1. The main cause of death has changed from infectious diseases to diseases related to unhealthy behaviors and lifestyles. 2. The increase of medical expenses highlights the importance of educating people about healthy behaviors to reduce the risk of diseases. Health is considered as a sign of positive happiness, not the absence of disease. 4. Some health care workers put forward a broader view of health and disease. Patterns of disease and death: The main health problem is no longer infectious diseases, but chronic diseases with long course, persistence or recurrence. During 1993, the four leading causes of death in the United States were heart disease, cancer, chronic obstructive pulmonary disease and stroke (in 2003, the top ten causes of death in Taiwan Province Province were cancer, cerebrovascular disease, heart disease, diabetes, accidental injury, chronic liver disease and cirrhosis, pneumonia, nephritis and renal syndrome and renal degenerative diseases, suicide and hypertension; Top ten cancers: liver cancer, lung cancer, colorectal cancer, female breast cancer, gastric cancer, cervical cancer, oral cancer, prostate cancer, non-Hodgkin's lymphoma, pancreatic cancer). Nowadays, most deaths are caused by diseases related to personal behavior or lifestyle. Cardiovascular disease (including stroke), cancer, chronic obstructive pulmonary disease (including emphysema and chronic bronchitis), accidents, diabetes, suicide and cirrhosis have been proved to be related to stress, smoking, alcoholism, improper eating habits and sedentary behavior. In addition, the rapidly rising infection rate is related to parasitic diseases and unsafe sex (HIV). The causes of death based on the total population will vary according to age and race. In addition, some people think that the relationship between social class (socio-economic status) and mortality is stronger than racial factors; Income, occupation and education are also related to race.
Poverty is one of the factors leading to diseases and shortening life expectancy. Poverty is related to poor health habits, increased risk of disease and difficulty in obtaining medical care. From birth, the danger of poverty includes health problems. Poverty is a serious health crisis. Education level is another factor related to ethnic background. Low education level will increase harmful behaviors, such as smoking, high-fat food and maintaining a sedentary lifestyle. The mortality difference between different races should be attributed to lifestyle and unhealthy behavior. If the two can be avoided, the differences between races should be reduced.
1900, the average life expectancy of Americans is 47.3 years. By 1995, the average life expectancy has increased to nearly 76 years. The reasons for the change are healthy and conscious lifestyle, the control of infectious diseases and the reduction of neonatal mortality. Among them, the popularization of vaccination, safe drinking water, milk supply, effective sewage treatment, increased nutrient intake, the use of antibiotics, as well as medical teams and better intensive care units have all contributed to prolonging life.
In a word, in the 20th century America:
Chronic diseases have replaced infectious diseases as the main cause of death. Accidents, murders and suicides account for more than 3/4 of juvenile deaths. The so-called health differences between different races should come from the differences in socio-economic status and education level, rather than racial problems. The increase in life expectancy is due to the decrease in infant mortality.
The increase of medical expenses: the increase of medical expenses is related to the increase of life expectancy, and the increase of middle-aged and elderly people also increases the expensive medical needs of many chronic diseases. The growth of medical expenses is faster than that of inflation. The annual medical care expenses per person in the United States increased from $592 in 1975 to $3,299 in 1993, an increase of over 500%. These expensive medical expenses can remind the public to find diseases early, adopt a healthier lifestyle and prevent diseases. If we can find the symptoms of the disease early, we will have a chance to control the situation and reduce the risk of serious illness and death.
It is appropriate and worthwhile to spend money to screen the risk groups, because chronic diseases are difficult to treat and living with patients will also reduce the quality of life. But maintaining physical and mental health through a healthy lifestyle is a better choice, because it is easier to maintain health and less costly than restoring health. Through a healthy lifestyle, early detection of symptoms and reduction of health risks have become the direction of change in the field of medical care.
What is health? According to the definition of George Si Tong (1987), there are two types of health: First, health is an ideal state. Any disease or injury will make us deviate from our healthy state, but we can restore our health by eliminating the disease or disability. Second, health is a positive trend. Health is a continuous online direction. It is better to move in a healthy direction than in the opposite direction. Moreover, health is multidimensional, and all aspects of life (including biology, psychology and society) need to be considered.
