PSYCHOLOGICAL MEDIATOR OF HEALTH

PSYCHOSOCIAL MEDIATOR OF HEALT

Health outcomes of relevance to health promotion are the result of complex interaction between BIOLOGICAL, SOCIAL, ENVIRONMENTAL and PSYCHOLOGICAL factors. Here we will examine some of the processes through which environmental stressors and stressed responses may influence health.

 There are many factors which can affect our health and life style, most of them are not biological factors, we get effect of those factors through our environment. So here we will discuss some of the psychosocial factors in details.

Lifestyle and Health:

About 50% of premature deaths can be attributable to lifestyle. Smokers on average, reduce their life expectancy by five years, individuals who lead a sedentary lifestyle by two to three years, and so on. Four behaviors in particular are associated with disease: Smoking, Alcohol misuse, Poor nutrition and Low levels of exercise the so-called “holly four”. Conversely, rarely eating between meals, sleeping for seven to eight hours each night, and eating breakfast nearly every day have been associated with good health and longevity. More recently, high risk sexual activity has been added to the risk added list.

Dietary Habits:

Evidence from nearly half a million people attests to the role of blood cholesterol levels as a major risk factor for coronary heart disease (CHD)

Cholesterol combines with lipoproteins at differing stages of its metabolism within the body, to form high density and low density lipoprotein (HDL & LDL) cholesterol; HDL is considered the “good” cholesterol as it is involved in transportation from the arteries and other tissues to the liver, LDL is considered the “bad” cholesterol because it contributes to the formation of plaque within the arteries.

Blood cholesterol levels are to a significant degree mediated by dietary intake of fats. Diet is also linked to cancer; a research suggested that up to 25% of cancer-related deaths are attributable to dietary factors, including high fat, low fiber and inadequate vitamin and mineral intake.

Risk factors include meat, total fat, saturated fat, preserved food and salt.

Protective factors include fruit, vegetables, fiber, antioxidants, fish oils and calcium.

Interestingly, smokes may reduce their risk of developing lung cancer if their diet includes high levels of antioxidants found in fruit and vegetables. Conversely, a low intake of fruit and vegetables combined with high alcohol intake significantly increases risk for oral, pharyngeal and oesophageal cancers.

Smoking:

Smoking is considered responsible for 25%od all CHD-related deaths, 80% of cases of chronic obstructive airways disease, and 90% of deaths associated with lung cancer, as well as contributing to the development of cancers of the larynx, mouth, oesopgagus, pancreas and bladder.

Reduction in ingested tar of over 50%, following the introduction of filters to cigarettes, are thought to contribute to reductions in cancer levels, but have not impacted on those for CHD. Smoking not only affects the smoker; about 25% of lung cancers that occur in non-smokers are considered to be attributable to passive smoking.

Excessive Alcohol Consumption:

Excessive alcohol consumption may impact adversely on both short and long-term health. Up to 40,000 people in UK are thought to die pre-maturely as a consequence of excess alcohol intake. Although cirrhosis of the liver is the disease most frequently associated with alcohol damage, most deaths result from cancer, three percent of all cancers are attributed to excess alcohol. Even more dramatically, a combination of smoking and high alcohol consumption results in a 44 fold increase in oesophageal cancer. The negative consequences of excess alcohol intake are not just medical but involve social and psychological outcomes. 20% of psychiatric admissions, 60% of parasuicide, 30% of divorces, and 40% of incidences of domestic violence are associated to some degree with alcohol misuse.

Risk of heart disease is now thought to be lowered by moderate consumption of alcohol, mediated by increased HDL cholesterol levels in such drinkers. However, a linear relationship between physical harm and alcohol consumption is  found for all other outcomes including cirrhosis, cancer and stroke.

Exercise:

Those who are physically active throughout their adult life live longer than those who are sedentary. For example, those who expanded more than 2000 kcal of energy in active leisure activities per week lived, on average, two and a half years longer than those classified as inactive. Exercise is protective against both CHD and some cancers. How this protection is achieved, whether through short intense of exercise or longer, more frequent less intense periods appears irrelevant and no additional health gain is achieved by exceeding these limits.

Those who engage in exercise are more likely to be young, male and well educated adults, members of higher socio-economic groups, and those who have exercised in the past. Obstacles to exercise include not having enough time, lack of support from family or friends and perceived incapacity due to ageing.

