CHAPTER 1
Introducing Health Psychology
Lecture Outline
I. The Changing Field of Health
During the 20th century, changes in the field of health were accompanied by changing
patterns of disease. In 1900, most diseases were short-duration, infectious diseases, but by the
end of the century, behavior and lifestyle were the underlying causes of most diseases. These
changes have influenced the cost of medical care and even the definition of health, which point
to the possibility that a biopsychosocial approach may provide a better model than the
biomedical model.
A. Patterns of Disease and Death
In recent years chronic diseases have become the leading causes of death in the United
States and many other countries around the world, especially industrialized ones. In 1900,
three of the leading causes of death were pneumonia, influenza, and tuberculosis, while in
2009 three of the leading causes of death were heart disease, cancer, and stroke. These three
causes of death account for about 60% of deaths in the United States. These causes of death
have declined in recent years. Unintentional injuries and other diseases that primarily affect
young and middle-aged people have increased in recent years. Diseases that affect older
people, such as Alzheimer’s disease and Parkinson’s disease, are increasing as the U.S.
population ages.
1. Age
Age is an important factor in mortality. Cardiovascular disease and cancer account for
2. Ethnicity, Income, and Disease
3. Changes in Life Expectancy
Life expectancy has grown from 47.3 years in 1900 to over 77 years today. Behavior
has also been a factor in the decline in deaths due to cardiovascular disease, but the major
gains in life expectancy during the 20th century were due to decreases in infant mortality.
Prevention of disease—such as vaccinations and safer drinking water—is also a
contributor to the increase in life expectancy.
B. Escalating Cost of Medical Care
In the United States, costs of medical care have escalated far beyond the inflation rate.
Between 1975 and 2005, medical costs rose over 600%, and during the early years of the 21st
century, over 15% of the gross domestic product was spent for health care. This escalating
cost has led some people to question the cost effectiveness of cures and to emphasize the role
of prevention as a way to contain medical costs.
C. What is Health?
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The traditional view of health is the absence of disease, a definition that follows the
biomedical model of diseases produced by pathogens. The biopsychosocial model offers
an alternative view, adding psychological and social factors to biological factors. Theorists
who advocate this model study the interactions among biological, psychological, and social
factors in health and disease. This definition allows a definition of health as the attainment of
II. Psychology’s Relevance for Health
Health psychologists concentrate on the behavioral and lifestyle components in the
development of chronic diseases, but they also attempt to help people cope with stress, pain, and
chronic disease.
A. The Contribution of Psychosomatic Medicine
Psychosomatic medicine is based on the premise that physical illness has its roots in
psychological and emotional conflicts. This view emphasized the connection between
emotion and disease, which is a positive contribution, but the negative aspect of
psychosomatic medicine was the belief that disease has no real basis and is “all in the
person’s head.”
B. The Emergence of Behavioral Medicine
The development of behavioral medicine altered psychology’s role in medicine by
concentrating on behavioral rather than mental factors in health and illness. Behavioral
medicine is an interdisciplinary field that attempts to integrate behavioral and biomedical
knowledge and techniques and to apply this knowledge to prevention, diagnosis, treatment,
and rehabilitation.
C. The Emergence of Health Psychology
Health psychology is a field of psychology dealing with the scientific study of behaviors
that relate to health enhancement, disease prevention, and rehabilitation. This relatively
new discipline developed as a result of an APA taskforce that found a scarcity of health-
related research by psychologists. In 1976, psychologists interested in and working in
health-related settings formed Division 38 (Health Psychology) of the American
Psychological Association.
III. The Profession of Health Psychology
Psychologists in general and health psychologists in particular have the training to
A. The Training of Health Psychologists
Health psychologists receive a solid core of generic training at the doctoral level in the
basic areas of psychology plus training in biological and medical specialty areas that prepares
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them to work as part of interdisciplinary teams and possibly to become primary health care
providers.
B. The Work of Health Psychologists
Health psychologists have jobs that are similar to those of other psychologists—they
teach, provide assessments, conduct research, and provide services. Those who are employed
Exploring Health on the Web
The Internet is a source for health information on all levels, from press releases to technical
research. Problems arise in selecting valid information from the many sources available.
