Table of Contents
Title Page
Copyright
Editorial Board
Handbook of Psychology Preface
Volume Preface
Contributors
Part I: Overview
Chapter 1: Health Psychology: Overview
What is “Health”?
Policy, Ideology, and Discourse
A Taxonomy for Interventions
Conclusions
References
Part II: Causal and Mediating Psychosocial Factors
Chapter 2: Stressful Life Events
Stressful Life Events
Stress and Critical Life Events: Theoretical Perspectives
The Nature of Stressful Life Events and Disasters
Assessment of Stressful Life Events
Research Examples of Stressful Life Events
Stressful Life Events in the Light of Gender, Culture, Ethnicity, and Age
Future Directions
References
Chapter 3: Coping and Social Support
Coping
Theories of Coping
The Role of Coping in Health Behaviors and in the Management of Health Risk
Coping and Health Outcomes
Coping and Psychological Adaptation to Disease
Social Aspects of Coping
Challenges, Conclusions, and Future Directions
Social Support
Social Support and Health Outcomes
Social Support and Disease Recovery
Disease Progression and Mortality
Social Support and Psychological Outcomes
Mechanisms for the Effect of Social Support on Well-Being
Conclusions and Directions for Future Research
References
Chapter 4: Psychoneuroimmunology: Mechanisms, Individual Differences, and Interventions
Stress-Immune Bidirectional Pathways
Acute Versus Chronic Stress
Individual Psychological Differences
Social Relationships and Psychoneuroimmunology
Psychological Interventions
Conclusion
References
Part III: Diseases and Disorders
Chapter 5: Asthma
Epidemiology and Health-Care Costs Related to Asthma
Evidence Basis for Psychological Theories Applied to Mechanisms Involved in Asthma
Psychological Factors Associated With Asthma
Medical Treatments for Asthma
Adherence
Psychosocial Factors Associated With Medical Treatments and Outcomes
Psychological Interventions for Asthma
Conclusions, Unanswered Questions, and Future Directions
References
Chapter 6: Understanding and Managing Obesity
Classification of Obesity
Epidemiology of Obesity
Consequences of Obesity
Psychosocial Consequences of Obesity
Economic Costs of Obesity
Contributors to Obesity
Treatment of Obesity
Lifestyle Interventions
Pharmacotherapy
Bariatric Surgery
Strategies to Improve Long-Term Outcome
Strategies for Maintaining Weight Loss: Findings From Correlational Studies
Strategies for Maintaining Weight Loss: Findings From Randomized Trials
Improving the Management of Obesity
Prevention of Obesity
Conclusion
References
Chapter 7: Nicotine Dependence
Introduction
Basic Mechanisms of Nicotine Addiction
Evidence for Genetic Influence on Nicotine Dependence Phenotypes in Humans Accumulates
Social, Psychological, and Environmental Risk Factors for Initiation and Maintenance of Tobacco Use
Recent Developments in the Multidimensional Assessment of Nicotine Dependence
Prevention and Treatment of Nicotine Dependence
Tobacco Prevention in Youth
Macroenvironmental Factors
Summary
References
Chapter 8: Arthritis and Musculoskeletal Conditions
Osteoarthritis (OA)
Rheumatoid Arthritis (RA)
Fibromyalgia (FM)
Stress-Sensitive Systems
Psychosocial Factors
Treatment
Conclusion
References
Chapter 9: Diabetes Mellitus
Diabetes Mellitus: A Primer
Diabetes and Stress
Diabetes and Depression
Diabetes and Social Support
Sleep Disturbance and Diabetes
Treating Diabetes: Psychosocial Interventions
Future Directions
References
Chapter 10: HIV/AIDS
Introduction
Overview of HIV Disease and Health Psychology
Primary Prevention
Secondary Prevention and HIV Care
Future Directions
Closing Comments
References
Chapter 11: Headaches
Introduction
Headache Classification and Diagnosis
Measurement of Headache Pain
Nonpharmacological Treatments for Headache
Biobehavioral Management of Headache
