Five Questions for Chris E. Stout, PsyD
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Chris E. Stout, a clinical psychologist and professor at the College of Medicine at the University of Illinois at Chicago, has studied the impact of globalization on people's lives. Throughout a 20-year career, Dr. Stout has focused on the interconnectedness of global matters, such as conflict, war, global health and poverty. Dr. Stout has worked as special representative to the United Nations for the Society for the Psychological Study of Social Issues (SPSSI- APA's Division 9) and is the founding director of the Center for Global Initiatives. As the challenges of globalization become more pressing, Dr. Stout addresses how psychology can help combat poverty and create a more sustainable world.
APA. What role does psychology play in public and global health issues?
Dr. Stout: Without mental health, there is no health. Many public health factors, such as violence, substance abuse and obesity, are behavioral. Mental health is on par with physical health in determining the person's quality of life, productivity and mortality rates; yet, there is a perplexing disconnection between behavioral health and primary care. In addition, people's psychosocial well-being is greatly affected by poverty and unemployment, which we know are barriers to creating social development. If it's not addressed, risk of trauma is heightened from conflict, war and terrorism.
There has been increasing recognition within the United Nations system of the negative social and economic impact of impaired mental health and mental illness. The secretary general's report to the 48th General Assembly made recommendations based on research findings that served as a basis for courses of action for governments to consider. For example, it was recommended governments implement national strategies for dealing with severe dysfunctional conditions such as post-traumatic stress.
APA. What are the psychological aspects of behavior that contribute to conflict and war?
Dr. Stout: A lot of psychological research, in and of itself, is focused on avoiding conflict. When we consider what leads to wars, psychology is at the forefront " be it obedience to authority or simple passivity. Another well-supported theory is that of circumstance. This idea holds that war is less the result of malevolent dictators or the actions of inhumane ethnic or religious zealots, but rather disproportionate and unfair socio-economic circumstances, a generally dangerous or unsafe environment, and real or perceived risk of physical harm or loss to one's self, family, property or community.
History has shown us that as the population swelled and communities began to form, wars became more frequent and more intense.
APA. How does illness impact conflict and what can be done to combat these effects?
Dr. Stout: The link from war to poor health is clear: Wars kill and injure soldiers and civilians, but they also destroy infrastructure and social structures. Both cases produce adverse effects on the population's general health. In the eastern Democratic Republic of Congo, for example, war and ill health are tightly entwined. Of the 1.7 million preventable deaths between August 1998 and May 2000, only 200,000 were attributable to acts of violence. Wherever the war worsened, infectious disease and malnutrition followed.
What's less obvious is that there's also evidence of the reverse effect of health on war. Combatants in today's wars are often the socially excluded, even if they only act as proxies for more socially advantaged groups. Poor health shortens people's lifespan, making them more likely to engage in risky behavior. Conversely, strong democracies with broad support from healthy populations are less likely to engage in conflict. To prevent war, we might look more closely at the means to bring health and social stability to poor countries.
APA. How does a lack of proper health care affect the economy?
Dr. Stout: Research shows us a distinct relationship between health and economics. At the microeconomic level, improved health status is associated with economic growth. The most direct mechanism that explains this effect is the fact that improved health increases productivity and reduces worker absenteeism.
Most notably, research suggests that the effects of improved health are probably greatest for the most vulnerable " the poorest and the least educated. Ill health, including poor mental health, leads to vicious spirals, aggravating insecurity and decreasing the return on all investments in the future by reducing the economic productivity. This leads to isolation from the global economy, where connectivity is the key to prosperity.
APA. How can psychology and psychologists help improve access to care?
Dr. Stout: Psychological principles can be used in various ways depending on the issues, problems and culture. For example, we are collaborating with a clinic in India where there is a stigma for women seeking help for emotional problems—especially if it is via a male provider. They adopted an approach that female primary care doctors would gain counseling training, so when women sought care for a culturally "approved illness," following the physical exam, counseling could begin on the actual psychological issues present. One first has to understand the needs, the culture, and the limitations in order to address possible solutions that can be tried and evaluated.
I believe psychology is one of the most culturally mindful health care professions. Our undergraduate and graduate training incorporates a cultural competence and literacy in all that we do. This is particularly important in these more globalized times and we find ourselves working in different cultures and with immigrant or refugee populations.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.
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