According to Stone, improving biological functions, such as maintaining normal blood pressure, good cardiac output, high respiratory capacity and the ability to resist stress, infection and physical injury, are all part of good health. The presentation of health at the psychological level is a subjective feeling of happiness. The social aspects of health include high level of social productivity and low demand for health care system. From 65438 to 0946, WHO defined health as a complete state of physical, psychological and social happiness, not just the absence of disease. Therefore, affirming health is a positive state.
Milstein & Irwin (1987) found that only 28% of teenagers think that health means not getting sick, and most teenagers take physiological and psychological factors into account, such as the ability to complete activities and the performance of positive emotional state. Health and not getting sick are related, but they are not the same concept. The absence of disease is only part of the definition of health, not the whole.
Change of health model: The biomedical model in the 20th century can treat or control many diseases with drugs, so it is optimistic that many diseases can be cured, and the focus is on diseases rather than health, while the biomedical model defines health as no disease. Since the recent1/4th century, many doctors, psychologists and sociologists have acknowledged that the biomedical model has made considerable contributions to the treatment of diseases, but the level of consideration is too narrow, ignoring many factors other than biology, so they hope to put forward a new viewpoint to replace it. This new view must retain the advantages of the old view and make up for the shortcomings of the old view. This new model is called the biopsychosocial model.
The biopsychosocial model of disease includes physiological factors, psychological factors and social factors. In order to provide a basic understanding of disease factors and realize a reasonable treatment and health care model, medical models must be able to explain the social background of patients' lives and the compensation system for the negative effects caused by society in response to diseases. In other words, doctors and the health care system. This requires a bio-social psychological model. (Engel, 1977, P. 132) Engel believes that if we persist in the outdated biomedical model, there will be a crisis, and different patients need different medical care methods, so it is urgent to adopt bio-psychological and social models for medical care.
Joseph Matarazzo (1994), a pioneer of health psychology, mentioned that before drugs were widely used, sympathy and empathy were almost all that doctors could give to patients. It is found that even doctors who receive biomedical model education tend to add psychological and social factors to the judgment of diseases, and support the importance of biomedical model.
Most chronic diseases may be partly related to personal behavior, so it should be beneficial to add psychological views and techniques to health care. According to Taylor (1990), the concept of psychology is added to the field of health care to safeguard personal health, rather than waiting for people to get sick before treatment. In the contribution of psychology to health, the skills of behavior change have been included in chronic diseases. In addition to changing unhealthy behaviors, psychologists also use their skills to relieve patients' pain and pressure, promote the behavior according to doctors' orders, and help patients and their families through chronic diseases.
Psychology in the medical environment: At the beginning of the 20th century, psychologists were mostly doctors, and they were closely related to the medical field. 19 1 1 year APA discusses the role of psychology in medical education; 19 12 years, J. Watson, the father of behaviorism, designed a set of psychology courses for medical students. He thinks that doctors need some psychological training to make them treat patients more humanely, but this has not received much recognition. During the period of 1940s, although medical training involved the selection of mental illness courses, it was mostly led by doctors and tended to be psychiatric, and psychologists rarely had the opportunity to cooperate with doctors outside psychiatry. Since1960s, behavioral science has been a part of the curriculum of most medical schools. Before1970s, almost all medical schools had psychologists.
Matarazzo( 1994) estimates that from 1969 to 1993, the number of psychologists with teaching positions in medical schools has almost tripled. Since 1990, doctors no longer regard health psychologists as statistical consultants, candidates or therapists who only treat psychosomatic diseases. Health psychologists, like neuropsychologists and rehabilitation psychologists, have been accepted by most medical staff.
