In the 1940’s cardiovascular diseases were the number one cause of mortality in Americans. Prevention and treatment were so poorly understood that “most Americans accepted early death from heart disease as unavoidable.” However, the death of President Franklin Roosevelt spurred a movement in research of cardiovascular disease.

In 1944, President Roosevelt was diagnosed with “hypertension, hypertensive heart disease, and cardiac failure.” This diagnosis was given to him by a cardiologist, but his personal physician denied anything being out of the ordinary. His high blood pressure ultimately led to his untimely death nearly a year later. The death of President Roosevelt shows just how little was known about cardiovascular diseases in the mid-20th century. Just over two years later, President Harry Truman signed into law the “National Heart Act,” and the Framingham Heart Study began.

The objective of the Framingham Heart Study was to identify common factors or characteristics that contribute to cardiovascular diseases by following its development over a long period of time with a large group of participants who had not yet developed symptoms of cardiovascular disease or suffered a heart attack or stroke. More than 5,000 male and female residents of Framingham, Massachusetts, were enrolled as the first group of participants. Every two to four years, participants underwent extensive medical, physical examinations and lifestyle interviews. All were later analyzed for common patterns related to cardiovascular disease development. In 1971, the study enrolled a second generation, using the original participants’ adult children and spouses. In 1994, the study participants were revised to include a more diverse population (OMNI). In 2002, the second group of OMNI participants were enrolled.

The Framingham study has led to the identification of major cardiovascular disease risk factors, including high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity. The Framingham Heart Study corrected clinical misconceptions, showed that there is no essential and sufficient cause, developed a multivariable risk assessment profile (the Framingham risk score) and introduced the concept of preventive cardiology to physicians.

 

Hajar, R. (2016). Framingham Contribution to Cardiovascular Disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966216/

While western medicine uses a biomedical approach to health, health psychologists prefer to evaluate health through a biopsychosocial lens. Quite simply, this approach includes the influences of biological factors, psychological factors, and social factors when looking at overall health. The biopsychosocial approach focuses on the biology or physiology underlying health; the psychology of thoughts, feelings, and behaviors influencing health; and the ways that society and culture all influence health. The biopsychosocial approach allows us to see how health changes not only biologically, but how your inner thoughts and feelings and the society around you influences your perception and determination of health.

 

So, what’s the big difference between a biomedical approach and a biopsychosocial approach? Well, when we break it apart, it comes down to cells vs societal influences. The biomedical approach takes health from a purely biological perspective. If this cell does this, then this is what happens to the body. If this muscle does this, then this must happen. But take a step back…is that really how health works? The biopsychosocial approach suggests that there is more. In 1977, George Engel argued that well-being includes the effects of psychological, behavioral, and social dimensions. His biopsychosocial approach advocates for the necessity of treating and thinking about illnesses by including the social and behavioral factors that play a role in overall health (e.g., poor eating habits and obesity, smoking, stress/anxiety/depression, etc.).

 

Here is an example of how a biopsychosocial approach differs from a purely biomedical perspective.

 

Smoking:

• BIOMEDICAL APPROACH: A biomedical approach analyzes smokers from the biological perspective and reasons for smoking: addiction or heritability. However, we can see from a biopsychosocial approach that there are many reasons that people start smoking, and they are not necessarily from a biological origin.
• BIOPSYCHOSOCIAL APPROACH: People may start smoking for PSYCHOLOGICAL reasons, such as thinking it makes them less stressed or because of personality traits (extroverts are more likely to smoke). People may start smoking due to SOCIAL networks or perceived cultural norms. Finally, we still must note that addictions and heritability are BIOLOGICAL components that can contribute to smoking behaviors.

 

Gurung, R. A. R. (2014). Health Psychology: A Cultural Approach. Belmont, CA: Wadsworth.

The biopsychosocial approach is the main theoretical approach used by health psychologists. It combines the biological, psychological, and social influences on an individual’s health behaviors and overall health (Gurung, 2014). This approach is important to remember the World Health Organization defines health as complete well-being, not just the absence of disease.

Some of the factors that fall under Biological are:

• Gender
• Physical Illness
• Disability
• Genetic Vulnerability
• Immune Function
• Neurochemistry
• Stress Reactivity
• Medication Effects

Some of the factors that fall under Psychological are:

• Learning & Memory
• Attitudes & Beliefs
• Personality
• Cognitions
• Behaviors
• Emotions
• Coping Skills
• Past Trauma

Some of the factors that fall under Social are:

• Social Support
• Family Background
• Cultural Traditions
• Socioeconomic Status
• Education
• Society
• Community

(Gurung, 2014)

There are several reasons why using the biopsychosocial approach is important today. The main causes of death have shifted from being infectious diseases to chronic diseases. Societal features such as SES and culture, are also becoming more pertinent. Medical costs continue to rise, and it is important that medical issues can be prevented and/or detected early (Gurung, 2014).

The biopsychosocial approach can be applied to understand a variety of health behaviors. For example, the biopsychosocial approach can be used to understand the health behavior of excessive drinking. A person may excessively drink because they have a genetic disposition for an addiction to alcohol (Biological). A person may be struggling with negative emotions and use alcohol as a coping mechanism (Psychological). A person may also be prone to drink excessively when they are with friends that also drink excessively (Social).

The Biopsychosocial approach can also be used in understanding what determines health behaviors (Gurung, 2014).

Biological:

• Genes
• Physiology
• Age
• Gender
• Fitness
• Weight

Psychological

• Personality
• Rewards/Punishments
• Cognitive Biases
• Emotion/Motivation

Societal

• Social Support
• Society
• SES

The Biopsychosocial approach can be applied to a variety of aspects of the world of psychology. It can specifically be applied to understanding overall health and health behaviors. It is a beneficial approach to us because it looks at all the possible biological, psychological, and social influences affecting overall health and health behaviors.

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Gurung, R. A.R. (2014). Health Psychology: A Cultural Approach. (3^rd Ed.) Wadsworth: Cengage Learning.