Exploring Health on the Web offers information on selected Internet sites that provide credible
health information.
other sites is healthfinder®. The U.S. Department of Health and Human Services maintains this
gateway website, and it is an excellent place to access information and to link to other sites
devoted to health information. This website is oriented toward consumers and includes a
homepage with a variety of choices that will help patients use the Internet to obtain information
and to find links to other sites. The site also provides options that allow users to gain access to
the technical health information collected by various government agencies.
Medicine. It includes information from the National Institutes of Health and other government
sources as well as information on hospitals and physicians, prescription and nonprescription
drugs, and a great deal more. MedlinePlus can be a basic resource for obtaining health
information because this website contains no advertising, is screened for quality of information,
and is updated daily.
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This website is the home for The Society of Behavioral Medicine. The Society for
Behavioral Medicine is an organization of researchers and practitioners concerned with the
development, evaluation, and integration of behavioral, psychosocial, and biomedical science
techniques relevant to prevention, diagnosis, treatment, and rehabilitation of a variety of health
conditions.
Suggested Activities
Personal Health Profile I — Personal Definition of Health
As a course project, you may choose to have your student complete a Personal Health
Profile in which they examine their personal health-related behaviors, review the literature
concerning these different behaviors, and write an analysis of things they are doing right and
things they could change to improve their health and lower their risks for disease. This activity is
designed to begin in this chapter and continue for the duration of the course.
For Chapter 1, students should examine their personal definitions of health as a beginning
for their Personal Health Profile. One way to examine personal definitions of health is through
International Mortality Rates
Chapter 1 presents the causes of death in the United States for the years 1900 and 2012.
During those years the causes of death in the U.S. have shifted from predominantly infectious
diseases to mostly chronic diseases. However, this trend has not occurred in all countries.
Ask your class to research the leading causes of death in other countries. One source for
life expectancy information is the CIA World Factbook, which is published yearly. They can
The leading causes of death for some countries more closely match the United States in
1900 than those for 2012. Some countries have a similar pattern of causes of death but a lower
death rate than the United States. Discuss both types of differences and the economic and social
factors that contribute to each country’s leading causes of death.
Personal Beliefs about the Nature of Illness
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Explore people’s conceptualization of illness by allowing your students to interview
people about their last illness. The interviewer should ask the person to explain the illness, why
he or she got sick, and what helped the person to get well.
Class members can examine the explanations for biological, psychological, and social
attributions for illness. These attributions may also appear in the explanations for getting well.
Do these people’s explanations of their illness reflect a biopsychosocial model of illness?
Interview a Health Psychologist
To better understand the work of health psychologists, your students can interview a
health psychologist. (To avoid burdening health psychologists, this activity might be best as a
group assignment. Divide your class into groups, each preparing a set of questions for the
psychologists.) Attempt to locate some health psychologists who work in academic settings and
some who provide assessment, diagnosis, and therapy services.
The health psychologists may be interviewed by students, participate in a panel
discussion, or even provide their answers over the Internet. After students have gathered the
information, they should participate in a discussion to examine how the information matches and
diverges from their conceptions of what health psychologists do.
Health Psychology in All Fields
Many students of health psychology are not psychology majors, but rather nursing or
public health majors. The last two sections of Chapter 1 discuss psychology’s relevance in health
fields and it may be useful for students to hear how the principles and theories they will learn this
semester can be applicable in their chosen field.
Reading Current Research
perceptions of aging, even after controlling for age, gender, SES, loneliness, and functional
health status. This article provides a nice introduction to the biopsychosocial model, as well as
good fodder for a discussion of why these findings might appear. Why would a person’s beliefs
about aging influence their longevity? Discussion may lead to factors such as health behaviors,
the social environment, socioeconomic factors, as well as how people cope with stress.
Citation: Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity
increased by positive self-perceptions of aging. Journal of Personality and Social Psychology,
83(2), 261-270.
