In October 2002, I had the honor of presenting the Psi Chi Distinguished Lecture for the New England Psychological Association's meeting at Riviers College, Nashua, New Hampshire. I was particularly pleased to have the opportunity to speak to and interact with educators and students who were deeply committed to the discipline of psychology and to promoting quality in teaching and research. The lecture was based on the work compiled for my 2001 American Psychological Association Presidential Initiative and the resultant book, Psychology Builds a Healthy World: Research and Practice Opportunities (Rozensky, Johnson, Goodheart, & Hammond, in press).
My presidential initiative espoused the biopsychosocial model of health proposed by George Engel (1977). Engel's model focused on the necessity of understanding and integrating into health care the role of psychological factors such as cognition, behavior, emotions, and social circumstances. My initiative added the influence of culture upon health and included strength-based approaches (Johnson, Worell, & Roberts, 1999), positive psychology (Seligman, 2002), and systems such as the family, community, and work.
To facilitate this conversation, four national and international experts were invited to give presidential addresses at the 2001 APA convention in San Francisco. Mary Pipher, William Pollack, Susan Pick, and James Campbell Quick spoke of the psychological research and practice opportunities for the health of immigrants, families, communities, and within the workplace.
The American Psychological Association (APA) affirmed the primacy of psychology and health when it amended its mission statement in May 2001 to include the word "health." The mission statement now is: The mission of the American Psychological Association shall be to advance psychology as a science and a profession, and as a means of promoting health and human welfare.
The passage of this change by the APA membership, after its unanimous approval by the APA Board of Directors and near unanimous approval by the APA Council of Representatives (APA, 2001), marked another milestone in recognizing the importance of psychology in health science and health practice.
Support for the integration of psychological research and practices is espoused by international and national organizations concerned about health. Since 1944 the World Health Organization (1948) has defined health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. And the Institute of Medicine (2000) asserted that a key to helping people enjoy longer, healthier lives is understanding how to promote behavioral change and to create healthier environments.
Intertwining Health and Psychology
We must work as psychologists to erase the line between health and mental health in research, practice, and public policy. And educators must be at the forefront of presenting to students and future psychologists the latest in psychology health research and health practices. Illustrative of the significance of psychological factors in health is the depth and breadth of psychological research and practice across the health spectrum of wellness, prevention, acute and chronic illnesses, recurrence, and death and dying.
Here are but a few examples of the intertwining of psychological contributors to illness, disability, and wellness: The U. S. Department of Health and Human Services (2000) reported mental illness as the third leading cause of death and disability, after heart disease and cancer. What does research say about these three major killers? Research has demonstrated a significant relationship between the onset and progression of heart disease and psychological factors. Social/cultural and behavioral, emotional, and cognitive factors have been demonstrated to contribute to cancer. And an appalling rate of disabilities and death are attributed to mental illness.
The implications for psychological research are international. In 1999, cardiovascular disease (CVD) contributed to one-third of deaths world wide. By 2010 it is expected that CVD will be the leading cause of death in developing countries. Research findings by Blumenthal et al. (1997) demonstrated the emotional and social contributors to CVD, including hostility, anger, stress, depression, and social isolation. Hostility in younger people was related to coronary artery calcification (Matthew et al., 1989). On an emotional level, research indicates that depressed patients who have had one heart attack are more likely to die from a recurrence (Blumenthal et al., 1997). And it is now well accepted that behaviors such as smoking and eating habits contribute to heart disease and cancer.
On a recent trip to England I read that Parliament was considering reducing the national health benefits for obese patients who did not make substantive attempts to reduce their weight. As the world becomes aware of the psychological underpinnings for many major diseases and disabilities and hence the drain on national resources, it is increasingly critical that psychological research and interventions be integrated into public health policy internationally. Health services must be universally available and the line between health and mental health must be erased. Health and mental heath services must be equally available.
A model for health should include cultural elements for a variety of reasons. Although we live in a country of enormous riches, there are still vast health disparities. Ethnicity, race, immigration class, social class, and gender have a major impact on the quantity and quality of health services available. Thirty million Americans have no health insurance. And we know that without appropriate early interventions, acute illnesses become serious and chronic. Social economic factors are related to access to appropriate health care and there is a direct ratio of health dollar expenditure with race and social class and health services.
Gender is also an important factor in health and the accessing of health services. Men's health may be jeopardized by several factors. Men ages 30-50 tend to ignore symptoms of health problems and delay seeking help, and men of all ages engage in risky behaviors that jeopardize their health (Stanton & Courtenay, in press). Women's health may be compromised by health providers who minimize reported symptoms and the type of stress women encounter due to their roles as primary caretakers (Stanton & Courtenay, in press).
The Surgeon General's Report (2001) boldly laid out the discrepancies in mental health services related to culture, race, and ethnicity. I was honored to introduce Dr. Satcher, the Surgeon General, at APA's 2001 Convention, where he presented for the first time to a national audience, this report's call to action.
Psychologists must be in the forefront of espousing a biopsychosocialcultural model of health research and health care. This model would feature collaborative involvement with psychological research and psychology practitioners integrated into health settings beginning with public and private primary care settings. Education from high school through undergraduate, doctoral, and post-doctoral programs would include units on the psychological aspects of the health spectrum, including wellness, causes of illness, and treatments of disease and illness.
Psychologists as public advocates can actively work in their communities, states, as well as nationally to enact health care policies that increase access, reduce health disparities, and promote a prolonged and improved quality of life. By actively educating ourselves and then informing the public of the psychosocialcultural aspects of health and the psychology research and practices that foster a healthy world, we can work together to remove the line between mental health and health.
As educators, you are on the front line in influencing the next generation of citizens. As psychologists, you are part of the important and dynamic changes taking place today in health. I would like to hear how you enact or envision psychology and health. Contact me at firstname.lastname@example.org.
American Psychological Association. (2001, February). Draft minutes. Council of Representatives, February 23â€"25, 2001. Washington, DC: American Psychological Association.
Blumenthal, J. A., Wei, J., Babyak, M., Krantz, D. S., Frid, D., Coleman, R. E., et al. (1997). Stress management and exercise training in cardiac patients with myocardial ischemia: Effects on prognosis and on markers of myocardial ischemia. Archives of Internal Medicine, 157, 2213â€"2223.
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Seligman, M. E. P. (2002). Positive psychology, positive prevention and positive therapy. In C. R. Snyder & S. J. Lopez (Eds.). Handbook of Positive Psychology. (pp. 3â€"9). New York: Oxford University Press.
Stanton, A. L. & Courtenay, W. (In press). Gender, stress, and health. In R. H. Rozensky, N. G. Johnson, C. D. Goodheart, & W. R. Hammond (Eds.). Psychology Builds a Healthy World: Research and Practice Opportunities. Washington, DC: American Psychological Association.
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