Headache Type, Frequency, and Chronicity
Comorbid Psychological Disorders
Treatment Algorithms
Treatment Format and Delivery
Conclusions
References
Chapter 12: Psychosocial Oncology
Cancer: A Basic Primer
Behavioral Risk Factors
Psychosocial Effects of Cancer
Psychosocial Interventions for Cancer Patients
Family and Caregiver Issues
Summary and Future Directions
References
Chapter 13: Chronic Pain
Unidimensional Conceptualizations of Chronic Pain
Behavioral Conceptualizations
Integrative, Multidimensional Model—Gate Control Theory
Psychology of Pain
An Integrated, Biopsychosocial Model
Assessment
Assessment of Functional Activities
Assessment of Coping and Psychosocial Adaptation to Pain
Assessment of Overt Expressions of Pain
Cognitive-Behavioral Perspective on the Treatment of Chronic Pain
Patient Uniformity Myth
Interdisciplinary Pain Rehabilitation
Concluding Comments
References
Chapter 14: Nature and Treatment of Insomnia
Introduction
Insomnia: Scope of the Problem
Evaluation of Sleep Complaints and Disorders
Treatments
Conclusions and Directions for Future Research
References
Chapter 15: Coronary Heart Disease and Hypertension
Coronary Heart Disease and Risk Factors
Treatment of CHD
Hypertension and Risk Factors
Treatment of Hypertension
Conclusion
References
Chapter 16: Gastrointestinal Diseases
Irritable Bowel Syndrome
Esophageal Disorders
Inflammatory Bowel Diseases
Conclusions and Future Directions
References
Chapter 17: Spinal Cord Injury
Anatomy and Classification of Spinal Cord Injury
Psychological Perspectives of SCI Rehabilitation and Research
Psychological Interventions
Concluding Remarks and Future Directions
References
Part IV: Health Psychology Across the Life Span
Chapter 18: Child Health Psychology
Levels of Risk and Related Psychological Interventions
Universal Interventions
Selective Interventions
Indicated/Clinical Interventions
Conclusions
References
Chapter 19: Adolescent Health
Adolescent Development and Health
Salient Areas of Adolescent Health
Special Services for Adolescents
Future Directions
Summary
References
Chapter 20: Adult Development and Aging
Introduction
Personality Research
A New Look at Risk Factors and Dementia
Positive Emotions and Health
Implications of Population Aging
Concluding Thoughts and Emergent Issues
References
Chapter 21: Women's Health Psychology
Introduction
Physical Health Issues
Mental Health Issues
Stressful Reproductive Health Issues
Health Care
Social and Cultural Influences on Women's Health
Conclusions and Future Directions in Women's Health
References
Chapter 22: Primary Care Psychology
Primary Care Psychology
Historical Overview
Foundations of Primary Care Psychology: Challenges and Opportunities
Common Problems in Primary Care
Future Directions
References
Chapter 23: Sociocultural Aspects of Health Psychology
Introduction
Race-Ethnicity
Behavioral Treatment and Prevention Approaches for Ethnic Minorities
Gender
Psychosocial Factors
Biobehavioral Factors
Gender, Treatment, and Prevention Approaches
SES
Future Research Directions
Conclusion
References
Chapter 24: Occupational Health Psychology
The History of Occupational Health Psychology
Ecological Dimensions of Occupational Health Psychology
Preventive Health Management
Organizational Health
Training in Occupational Health Psychology
A Case Study
Future Directions in Occupational Health Psychology
References
Chapter 25: Complementary and Alternative Therapies
Western Systems of Healing
Eastern Systems of Healing
Other Common Healing Approaches
Future Directions
References
Author Index
Subject Index
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Library of Congress Cataloging-in-Publication Data:
Handbook of psychology / Irving B. Weiner, editor-in-chief. — 2nd ed.
v. cm.
Includes bibliographical references and index.