Defining Health
In Chapter 1, students will learn that college is good for their health (“Would You
Believe…?”) but students likely will come into this course will differing perceptions of what
“health” means. Table 1.2 in the textbook lists definitions of health. Asking students to define
health before they read the chapter may provide useful information for you (and your students)
as you progress through the course. For example, asking students a wide range of questions
about their health before you begin the course may provide you with some data and current
health behavior of your students: What is health? What behaviors should one engage in to be
healthy? Are you engaging in these behaviors? Why or why not?
Video Recommendations
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From Films for the Humanities & Sciences:
Promoting Healthy Behavior (1998) introduces the complexities of the concepts of health and wellness
and shows how people can become more actively involved in their health.
Achieving Psychosocial Health (1998) is a 29-minute program that highlights the role of psychological
and social factors in achieving comprehensive health.
Videos from the Web:
Chapter 1 introduces the topic of socioeconomic disparities in health. Several excellent and short
video clips are available that document these disparities. One of these clips is “Becoming
Chapter 1 also introduces the biopsychosocial model. Two video clips examine this model. The
Multiple Choice Questions
1. People’s beliefs about health and illness may be incorrect. Which of these common
beliefs is true?
a. The United States ranks in the top five nations in the world in terms of life
expectancy.
b. The 30-year increase in life expectancy that occurred in the United States during
the 20th century was due mostly to improved medical care.
c. Good health is the absence of disease.
d. None of these is true.
2. A century ago, life expectancy in the US was ______ years and currently life expectancy
in the US is ______ years.
a. 20; 60
b. 30; 70
c. 50; 80
Introducing Health Psychology
d. 50; 70
3. Chronic diseases
a. develop and persist over a period of time.
b. are due to infectious agents such as bacteria or viruses.
c. are not as common today as during the 19th century.
d. include influenza and pneumonia.
4. _________ diseases are a class of diseases that consist of heart disease, cancer, and
stroke.
a. Infectious
b. Chronic
c. Unintentional
d. Cardiovascular
5. In 1900, most deaths in the United States were caused by ____, whereas today most are
due to ____.
a. pneumonia. . . cancer
b. chronic diseases. . . cancer
c. infectious diseases. . . chronic diseases
d. cancer. . . alcohol-related causes
6. During the last few years of the 20th century, chronic diseases in the United States
a. began to rise more rapidly than during the previous 50 years.
b. began to decrease while deaths not due to lifestyles began to increase.
c. began to increase while deaths not due to lifestyles began to decrease.
d. were replaced by acute diseases as the leading cause of death.
7. The leading cause of death in the United States
a. is due to acute, infectious disease.
b. is due to risky sexual behaviors.
c. has shifted from cardiovascular disease to cancer.
d. has shifted from acute to chronic diseases.
8. In the United States during the early years of the 21st century,
a. deaths from Alzheimer’s and Parkinson’s diseases increased.
b. deaths from accidents increased significantly.
c. deaths from heart disease increased significantly.
d. deaths only moderately related to lifestyle decreased significantly.
9. In the United States, young people have a low mortality rate; those who die are most
likely to die from
a. cancer.
b. unintentional injuries.
c. homicide.
d. HIV infection.
10. Cardiovascular disease and cancer account for about _____ of all deaths in the US.
a. 40%
b. 50%
c. 60%
d. 70%
11. All of the following are factors in life expectancy EXCEPT:
a. age
b. education
c. ethnicity
d. mother’s personality
12. In the United States, young people ages 15 to 24 are most likely to die from _______
and _______.
a. cancer. . . . heart disease
b. unintentional injuries . . . . homicide
c. homicide . . . . cancer
d. suicide . . . . HIV infection
13. In the United States, the three leading causes of death for adults ages 35 to 44 are
a. unintentional injuries, cancer, and heart disease.
b. suicide, homicide, and HIV infection.
c. HIV infection, heart disease, and pneumonia.
d. cancer, HIV infection, and pneumonia.
