Chapter

Introductory Chapter:
Bio-Psychosocial Model of Health
Simon George Taukeni

1. Introduction

Health psychology explores different ways in the pursuit of getting people to

embrace health promotion, illness prevention and health maintenance. As a speciality,
health psychology examines how biological, psychological and social factors influence
people’s behaviour about their health status. The aim of this chapter is to examine
possible contributory connections between bio-psychosocial factors and health at the
population level. The book explores bio-psychosocial model which can help individu-
als to develop and maintain healthy lifestyles so as to promote good health and prevent
illness. Friedman and Adler [1] noted that the original bio-psychosocial model shaped
not only research and theory on health but also the development of health psychology.

2. Definitions

2.1 Health

Kazarian and Evans [2] suggest that people commonly think about health in
terms of an absence of (1) objective signs that the body is not functioning properly
and (2) subjective symptoms of disease or injury, such as pain or nausea. World
Health Organization defined health as ‘a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity’ (WHO, 1946
cited in [3]:4). Some health psychologists defined health as a positive state of
physical, mental and social well-being not simply the absence of injury or disease
that varies over time along a continuum [4]. At the wellness end of the continuum,
health is the dominant state. At the other end of the continuum, the dominant state
is illness or injury, in which destructive processes produce characteristic signs,
symptoms or disabilities [4]. For further detail, see Figure 1.

2.2 Health psychology

Health psychology is a speciality within the discipline of psychology con-

cerned with individual behaviours and lifestyles affecting physical health. The
discipline strives to enhance health, prevent and treat disease, identify risk factors
and improve the healthcare system public opinion regarding health issues [5].
Matarazzo in 1980 (as cited in [3]:4) offered a definition of health psychology
which has become widely accepted:

Health psychology is the aggregate of the specific educational, scientific and

professional contributions of the discipline of psychology to the promotion and
maintenance of health, the prevention and treatment of illness, the identification of

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Psychology of Health - Biopsychosocial Approach

etiologic and diagnostic correlates of health, illness and related dysfunction, and the
analysis and improvement of the health care system and health policy formation.

2.3 The goals of health psychology

Sarafino ([4]:11) mentioned the following goals of health psychology as to:

• Promote and maintain health

• Prevent and treat illness

• Identify the causes and diagnosis correlates of health, illness and related
dysfunction

• Analyse and improve healthcare systems and health policy

2.4 Background of health psychology to public health

The recognition of health psychology as a designated field is widely acknowl-

edged. The relationship between mind and body and the effect of one upon the
other has always been a controversial topic amongst philosophers, psychologists
and physiologists. Within psychology, the development of the study of psychoso-
matic disorders owes much to Freud [3]. It has been observed in the recent studies
that more deaths are caused now by heart disease, cancer and strokes which are
by-product of changes in lifestyles in the twentieth century. Psychologists can be
instrumental in investigating and influencing lifestyles and behaviours which are
conducive or detrimental to good health [3].

2.5 Health behaviours

Health behaviour is part of maintaining a healthy lifestyle and avoiding ill

health. These are known as protective health behaviours. Health protective behav-
iours include the following categories:

• Environmental hazard avoidance—avoiding areas of pollution or crime.

• Harmful substance avoidance—not smoking or drinking alcohol.

• Health practices—sleeping enough, eating sensibly and so forth.

• Preventive health care—dental check-ups and smear tests.

• Safety practices—repairing things, keeping first aid kits and emergency

telephone numbers handy.

