ONTENTS
INTRODUCTION
2. THE DEVELOPMENT OF HEALTH PSYCHOLOGY IN SPAIN
3. RESEARCH IN HEALTH PSYCHOLOGY IN SPAIN
3.1. The Relationship between Behavior and Physical Illness.
3.2 Unhealthy behaviors and life-styles.
3.3 Psychological interventions as supplements to or substitutes for medical therapy.
3.4 Coping with illness and stressful medical and/or surgical procedures.
3.5 Health Promotion.
4. EDUCATION AND TRAINING
5. FINAL REMARKS.
6.REFERENCES
This paper examines the most important topics related to Health Psychology in Spain and the work done by the various research teams currently contributing to this field. The main areas of research the following: the relationship between behavior and physical illness, Unhealthy behaviors and life styles, Biofeedback as a therapeutical instrument, coping with illness and stressful medical or surgical intervention, health promotion and education. Spanish Health Psychology is now in a phase of increasing development in Health Organizations as well as in Universities. Postgraduate programs are already available and several Journals publish regular scientific findings and review programs and achievements. Research projects and stable jobs are a consequence of the contribution of Health Psychologist to the public and private health systems that exist in the country. In a near future a Health Psychology Division will be created within the Colegio Oficial de Psicologos. This field of expertise has received formal recognition and status in the scientific community and among their clients.
The current national health system in Spain is the result of a process which began in 1908 with the creation of a national institute of health. Several organizational modifications and name changes were instituted over the years (in 1944, 1967 and 1978) and the current system is known as Insalud (Instituto Nacional de Salud or the National Health Institute) (De Miguel and Guillén, 1987). This system is regulated by the Ley General de Sanidad (LGS roughly translated as the General Health Act) which was enacted by the Spanish Parliament in 1986 to address issues related to the health care delivery system in Spain. Insalud provides medical care for virtually the entire Spanish population and coordinates the health care services provided by regional governments through their respective health services.
This legislation is an attempt to reform the health care system and is based on five principles: 1) health for all; 2) health as an integral concept; 3) community participation; 4) health education and 5) the rights of patients as consumers.
Insalud is the institutional and organizational manifestation of these principles, and its main objective is to make these principles reality. The goal of ensuring good health for all is a constitutional mandate (art. 43.1 of the Spanish Constitution) which corresponds to the "health for all" goal of the WHO (Pinilla-Pareja, 1990). Health as an integral concept refers to the inclusion of many important aspects of medical care other than the purely curative ones such as the promotion of good health, the prevention of illness and social rehabilitation (Mansilla, 1984). All these are contemplated in the LGH.
Therefore, if one accepts, as is stated in the LGH, that the means and implementation of the health system should have as its first priority the promotion of good health, the prevention of illness and the functional rehabilitation and social reinsertion of patients, as well as the guarantee of medical assistance whenever necessary, (art. 3, 6 and 18 of the Spanish Constitution), then it is easy to infer that Health Psychology constitutes one of the fields of applied psychology whose development is closely tied to a correct application of the law (Rodríguez-Marín, 1988). Nevertheless, to date, the work of applied psychologists in the health system has been fundamentally linked to psychiatric hospitals, to the psychiatric wards of general hospitals, or to mental health centers, and their work has been oriented towards mental illness. Until recently, it was not possible to speak of the practice of Health Psychology in Spain. However, in a broad sense, one may say that Spanish psychologists do deal with problems related to this field within an indiscriminate range of problems more related to mental health. (Camarero and Ferrezuelo, 1988) It is also true that the progressive implementation of the LGS in Spain through the regional health services is producing an increasing incorporation of psychologists into the health system whose role is not necessarily limited to dealing with psychiatric problems (Fernández-Ballesteros and Carrobles, 1988).
On the other hand, whereas in other countries the concept of Health Psychology seems to be fairly clearly defined and differentiated from other fields, in Spain there still exists confusion concerning this concept. On some occasions, Health Psychology is confused with Clinical Psychology, on others, with Behavior Therapy, and ultimately with Behavioral Medicine.
I personally endorse Matarazzo's definition of Health Psychology (Matarazzo, 1982): "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 etiologic and diagnostic correlates of health, illness and related dysfunction, and the analysis and improvement of the health care system and health policy formation" (p.4). This definition was also adopted by the task force on Health Psychology within the Colegio Oficial de Psicólogos (C.O.P. or the Spanish Professional Psychologists Association) and is the definition used in the formulation of this paper.
JOSÉ RAMÓN CORREAS GONZALEZ
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LAST UPDATED Sunday 6 de August de 1995 - -