14. Cancer is the leading cause of death in which of the following ethnic groups?
a. European Americans
b. Hispanic Americans
c. African Americans
d. Asian Americans
Introducing Health Psychology
15. What two factors can help explain some of the ethnic differences in health and life
expectancy?
a. Poverty and age
b. Poverty and low education level
c. Low education level and age
d. Low education level and drug use
16. People who graduate from college show the following positive outcomes EXCEPT
a. higher average incomes.
b. more likely to exercise.
c. better access to health care.
d. more likely to eat a high-fat diet.
17. The single most important contributor to an increase in life expectancy is
a. the decrease in the infant mortality rate.
b. the increase in individuals’ beliefs in the importance of exercise.
c. advancement in medical technology.
d. advancement in medical care.
18. Rhona is a 32-year-old African American college professor. Gena is a 32-year-old
Hispanic American engineer. Leah is a 32-year-old European American who has been
unemployed for most of the past 10 years and living below the poverty level. Helen is
a 32-year-old Asian American dentist. The woman most at risk for poor health is
a. Rhona.
b. Gena.
c. Leah
d. Helen.
19. In the United States, people living below the poverty level generally
a. have low educational levels.
b. are more likely than other people to have health insurance.
c. are members of ethnic minority groups.
d. both a and c are correct.
20. The increase in life expectancy since 1900 is due mostly to
a. the decrease in cancer deaths.
b. the conquest of influenza.
c. major changes in lifestyle.
d. none of these.
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21. Sheldon Cohen’s research on the common cold showcase that the ________ approach
to understanding sickness and infection is inadequate.
a. biopsychosocial
b. biomedical
c. the psychological
d. biochemical
22. In Sheldon Cohen’s research on the common cold, all participants received a cold
virus injection and after a week,
a. all participants showed signs of having a cold.
b. only participants who were sick to begin with got a cold.
c. only health participants got a cold.
d. only participants who had dealt with a stressful experience got a cold.
23. An inverse relationship exists between educational level and death rates, which means
that
a. people who graduate from high school have higher death rates than those who do
not.
b. people who attend college have higher death rates than those who drop out of high
school.
c. people who attend college live longer than those who have never attended college.
d. both a and b
24. College graduates generally live longer than people who drop out of high school.
Which of these conditions is most likely to explain these differences?
a. College graduates are more likely to smoke cigars.
b. High school dropouts are more likely to seek health care.
c. High school dropouts are less likely to use illicit drugs.
d. College graduates are less likely to smoke cigarettes.
25. Which of these has been a major health trend in the U.S. since 1900?
a. Cost of medical care has risen faster than inflation.
b. Health has been more frequently defined as the absence of illness.
c. Acute illnesses have replaced chronic diseases as the leading causes of death.
d. The biomedical model has been accepted by most psychologists.
Introducing Health Psychology
26. During the past 30 years, death rate from heart disease in the United States has
declined. At the same time,
a. medical costs have increased.
b. smoking rates have increased.
c. life expectancy has decreased.
d. acceptance of the biomedical model has increased.
27. Which of the following has been the LEAST significant contributor to escalating
medical costs?
a. increases in population
b. the aging of the population
c. more sophisticated medical technology
d. increases in the number of complex surgical procedures
28. The biomedical model of disease
a. was common during the 1800s but was replaced by the biopsychosocial model
during the early 1900s.
b. views pathogens as the causes of disease.
c. is more common among the public than among health care professionals.
d. cannot explain infectious illness or the prevalence of viral illness.
29. Many medical advances during the 19th century were prompted by the biomedical
model that
a. emphasized emotional rather than physical factors in diseases.
b. replaced the Cartesian model.
c. led to a search for microscopic organisms that cause disease.
d. took a holistic view of health and disease.
30. Cade attributes catching a “cold” to not getting enough sleep and feelings of distress.
Thus, Cade has an implicit acceptance of the ____ model of health.
a. biochemical
b. biomedical
c. Cartesian
d. biopsychosocial
31. Health psychologists are most likely to see health
a. from a biomedical viewpoint.
b. from a biopsychosocial viewpoint.
c. as the absence of illness.
d. as a single dimensional condition.
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32. Before 1950, psychologists were involved with physical health primarily in the area
of
a. changing lifestyles.
b. changing attitudes.
c. pain management.
d. teaching in medical schools.