Although most of us are familiar with the need to engage in these health behav-
iours, only a few of us actually do so, and that is what we need to work on to remind
people of adopting a better health lifestyles. Many other researchers such as Berg
(1976 as cited in Pitts, 1998) asserted that most people are aware of which health
behaviours should be engaged in; however, they frequently do not do so, and they
instead do engage in activities which they know to be harmful to their health. It is
this cantankerousness which psychologists have spent a great deal of time examin-
ing. The dilemma for health psychologists is to explain why some or many people do

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 Introductory Chapter: Bio-Psychosocial Model of Health
DOI: http://dx.doi.org/10.5772/intechopen.85024

Figure 1.
Health (source: adopted from Sarafino [4]).

not do what they know is in their own best interest to do and why some people are
more amenable to the adoption of healthy habits than others.
This chapter is therefore in support of a consistent focus on the role of knowl-
edge in informing people of the risks to themselves that certain behaviours can
engender. Pitts [3] reported studies that examining a range of issues relevant to
health such as smoking, drug-taking, medical checks and adopting safer sex have
fairly consistently shown that knowledge, by itself, does not lead to behaviour
change. The only question left to ask is: So what is required, other than knowledge,
to persuade people to look after their health? This question is the guiding principle
to understand the role of health psychology in persuading people to look after their
health informed by bio-psychosocial model.

2.6 Models of health

It is generally recognized that there are two models of health, namely, biomedi-
cal and bio-psychosocial models. Biomedical model focuses on treatment and
elimination of symptoms, while bio-psychosocial model focuses on individual’s per-
ception of their symptoms and how they and their families respond to symptoms
they are experiencing [6]. Also Deacon [7] asserts that under the biomedical model,
illnesses were understood as having physiological aetiologies that were diagnosed
through distinct biochemical markers and were to be treated through physical inter-
ventions. This chapter however is primarily focusing only on the bio-psychosocial
models of health. Its founder, Engel [8], discovered that bio-psychosocial model rep-
resents the contribution of biological, psychological and social factors in determining
health. Table 1 shows the differences between the two models.
Within health psychology one model that has enjoyed considerable popularity is
the ‘stress-diathesis’ model (Steptoe cited in [3]) which is currently called bio-
psychosocial model. This model was first described by G.L. Engel in 1977. It empha-
sizes the interactive effect of environment and individual vulnerability (genetic and
psychological characteristics) factors upon health [3]. According to bio-psychosocial
model, psychological, physical and social threats present demands upon an individual’s
resources and capacity for coping which give rise to physiological reactions involving
the autonomic nervous system (ANS) and endocrine and immune system of the body.
The effects include both short-term and long-term components, and these may
have consequences on health depending upon the individual’s predisposition or

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Psychology of Health - Biopsychosocial Approach

Focal area Biomedical model Bio-psychosocial model

What causes Biological factors (chemical Biological (virus), psychological (beliefs,
illness? imbalances, bacteria, viruses and behaviour) and social (unemployment)
genetic predisposition)
Who is Individuals are regarded as victims of Individuals should be held responsible
responsible for some external force causing internal for his/her health and illness
illness? changes. Because illness is seen as a
result of biological changes beyond
their control, individuals are not seen
as responsible for their illness
How should Through vaccination, surgery, The whole person should be treated, e.g.
illness be treated? chemotherapy and radiotherapy, all of behaviour change, change in beliefs and
which aim to change the physical state coping strategies and compliance with
of the body medical recommendations
Who is The responsibility for treatment rests The focus is the whole person to be
responsible for with the medical profession treated not just their physical illness; the
treatment? patient is therefore responsible for their
treatment (e.g. taking the medication or
changing their behaviour)
What is the Health and illness are seen as Health and illness exist on a continuum.
relationship qualitatively different—you are either Individuals progress along this
between health healthy or ill—there is no continuum continuum from health to illness and
and illness? between the two back again

What is the The mind and body function The focus is on an interaction between
relationship independently of each other. In other the mind and the body. The mind and
between the mind words, the mind and body are separate body interact
and the body? entities
What is the role Illness may have psychological Psychological factors not only as
of psychology consequences, but not psychological possible consequences of illness but as
in health and causes (e.g. cancer may cause contributing to it at all stages along the
illness? unhappiness, but mood is not seen continuum from healthy to being ill
as related to either the onset or
progression of the cancer)

Table 1.
Comparing biomedical and bio-psychosocial models of health.

vulnerability to adverse effects. Vulnerable individuals develop chronic allostatic

reactions such as reduced immunocompetence or exaggerated sympathetic activa-
tion of the ANS or increased secretion of adrenal hormones. Physiological reactions
of these types have been implicated in the development of many disease states,
including cancers, cardiovascular diseases and other non-communicable diseases
susceptibility to infections [3]. The following section presents the strengths and
critical views of bio-psychosocial model.

