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CHAPTER 16
Future Challenges
Lecture Outline
I. Challenges for Healthier People
People in the United States and other industrialized nations are inundated with health
information. Although information does not always translate into behavior, many people
have accepted the importance of behavior in health. This concern over good health has
appeared in national policy as well as in individual actions. Some of this knowledge and
concern has translated into behavior, which is reflected in declining mortality for heart
disease, cancer, stroke, homicide, and unintentional injuries.
An example of the influence of health-consciousness on a national policy level is the
Healthy People 2020 report that included both broad and specific goals. The broad goals
included increasing the span of healthy life and reducing health disparities among in the
United States.
A. Increasing the Span of Healthy Life
Increasing the span of healthy life is a different goal from increasing life expectancy.
B. Reducing Health Disparities
The United States does a poorer job of dispensing health care to its citizens than any
other industrialized country. Social and economic factors contribute to these disparities,
but the underlying reasons for the relationship between socioeconomic factors and health
II. Outlook for Health Psychology
The field of health psychology has grown rapidly, as evidenced by the amount of
research published by psychologists on health-related topics and by the growing number of
psychologists who work in health care facilities. Nevertheless, health psychology still faces
several challenges posed by the social and economic forces that are changing health care.
A. Progress in Health Psychology
After its founding in the late 1970s, health psychology made rapid strides, changing
psychology to include research and care related to physical health and disease.
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Challenges include acceptance by the medical establishment and providing cost effective
services in a health care system troubled by rising costs.
B. Future Challenges for Health Care
Providing health care for an aging population is one challenge for the health care
system, and elimination of health disparities is another. Woven throughout these
challenges is the issue of escalating health care costs, which have risen in the United
States at a much higher rate than inflation.
1. Controlling Health Care Costs
Cost is a significant barrier to receiving adequate health care. The problems stem
from proliferation of high technology, a large proportion of physicians who are
specialists, inefficient administration, inappropriate treatments, and a profit-oriented
system that resists controls. Figure 16.2 shows where health care dollars go. Costs
2. The Importance of Prevention
It is important to maintain and promote health as a way to curb medical care
3. Adapting to Changing Health Care Needs
Management of chronic illness is a current need that will become more important
in the future. CVD, cancer, chronic lower respiratory disease, and diabetes account
for nearly 70% of deaths in the United States. Creating a system that will provide
more effective management of chronic illnesses will demand a shift from hospital-
and physician-based care to a team approach that includes access to medical care and
patient education to improve monitoring and self care. Self care is a possible strategy
for reducing the need for medical services through primary and secondary prevention.
Such efforts can be costly because the number of people at risk may be much larger
than the number who has developed the disease.
C. Will Health Psychology Continue to Grow?
Health psychologists’ commitment to the biopsychosocial model has helped to
III. Making Health Psychology Personal
Health psychology also offers information that allows individuals to understand how their
behavior affects their health risks. That understanding can lead to behavioral changes that
enhance health and decrease risks for disease.
A. Understanding Your Risks
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Most college students rate their health as good, but this perception may lead them to
believe that they are not vulnerable to health risks. College students are unlikely to
develop diseases such as heart disease or cancer, but injuries are common among that age
group.
1. Injury and Violence
Injuries and violence are the leading causes of death among college-aged
individuals, with automobile crashes as the single largest source of such injuries.
Alcohol is a major contributor to these crashes, and college students are more likely
2. Lifestyle Choices
During adolescence and young adulthood, individuals adopt lifestyles that may
contribute to health risks or to protection against risks in future years. Smoking is less
common among college students than others the same age, and this choice offers
B. Cultivating a Healthy Lifestyle
In modern society people are inundated with health information, which may make
healthy choices difficult—people may lack the health literacy to evaluate this information
and translate it into personal terms.
1. Increase Your Health Literacy
Most people obtain health-related information from family, friends, and the
2. Adopt a Healthy Lifestyle—Now
Rather than waiting for middle age, college students should adopt healthy
behaviors while they are young. The Alameda County Study provides a simple guide
for a healthy lifestyle: 1) refrain from smoking cigarettes, 2) engage in regular
physical activity, 3) drink alcohol in moderation or not at all, 4) maintain a healthy
weight, and 5) get 7 to 8 hours of sleep a night.