ISBN 978-0-470-61904-9 (set) — ISBN 978-0-470-89192-6 (cloth : v.9) — ISBN 978-1-118-28205-2 (ebk.) – ISBN 978-1-118-28257-1 (ebk.) – ISBN 978-1-118-28677-7 (ebk.)
1. Psychology. I. Weiner, Irving B.
BF121.H213 2013
150—dc23
2012005833
Editorial Board
Handbook of Psychology Preface
The first edition of the 12-volume Handbook of Psychology was published in 2003 to provide a comprehensive overview of the current status and anticipated future directions of basic and applied psychology and to serve as a reference source and textbook for the ensuing decade. With 10 years having elapsed, and psychological knowledge and applications continuing to expand, the time has come for this second edition to appear. In addition to well-referenced updating of the first edition content, this second edition of the Handbook reflects the fresh perspectives of some new volume editors, chapter authors, and subject areas. However, the conceptualization and organization of the Handbook, as stated next, remain the same.
Psychologists commonly regard their discipline as the science of behavior, and the pursuits of behavioral scientists range from the natural sciences to the social sciences and embrace a wide variety of objects of investigation. Some psychologists have more in common with biologists than with most other psychologists, and some have more in common with sociologists than with most of their psychological colleagues. Some psychologists are interested primarily in the behavior of animals, some in the behavior of people, and others in the behavior of organizations. These and other dimensions of difference among psychological scientists are matched by equal if not greater heterogeneity among psychological practitioners, who apply a vast array of methods in many different settings to achieve highly varied purposes. This 12-volume Handbook of Psychology captures the breadth and diversity of psychology and encompasses interests and concerns shared by psychologists in all branches of the field. To this end, leading national and international scholars and practitioners have collaborated to produce 301 authoritative and detailed chapters covering all fundamental facets of the discipline.
Two unifying threads run through the science of behavior. The first is a common history rooted in conceptual and empirical approaches to understanding the nature of behavior. The specific histories of all specialty areas in psychology trace their origins to the formulations of the classical philosophers and the early experimentalists, and appreciation for the historical evolution of psychology in all of its variations transcends identifying oneself as a particular kind of psychologist. Accordingly, Volume 1 in the Handbook, again edited by Donald Freedheim, is devoted to the History of Psychology as it emerged in many areas of scientific study and applied technology.
A second unifying thread in psychology is a commitment to the development and utilization of research methods suitable for collecting and analyzing behavioral data. With attention both to specific procedures and to their application in particular settings, Volume 2, again edited by John Schinka and Wayne Velicer, addresses Research Methods in Psychology.
Volumes 3 through 7 of the Handbook present the substantive content of psychological knowledge in five areas of study. Volume 3, which addressed Biological Psychology in the first edition, has in light of developments in the field been retitled in the second edition to cover Behavioral Neuroscience. Randy Nelson continues as editor of this volume and is joined by Sheri Mizumori as a new co-editor. Volume 4 concerns Experimental Psychology and is again edited by Alice Healy and Robert Proctor. Volume 5 on Personality and Social Psychology has been reorganized by two new co-editors, Howard Tennen and Jerry Suls. Volume 6 on Developmental Psychology is again edited by Richard Lerner, Ann Easterbrooks, and Jayanthi Mistry. William Reynolds and Gloria Miller continue as co-editors of Volume 7 on Educational Psychology.
Volumes 8 through 12 address the application of psychological knowledge in five broad areas of professional practice. Thomas Widiger and George Stricker continue as co-editors of Volume 8 on Clinical Psychology. Volume 9 on Health Psychology is again co-edited by Arthur Nezu, Christine Nezu, and Pamela Geller. Continuing to co-edit Volume 10 on Assessment Psychology are John Graham and Jack Naglieri. Randy Otto joins the Editorial Board as the new editor of Volume 11 on Forensic Psychology. Also joining the Editorial Board are two new co-editors, Neal Schmitt and Scott Highhouse, who have reorganized Volume 12 on Industrial and Organizational Psychology.
