Health Psychology Baseline Comparison Theory.
This paper examines government initiatives to improve the health of the population. The application of scientific research within the field of health psychology is discussed in relation to these government initiatives. In particular, the need to address diseases of lifestyle via the application of such research is highlighted in terms of costs to the NHS. The need for a national shift in health attitudes is emphasised, as well as a need for policy to promote individual responsibility for health and well-being.
The ‘Choosing Health: White Paper’ (2004) reflects governmental initiatives to support people in their health decisions. Undoubtedly, the most effective method of choosing health is by taking personal responsibility for lifestyle choices. The recent smoke-free legislation and National Alcohol Strategy, as well as other public health initiatives, indicate that diseases of lifestyle are a governmental priority. There are a wealth of implications and costs in treating diseases caused by diet, alcohol abuse, and smoking. As an example, obesity prevalence has trebled since the 1980s, costing the government a staggering £3.3– £3.7 billion annually [1]. Unhealthy lifestyle choices are clearly intensifying the individual and societal burden.
Unique scientific research within Health Psychology could offer insight into how health decisions are made. For example, how do we know how healthy or unhealthy we are? Health Baseline Comparisons (HBCs) have been proposed as the initial cognitive stage in answering this question. The HBCs include comparing ones health with past health, changes in physical ability, or with the health of others, in an attempt to decide how healthy one is [2]. Baselines in the form of comparison points, or reference points, are used to help us evaluate our current health status and any changes that may occur to our health. Through the development of the first questionnaire designed to measure these baselines, research with cancer patients has facilitated an understanding of the different types of health baselines utilised. Furthermore, these baselines appear to be influential in terms of outcomes such as quality of life and health behaviours. Although HBC theory is being explored with cancer patients, its concepts are applicable at a micro and macro level across the general population.
The very foundations of the NHS could be endangered by continuing to finance and resource diseases of lifestyle, as is becoming apparent within the current limitations of the NHS system. The NHS is, at least partially, diminishing individual responsibility for health. A largely neotonous population has emerged whereby the individual can remain, to a large degree, unmindful of their own health needs because the NHS will intervene. It is possible that if people assess their health via appropriate baselines, they may be more equipped to take greater responsibility for their health in the form of healthier lifestyle choices. People tend to only think about their health when it is challenged or compromised, yet HBC initiatives could help people understand that lack of any physical manifestations of an unhealthy lifestyle does not negate risks to health. Advancements in medical knowledge have resulted in a greater understanding of the physical health implications of certain behaviours but, in general, humans have not adapted to this knowledge. If such knowledge were integrated into carefully designed initiatives that draw on HBC theory, it is likely to result in more informed and healthier decisions.
Research on HBC could also play an important role in the management of illness. Of paramount importance in healthcare is adherence to medication. Non-adherence has become a major problem, with adherence rates in developed countries being lower than 50% [3], thus reducing the overall effectiveness of health systems. Health Baseline Comparisons theory can offer some insight into the common problem of why so many individuals initially follow medication regimens, only to later reduce their adherence. It is plausible that some individuals do not adjust their HBC in line with adherence outcomes, such as reduced symptoms. It could be argued that medications mask an individual’s true health status and that HBC interventions may be an effective method of educating patients about this.
Just as the government has orchestrated a momentous shift in public perceptions of smoking, HBC theory could help facilitate such a national shift in health attitudes. Any educational interventions could be applicable in hospitals, the workplace, schools, and perhaps most importantly, to the general public. It is possible that if the government’s health policies consistently support individuals to take responsibility for their health, eventually the general ethos will reflect the key message that good health often results from individual responsibility. Changing public opinion is a very slow and methodical task, but could offer long-term and cost-effective benefits for the health of the nation.
References
The Health Select Committee (2007) Health risk and costs of obesity. Department of Health. Available at:
http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Obesity/DH_4133949 (accessed 24/03/08).
Davies, N.J. and Kinman, G. (2006) Health baseline comparison theory: Adjustment to rheumatoid arthritis. Health Psychology Update, 15(3): 31–36.
World Health Organisation (WHO; 2003) Adherence to long-term therapies: Evidence for action. Available at: http://www.emro.who.int/ncd/Publications/adherence_report.pdf (accessed 24/03/08).