Positive Health

Is health more than the absence of illness and informity?

Posted Oct 31, 2010

The premise of positive psychology is simple but important: the absence of distress and disorder is not the same thing as happiness and fulfillment. Can a similar premise be proposed with respect to physical well-being, namely that the absence of symptoms and illness is not the same thing as health and vigor?

Of course it can, and it was proposed decades ago. In the 1946 charter of the World Health Organization can be found this definition of health:

"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

However, this definition is largely a slogan. Virtually all of so-called health care is really illness care, and even the occasional forays made byprofessionals into disease prevention and health promotion focus on the reduction of risk factors for illness and very rarely on the encouragement of good health in its own right.

A new initiative is now underway to take seriously the idea of positive health. Supported by the Robert Wood Johnson Foundation, this initiative has gathered together an interdisciplinary team from cardiology, psychiatry, psychology, epidemiology, exercise science, and public health to examine what it means to be healthy above-and-beyond the absence of symptoms and diseases. I am a member of this team, and part of our work has been to undertake research showing that attention to the positive matters for physical well-being, just as it does for psychological well-being, even when risk factors for morbidity and mortality are taken into account.

We have defined positive health as the scientific study of health assets: factors that produce longer life, lower morbidity, lower health care expenditure, better prognosis when illness does strike, and/or higher quality of physical health ... over and above the usual suspect risk factors like hypertension, obesity, and a sedentary lifestyle. The field of positive health overlaps with other fields like disease prevention, health promotion, and wellness but has its own signature provided by its explicit focus on health assets.

As I see it, this new field of positive health generates two proposals, a modest one and a bold one.

The modest proposal - modest only in relative terms, I add - is that "positive" factors indeed predict good health. The evidence for the modest proposal is already strong, especially for cardiovascular health. Research by our own group and others have shown that such factors as life satisfaction, happiness, positive emotions, optimism, self-regulation, meaning and purpose, engagement, and social support indeed predict good health.

For many of these factors, there already exist deliberate interventions that bolster them Whether these interventions pay health dividends is unknown at present but obviously a question worth exploring. Perhaps the day will come when one or more positive psychology interventions are as much a part of the repertoire of someone trying to stay healthy as are a daily aspirin and jog on the treadmill. Stay tuned.

The bold proposal is that there exists a phenomenon that can be described as super health, shown by such indices as:
• Less frequent and briefer ailments
• Rapid wound healing
• Enhanced recuperative ability
• Greater physiological reserves

Here we have no evidence other than anecdotes about people who never miss a day of work (e.g., Cal Ripken, Brett Favre) or people who stay physically active long after their cohort members retire to a rocking chair (e.g., Gordie Howe) or people who lead a flourishing life despite serious illness (e.g., Stephen Hawking, Magic Johnson) or - simply put - people who are off-the-chart with respect to their physiological capabilities (e.g., Lance Armstrong, Michael Phelps). Are these people and others like them merely exceptions, or is there something more systematic at work*?

Part of our work has been to identify candidate factors that may lead to super health, if indeed super health exists. We have classified these candidates into three groups: biological, subjective (i.e., psychological), and functional.

Biological candidates include high heart rate variability, high HDL/LDL ratio, high VO2 max, greater telomere length, low BMI, high levels of neuropeptide Y, and low levels of fibrinogen.

Subjective candidates include the factors studied by positive psychologists: zest, hope. Internal locus of control, life satisfaction, happiness, positive emotions, and curiosity.

Functional candidates include notable sensory acuity, exceptional central nervous system function (e.g., balance, coordination, cognition, and memory), and social integration.

Again, stay tuned.

*I know, I know, Lance Armstrong has had cancer, and Magic Johnson, Michael Phelps, and Brett Favre have had well-chronicled lapses of judgment, but my point here is not undercut by these facts. Perhaps it is even strengthened. People's well-being needs to be approached as a profile of characteristics, some good or even astonishing, others less so.

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