Health is

Health is not simply the absence of disease: it is something positive... —Henry Sigerist (1941, p. 100).

Kinds of Happiness HedoniaEudaimonia

Origins of Flourishing Hedonia Eudaimonia Flourishing

Signs of Mental Health (Keyes, 1999, 2002) Hedonic Well-Being 1. Satisfied with your life 2. Positive affect in life Eudaimonic Well-Being 3. Contribution to society 4. Social integration 5. Social growth and potential 6. Acceptance of others 7. Social interest and coherence 8. Self acceptance 9. Environmental mastery 10. Positive relations with others 11. Personal growth 12. Autonomy 13. Purpose in life

What’s Your Mental Health? High Level = Experience sign of mental health “every day” or “almost every day” Low Level = Experience a sign of mental health “once or twice” or “never” Flourishing –High level on 1 or more hedonic well-being and –High level on 6 or more eudaimonic well- being Languishing –Low level on 1 or more hedonic well-being and –Low level on 6 or more eudaimonic well- being Moderately Mentally Health –if you are neither flourishing nor languishing

% DSM 12 Month Mental Disorders MIDUS 1 Adults Keyes (2005a)

Low High Mental Health High Mental Illness Data Support the Two Continua Model

Complete State Approach

Anything Less Than Mental Health as Flourishing in Adults (Keyes, 2007) Productivity –Missed days of work –Workday cutbacks Chronic Physical Illness and Conditions –Any CVD –Number of conditions at all ages Disability –Health Limitations of IADLs Psychosocial Assets –Report Being More Resilient –Clearer Goals in Life –Feel More Loved and Cared For (Intimacy) –Low Sense of Helplessness Healthcare Utilization –Few Overnight Hospitalizations –Medical Visits (for physical or for emotional, psychological) –Few Medical Prescriptions

Flourishing Across the Life-Span (MIDUS 1995 and MIDUS 2005 Longitudinal Follow Up)

Cardiovascular Disease (CVD) CVD prevalent and costly +6o million Americans have at least one type of CVD –40% are above the age of 65 Highest combined direct and indirect costs cost ($180 billion in 1999) About 1 per 2.5 deaths directly result from CVD –47% of men –54% of women died from some CVD (1999) Deaths from CVD decreased by 30% Less recognizable risk factor in the is mental illness (MDE)

Happy Heart Hypothesis (Keyes, 2004)

2nd 1st 3rd

Chronic Physical Conditions (27 possible) Keyes (2005b)

Mental Health and Illness: Which is Cause and Effect?

Flourishing Moderate Mental Health Languishing 19.2% 22.3% 17.2% 63.6%60.4% 17.3% 3.1% 46.3% 50.6% Change in Adults’ Mental Health Status: Destinations and Origins Flourishing

Flourishing Moderate Mental Health Languishing 19.2% 22.3% 17.2% 63.6% 60.4% 17.3% Change in Adults’ Mental Health Status: Destinations and Origins Moderate Mental Health 67.5% 18.6% 13.9%

Flourishing Moderate Mental Health Languishing 19.2% 22.3% 17.2% 63.6%60.4% 17.3% 45.7% Change in Adults’ Mental Health Status: Destinations and Origins Languishing 50.2% 4.1%

Adjusted* Odds Ratio of any 2005 Mental Illness (MDE, GAD or Panic Disorder) by Change in Mental Health Status (Adjusted for Race, Age, Sex, Education, and Total Chronic Physical Illness in 2005)

Keys to Aging Positive in Terms of Flourishing

Mental Health in Middle School and High School Youth in the U.S. (CDS 2002 Data; Keyes, 2006)

Keys of Aging Successfully Transition into adulthood Socially Engaged –Generativity Recognize social contact goals change –selectivity Compensate to continue things you love to do –Adapt Try to new things as some things are no longer possible –Innovate 4 Things to look out for –Loss of purpose in life –Loss of social contribution –Loss of social interest and coherence –Loss of personal growth

Why Governments, Public Health and Healthcare Must Change 1. Health is something specific; mental health includes two kinds of happiness –Flourishing combines functioning well and feeling good 2. Absence of illness does not mean the presence of health –Mental health and illness are on separate continua 3. Presence of mental illness is a burden (yes!); but, the absence of mental health is also a burden 4. The is too much mental illness (yes!); but there is also too little (flourishing) mental health 5. Increase in mental health (flourishing) causes a decrease in odds of mental illness; declines in mental health cause an increase in odds of mental illness –Thus, increasing rates of flourishing will reduce mental illness 6. There is a “wanting — doing” gap in public health –We say we want “health”; we only focus on illness and disease “Can’t get to health through only illness reduction (see points 2- 5) 7. What then is the greatest challenge facing our civilization this century and beyond... presence of illness or the absence of health? –It is the absence of health, which increases the risks of onset of illness Salutogenic Healthcare Must Take Priority -- Promote, Maintain, Respond to Early Deviations from, True Health Pathogenic Healthcare Has Its Place -- Cures, Treatments, and Risk Reduction for Illness and Disease