The Handbook of Psychology was prepared to educate and inform readers about the present state of psychological knowledge and about anticipated advances in behavioral science research and practice. To this end, the Handbook volumes address the needs and interests of three groups. First, for graduate students in behavioral science, the volumes provide advanced instruction in the basic concepts and methods that define the fields they cover, together with a review of current knowledge, core literature, and likely future directions. Second, in addition to serving as graduate textbooks, the volumes offer professional psychologists an opportunity to read and contemplate the views of distinguished colleagues concerning the central thrusts of research and the leading edges of practice in their respective fields. Third, for psychologists seeking to become conversant with fields outside their own specialty and for persons outside of psychology seeking information about psychological matters, the Handbook volumes serve as a reference source for expanding their knowledge and directing them to additional sources in the literature.
The preparation of this Handbook was made possible by the diligence and scholarly sophistication of 24 volume editors and co-editors who constituted the Editorial Board. As Editor-in-Chief, I want to thank each of these colleagues for the pleasure of their collaboration in this project. I compliment them for having recruited an outstanding cast of contributors to their volumes and then working closely with these authors to achieve chapters that will stand each in their own right as valuable contributions to the literature. Finally, I would like to thank Brittany White for her exemplary work as my administrator for our manuscript management system, and the editorial staff of John Wiley & Sons for encouraging and helping bring to fruition this second edition of the Handbook, particularly Patricia Rossi, Executive Editor, and Kara Borbely, Editorial Program Coordinator.
Irving B. Weiner
Tampa, Florida
Volume Preface
When we were asked to serve as editors of the second edition of the health psychology volume for the Handbook of Psychology, we were once again very excited to be part of a larger set of editors whose landmark, but daunting, task was to corral an impressive list of leading psychologists to chronicle “all of psychology.” In addition, we continue to believe that such a comprehensive text could be useful to a large contingency of individuals, including graduate psychology students, health psychology researchers interested in having up-to-date information, clinical health psychologists working with medical patients, and nonpsychology professionals (e.g., physicians, nurses) who wish to learn more about psychology's contributions to health and health service delivery.
Therefore, it was these four audiences that we continued to have in mind when we maintained the structure originated in the previous edition. Specifically, we continue to be interested in covering both conceptual and professional issues (Parts I and II, “Overview” and “Causal and Mediating Psychosocial Factors,” respectively), as well as a myriad of specific medical diseases (Part III, “Diseases and Disorders”), which focuses on major disease entities or medical problems and provides information concerning prevalence, psychosocial causal factors, and treatment approaches. Because we view all phenomena as taking place within varying contexts, we also believe that health and health care need to be viewed within the context of varying developmental stages, hence the inclusion of Part IV, “Health Psychology Across the Life Span.” Because we believe there are additional contextual issues, such as gender, culture, and ethnicity, as well as emerging related issues in the field, we included these special topics. One entirely new chapter addresses primary care psychology.
Although we provided wide latitude to the various authors in terms of chapter structure and content, we insisted on comprehensive and timely coverage for each topic. Our major goal is to chronicle the field since the first edition was published. We believe each set of authors did a magnificent job. To that end, we wish to thank them for their outstanding contributions. We also wish to thank Irv Weiner, Editor-in-Chief of the Handbook, for his indefatigable support, feedback, and advice concerning this volume.
Arthur M. Nezu
Christine Maguth Nezu
Pamela A. Geller
Contributors
Part I
Overview
Chapter 1
Health Psychology: Overview
What Is “Health”?
Policy, Ideology, and Discourse
A Taxonomy for Interventions
Conclusions
References
Before discussing health psychology, it is helpful to clarify what is meant by the term health. To understand the use of this term, we must take a dip into etymology, the study of the origin of words. Etymologists suggest that the word health originated in Old High German and Anglo-Saxon words meaning “whole,” “hale,” and “holy.” The etymology of heal has been traced to a Proto-Indo-European root kailo- (meaning “whole,” “uninjured,” or “of good omen”). In Old English, this became hælan (“to make whole, sound, and well”) and the Old English hal (“health”), the root of the adjectives “whole,” “hale,” and “holy” and the greetings “Hello,” “Hallo,” or “Hi.”