Psychosomatic medicine: it emphasizes that physiological diseases have emotional and psychological components, and believes that psychological and physiological (physiological) factors interact to cause diseases. The research of psychosomatic medicine began in 1932 with Walter Cannon's observation of physiological changes accompanied by emotional changes. He believes that emotions are an emergency response, and emotions will cause changes in the body to cope with the external environment. So emotions can cause changes and may also lead to diseases. H.F. Dunbar (1943) put forward the viewpoint of habitual response, and thought that some personality traits displayed by people may be related to a specific disease.
F Alexander (1950) thinks that psychosomatic diseases are a link between personal conflicts and specific diseases. Such as peptic ulcer, rheumatoid arthritis, hypertension, asthma, hyperthyroidism, neurodermatitis, ulcerative colitis, etc., are all considered psychosomatic diseases. Stress has a greater impact on the organ system of these people than the average person. Once organ weakness and stress appear together, these sensitive people will get sick on this organ. After 1970's, psychosomatic diseases no longer refer to specific diseases, because human diseases cannot be conceptualized or treated by a single factor-a single disease, and all diseases include multiple factors related to the physiological and psychological process between individuals and the environment.
Doctors who accepted the concept of psychosomatic diseases were the first to accept the bio-psychological-social model. Oken( 1987) believes that under the new definition of psychosomatic diseases, all diseases are psychosomatic diseases because they all contain psychological and social components. Mchugh company. Vallis( 1986) thinks that psychosomatic medicine is an innovative movement in the medical field, but psychosomatic medicine still belongs to a branch of psychiatry, and the psychological and physical aspects of diseases are not completely integrated. They claim that psychosomatic medicine should be included in the field of behavioral medicine.
Behavioral medicine: Until the 1970s, the role of psychologists in medicine was still limited to education, psychological testing, psychosomatic medicine and psychotherapy. Its professional knowledge is limited to mental health problems, and it is rarely used to help patients quit smoking, maintain a healthy diet, exercise correctly, reduce stress or control pain. The more we understand the relationship between behavior and disease, and the development of psychology in effectively changing behavior, the more important the role of psychology in health care. 1977, the seminar of Yale University defined behavioral medicine as: caring about the development and integration of knowledge and skills in behavioral science and biological science related to health and disease, and applying these knowledge and skills to the prevention, diagnosis, treatment and rehabilitation of diseases.
Therefore, behavioral medicine can be used to integrate medicine with different behavioral sciences, especially psychology. Its goal is similar to other areas of health care: to promote the prevention, diagnosis, treatment and rehabilitation of diseases. Behavioral medicine combines psychology, behavioral science and medicine to improve health and treat diseases.
Behavioral hygiene: it appears at the same time as behavioral medicine, emphasizing the health promotion and disease prevention of ordinary people, rather than the diagnosis and treatment of patients' diseases. It is an interdisciplinary field in the branch of behavioral science, with special emphasis on the health maintenance of healthy individuals and the prevention of diseases and dysfunction. Topics of concern include: disease prevention, smoking, drinking, diet and exercise. The emphasis is on individual responsibility for health and happiness, not diagnosis, treatment or rehabilitation based on physiology. At present, there is no formal subject training course.
Health psychology: the field of psychology related to behavioral medicine and behavioral hygiene, which focuses on personal behaviors and lifestyles that affect health, including: promoting health, preventing and treating diseases, defining health risk factors, improving medical care system, and shaping public opinion to improve health. In particular, psychological principles are applied to the field of physical health: reducing hypertension, controlling cholesterol, stress management, relieving pain, quitting smoking, reducing other risky behaviors and encouraging regular exercise, physical and dental health examination and safe behavior. In addition, health psychology helps to determine the relationship between health and the treatment and diagnosis of chronic diseases, and correct their behavioral factors in physical and psychological rehabilitation. The position of health psychology in psychology: Matarazzo (1986) thinks that even in the next decade after the establishment of the Health Psychology Association, health psychology is still in its infancy. In addition to studying the core courses of psychologists, health psychologists should also dabble in biostatistics, epidemiology, physiology, biochemistry, cardiology and other fields. So health psychologists are mainly psychologists, supplemented by health experts. Health psychology is not a branch of general psychology, but applies psychological knowledge to health field.