Optimizing Wellness: The Role of Health Psychology in India
Health has traditionally been discussed with reference to the physical body. Moreover, it is often understood in terms of the absence of any objective or subjective signs of illness. However, such notions do little justice to the multi-dimensionality of health.
The WHO has defined health far more comprehensively as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The definition has not been amended since it was originally developed in 1948. The health sector in India presents a very mixed picture. On one hand, India has made enormous strides in the last few decades. Life expectancy has crossed 67 years, fertility rates have declined, improvements have been seen in infant and under-five mortality rates and certain diseases such as polio have been eradicated. On the other hand, like many developing countries in the world, India presently endures the complex burden of two kinds of illnesses. The first of these are communicable or infectious diseases including tuberculosis, malaria, and HIV. The other category is of non-communicable or chronic diseases such as heart ailments, cancer, respiratory diseases and diabetes. Concerns around chronic illnesses have begun to increase, firstly because they affect a large proportion of the population, and secondly because they have started to appear at earlier ages. It has been projected that by 2020, chronic diseases will account for almost three-quarters of all deaths worldwide.
Much research is now being devoted to establishing the risk factors for chronic illnesses. Diet and nutrition are now understood to play a key role as risk factors for chronic diseases. Traditional, largely plant-based diets have been replaced by diets that are high in sugar and fat. A survey conducted by the George Institute for Global Health in 2019 found that India's packaged foods and drinks were found to be the mostly energy-dense, among the 12 countries surveyed. Another contributory factor is the lack of physical activity. While gymnasiums and fitness centers abound in Indian cities, many people continue to lead sedentary lifestyles. In a study conducted in the year 2019 on 3000 Indians by the market intelligence agency Mintel, nearly 64% Indians reported that they do not exercise, primarily due to lack of time. The third major risk factor for chronic illnesses is the consumption of harmful substances such as tobacco. Approximately 34.6% of adults in India (out of which 47.9% are males and 20.3% are females) are smokers. Further, it has been found that up to 60% of total cancers among males in India are tobacco-related.
The need to counter the spread of the chronic disease epidemic is now widely recognized. WHO has estimated that India stands to incur a cost of $4.58 trillion between 2012 and 2030 due to non communicable diseases and mental health conditions. However, these losses are not inevitable. Given that chronic illnesses are influenced by lifestyle based factors, they are largely preventable. Primary prevention grounded in screening programs and a well-developed health infrastructure is considered to be the most cost-effective and sustainable course of action available. Prevention efforts can be strengthened by referencing to the corpus of knowledge offered by Health Psychology. Psychology has traditionally emphasized mental health problems. However, health psychology which emerged in the 1970s is based on the understanding that there is a critical role for psychologists to play in the promotion of physical well-being.
Health psychologists work with individuals, groups, and communities to decrease the risk factors for chronic illness, improve overall health, and reduce physical illness. Division 38 of the American Psychological Association is devoted to health psychology. The discipline of health psychology subscribes to the Biopsychosocial model of health and illness, presented by the psychiatrist, George Engel in 1977. Engel questioned the long-held assumption that only the biological factors underlying health and disease were worthy of consideration. His model views health and illness as an interaction of biological (genetics, immune system functioning, hormones), psychological (personality, cognitions, emotions, motivations) and social factors (cultural, familial and peer influences). Take the example of breast cancer. It is clearly an illness that manifests in the body and genetics have been implicated in its causation. However, psychological barriers such as fear and shyness may prevent women from going in for regular screening check-ups. reducing the possibility of early detection. At psycho-social level, breast cancer and other life threatening illnesses can force us to make major life adjustments, change our plans and transform our relationships with other people. it can be a terrifying experience to endure although meaningful engagement with a life-goal and support from loved ones can play a critical role in recovery. Hence breast cancer has not only physical but also psychological and social impacts on the patients. Health psychologists as-sist patients in managing these psycho-social aspects of their illness and its treatment.
Health psychologists are trained in the scientist-practitioner model. They may work as independent clinicians or as part of health care teams in hospitals. It is so because health psychology emphasizes how thinking, emotions, relationships and behavior influence health, it is uniquely positioned to help people change in ways that contribute to health and well-being. Some examples of their work include helping patients identify life plan changes needed as part of treatment, providing biofeedback therapy for dealing with anxiety or depression resulting from a health problem, helping families in coming to terms with the patient's illness and working with doctors or nurses to help them better understand patient's needs. Psychologists who work in this field might conduct applied research on how to prevent unhealthy behaviors (such as smoking or consumption of junk food) and look for new ways to encourage healthy actions such as exercising. While most people realize that certain behaviors have negative impacts on their health, they continue to engage in those behaviors due to old habits, lack of self-efficacy, convenience or the cost involved in making a healthy change. Healthy psychologists have sought to create efficacious interventions by which such barriers may be overcome so that people make healthier choices.
Health psychology is a nascent field in India. In comparison to countries such as the United Kingdom and Australia, very few universities in India offer Health Psychology programs. The focus in India remains mainly on clinical psychology and on the treatment of mental illnesses. Yet given the changing patterns of physical illnesses in the country, a discipline like health psychology which is geared towards prevention and health promotion can prove to be extremely useful in improving health parameters and reducing health-care costs.
It is time we devote our attention to increasing the scope of the field in our country with the goal of optimizing wellness.