2.7 Strengths of bio-psychosocial model

Bio-psychosocial model benefits the patients and healthcare system as revealed

by research [8–14]:

• Guiding application of medical knowledge to the needs of each patient.

• Improved patient satisfaction, better adherence to prescriptions, more main-

tained behaviour change, better physical and psychological health and less of a
tendency to initiate malpractice litigations.

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Introductory Chapter: Bio-Psychosocial Model of Health
DOI: http://dx.doi.org/10.5772/intechopen.85024

• Development and application of techniques to reduce health risk behaviour.

• Reduce multiple visits and admission into hospitals.

• Individuals with health challenges are acknowledged to be active participants

in the recovery process and good health, rather than mere passive victims.

• Increase efficiency of care by reducing unnecessary prescription of drugs (i.e.

diabetes and other chronic conditions).

• Development of psychological techniques in the strengthening of immune

reaction to illness.

• Bio-psychosocial model can be used as a predictor of pain and other psychoso-

cial problems resulting into development appropriate prevention and interven-
tion strategies.

• Improvement of communication between health staff and the patients.

• Development and introduction of programmes of life quality improvement for

chronic patients, physically disabled individuals and the elderly patients.

• A significant influence on contemporary understanding of mental health

difficulties.

• Development and application of psychosocial support for the terminally ill

patients and their families.

2.8 Critical views of bio-psychosocial model

A list of critical views of bio-psychosocial model has been noted in literature

[9, 10, 12, 15–18] as follows:

• Time-consuming and expensive apply.

• It requires more information be gathered during the assessment about an

individual’s socioeconomic status, culture, religion, as well as psychological
factors that might affect the individual’s condition.

• There is a lack of theoretical basis of bio-psychosocial model and scientific

evidence to support the model.

• The complex relations between causes and effects of biological, psychological

and social factors to influence the state of health and or occurrence of diseases.

• The holistic nature of the bio-psychosocial model makes it a luxury many

healthcare systems in resource-poor settings cannot afford.

• Insufficient training opportunities or financial resources available to support

the existence of multidisciplinary teams consisting of psychiatrists, clinical
psychologists, mental health nurses and social welfare workers to allow for a
full understanding of the biological, psychological and social factors involved
in individual’s condition.

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Psychology of Health - Biopsychosocial Approach

• The model’s failure to provide straightforward guidelines for clinical treatment

or rules for prioritization in clinical practice.

• Medical students receive very limited amount of content in psychosocial

subjects compared to biomedical-oriented courses.

3. Conclusion

The focus of this chapter was mainly on integrating bio-psychosocial model in

public health discipline. Authors like Nadir et al. [12] found that bio-psychosocial
model has been a mainstay in the ideal practice of modern medicine. It is attributed
to improve patient care, compliance and satisfaction and to reduce physician-
patient conflict. Both strengths and critical views of bio-psychosocial model were
presented in the chapter. Even though it appears that patients and healthcare system
are likely to benefit from the utilization of bio-psychosocial model, further research
is still needed to determine whether or not bio-psychosocial model is a workable
model in healthcare system to benefit all patients. In particular, more knowledge
about how psychosocial factors can influence health and disease remain unclear to
most public health professionals.
Introductory Chapter: Bio-Psychosocial Model of Health
DOI: http://dx.doi.org/10.5772/intechopen.85024

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