Galen (C.E. 129–200), the early Roman physician, followed Hippocratic tradition in believing that hygieia (health) or euexia (soundness) occurs when a balance exists between the four humors: black bile, yellow bile, phlegm, and blood. Galen believed that the body's constitution could be put out of equilibrium by excessive heat, cold, dryness, or wetness. Such imbalances might be caused by fatigue, insomnia, distress, anxiety, or food residues from eating the wrong quantity or quality of food. For example, an excess of black bile would cause melancholia. The theory was closely related to the theory of the four elements: earth, fire, water, and air (Table 1.1). Some current health beliefs are direct descendants of ancient Greek and Roman theories of medicine. In winter, when it is chilly and wet, we might worry about catching a cold, caused by a buildup of phlegm. In summer, we might worry about not drinking enough water to avoid becoming hot and bothered, or bad-tempered. The idea of health as an optimum balance between elements of life is an principle that remains relevant to modern constructions of health. In Chinese medical theory, the yin-yang balance concept is fundamental, along with microcosm–macrocosm correspondences (tien-jen-hsiang-ying) and harmony (t ‘iao-ho) (Kleinman & Lin, 1981). The concept that health consists of a balance of elements is a core feature across diverse cultures and times. In valuing balance, Western and Eastern cultures have not changed in 2,000 or 3,000 years.
Table 1.1 Galen's Theory of Humors
Health, illness, medicine, and health-care stories are plentiful in the mass media, especially about the dread diseases: cancer, HIV, and, more recently, obesity. The Internet spews out stories by the million on every health-related topic at the touch of a few keys. A popular search engine revealed a total of 1.24 billion items on “health.” This total may be compared to the lower figure of 1.19 billion items on “sex” and a meager 0.568 billion items on “football.”
In spite of universal interest, there is not a single accepted definition of health. Experts and laypeople alike act as if they know what is meant by the term, and so there is no pressing need to define it. This lacuna of presumption is a source of confusion in the theory and policy of health care. The World Health Organization (Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June 19–22, 1946) defined health as follows: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition has obvious flaws. One must doubt whether any living person could ever reach “a state of complete physical, mental and social well-being.” More familiar to most people is the opposite state: incomplete physical, mental, and social well-being, with the presence of illness or infirmity. Apart from the idealism of the WHO definition, it missed key elements of health, elements that many believe to be fundamental. Health is a multidimensional state, which is complex, complicated, and nonreductive.
Any health psychologist would insist that health has psychological aspects that must be included in any definition of health. Psychological processes such as cognition, imagination, volition, and emotion are all mediators of health experience. The adjective psychosocial is preferred to the more restrictive psychological, denoting that human behavior within social interaction influences the wellness–illness continuum (Cohen & Wills, 1985). Culture (e.g., Landrine & Klonoff, 1992) and economic status (e.g., Adler et al., 1994; Kawachi et al., 1997) are also mediators of health. Spirituality can significantly strengthen resilience in the face of illness, grief, and suffering (e.g., Thoresen, 1999). For many people, spirituality is an essential part of what it means to be human. Sawatzky, Ratner, and Chiu (2005) carried out an extensive literature search of 3,040 published reports, from which 51 studies were included in a final analysis. They reported a bivariate correlation between spirituality and quality of life of 0.34 (95% CI: 0.28–0.40). The authors concluded: “The implications of this study are mostly theoretical in nature and raise questions about the commonly assumed multidimensional conceptualization of quality of life” (p. 153). In one's practice as a health psychologist, personal leanings as a believer or nonbeliever are not an issue; the patient is the focus, and the patient's spiritual or religious needs can never be discounted. They can be a potent force in rehabilitation, therapy, or counseling.
