Difficulty: Foundational | Prerequisites: None. These themes run through the entire course and should be understood before tackling any specific disease chapter.
These are the conceptual threads that hold the entire PSY 320 course together. Every disease chapter (cancer, heart disease, HIV/AIDS) and every process chapter (pain, patient-provider communication) is built on the biopsychosocial model, shaped by social determinants of health, and modulated by social support. The exam will test whether you can apply these frameworks across topics, not just recite them. If you can explain how the biopsychosocial model applies to pain, cancer, and heart disease with different examples each time, you understand it. If you can only define it, you do not.
Health is never purely biological: it is always shaped by psychological processes (thoughts, emotions, coping) and social context (family, culture, SES, systemic factors). Social support protects health but is undermined by stigma. The health gradient shows that health outcomes improve at every step up the socioeconomic ladder, not just above a poverty line. Multi-level thinking (the "health onion") means looking at individual, interpersonal, community, and societal layers together.
Biopsychosocial model
A framework that explains health and illness through the interaction of three domains: biological (physical causes, diseases, injury), psychological (thoughts, emotions, expectations, coping), and social (family, culture, SES, systemic factors). In simple terms, health is never just about your body; it is also about your mind and your world.
Social support
The network of family, friends, community, and institutional resources that help a person cope with stress, illness, and daily life. Social support is consistently linked to better health outcomes across every disease chapter in this course.
Stigma
Negative attitudes, beliefs, or discrimination directed at a person because of a health condition, identity, or social status. Stigma undermines social support by isolating people and discouraging them from seeking help.
Social determinants of health
The conditions in which people are born, grow, live, work, and age that shape health outcomes. These include income, education, employment, housing, neighbourhood safety, access to healthcare, and exposure to discrimination.
Health gradient
The observation that health outcomes improve at every step up the socioeconomic ladder, not just above a poverty threshold. In simple terms, a middle-income person is healthier than a low-income person, but less healthy than a high-income person, and this pattern holds all the way up.
Multi-level thinking (the health onion)
An approach that examines health at multiple nested levels: individual (biology, behaviour), interpersonal (family, social support), community (neighbourhood, local services), and societal (policy, culture, systemic inequality). Think of it as peeling an onion: each layer influences the ones inside it.
Phantom pain
Pain felt in a body part that has been amputated or is no longer there. A vivid example of how psychological processes can produce real physical sensations without a current biological cause.
This is the single most important framework in health psychology. It holds that health and illness result from the interaction of three domains:
Biological: Physical factors such as diseases, injury, genetics, and physiological processes. Pain is felt in the body. Cancer develops in cells. Heart disease involves arteries and blood pressure.
Psychological: The level, intensity, and duration of what we experience is shaped by our thoughts, expectations, and emotional state. Phantom pain (pain without a current physical cause) is a clear example. Catastrophising amplifies pain; optimism improves cancer adjustment; depression worsens heart disease outcomes.
Social: How we experience health is shaped by the family we grew up in, the culture we come from, and the support we receive. Family reinforcement can increase a child's pain behaviour. Cultural norms affect whether someone seeks treatment or screens for cancer. SES determines access to care at every level.
The model applies everywhere in this course. On the exam, expect to apply it to specific scenarios rather than simply define it.
Social support is consistently linked to better health outcomes: it delays cancer progression, encourages adherence to heart disease treatment, improves adjustment to HIV/AIDS, and reduces pain perception.
Social support works through multiple pathways: it changes health behaviours (encouraging exercise, discouraging smoking), provides emotional resources for coping, and may directly affect physiological stress responses.
Stigma undermines social support. People with stigmatised conditions (HIV/AIDS, mental illness, certain cancers) may lose their support networks or avoid seeking help, which worsens their health outcomes. Stigma leads to isolation, discrimination, and violence.
The interplay between illness and stigma is a recurring exam theme: HIV/AIDS stigma reduces testing and treatment adherence; mental health stigma causes delays in seeking care; cancer fatalism in some communities reflects internalised stigma.
Health is shaped at multiple nested levels, often visualised as an onion:
Individual: Biology, genetics, personal behaviour, coping style.
Interpersonal: Family, friends, social support networks, patient-provider relationships.
Community: Neighbourhood, local healthcare infrastructure, community norms, access to services.
Societal: National policy, cultural values, systemic inequality, discrimination, media.
