Exploring Another Approach: 'Positive Health'

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

-- Preamble of the World Health Organization Constitution, 1948 (emphasis added)

Penn psychologist Marty Seligman takes the W.H.O. definition of health more literally than most.

The vast majority of health research has focused on the last part of the definition: disease and infirmity. What causes it? How can it be prevented? How can it be treated?

Dr. Seligman and his crew at Penn, however, have opted to explore the first part: well-being. What is it? What does it prevent? How can it be cultivated?

To focus on disease and infirmity is to embrace a deficit-based approach where the goal is to prevent and alleviate the negative.  That’s the norm in public health and medicine -- and it has proved successful in increasing life expectancy by 30 years over the course of the 20th century.

That said, to focus on health and well-being is to embrace an asset-based approach where the goal is to promote the positive. This is a novel and relatively untested idea – and it may just open a door to a new dimension of health research that can improve quality of life.

Dr. Seligman and his colleagues call their approach “positive health,” and it is founded on the principles of positive psychology. In short, positive psychology is all about identifying why people thrive; the positive emotions, traits, and institutions that enable them to do so; and how to promote these attributes in society.

Digging deeper, positive health is concerned with identifying traits — optimism, happiness, and other positive emotions — that protect against disease and promote well-being. The field of positive health is  about determining what makes people healthy, not just what makes them sick, and developing ways strategies to cultivate these qualities through low-cost interventions. 

For example, let’s say that an optimistic outlook among adolescents is associated - this is a hypothetical - with increased condom use. (Not just with having sex!) A school-based program on sexually transmitted diseases program could, in addition to providing information about the risks of unprotected sex, include a psychological component aimed at increasing optimism. Makes intuitive sense, right?

But sound logic is rarely sufficient to gain the resources needed for large-scale public health interventions. That requires evidence. And so, with support from the Robert Wood Johnson Foundation, Seligman and colleagues have set out to explore how positive attributes are associated with good health and might also have a cause-and-effect relationship.

To do this, the research team has gone back and re-analyzed data from a number of large longitudinal studies with an eye towards understanding how positive traits may protect against adverse health events. The first publications from this endeavor appeared over the summer.

One study found that low levels of negative emotion significantly reduced mortality risk.  Another study determined that being satisfied with one’s life was associated with reduced risk of heart disease. As results continue to emerge, researchers will be able to better quantify and predict how psychological well-being might cause better health.

Positive psychology and positive health are not without their critics. Positive psychology’s rapid growth, mainstream appeal, and comparatively weak evidence base has lead some to label it as “fluff for the masses,” self-help, and a shameless scheme to sell books.

While the empirical foundation for positive health may not yet be strong enough to sway hardened health researchers, the re-analysis of longitudinal studies could make a difference.

After all, to focus on preventing illness, without exploring what promotes well-being, is to embrace a one-sided definition of health.  As the drafters of the W.H.O Constitution acknowledged, public health should be about promoting well-being and making the lives of all people happier and healthier -- not just  preventing disease and infirmity.

It took us over 60 years to recognize this, and it’s time to put the theory to the test.

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