Chapter 17 Future Challenges
recent history - Over the past 35 years, Americans have made some healthy changes that have lowered mortality rates from a variety of causes but much remains to be done.
Healthy People 2000 - was a report by the USDHHS (U. S. Department of Health and Human Services) outlined three broad goals: (1) increasing healthy life span, (2) reducing health disparities among Americans, and (3) access to preventive services for all people in the U. S.
well-year - The equivalent of one year of completely "well" living. In other words, a year free of diseases and health problems.
health expectancy - The number of years that a person spends free from disability.
health expectancy vs. life expectancy - "Health expectancy" (number of well years) has NOT kept pace with increases in "life expectancy" (number of years lived).
national differences - exist in "healthy life expectancy." Japan heads the list at 75 years, about five years ahead of the U. S., Germany, and the United Kingdom.
ethnic disparities - in health status and access exist. Research suggests that African Americans receive poorer health care than European Americans despite the fact that physicians believe they do not treat the groups differently.
Native Americans - have poorer health and receive poorer care: (1) the Indian Health Service has a record of poor funding and mistreatment, (2) many Native Americans live in "rural settings" which limits access to health care, and (3) Native Americans engage in many risky behaviors, including smoking, heavy alcohol use, and poor diet.
Hispanics - also have poorer health care than European Americans. Cuban Americans, who are generally better educated and of higher SES than Mexican or Puerto Rican Americans, have better access to health care than the other two Hispanic groups.
Asian Americans - have the longest life expectancy and best health of any ethnic group in the U. S.
"moderation in all things" - Terence, the Roman playwright, who lived during the second century B. C. was correct when he advocated this. Paffenbarger's Harvard Alumni Study found that with regard to predicting a longer lifespan, eating a moderate amount of "candy" was better than either totally refraining OR overindulging.
Does universal health care end disparity? - Not entirely, even in countries that have universal health care, people who (1) are of higher SES and (2) who are more educated, have better health (independent of access to health care).
origins of health psychology - A 1969 American Psychologist article by William Schofield led the 1976 APA Task Force on Health Research to conclude that health concerns were not adequately being addressed by psychology. This led to increased interest and research into health related topics. The current mission statement of the American Psychological Association includes the goal of "promoting health, education, and human welfare."
the "Boulder Model" - (also known as the "scientist-practitioner model") has been the accepted model of training clinical psychologists since its introduction in 1949. This model, which stresses that psychologists are both (1) scientists, and (2) practitioners, is also embraced by health psychologists.
expertise in statistics, measurement, and research methodology - is a primary contribution that health psychologists have to offer the health care system.
services performed by health psychologists - in clinics and hospitals include: (1) treating disorders that respond favorably to behavioral interventions, (2) providing traditional psychological treatment, and (3) improving rates of patient adherence.
the challenge of an aging population - By 2010, the average life expectancy in the U. S. will be more than 78 years. As previously noted, health expectancy is lagging behind life expectancy so health care costs will be a major challenge.
where your health care dollar goes - The largest chunk (32 cents) goes to hospitals. Doctors are second at 22 cents.
causes of increasing health care costs - include: (1) expensive technologies, (2) many "specialist' physicians, (3) inefficient administration, and (4) a profit oriented system that resists controls.
controlling health care costs - Health care costs in the U. S. are rising faster than inflation and other costs of living. Compared with Canada, Great Britain, and Germany, health costs in the U. S. are increasing at a much greater rate (see Fig. 17.3).
the history of HMOs - Originally, health maintenance organizations were non-profit and directed toward preventive care. As HMOs became "corporate," they began cutting and limiting services to contain costs. Eventually, a backlash "patient's rights" movement developed, leading to a demand for increased services. This, of course, leads to increased costs.
public attitudes - are a problem. The widespread belief that modern medicine can "cure anything" leads people to rely on the health care system rather than taking steps to improve their own health.
changing needs - During the course of the 20th century, deadly infectious diseases have become less of a problem whereas "chronic" diseases that require "management" have become more common. The health care system is lagging behind in adjusting to this important change.
primary prevention - consists of immunizations and programs that encourage healthy lifestyle changes. This approach is very cost effective and a "bargain,"
secondary prevention - focuses on screening people for risk factors so that problems can be detected at their early and more treatable stages.
conclusions - The vision of the 1976 APA Task Force has been achieved. Psychologist now play a major role in increasing our understanding of the behavioral factors involved in the development and treatment of diseases.