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Exploring Health on the Web
Suggested Activities
Personal Health Profile — Estimating Life Expectancy
As a final activity for the Personal Health Profile, have your students estimate their
life expectancy with the help of an online assessment, which appears at
http://www.livingto100.com. This assessment asks a series of questions about lifestyle and
health habits as well as family background. The quiz immediately delivers a life expectancy
estimate, along with a rationale for each of the questions. This activity should dramatically
demonstrate the influences of behavioral factors in health by showing students good health
habits add and bad health habits subtract years from their life expectancy.
Underlying Causes for Health Disparities
Eliminating health disparities due to ethnicity is one of the major goals of Healthy
People 2020 and the subject of a major health initiative in the United States. The existence of
What Should Be Done in Moderation?
Explore the extent to which modern research on health has confirmed the Roman
writer Terrence, who advised moderation in all things. Assemble a list of health behaviors
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The system for providing health care in the United States differs from most other
developed countries, but these countries also differ from each other. Contrasting the
provision of health care, the costs, the provisions for payment, and the availability of care can
be an interesting experience for your students. Have them choose countries and obtain
information about the health care systems in these countries. A good place to begin is Rose
Weitz’s book, The Sociology of Health, Illness, and Health Care: A Critical Approach (2007,
4th edition, Wadsworth). This book provides information about several countries, contrasting
these countries with the system in the United States, but you may want to consider additional
After assembling all of this information, try to answer the following questions: What
is the life expectancy of people in these countries? What are the advantages and
disadvantages of each system? Who controls access to health care? How available is health
care to everyone in the country?
Understanding How Attitudes Influences Behavior
Have students take the following scale which assesses attitudes toward HIV and discuss
with students how attitudes can shape intentions and behaviors. The concept of attitudes was
discussed alongside health theories in Chapter 4. At the end of the course, students should
have a better appreciation of the complexity of getting individuals to change their health
Healthy Living on College Campuses
Have students come up with a list of tips and advice for other students at their
college. Are there any traditions or activities specific to your college that can be used to
increase students’ physical and psychology health? You could also have students pick a
health issue and design health communications to increase (or decrease) the relevant health
issue.
Revisiting: (From Chapter 1) Health Psychology in All Fields
One of the suggested activities in Chapter One was to discuss with students how
psychology is relevant in many different health-related fields. As a reflection of the course,
ask students how they believe they will incorporate health psychology into their careers.
Video Recommendations
From Films for the Humanities & Sciences:
How to Live to Be 101 (2007) explores the phenomenon of extraordinarily long life, which
occurs in various places throughout the world, and the research on why some people live to
an advanced age.
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Who Plays God? Medicine, Money, and Ethics in American Health Care (1996) is a
provocative program that explores controversial issues in medical treatment, including
prolonged life support and the crisis that accompanies inaccessibility of health insurance.
Tom Brokaw Reports: Critical Condition (2004) explores the difficulties in paying for health
care in the United States by reporting the stories of several patients and interviewing scholars
and health care providers.
World-Class Healthcare: Why Isn’t the U.S. the Best? (2003) is a short (23 minute) video
that explores the strengths and weaknesses of the U.S. health care system, presenting the
Canadian system as a contrast.
Videos from the Web:
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Multiple Choice Questions
1. During the past 35 years, people in the United States have
a. decreased their rate of obesity.
b. decreased their rate of cardiovascular disease.
c. decreased their use of seatbelts.
d. increased their rate of unintentional injuries.
2. If the people of the United States can increase their span of healthy life, then they will
have
a. increased their longevity.
b. reached all the major goals of Healthy People 2020.
c. increased their number of well-years.
d. accomplished all of these.
3. The term well-year refers to
a. the life expectancy of a person at birth.
b. the number of positive health practices a person performed in a calendar year.
c. the wellness behaviors associated with preventive health care.
d. a year of life free from health-related problems.
