Health Psychology. Michael Murray
the potential impact of this on our longer-term health. In many cases, moderation is often the key.
2.30 All capable adults are responsible for these very personal choices. At the same time, we do not have total control over our lives or the circumstances in which we live. A wide range of factors constrain and influence what we do, both positively and negatively.
2.31 The government’s approach to improving health and wellbeing – relevant to both national and potential local actions – is therefore based on the following actions, which reflect the Coalition’s core values of freedom, fairness and responsibility. These are:
strengthening self-esteem, confidence and personal responsibility;
positively promoting ‘healthier’ behaviours and lifestyles; and
adapting the environment to make healthy choices easier.
In the above policy document, personal responsibility remains at the top of the agenda. The statement that ‘we do not have total control over our lives or the circumstances in which we live’ is a small step forward but, unfortunately, taking two steps back negates this. Only holistic public policies can lower the toxicity of the environment, and to declare otherwise is a cop-out. Yet large corporations are engaged as the new allies of health promotion in the twenty-first century. The UK government enlisted the food industry, including McDonald’s and Kentucky Fried Chicken, among other corporations, to help to write policy on obesity, alcohol and diet-related disease (MailOnline, 2010). Processed food and drinks manufacturers, including PepsiCo, Kellogg’s, Unilever, Mars and Diageo, were contributors to five ‘responsibility deal’ networks set up by then Health Secretary Andrew Lansley. In a similar sponsorship arrangement to previous Olympic Games, McDonald’s and Coca-Cola sponsored the 2012 London Olympics. This is putting foxes in charge of the hen house!
In the USA there has been a similar shift in thinking: the ‘anything in moderation’ philosophy of responsible consumption is no longer the principal foundation for public health interventions. The Surgeon General’s Vision for a Healthy and Fit Nation states:
Interventions to prevent obesity should focus not only on personal behaviors and biological traits, but also on characteristics of the social and physical environments that offer or limit opportunities for positive health outcomes. Critical opportunities for interventions can occur in multiple settings: home, child care, school, work place, health care, and community. (US Surgeon General, 2010: 5)
In twenty-first-century health care, the opportunities for health psychological interventions to assist within the major settings has never been greater. But one must ask whether the discipline is fit to meet these challenges. Alternative methods must be tried and tested if we are to make in-roads into the massive scale of issues on the public health agenda.
Economic analyses use gross domestic product (GDP) as a measure of output and, to a degree, an indicator of welfare also (Oulton, 2012). GDP measures the value of goods and services produced for final consumption, private and public, present and future. Across countries, GDP per capita is highly correlated with important social indicators. GDP is positively correlated with life expectancy and negatively correlated with infant mortality and inequality. One of the most traumatic events in anybody’s life is the loss of a child, and infant mortality rates might be thought of as a proxy indicator of happiness. Figure 4.1 plots infant mortality against per capita GDP for a large sample of countries. The graph shows that richer countries tend to have greater life expectancy, lower infant mortality and lower inequality. As always, it is important to state that correlation is not necessarily causation, although there is strong evidence that higher GDP per capita leads to improved health (Fogel, 2004).
Figure 4.1 Infant mortality versus household consumption per head across 146 countries
Source: Oulton (2012)
A key component of subjective well-being and quality of life is employment. A strong relationship exists between these factors. Unemployment brings stigma, lowered self-esteem and mental health problems, especially depression and feelings of low self-worth (Warr et al., 1988). In some cultures, for example in Japan, a particularly strong correlation exists between the suicide rate and unemployment rate among men (Chen et al., 2012). Under a blanket of statistics lies a multitude of individual calamities.
Population growth and the scourges of unhealthy commodities, unemployment, poverty and inequality place their fingerprints over human existence. In charting the macro-social environment for health, we consider the transitions that have accompanied the globalization of unhealthy commodities, population growth and widespread poverty; we briefly discuss inequalities both within and between societies, and the inequities that exist between genders and ethnic groups. In the following chapters, we take up social justice issues in more detail (Chapter 5) and explore the significance of culture (Chapter 6).
Epidemiological Transition and Globalization
Epidemiology is concerned with the distribution of disease and death and their determinants and consequences. Diseases can be divided into two broad categories: communicable and non- communicable. Communicable diseases spread from one person to another or from an animal to a person. This spread may happen via airborne viruses or bacteria, but also through blood or other bodily fluid. The terms ‘infectious’ and ‘contagious’ are used to describe communicable disease. Major examples are influenza, HIV infection, hepatitis, polio, malaria and tuberculosis. Non-communicable, or chronic, diseases are generally diseases of long duration and have a slow progression. Major examples are cardiovascular diseases (e.g., heart attacks and stroke), cancer, chronic respiratory diseases (e.g., chronic obstructed pulmonary disease and asthma) and diabetes. Non-communicable diseases (NCDs) are currently the leading cause of death in the world, representing 63% of all annual deaths (World Health Organization, 2014b). NCDs kill at least 36 million people each year, some 80% of which occur in low- and middle-income countries.
Omran (1971) described what he termed the ‘epidemiological transition’. This refers to a reduction in prevalence of communicable diseases and an increase in the prevalence of NCDs that occur as a country becomes economically stronger. NCDs are lifestyle-related chronic diseases that accompany increased usage of unhealthy commodities such as alcohol, tobacco and processed foods. During this transition, countries that have low or middle incomes face a heavy burden from both communicable and non-communicable diseases. In industrial countries such as the USA, Germany, the UK and Japan, the prevalence of communicable diseases is much lower compared to chronic NCDs. In India, and other low- and middle-income countries, while communicable diseases are still present, the rise of NCDs has been rapid (Anjana et al., 2011). Low- and middle-income countries like India, therefore, are currently facing an epidemiological transition with a ‘double burden’ of disease.
The major driver of the transition towards widespread prevalence of NCDs is corporate globalization. From the point of view of human health, globalization flies a banner of progress and freedom yet brings illness and an early death to millions of people. Transnational corporations are indeed the major drivers of NCD ‘pandemics’ as they scale up their promotion of, and huge profits from, tobacco, alcoholic and other beverages, ultra-processed food and other unhealthy commodities throughout low- and middle-income countries.
Stuckler et al. (2012) observed that the sales of unhealthy commodities across 80 low- and middle-income countries are strongly interrelated. They argue (see Figure 4.2) that:
in countries where there are high rates of tobacco and alcohol consumption, there is also a high intake of snacks, soft drinks, processed foods, and other unhealthy food commodities. The correlations of these products with unhealthy foods suggest they share underlying risks associated with the market and regulatory environment. (Stuckler et al., 2012: 3)
Referring to these data,