33. Psychosomatic medicine sees physical illnesses as
a. having emotional and psychological components.
b. having biological causes.
c. causing stress and subsequent organic illnesses.
d. all of these.
34. Presently, physicians and health psychologists are most likely to agree that
psychosomatic illnesses are
a. a primary means of coping with acute pain.
b. all in the head of the person with the illness.
c. diseases linked to a complex of biological, psychological, and social factors.
d. flow from unconscious factors and are a means of reducing anxiety.
35. Behavioral medicine assumes
a. a link between individual behaviors and health.
b. the existence of a specific pathogen in illness.
c. that disease can be controlled, but that health cannot be enhanced.
d. that the goals of medicine and psychology are incompatible.
36. The discipline that emphasizes the prevention of illness and the enhancement of
health in currently healthy people is called
a. behavioral health.
b. health psychology.
c. behavioral medicine.
d. medical psychology.
37. Health psychology is best defined as the scientific study of those behaviors related to
a. the adoption of the sick role for persons who believe themselves to be ill.
b. health enhancement, disease prevention, and rehabilitation.
c. the development of psychosomatic illness.
d. the development of psychological and emotional illness.
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38. Health psychology is
a. a branch of medicine related to psychological health.
b. a discipline within psychology related to psychological health.
c. a new name for psychosomatic medicine.
d. a discipline within psychology related to health.
39. In the biopsychosocial model proposed by the textbook’s authors, health and disease
outcomes flow DIRECTLY from
a. psychological factors.
b. biological factors.
c. sociological factors.
d. all of these.
40. In contrast to the biopsychosocial model, the biomedical model views health as
a. a positive condition.
b. an incorporation of psychological and social factors.
c. a result of a combination of factors such as genetics, beliefs, and stress.
d. the absence of disease.
41. During the last quarter of the 20th century, psychology became involved in the
changing field of health primarily by
a. treating physical diseases.
b. treating mental diseases.
c. studying behaviors that enhance health and prevent disease.
d. practicing psychosomatic medicine.
42. Most experts in health psychology recommend that
a. health psychologists should be physicians first.
b. health psychologists should receive at least two years of postdoctoral training.
c. health psychology should be a separate discipline from generic psychology.
d. the training of health psychologists should be shortened to meet the demands for
workers in the field.
43. The work of health psychologists is similar to other psychologists because it includes
a. counseling people with personal problems.
b. conducting research on personality and health habits.
c. assessment, research, and provision of services.
d. working in health care settings.
44. Janelle, a health psychologist, could do any of the following tasks EXCEPT
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a. offer alternatives to pharmacological treatments.
b. provide behavioral interventions to treat physical disorders.
c. design effective health communication to promote positive physical health.
d. design drug trials to enable doctors to find a drug to treat breast cancer.
45. Health psychologists are MOST likely to
a. be part of an interdisciplinary team.
b. work as a practitioner in a solo private practice.
c. go to medical school after finishing a doctoral degree in psychology.
d. do all of these.
True/False Questions
1. Health is generally defined as an absence of disease.
2. Currently, the leading cause of death in the United States is cancer.
3. Most people in the United States die of chronic diseases.
4. Death rates in the United States from both heart disease and cancer are declining.
5. Stress is the leading cause of death in the United States.
6. African Americans have a higher death rate than European Americans.
7. Despite national media coverage to the contrary, poverty is not related to the mortality
rate in the United States.
8. College graduates generally have a higher death rate than high school dropouts.
9. The training of health psychologists includes earning doctoral degrees.
10. Health psychologists rarely work in hospitals.
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Essay Questions
1. Trace the changes in patterns of disease during the 20th century. Are there signs that those
trends are changing? If so, how?
2. What roles do age and ethnicity play in mortality?
3. Discuss the implications of the acceptance of the biopsychosocial model over the biomedical
model.
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4. Before the development of health psychology, how was psychology involved in health?
5. Trace the development of behavioral medicine and health psychology.
6. Discuss how the preparation and work of health psychologists differ from and are similar to
those of other psychologists.
Introducing Health Psychology