Multicultural psych perspective.

1. Ch. 21: Health Psychology in Multiethnic Perspective By: Jacqueline Heler

2. Primary Objective To identify associations between physical and mental/social health and evaluate how health providers can counsel behavior change

3. Secondary Objectives To understand how and why socioeconomic status (SES) and ethnicity cause illness and inadequate health behaviors To outline the current concept of “patient-centered consultation” in medical practice and its application to cross-cultural counseling

4. “Health” as a two component definition One is that health is seen as a continuum, ranging from illness to well-being, with growth toward the positive end of the spectrum being as important as recovery from the disease end The second component is the explicit recognition of the importance of mental and social health, as well as its potential impact on physical health, and vice versa

5. Physical Health and Social Markers By examining physical health in relation to socioeconomic status, ethnicity, gender, and age, researchers have identified lower SES groups, minority ethnic groups, and the young as in special need of proactive services Minority ethnic groups tend to have lower income and occupation and fewer economic assets to be used in an emergency than Whites, despite having the same educational level The impact of SES and ethnicity on health is less due to biological vulnerability but rather to social inequality

6. Mortality Both SES and ethnicity, separately or together, are strongly related to one’s chances of dying prematurely Higher premature death rate is largely due to three causes: infant mortality, cardiovascular disease (heart attack and stroke), and cancer Higher cardiovascular disease is often attributed to hypertension due to the stresses of racism

7. Physical and Mental Illness Health, as measured by signs of cardiovascular disease, depression, and self-ratings of overall health, was significantly worse with each step down in SES Mental illness is the same; both lifetime and 12-month combinations of depression, anxiety, and substance abuse are more likely to be present in those ages 18-54 years with lower education Compared to those with college education, those who did not complete high school were almost four times more likely to have a combination of these mental illnesses: high anxiety, depression, substance abuse problems, or a combination Black men and women are more likely to have hypertension than White men and women at each level of SES Diabetes is also much more common among Black and Asian adults than Whites, leading to more rapid decline in kidney function In summary: there appear to be social inequalities in mortality and physical illness whereby those with lower education, income, and occupation are more likely to die prematurely and suffer from certain diseases such as heart and respiratory problems than those at a slightly higher SES, all the way up the SES scale

8. Pathways From SES-Ethnicity to Health Pathways from social status to health fall into several categories: (a) the physical environment (e.g., crowding, toxicity), (b) the social environment (e.g., single-parent family, less control over job demands, values), (c) health behaviors (e.g., smoking, drinking, diet, exercise), and (d) access to and use of medical information, treatments, and preventive services The developmental course of poor and minority children indicates that health behaviors may constrain their educational careers and, thereby, their adult occupation and income Those who remained in high school and had high achievement showed better health behaviors. So, adolescents have the opportunity to diverge from their parents’ SES by making choices as to who their peer reference group will be, how achievement oriented they will be, and how much drinking, smoking, and sexual activity they will engage in One of the reasons why education translates into health and long life concerns the ability to seek and make good use of current health care information and services. Although schooling and health literacy were moderately related, the actual ability to read and understand healthcare materials was a stronger determinant of health