our attention!

Both access to health care and regard for its advice are behaviorally influenced and that the burden of illnesses and disabilities in the US and the world is closely related to social, psychological, and behavioral aspects of the way of life of the population
(Institute of Medicine, 1982)
01-Introduction
19 February 2013
Sociocultural environment
Expanded model of disease process

Treatment Exposure to pathogen Disease state
Behavioral Medicine
The interdisciplinary field concerned with the development and integration of biomedical, behavioral, psychosocial, and sociocultural science, knowledge, and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to disease prevention, diagnosis, treatment, rehabilitation, and health promotion.
[Source: Schneiderman & Orth-Gomer, Integrating behavioral and social sciences with public health, 1996]
Psychosocial processes
Recovery Chronic state Death
Personal history: Genetic Learned Developmental
Physiological & biochemical mechanisms
13
Health Psychology
Educational, scientific, and professional contributions of psychology to promote and maintain health, prevent and treat illness, and determine etiologic and diagnostic correlates Psychology: the science of behaviour Health psychology: scientific analyses of behavior at the individual level Community psychology: scientific analyses of behaviour at the group level Social-behavioral science: a core area of competence for graduates of accredited MPH programs [Source: Matarazzo, 1980]

It seems simple to identify smoking, diet, alcohol use, and inactivity as major behavioral risk factors (BRF) However, each of these behaviors is highly complex e.g., alcohol use is the product of a chain of behaviors that includes selecting and procuring alcohol, finding a context in which to drink, consuming alcohol, and determining when to stop
Summary
I hope students are able to: Discuss the historical perspective of health and behavior Compare the traditional and expended model of disease process Define the terms behavioral medicine and health psychology
Course Materials
http://lms.upm.edu.my

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01-Introduction

2nd Sem. 2012-2012

PKK 3304 BEHAVIOR AND HEALTH

Traditional medical model of disease process

Relations between cause of death and behavioral risk factors

Definitions & Approaches

Definitions & Approaches

Expanded model of disease process

Recovery Chronic state Death

Personal history: Genetic Learned Developmental

Physiological & biochemical mechanisms

Definitions & Approaches

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