With these thoughts in mind, I offer the following definition of health: Health is a state of well-being with physical, mental, psychosocial, educational, economic, cultural, and spiritual aspects, not simply the absence of illness. The principle of compensation enables any one element that is relatively strong to compensate for lack in one or more other elements. If one or more of the elements is diminished, a person may yet experience a positive and sustainable state of health. This feature is illustrated in Figure 1.1 (see cases C and D). Thus balance and compensation are as important as the individual strength of any one particular element.
Figure 1.1 A multidimensional theory of health
Researchers have struggled with the possibility of measuring health by using a single universal scale of measurement. The complexity of the task is evidenced by the structure of scales developed to measure health. Four leading scales are:
Essink-Bot, Krabbe, Bonsel, and Aaronson (1997) factor-analyzed the four scales and derived factors that correspond to two of the seven dimensions in the present theory, physical health and mental health. Empirical support for the five remaining dimensions is available in multiple reviews and meta-analyses: psychosocial (e.g., Uchino, Uno, & Holt-Lunstad, 1999), economic status (e.g., Douglas, 1950; Marmot et al., 1991), educational (e.g., Gesteira, 1950), culture (e.g., Kleinman, Eisenberg, & Good, 1978; Office of Behavior and Social Science Research, 2004; Pelletier-Baillargeon & Pelletier-Baillargeon, 1968), and spirituality (e.g., Ellison & Fan, 2008; Thoresen, 1999). None of these mediators of health is a new discovery. We have been slow as a discipline to acknowledge their primary role in our construction of what it means to be healthy.
The principle of compensation has a parallel in economics in the form of resource substitution: When wants and needs exceed the available resources, then a different resource will be used to fulfill those wants and needs. A similar principle operates between health and education, in which the absence of one resource is less harmful if other resources can substitute for it (Ross & Mirowsky, 2006). The balance of the seven ingredients in this recipe for health should be considered when attempting an account of a particular person's state of health.
The trends shown later in Figure 1.3 indicate that research on cultural differences in health behavior is gradually increasing. Continuation of this trend will enable theory and practice to converge more effectively in creating interventions relevant to those who most need them. In illustrating this point, Adams and Salter (2007) focused on African settings. The authors explored three culture-specific examples of health concerns from Africa: the prominent experience of personal enemies, epidemic outbreaks of genital-shrinking panic, and fears about sabotage of vaccines in immunization campaigns. One can envision totally different health psychologies emerging from diverse cultures. The health psychology of high-income countries, as currently formulated, could well prove almost irrelevant to cultures existing outside of these zones. Within a country, widespread cultural, socioeconomic, and ethnic differences are evident in many aspects of health experience. Banthia, Moskowitz, Acree, and Folkman (2007) measured religiosity, prayer, physical symptoms, and quality of life in 155 U.S. caregivers. The findings indicated that prayer was significantly associated with fewer health symptoms and better quality of life only among less educated caregivers. This finding shows how a resource from one domain (spirituality) can compensate for a lack in another (education).
Health psychology is concerned with the application of psychological knowledge and techniques to health, illness, and health care. The objective is to promote and maintain the well-being of individuals, communities, and populations. The field has grown rapidly, and health psychologists are in increasing demand in health care and medical settings. Although the primary focus has been clinical settings, interest is increasingly directed toward interventions for disease prevention, especially sexual health, obesity, alcoholism, and inactivity, which have joined smoking and stress as targets for health interventions.
It is evident that everyday concepts of healthy living have advanced little since classical times. Current public health priorities and the associated interventions correlate with ancient concepts of the evils in society that need to be amended. Pope Gregory I was familiar with them all when, in A.D. 590, he defined the seven deadly sins (Table 1.2).
Table 1.2 Seven Deadly Sins, Common English Terms, Behavioral Counterparts, and Available Interventions
A holistic tendency, embracing a biopsychosocial approach, is increasingly evident within health care. Health psychologists are working in collaboration with multidisciplinary teams at different levels of the health-care system to perform a variety of tasks: carrying out research; systematically reviewing research; helping to design, implement, and evaluate health interventions; training and teaching; consultancy; providing and improving health services; carrying out health promotion; designing policy to improve services; and advocating social justice so that people and communities are enabled to act on their own terms.