The point of multi-level thinking is that interventions at only one level are insufficient. A patient who learns about healthy eating (individual) but lives in a food desert (community) and lacks health insurance (societal) will not see the benefit.
Every health disparity discussed in this course, from cancer screening rates to HIV transmission to pain treatment, can be explained through multi-level factors.
Social determinants of health are the conditions in which people live, work, and age. They include income, education, employment, housing, neighbourhood safety, and access to healthcare.
The health gradient is the finding that health improves at every step up the socioeconomic ladder, not just above a threshold. There is no point at which "enough" income makes you maximally healthy; the relationship is continuous.
SES is the single greatest factor in treatment-seeking (from Ch. 9) and is a driver of disparities in cancer, heart disease, HIV/AIDS, and pain treatment.
Education, in particular, is consistently associated with better health outcomes: more education = less heart disease risk, more screening, better adherence, greater health literacy.
⚠️ Expect to apply the biopsychosocial model to a specific scenario (pain, cancer, heart disease, or HIV/AIDS) rather than just define it.
⚠️ Know that social support is linked to better outcomes in every disease chapter: cancer progression, heart disease adherence, HIV/AIDS resilience, pain coping.
⚠️ Understand how stigma disrupts the social support pathway and worsens health outcomes.
⚠️ The health gradient is continuous, not a threshold. Be ready for a question that tests whether you understand this distinction.
⚠️ Multi-level thinking: if a question asks "why" a disparity exists, the answer is almost never a single-level explanation. Look for individual, interpersonal, community, and societal factors.
⚠️ SES as the greatest single factor in treatment-seeking connects directly to the health gradient.
Fill in the blank: The three domains of the biopsychosocial model are biological, ________, and social. (Psychological.)
True or False: The health gradient means that only people below the poverty line have worse health outcomes. (False: health improves at every step up the socioeconomic ladder.)
Fill in the blank: ________ is the single greatest factor in whether someone seeks treatment. (SES / socioeconomic status.)
True or False: Social support has been shown to delay cancer progression but has no effect on heart disease outcomes. (False: social support helps change habits and encourages adherence in heart disease as well.)
Fill in the blank: Pain felt in a body part that has been amputated is called ________ pain. (Phantom.)
Q: Apply the biopsychosocial model to explain why two patients with the same cancer diagnosis might have very different outcomes.
A: Biologically, they may have different tumour types or stages. Psychologically, one patient may be optimistic and use active coping strategies, while the other may be avoidant or depressive, which is associated with poorer outcomes and impaired NK cell function. Socially, one may have strong social support (which delays cancer progression) while the other may be isolated, have low SES (reducing access to quality care and screenings), or belong to a cultural group where fatalism discourages treatment.
Q: How does stigma affect the health of someone living with HIV/AIDS, using a multi-level framework?
A: At the individual level, stigma can lead to depression and avoidance of testing or treatment. At the interpersonal level, it can erode social support, discourage disclosure, and increase isolation. At the community level, stigma may reduce funding for local HIV services and create hostile environments. At the societal level, cultural misconceptions and discriminatory policies slow public health responses and research funding.
Q: Explain the health gradient and how it differs from a simple poverty-threshold model of health.
A: A poverty-threshold model would suggest that people above a certain income level are healthy and people below it are not. The health gradient shows something more nuanced: health outcomes improve at every step up the socioeconomic ladder. A middle-income person is healthier on average than a low-income person, but less healthy than a high-income person. This pattern holds continuously, meaning there is no point at which more resources stop mattering.
Q: A patient with chronic pain lives alone, has low income, believes they have no control over their condition, and comes from a cultural background where expressing pain is discouraged. Using the biopsychosocial model, explain their experience.
A: Biologically, the chronic pain has a physical basis (tissue damage or nerve dysfunction). Psychologically, their low locus of control amplifies the pain experience, and isolation removes coping resources. Socially, living alone means fewer competing stimuli and no social support to buffer the experience, low income limits access to treatment, and cultural norms around pain expression may delay help-seeking and lead to under-treatment by providers who assume this patient is in less pain than they are.
Biopsychosocial model, biological psychological social, social support, social support and health, stigma, stigma and health, social determinants of health, health gradient, health onion, multi-level thinking, SES and health, socioeconomic status, health disparities, phantom pain, locus of control, coping, resilience, cultural competence, health literacy, access to care, health equity, structural determinants