6 Health Psychology: Overview and Professional Issues
recognition of the “eld of health psychology in the United
States occurred less than 20 years ago. It is no longer correct
to speak of health psychology as an •emerging• specialty
within American psychology; for the last dozen or so years,
health psychology has ”ourished as one of the most vibrant
specialties within the larger discipline of psychology. Not
only is it recognized as a specialty in its own right, health
psychology has had a profound impact on clinical psychol-
ogy, and has played a major (if not the major) role in
developing and vitalizing the interdisciplinary “eld called
•behavioral medicine•Ž (p. 215). The overlap with behavioral
medicine in both theory and practice has been strong and, like
behavioral medicine, health psychology is really an interdis-
ciplinary “eld (Marks, 1996). Because the leading causes of
mortality have substantial behavioral components, behav-
ioral risk factors (e.g., drug and alcohol use, unsafe sexual
behavior, smoking, diet, a sedentary lifestyle) are the main
focus of efforts in the area of health promotion and disease
prevention. Behavioral methods are also playing an increas-
ing role in treatment and rehabilitation. Beyond the clinical
domain, the relevance of psychology to public health, health
education and health promotion has been discussed by
health psychologists (Bennett & Murphy, 1997; Winett,
King, & Altman, 1989) and health promotion specialists
(Macdonald, 2000).
Given its emphasis on behavior and behavioral change,
psychology has a unique contribution to make to health care
and public health. Health psychologists are currently con-
ducting research on the development of healthy habits as well
as the prevention or reduction of unhealthy behaviors. Both
the impact of behavior on health as well as the in”uence of
health and disease states on psychological factors are being
explored. Psychosocial linkages in areas such as psycho-
neuroimmunology, pain, cardiovascular disorders, cancer,
AIDS/HIV, and other chronic diseases are being de“ned.
Psychosocial mediators of effective public health promotion
are being identi“ed.
The United States has produced the most in”uential theo-
retical and ideological frameworks and a large proportion of
the empirical work. The Health Psychology Division of the
APA (Division 38) is one of the largest and fastest growing in
the association. Its journal, Health Psychology,has one of the
largest circulations among psychology journals. However, in
the 1990s, a considerable amount of research was initiated in
Europe. Health psychology was no longer totally dominated
by developments in the United States. The European Health
Psychology Society (EHPS) has organized scienti“c meet-
ings since 1986. Undoubtedly these have had an in”uential
role in the proliferation of the European health psychology
scene. Linked to the EHPS, the journal Psychology and
Healthis a respected review of health psychology and since
1985 has been the leading European journal. The establish-
ment of the Journal of Health Psychologyin 1996 has en-
couraged an interdisciplinary and international orientation to
the “eld and created a forum for new methods and theories,
discussions, and debate, including critical approaches. An-
other journal, Psychology, Health & Medicinehas focused on
psychological care for medical problems. Other journals that
publish papers in this “eld are the International Journal of
Behavioural MedicineandSocial Science & Medicine.Sev-
eral other academic journals focus on health psychology at a
national level (e.g., British Journal of Health Psychology,
Gedrag & Gezondheid: Tijdschrift voor Psychologie en
Gezondheid, Revista de Psicologia de la Salud, Zeitschrift
far Gesundheitpsychologie). As in the United States and
Europe, psychological associations in Canada, Australia,
New Zealand, and elsewhere have boards, divisions, or
branches specializing in health psychology and research and
professional work in the “eld are expanding rapidly.
In the light of these developments, it can be seen that
health psychology is one of the most vibrant and dynamic
“elds in Western psychology. As health psychology pro-
gresses from a research “eld to health service delivery, it is
inevitable that professional and ethical issues are at the
forefront of discussion within the major psychological asso-
ciations. This chapter re”ects the principle focus of this dis-
cussion that is on education and training.THE DEFINITION AND SCOPE OF
HEALTH PSYCHOLOGYThe currently accepted de“nition of health psychology was
originally proposed by Matarazzo (1982) as:[T]he aggregate of the speci“c educational, scienti“c, and pro-
fessional contributions of the discipline of psychology to the
promotion and maintenance of health, the prevention and treat-
ment of illness, the identi“cation of etiologic and diagnostic cor-
relates of health and illness and related dysfunctions, and the
analysis and improvement of the health care system and health
policy.Virtually every health psychology organization and
textbook has adopted Matarazzo•s (1982) de“nition without
criticism, debate, or discussion. For researchers in health
psychology, this de“nition is a very “ne and appropriate one.
Researchers invariably specialize and the fact that a de“ni-
tion of their “eld is a very broad one is not a problem.
For practitioners, however, the breadth of the Matarazzo