Perspective on Health (Person & Population Heath) Flashcards
Describe the biomedical approach, including its strengths and limitations
Pathological stimulus -> physiological/biochemical mechanisms -> disease state -> recovery, chronic or death
Limitations:
Assuming mind and body are separate, neglectful and reductionist. Treats the mind and body separately
Body can be repaired: mechanical metaphor
Prioritises technological responses
Focuses on the biological: reducitonist at the expense of other influences
Doctrine of specific aetiology (from germ theory)
Outline definitions of illness, and wellness, and health
WHO (2020): Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
Lay concepts: absence of disease (objective symptoms), absence of illness (subjective symptoms), functional fitness
Describe the biopsychosocial approach, including its strengths and limitations
Bio:
- Gender
- Disability
- physical heath
- neurochemistry
- stress reactivity
- genetic vulnerability
- substance abuse
- IQ, Temperament
Social:
- Education
- Social support
- peer relationship
- family background
- socioeconomic status
- family, relationship, life events
- substance abuse
Psycho:
- behaviour
- personality
- attitudes/belief
- learning and memory
- coping and social skills
- self-esteem and emotions
- IQ, Temperament
- family, relationship, life events
Pain Management
Bio:
- disease severity
- nociception
- inflammation
- brain function
Socio:
- cultural factors (religion, not seeking help)
- social environment
- economic factors
- social support
Psycho:
- mood/affect
- catastrophising
- stress
- coping
- placebo effect
- Nocebo effects (inert substance produces symptoms congruent with anticipated harm)
Value of biopsychosocial
- Sets the patient in their wider social, cultural and economic context - holistic
- Affords empathetic practice, improving communication
- enables patient-centred care and practitioner reflexivity
- enables medical practitioners to tailor their approach and advice
Limitations
- can place responsibility for ‘health’ on individuals
- might be regarded as being scientifically feeble (‘soft science’)
- qualitative methology - dominant in biopsychosocial research - sometimes regarded as inferior to quantitative methodology
- incorporation of biopsychosocial medicine topics into curriculum vary across clinical conditions
- over-diagnosing conditions as psychosomatic
Discuss the influence of psychological and social factors on health
Trust in doctor-patient relations enhances therapy/adherence
social/cultural meaning of some diseases impacts on experience and treatment: e.g. Aids, cancer, Ebola, COVID-19
Diagnostic labels can be both stigmatising or validating e.g. epilepsy/ADHD
Epigenetic
- The environment shapes how much, or whether, genes are expressed
Tegethoff et al. 2010: defined two types of psychosocial stress during pregnancy, life stress and emotional symptoms (e.g. anxiety)
- Stress = placental and foetal weight ration, suggesting compensation for the stress. (Smaller if theres not much food)
- Leading to changes in placental growth and development (stress in life and during pregnancy) - increased risk of CVD, pre-mature death
Kuzawa and Sweet (2009):
- gap in CVD health between African American and US White population
- Race as a social construct can produce real, harmful effects on bodies
- Biology is the outcome of racialisation rather than the underpinning of race (Ossorio and Duster 2005; Krieger 2005)
- Racism affects the future generation biologically
Slavery hypothesis Grazyna Jaskienska (2009):
- African American women ‘twice as likely as European American women to deliver children with weight below 2.5kg’
- Slavery history might be a cause for this difference
- “Contemporary black women who were born in African countries ancestral to slave populations, but who live in the United States, give birth to children with significantly higher weight than black women in the United States who have slave ancestry” (2009: 16)
- A connection between slavery and LBW (low birth weight) at the time seems of course plausible: maternal undernutrition and intense physical labor are obviously potential causes for smaller babies (2009: 22)
- Life conditions in the slavery period are responsible for LBW of African Americans today (2009: 22)
- Stress caused epigenetic changes affect the uterine environment of modern development
Neuroplasticity
- The brain is ‘plastic’; brains can be re-organised or ‘rewired’ – new connections can form, old ones can be rewired.
Maguire et al. (2006):
- Studied whether extensive cab driving could cause structural changes in the brain with MRI on the brains of London cab drivers
- Analysed the volume of their hippocampi and showed substantial enlargement
- Structural difference correlated with cab driving because proportional with number of years experience as taxi driver
- Showed how the overlap of and integration between long-term memory and spatial cognition, in response to environmental demands, can lead to local plastic changes in the structure of an adult human brain
- Contributes to dementia research