4. At age 65, women in the United States can expect to live another 16 years. Of those
16 years, they can expect that about _____ will be free of disability.
a. 15
b. 9
c. 5
d. 3
5. The people in the United States who use health care services more than any other
group are
a. children.
b. adolescents.
c. young adults.
d. older people.
6. Which of these contributes MOST to health care costs in the United States?
a. AIDS
b. childhood illnesses
c. illnesses among old people
d. infectious illnesses
7. The nation that leads the world in number of years of healthy life expectancy is
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a. the United States.
b. Japan.
c. Germany.
d. Canada.
8. Which of these groups of people is LEAST served by health care in the United
States?
a. Native Americans
b. well-educated African Americans
c. Cuban Americans
d. European Americans
9. People with high educational levels live longer than people with low educational
levels because they
a. smoke less.
b. have higher health literacy.
c. have greater access to health care.
d. have all of these factors.
10. The number of years a person lives is ________ and the number of years person lives
free from disability is _________.
a. health expectancy; well-year
b. health expectancy; life expectancy
c. life expectancy; health expectancy
d. life expectancy; life-year
11. What explains the difference between life expectancy and health expectancy?
a. economic factors
b. the changing nature of disease
c. health care costs
d. both a and b
12. Which of the following are the most documented health disparities in the United
States?
a. racial and ethnic disparities
b. gender and sexual orientation disparities
c. education and income disparities
d. geographic location
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13. ______ is the ability to read and understand health information to make health-related
decisions.
a. Health expectancy
b. Health literacy
c. Health disparity
d. Health communication
14. Even with universal access to health care, disparities exist between wealthy and
poorer individuals. One factor that may explain this discrepancy is
a. education and health literacy are higher among those with higher incomes.
b. health varies within countries, and women are healthier than men.
c. those with the lowest levels of social support are healthier than those with
many social contacts.
d. all of these contribute to health disparities.
15. Which group of U.S. citizens has the longest life expectancy?
a. European Americans
b. Asian Americans
c. African Americans
d. Hispanic Americans
16. Compared with European Americans, Asian Americans have
a. lower infant mortality rates.
b. longer life expectancy.
c. lower cardiovascular mortality.
d. all of these.
17. One barrier to the expansion of health psychology is
a. the lack of a body of knowledge associated with the field.
b. the costs associated with services provided by health psychologists.
c. the inexperience of health psychologists, especially in forming collaborative
relationships.
d. the amount of research that substantiates the biomedical model.
18. If life expectancy continues to increase,
a. the number of well-years will decrease.
b. the number of people dying of a chronic illness will increase.
c. the role of health psychology will diminish.
d. more people will die of acute illnesses.
19. The trend toward chronic diseases as the most common health problem
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a. will probably continue well into the 21st century.
b. will probably reverse itself within the next decade.
c. will probably be replaced by a growing problem with infectious diseases.
d. both b and c
20. Health psychologists can help the health care system by
a. improving people’s understanding of genetic risk information
b. understand people’s emotional responses to genetic testing
c. encourage people to maintain a healthy lifestyle
d. all of the above
21. Which of these countries has the highest per capita health care expenditures?
a. The United States
b. Great Britain
c. Canada
d. Germany
22. The greatest challenge facing the health care system in the United States is
a. too many physicians.
b. pressure from drug companies to lower costs.
c. escalating costs.
d. the growing attitude of consumerism among patients.
23. Which of the following is NOT a contributing factor to the high cost of health care?
a. the increase of technology in medicine
b. the high number of physicians who are specialists
c. the decrease in average length of hospital stays
d. hospitals that are profit oriented
24. The crisis in the U.S. health care system may be summarized as
a. too many people require treatment, and there are too few health care
professionals.
b. the health care system has not responded to meet the needs created by
changing patterns of illness during the 20th century.
c. patients have become reliant on drugs and surgery and are reluctant to change
their behaviors to achieve better health.
d. lawmakers do not understand the problems faced by the health care system,
and the resulting laws that control health care expenditures restrain
competition and actually increase costs.