A community perspective, promoting strategies for social change at the local level that can facilitate improved health and well-being, complements a focus on individuals. Within the latter paradigm, a communitarian perspective to health work can generate alternative methods of interventions. In working toward social justice and the reduction of inequities, people's rights to health and freedom from illness are viewed as a responsibility of planners, policy makers, and leaders of people wherever they may be (Marks, 2004). Individual and community approaches offer much potential for reducing health inequalities, but they both can also potentially distract attention from the broader structural causes of ill health. Health psychology training in masters and doctoral programs is available both within the community psychology framework and in mainstream health psychology (Marks, Sykes, & McKinley, 2003). I discuss the community approach later in this chapter. First, I deal with the dominant paradigm focused on the health of the individual.
The dominant discourse within neoliberal health policy has been that of the autonomous individual in which each individual is an agent, responsible for his or her own health. The dominant ideology of individualism dictates that each person is motivated by self-interest to elevate his or her well-being with the least effort and resources possible. The cult of the individual spawned the notion of the responsible consumer (RC). The RC is an active processor of information and knowledge concerning health and illness and makes rational decisions and responsible choices to optimize well-being. The epitome of the RC is the hypothecated “anything in moderation” person who eats five-a-day, never smokes, drinks alcohol in moderation, exercises vigorously for at least 30 minutes three times a week, always uses a condom when having sex, and sleeps 8 hours a day. The stereotype of the more common irresponsible consumer (IC) is the so-called couch potato, who enjoys beer and cola, smokes, eats junk food, watches TV for many hours each day, and rarely exercises. Accordingly, responsibility for illness relating to personal lifestyle is seen as the fault of the individual, not an inevitable facet of a social, corporate, economic environment designed to maximize shareholder profits.
Using a mixture of well-intentioned pleading, information, and advice, the traditional approach to health education aimed to persuade people to change their habits and lifestyles. Information campaigns designed to sway consumers into healthier living were the order of the day. The Report of the 2000 Joint Committee on Health Education and Promotion Terminology defined health education as “any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions” (Joint Committee on Terminology, 2001). In combination with policy and taxation, and against significant commercial forces, health education could claim some limited success over the past 50 years, such as the fall in lung cancer rates (Figure 1.2). Tobacco control has become a low but noteworthy benchmark for what may be achieved through consistent public policy, educational campaigns, and behavior change. However, the health gains made by this route were hard-won. The main public health call today is for a vigorous campaign to halt the obesity epidemic. If similar methods to those deployed for tobacco are used (i.e., voluntary controls, advertising restrictions, product labeling, health education), then it could take 50 to 70 years before obesity rates go into decline.
Figure 1.2 Cancer deaths, U.S. males, 1930–2005
Reproduced by permission of the American Cancer Society.
Endemic toxicity diffuses all health determinants: physical, mental, psychosocial, educational, economic, cultural, and spiritual. Lack of exercise and a poor diet, helplessness, loneliness, illiteracy, poverty, alienation, and cynicism are enemies of health and well-being. Christakis and Fowler (2007) argue from studies of social networks that obesity spreads along social lines of influence. They evaluated a social network of 12,067 people from 1971 to 2003 and found clusters of obese persons at all time points. The clusters extended to three degrees of separation. A person's chance of becoming obese was increased by 57% if he or she had a friend who had become obese in a given interval. Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. Social imitation in networks could be as important a determinant of health as any individual decision to live a healthy life.
In recent decades, appealing to the right-minded anything-in-moderation consumer has been prevalent throughout health care. The prescription to live well has always had a distinctively moral tone. Health promotion policy has been portrayed as a quasi-religious quest, a war against the deadly old sins of gluttony, laziness, and lust (Table 1.2