High Risk Sexual Behavior:

A marked increase in the prevalence of other sexually transmitted diseases and unwanted pregnancies, evidence of the high prevalence of unsafe sex practices and perhaps heralding future increase of HIV infection and AIDS. In contrast to the previous demographic of the disease, adolescent heterosexuals form an increasingly at-risk group for AIDS, accounting for about 20% of all newly reported cases in USA. Within this group, young women and ethnic minorities appear to be at particular risk. For example highlighted findings that AIDS-related illnesses form the leading cause of death for young women aged 25-34 in the USA and the third leading cause for those between 15-19 years old. Ethnic minority adolescents, the majority who were poor urban blacks, accounted for 53% of new AIDS cases. A similar picture is emerging in the UK. Although the majority of newly diagnosed cases of AIDS are still gay and bisexual men, the incidence of new cases among this group is falling slowly as the incidence of such cases among the heterosexuals community rises more rapidly.

Clearly, adolescent sexual behavior places many risk for disease.  They are sexually active group. Findings from British survey revealed that nearly half the adolescents aged between 16 and 17 have had at least one sexual partner during the previous year. However they are unlikely to plan intercourse and only half use of any form of contraception. In well-educated sample of heterosexual students, reported that the most frequent “safer sex” behavior was the use of the contraceptive pill. The least frequent sexual practice, reported by only 24% of the sample, was the use of condoms or dental dams.

Such inappropriate behavior may stem from the lack of knowledge.  However, even high levels of knowledge may not be associated with engaging in safer sex practices. Perhaps a more important factor is that a majority of young persons do not see themselves at the risk of HIV infection or have feeling of invulnerability towards the disease.

Social and Environmental influences on Health:

There is substantial evidence that behavior influence health status. What is also becoming increasingly evident is that the place we occupy in society also impact substantially on our health; indeed, such factors may over-whelm the impact of individual behaviors. We summarize some of the evidence linking gender, socio-economic status, and ethnicity to health and consider some of the mechanism through which these associations may be mediated.

Gender and Health:

Women, on average, live longer than men. According to a research in UK, the life expectancy of men is 71 years; that of women is 77 years. Men asses there health more positively, report fewer symptoms of illness, contact physicians less frequently and experience less acute non-life threatening illnesses than women.

Most explanations for these differences have focused on biological factors. Oestrogen probably protects women against coronary heart disease, through reducing clotting tendency and reducing blood cholesterol levels, while testosterone may serve to increase platelet aggregation.

However gender differences may not necessarily implicate genetic differences. A research has shown that women in traditionally male occupations exhibit the same level of stress hormones as do men in similar jobs. These finding suggest that at least some of these differences may be driven by social and cultural processes, not hard wired biological processes.

The relative power accorded to different gender, for example, may powerfully influence the negotiation of sexual intercourse and sexual behavior. A research reported that 38% of an Australian sample of young women reported having intercourse when they did not want it. Similarly, a number of British studies have found  that young women are disempowered in sexual negotiations such that their intentions to engage in safer sex  practices are not translated into action.

Whatever the cause, men behave differently to women. Men are more likely to be overweight, smoke more frequently using higher nicotine, eat less healthily, and drink more heavily than women. They are also more likely to encounter adverse working conditions, and contact with carcinogens and accidents. The former may work synergistically with health habits to contribute to greater levels of early mortality.

Together, these data suggest that while biological factors may mediate some of the differentials in health status between men and women, others are behaviorally or socially mediated. Gender differential in life expectancy may arise, to a significant degree, from the cumulative effects of different social worlds that men and women experience from the moment of their birth. Consequently, the health status of both men and women can be improved by modifying societal conditions that promote health-damaging behavior.

Ethnicity and Health:

Blacks have high age-adjusted mortality rates for heart diseases, cancer, liver diseases, diabetes and pneumonia than whites. For African-Caribbeans, excess mortality was associated with strokes and hypertension.

Differences in health behavior are associated with both health and gender. In USA, black females drink less alcohol and smoke less cigarettes than white females, while male resembles their white counterparts. Alcohol related morbidity is high among Asian males of Punjabi origin and African-Caribbean men, while a high dietary fat intake and an increasing incidence of diabetes have been observed among Asians. The influence of ethnicity on health behavior is perhaps highlighted when examining transmission of HIV. The most common exposure route for whites is through sexual intercourse between men, for blacks it is through heterosexual intercourse, while for Asians it is mixture of both.

Ethnic minorities may experience wider sources of stress as a consequence of discrimination and racial harassment, and experience more problems in gaining access to health services such as cancer screening and antenatal care than their white counterparts.

