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Illness/Health

Is illness more serious than health?  Is it enough to seek cures, treatment and protection from disease and illness as the way towards achieving better public health?  Public health expert Corey Keyes believes that a massive culture change is the most important factor in improving the quality of public health.

If your answer to both these questions above is “yes”, then Dr Corey Keyes, professor of sociology and public health at Emory University in Atlanta, believes you should reconsider. The way to true health, he says, is not just about curing illness - we’ll never eradicate illness completely - but should be focused on how to promote and maintain our own health and happiness.

In addition to his tenure at Emory, Keyes contributes to the World Health Organisation’s publication Mental Health Promotion Worldwide and consults with the US Centres for Disease Control and Prevention and Public Health Canada. He is also a core member of the ‘Pursuit of Happiness’, a five-year project funded by the Templeton Foundation, and is author of five books.

Last October the National Programme hosted a visit for Keyes to Scotland during Mental Health Week when he presented his views on a ‘positive paradigm’ for public health.  “We say we want ‘health’ for the nation, but public health focuses only on illness and disease,” says Keyes. “But we can’t get to health through illness reduction alone. That way, all we’re doing is removing the negative. What we need is mental health - that’s something positive. Increasing mental. health causes a decrease in the odds of mental illness. Less mental illness means less physical disease and ailments.

Pathogenic healthcare - which seeks to find cures and treatment for illness and disease - still has its place. But health care when we promote and maintain good health -must take priority.”

Keyes believes that people should be encouraged to take promotion of mental health and prevention of mental ill health seriously, and that if we understand more about it. We can shape our lives to enable more of it throughout our lifespan. It requires a massive culture change in how a nation values its people’s health, a change which is proving to be a very “hard sell” in the USA.

“Health in the USA has been completely medicalised. Depression is seen as a brain disease so that we can justify more therapies and drugs. The most prescribed medication in the USA is anti-depressants. The health service here is led by consumer demand in that it is driven by the hospitals, the pharmacies and the doctors. Consumers have become passive vessels in dealing with their health. “It is not illness - but the absence of health - which is our greatest challenge in the 21st century and beyond.”

Keyes has developed terminology to bring into sharper focus the nature of mental health. ‘Flourishing’ is his word for a mental state which combines feeling good about yourself and your relationships. Only 20% of the American adult population fulfill his criteria for flourishing.

Those who are not flourishing he terms as ‘languishing’. This constitutes 17% of the American population who are disconnected, unfulfilled and less productive. They are not clinically ‘depressed’ or technically ‘unhealthy’ but are still at much greater risk of physical illness.

Keyes has a list of 13 factors which contribute towards flourishing mental health. People who are classed as flourishing are more productive, suffer less chronic physical illnesses and conditions, require fewer medical prescriptions and hospital visits and generally report being more resilient. pursuing clear goals in life.

“Being happy is not the same as being un-depressed. Plenty of people without a clinical diagnosis of depression are not particularly happy or engaged. But if you are not flourishing there is a ripple effect leading to disability, chronic physical diseases and lack of productivity. In the USA only 20% of people are classed as flourishing. It’s costing us huge sums of money.”

He’s got the statistics to prove it. Cardiovascular disease (CVD) is one of the most prevalent and costly diseases in the USA, costing the economy around $180 billion a year (1999). A less recognisable risk factor in the cause of CVD is mental ill health. Keyes’ ‘Happy Heart Hypotheses’ (2004) shows that the highest incidence of CVD (18.9%) is in people ‘languishing or with major depression’. The number dips to only 8.2% in people who are ‘flourishing and mentally healthy’.

Keyes has written about the wellbeing of young people in America and raised some interesting issues for Scottish policy and practice for children and young people during his visit in October. Indeed, his research shows that nearly 50% of American youth between the ages of 12 and 14 are flourishing. Compare this with the dismal statistic that only 20% of American adults are flourishing, and it is clear that a lot of mental health is being lost during the transition into adulthood.

He is enthusiastic about work in Scotland on mental wellbeing and describes Scotland as “having the potential to be a shining example to other nations”. With Scotland’s “practical-minded optimism” he suggests that the required paradigm shift of attitudes towards public health is as likely to happen in Scotland as anywhere else in the world.

He describes parallels between Scotland and the USA: both countries are working to de-stigmatise mental illness, to change attitudes towards mental health and mental illness and to develop a climate of acceptance. But there is still a long way to go. Keyes has three key goals.

“First, we need to realise that there is more to health than merely the lack of illness. Second, we need to complement and balance out the current pathological approach - of curing and treating illness - with a more salutogenic approach - where we are encouraging promotion and maintenance of good health. Thirdly, we need to study the causes of flourishing.”

“The current approach to public mental health in America doesn’t promote mental health, nor does it reduce the incidence and prevalence of mental illness in the population. The trends suggest that mental illness is getting worse, not better, and healthcare is getting more, not less, expensive, despite the investment in pathological science. If this track record was corporate America, the CEO and CFO would have been fired and a whole new direction taken. It’s an issue which affects every one of us, so why is this situation allowed to persist in the public arena?”

For more go to www.sociology.emory.edu/ckeyes