Behavioural medicine

Another field that has arisen alongside the biomedical model is behavioural medicine. The term ‘behavioural medicine’ is thought to date back to 1973 in the title of a book by scientist Lee Birk entitled Biofeedback: Behavioral Medicine. The field had such a fast rise that just 3 years later, the National Institute of Health in the US created the Behavioural Medicine Study Section to support collaborative research, and in 1977 the Yale Conference on Behavioural

Medicine and a meeting of the National Academy of Sciences were organized to define and further the field.

Behavioural medicine focuses on how risk factors such as smoking, poor diet, alcohol consumption, and physical inactivity impact health. The statistics behind behavioural medicine are striking: approximately 75% of all deaths from cancer are related to behaviour. From the 10 leading causes of death, 50% of mortality is related to behaviour. And 90% of all lung cancer deaths are attributable to cigarettes.(17) These behaviours are closely linked to the environment: the environment itself can impact directly on health (such as through air pollution); certain behaviours can be encouraged by an environment (such as an urban area with lots of fast food restaurants promoting unhealthy eating); and individuals within an environment can be influenced by environmental norms (such as family behaviours or community pressures).

An important aspect of behavioural medicine is identifying potential barriers to behaviour change. These can include socioeconomic factors, local and national policies, and individual factors such as psychological state. Barriers to behavioural change can be closely linked with health inequalities, with healthy behaviours often less common among disadvantaged communities. Behaviours and their barriers are not just limited to potential illness-provoking behaviours, but also to the controlling of illness, such as treatment adherence and compliance. Aspects of doctor-patient relationships and patient monitoring have been shown to be important in supporting recovery. Further developments in behavioural medicine have focused on biological and genetic influences. For example, behavioural medicine has intersected with recent work in epigenetics: the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself. Behavioural epigenetics has shown that behaviours and our environment can modify the expression of genes.(18) Consequently, our behaviours can have long-lasting and deep- seated effects on our health.

Behavioural medicine proposes a different view to the biomedical model by suggesting that individuals have a duty of care to themselves, arguably shifting some of the responsibility away from doctors onto patients. However, under the framework of behavioural medicine, policy-makers also have a responsibility to develop health prevention and promotion strategies to encourage healthy behaviours and counteract unhealthy lifestyle recommendations by commercial organizations such as the marketing of alcohol, cigarettes, and unhealthy foods. Overall, behavioural medicine is gradually being recognized as a critical way of increasing life expectancy and improving quality of life. Indeed, in 2010, the Annual Status Report of the National Prevention, Health Promotion and Public Health Council in the US stated ‘the most effective approach to address the leading causes of death is to reduce and prevent underlying risk factors including physical inactivity, poor nutrition, tobacco use, and underage and excessive alcohol use.(19)

The Encyclopedia of Behavioral Medicine explores behavioural issues and care for a comprehensive range of health conditions to support research and practice among those working in and studying health.(20)

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