Stress and Health:

Stress is not a unitary construct, it is process involving a complex interaction between environmental, psychological and physiological processes.  The relationship between stress and  health, it is necessary first to define stress, and to work from this definition to examine its relationship to health and disease.

Stress as a physiological process:

The relationship between stress, health and disease status is mediated by physiological processes. The primary involves the two divisions of the autonomic nervous system: the sympathetic and the parasympathetic. They rise from the medulla oblongata in the brain stem, and enervate and control the functioning of most of the internal organs, including the heart, arteries, skeletal muscles, and colon. The sympathetic system is involved in arousal. At times of stress, activation of the system is involved in calming or reducing arousal. At times of stress, activation of the sympathetic system is predominant, at times of relaxation, the parasympathetic. Because these systems are mediated by neurotransmitters, collectively known as catecholamines, their activation is extremely fast, but is not sustained.

More prolonged activation results from hormonal processes. Activation of the sympathetic nervous system results in the medulla area of the adrenal glands, releasing the neurotransmitter hormones epinephrine and norepinephrine. These enter the blood stream and reach the organ controlled by the sympathetic system to maintain longer periods of activation. At the same time, a second “stress” system is activated. This involves sympathetic activation of the pituitary gland, situated under the hypothalamus I the brain, which releases a number of hormones, including adrenocorticotrophic hormone (ACTH). In turn, ATCH stimulates the adrenal cortex to release hormones known as corticosteroids. These increases availability of energy stores of fats and carbohydrates, helping maintain arousal. They also inhabit inflammation of damaged tissue.

One of the first coherent explanatory models of the association between stress and health suggested this sympathetically mediated activation is a non-specific response to all stressors, whatever their nature, involving three stages: alarm (driven primarily by sympathetic processes), resistance (mediated by hormonal changes, and exhaustion. Consistent over activation of the sympathetic nervous system may contribute to the development of a number of chronic diseases, including coronary heart disease, skin disorders, diabetes, and a number of gartro-intestinal disorders.

The exact aetiology of each disease process may differ. In the case of heart disease, for example, episodes of high sympathetic arousal consequent to stress are associated with the release of fatty acids into the bloodstream. At same point, a clot may be torn off a damaged artery wall, perhaps during an episode of increased blood pressure. If this reaches the arteries of the heart or brain and is too large to pass through an artery, it occludes the artery and prevents blood flow beyond, resulting in a heart attack or stroke.

Life Events as Sources of Stress:

Psychological model of stress, disregarding the physiological process. They explore the relationship between major life events and the development of disease. With scores 0-100, with higher scores reflecting more highly stressful events. Their theory stated that the higher an individual’s  score on this hierarchy, the more likely they were to experience a stress-related disease.

In particular, the scale does not take into account the meaning or impact of an event for the individual. The score for the most stressful item (death of spouse: 100) , is the same regardless of the individual’s age, their dependence on the spouse, the length and happiness of the marriage, and so on. In addition, the model takes no account of how well the individual copes with any life event which occurs, or the support available from the family or friends, to help them deal with it. The availability of such resources can provide a stronge buffer against the psychological and physical effects of stressful life events.

Individual differences in stress response:

A number of more recent theories have attempted to explain these individual differences in response to stress. One, the diathesis-stress model, proposed that while stressful events may form a trigger to the stress process, physiological predispositions towards a certain illness and previously experienced environmental conditions are important determinants of the disease outcome. What is also evident is that not all individuals react to potentially stressful events in the same way.

In one of the most influential models of stress, identified stress as a process in which environmental, in that these processes are bi-directional. The environment may trigger a stress response, but the environment may, in turn, ne modified by the individual to moderate, or exacerbate, its potential aversive effects.

summary:

The health status is not only mediated by biological factors, but is affected by social, economic, psychological and societal processes. Individually mediated behavior such as diet, exercise and smoking may directly affect health. Social class and sex also affect directly on health. A significant variance in health status is attributable to an interaction between behavioral and societal processes. Low socio-economic status is associated with environmental stress. It may also be associated with a lack of resources through which to mitigate the effect of such stressors or through which to engage in health promoting behaviors, poor access to appropriate health care resources, and so on, gender specific rules may influence uptake of exercise and job autonomy. In addition, family processes may influence a wide range of health-related behaviors.

Health and health-related behaviors occur within a complex system of interacting influences. According, effective health promotion should address the system, and not just isolated individuals with it. This will require multi-level interventions, focused on individuals, societal processes, environmental and cultural processes.