What are some structural determinants of health?
- Genetic - Constitutional (age/sex) - Culture - Lifestyle - Social/community networks - Living + working conditions
Which lifestyle factors promote mortality?
- Smoking - Obesity - Sedentary lifestyle - Excess alcohol - Poor diet
What does health psychology emphasise the role of?
Emphasises the role of psychological factors in cause, progression + consequences of health and illness
What are the 3 types of health behaviours?
- Health behaviour = behaviour aimed to prevent disease
- Illness behaviour = behaviour aimed to seek remedy
- Sick role behaviour = any activity aimed at getting well
What are some examples of changing health behaviours?
- Health belief model: perceived susceptibility, perceived barriers, benefits and self efficacy are all influences on changing behaviours
- Stages of change model: not thinking (pre contemplation) → thinking about changing (contemplation) → preparing to change → action → maintenance → stable changed lifestyle/relapse
- Motivational interviewing
- Social marketing
- Nudge theory (changing the environment to make the healthy option the easiest option)
- Financial incentives
What are modifiable and non-modifiable risk factors?
- Modifiable risk factors = things we can change, e.g. smoking
- Non-modifiable risk factors = things we can't change, e.g. age
What are 3 models of behaviour change?
- Health Belief Model (HBM)
- Theory of Planned Behaviour
- Stages of change (transtheoretical) model
What is the Health Belief Model?
Individuals will change if they believe they are susceptible, that the disease has serious consequences, or that the benefits of taking action outweigh the costs
What is the Theory of Planned Behaviour?
Intention is determined by a person's attitude to behaviour, perceived social pressure (subjective norm) + person's appraisal of their ability to perform behaviour (perceived behavioural control)
What is the Transtheoretical model?
Precontemplation (no intention), contemplation (beginning to consider), preparation (getting ready), action + maintenance
What is morality? What is ethics? What are the two types of ethics?
Morality is the concern with the distinction between good + evil. Ethics is a system of moral principles which defines what is good for individuals and society. Meta ethics = nature of good and bad, normative ethics = focus on acts
What are some different forms of ethical arguments?
- Top down deductive, where one specific ethical theory is consistently applied to each problem
- Bottom up inductive, using past medical problems to create guides to practice
- An approach where theories are considered which best fit one’s own beliefs before applying.
- Analogies can also be used
What is the doctrine of double effect?
Sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end
What are the 4 key ethical theories?
- Virtue ethics
- Four principles
What is consequentialism? What is utalitarianism? What is the doctrine of double effect?
- Consequentialism = act is evaluated in terms of consequences.
- Utalitarianism = consequentialist theory. Action is right if it leads to most happiness for greatest number of people
- Doctrine of double effect = doing something morally good with a morally bad side-effect, e.g. treatments with side effects
What is utalitarianism?
An act is evaluated solely in terms of its consequences. It acts to maximise good, e.g. killing one to save many
What is deontology?
Deontology = features of act themselves determine worthiness, not consequences. Actions are good or bad according to set of rules
What is virtue ethics? What are the five focal virtues?
- Virtue ethics = focus is on role of character, integrating reason and emotion
- The five focal virtues are:
What are the four principles?
- Autonomy = respecting patient's choice
- Beneficience = doing what is in the best interests of your patient
- Non-malificence = do no harm
- Justice = doing what's best for society as a whole
What is the definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
What is the biomedical model of health?
- Physical and biological factors of health - can be repaired
- Only health professionals can practice it
- Focus on diagnosis, cure + treatment of disease - solutions found in technologies
- Mind/body dualism (suggests can be treated separately)
- Knowledge is objective - neutral + distinct from social factors
What is the social model of health?
Contrasts biomedical model.
- Gives thought to a wide range of factors
- Wide range of people can practice it
- Focus on prevention
- Challenges mind/body dualism
- Knowledge is not objective - we are taught to see the body
What is the first theory of health, 'Health as an Ideal State'? What are its problems?
- Goal of perfect well-being (WHO definition)
- Disease, illness + forms of handicap must be absent
- Is anyone ever healthy?
- What is complete well-being?
- Can we ever attain this ideal state?
What is the second theory of health, 'Health as a state of social functioning'? What are its problems?
- Health is a means towards social functioning
- All forms of disease and social handicap need to be removed
- Can still be healthy (function socially) even when suffering with a chronic illness/disease
- Very narrow definition seeing health as the opposite of disease
- Patient's normal state may be unhealthy
- Refusal of treatment might be seen as healthy
What is the third theory of health, 'Health as a personal strength or ability'? What are its problems?
- Approaches are typically humanist - focus on how people respond to challenges
- Health is a means to a greater end - responding positively to problems
- Attempts to recover holistic ideas about health
- How can we interfere?
- Basically no good definition for health - twisted to suit purposes
What are the definitions of disease and illness?
- Disease = technical malfunction or deviation from the norm which is scientifically diagnosed. It isn't homogenous, doctors give different diagnoses
- Illness = the social, lived experience of symptoms and suffering
What is illness harmful to?
Has a double impact on the body and social functioning. Illness is harmful to social functioning thus it allows legitimate deviance from social obligation
What is the sick role? What are the 4 components?
- Sick role = concept that concerns the social aspects of becoming ill and the priviledges and obliagations that come with it:
- Patient exempt from normal social rules
- Is not responsible for their condition
- Should try to get well
- Should seek help and co-operate with medical professionals
What role does a doctor have in deciding if someone can enter the sick role?
- Sickness is either chosen or by force (by intolerable social expectation)
- Only a doctor can determine if someone is sick and can enter the sick role
- Official conformation that they are not malingering
What is the medicalisation hypothesis?
Professional’s tend to see problems in terms of their own profession. Doctors therefore see everything medically. Therefore some conditions that seem medical can be in fact products of social forces, e.g. ADHD/depression?