The Evolving Healthby Shaheen E Lakhan, MD, PhD, MEd, MS | March 5, 2006
In industrialized nations, health has changed from an era of infectious plagues and poor nutrition to chronic and often preventable morbidity. A combination of biotechnological advancements (e.g. vaccines) and mere improvement in personal and medical hygiene have eradicated diphtheria, typhoid fever, and measles from topping the major causes of death. Now, there is now a “new morbidity” where chronic conditions such as cardiovascular diseases, cancer, and diabetes topped the charts. Consequently, two major shifts in public health were observed: a significant reduction in infant mortality and significantly greater life expectancy at birth.
Infant mortality rate (deaths per 1000 births) has dropped in the last 50 years (Centers for Disease Control and Prevention, 2003).
Life expectancy rates have risen in the last 100 years (Centers for Disease Control and Prevention, 2003).
Health care costs rose sharply in the last half century in as a by-product of increased life-expectancy due to new technologies and the eradication of life-shortening illnesses. The distribution change in morbidity has caused industrialized societies to focus on prevention. However, administrators and the general public are increasingly realizing that disease prevention is best accomplished from a model that encompassed the broad spectrum of behavioral and social cultural influences that extend beyond the biomedical perspective, the biopsychosocial model.
Thus, over twenty-five years ago in response the failures of the biomedical model to account for evolving health and seemingly apparent psychological associations, American Psychiatrist George Engel introduced a major theory in medicine, the biopsychosocial model of health and illness (1977). The model accounted for biological, psychological, and sociological interconnected spectrums, each as systems of the body. In fact, the model accompanied a dramatic shift in focus from disease to health, recognizing that psychosocial factors (e.g. beliefs, relationships, stress) greatly impact recovery the progression of and recuperation from illness and disease.
The following outlines the triad system of the BPS model:
- Genetics & Biochemistry (neurochemistry and transmission, gene/protein/pathway regulation)
- Structural (brain functioning)
- Behavioral (health beliefs, learned actions, personality)
- Cognitive (thought processing, comprehension)
- Affective (emotional processing, mood)
- Stressors (environmental stimulus)
- Supporters (social networks, relationships)
- Roles (gender, economic status, identity)
- Developmental States (maturity, life stage, age)
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