25. The escalating costs that plague the United States’ health care system
a. have stabilized in the past five years but still represent a problem.
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b. are unique to the United States and Canada and do not affect other countries
around the world.
c. are larger problems in European countries than in the United States.
d. are more serious in the United States but affect all industrialized countries.
26. Most college students rate their health as good to excellent; that perception
a. is accurate—individuals in this age group have low morbidity and mortality.
b. is accurate for college women but not for college men, who experience poorer
health.
c. is not accurate—individuals in this age group experience more health
problems than older adults.
d. is true only for college student who do not drink alcohol.
27. Deaths among college students are traceable to
a. high cholesterol levels that produce heart disease.
b. high smoking rates that cause cancer.
c. behaviors that contribute to unintentional injuries.
d. suicide.
28. Of the young people who are injured or who die unintentionally, _____________ the
most frequent cause.
a. suicide is
b. homicide is
c. automobile crashes are
d. drowning is
29. Driving after drinking alcohol
a. is not as common among college students as young adults who do not attend
college.
b. is more common among college students than young adults who do not attend
college.
c. is a common practice of college students in many countries.
d. both b and c.
30. The experience of dating and sexual violence
a. occurs among college students, just as frequently as among other couples.
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b. occurs only about half as often among couples that are college students
compared to others.
c. occurs about twice as often among couples that are college students.
d. occurs more often when only one member of the couples is a college student.
31. Becoming a victim of violence
a. is more common for college students than for other young adults.
b. is more common for college women than other young women but occurs at
the same rate for college men and other young men.
c. is less common on college campuses than in other communities.
d. has nothing to do with college enrollment.
32. One protective health habit that is more common among college students than other
young adults is
a. not smoking.
b. not drinking alcohol.
c. eating a high-carbohydrate diet.
d. maintaining a high level of physical activity.
33. One dangerous health habit that is more common among college students than other
young adults is
a. smoking cigarettes.
b. binge drinking.
c. eating a low-carbohydrate diet.
d. leading a sedentary lifestyle.
34. College students can increase their health literacy by
a. gathering health information from the Internet.
b. listening to family and friends’ recommendations.
c. evaluating the findings from health research.
d. visiting their physician more often.
35. Health research that provides guidelines for a healthy lifestyle comes from
a. the Alameda County Study.
b. TV news reports.
c. the HART trials.
d. the Cunningham study.
36. College students are more likely than their peers to ______________.
a. smoke cigarettes
b. drive after drinking
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c. use cell phones while driving
d. both c and d
37. Over ____ of young adults engage in binge drinking.
a. 20%
b. 30%
c. 40%
d. 60%
38. The most important health behavior you could adopt is
a. maintaining a healthy weight
b. drinking alcohol in moderation
c. refraining from smoking
d. sleeping 7 to 8 hours a night
39. An important recommendation from the Alameda County study emphasizes _______,
which may allow individuals to cope better with stressful situations.
a. social support
b. drinking
c. exercise
d. both a and c
True/False Questions
1. In the United States, wealthy people have more well-years than poor people, but
they do not live longer than poor people.
2. The United States leads the world in number of years of healthy life expectancy.
3. African Americans have a longer life expectancy than European Americans.
4. Hispanic Americans have a lower death rate than European Americans.
5. On average, Native Americans live longer than European Americans.
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7. College students are less likely to smoke cigarettes but more likely to binge drink
than other young adults.
8. The United States has the highest per capita health care expenditure in the world.
9. Secondary prevention consists of screening people at risk for a disease in order to
discover potential health-related problems.
1. Contrast life expectancy with health expectancy. What are the implications of the
difference?
2. Discuss the obstacles to and advantages of achieving the two broad goals from the
Healthy People 2020 report.
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3. What factors have affected (and will continue to affect) the growth of health psychology?
4. Analyze the health benefits and risks that apply to college students compared with other
young adults.
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5. How can health disparities in the US be reduced?