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19 February 2013

2nd Sem. 2012-2012

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”

    “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 people’s 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]

Historical Perspectives
17th–19th Centuries: Emergence of reductionist perspectives Newton, Decartes
 Secrets of health and disease could be understood solely in terms of physical

Historical Perspectives
Koch’s 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

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


genetic.] Relations between cause of death and behavioral risk factors Behavioral factors (BF) can be found for almost any disease. intoxicated activities)  BF that influence physiological risk factors (e.g.g. Milbank Quarterly. improved nutrition.g. including:  host nutrition.5% of the total decline in mortality since 1900 could be attributed to medical interventions  Argued that changes in the environmental conditions (e. and behavioral aspects of the way of life of the population” (Institute of Medicine. cellular factors) Psychological (e. 1982) 2 . smoking. either through:  a causal risk factor that is behavioral (e.01-Introduction 19 February 2013 Traditional medical model of disease process Exposure to pathogen Treatment Recovery Physiological & biochemical mechanisms Disease state Chronic state Death Historical Perspectives  As the 20th century unfolded. coping & immune function) Sociological (e. the ability of the TB bacillus to infect the host depends on multiple variables. noncompliance with treatment regimens) Definitions & Approaches Biopsychosocial approach to health  Good/poor health is caused by dynamic interactions among many factors Biological (e. were most responsible for dramatic improvement in public health that occurred during 1900 – 1950 [Source: McKinlay & McKinlay. unsafe driving.g.. 55. government policies. psychological. 405-28. not control of diseasecausing micro-organisms.. and responses of body tissues to counteract the bacillus at the site of infection Historical Perspectives McKinlay & McKinlay (1997)  Concluded that only 3. high fat diet.g. it became obvious that few diseases satisfied Koch’s postulates completely  Example: In the case of TB. physical inactivity)  BF that influence treatment and prognosis (delay in health seeking behaviour. social support)  From an epidemiological perspective: focus on behavioral risk factors brings host & environmental factors to our attention! Definitions & Approaches  “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.g. actions of leukocytes. improved hygiene).

edu. and techniques …  relevant to the understanding of health and illness.g. finding a context in which to drink. and inactivity as major behavioral risk factors (BRF)  3 . consuming alcohol. knowledge. …  and the application of this knowledge and these techniques to disease prevention. each of these behaviors is highly complex  e. rehabilitation. scientific. and health promotion. Integrating behavioral and social sciences with public health. diet. 1980] Definitions & Approaches  It seems simple to identify smoking. treatment. prevent and treat illness. and professional contributions of psychology to promote and maintain health.. 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. alcohol use. and sociocultural science.upm.” [Source: Schneiderman & Orth-Gomer. 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. alcohol use is the product of a chain of behaviors that includes selecting and procuring alcohol. behavioral.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. diagnosis. psychosocial. 1996] Psychosocial processes Recovery Chronic state Death Personal history: Genetic Learned Developmental Physiological & biochemical mechanisms 13 Health Psychology  “Educational.