Happiness? That's nothing more than health and a poor memory

That’s a great quote from Nobel prize winner Albert Schweitzer and it would have served me well a few days ago when it felt like nothing was going right.  I was whining via email to my partner Steve and he wrote back simply, “Positive Mental Attitude.”  Steve’s point, a valid one that would resonate with most of us, was that if I could adopt a positive mental attitude, I would likely have a better outcome (or at least stop whining to him).

This body-mind connection is a concept that is commonly accepted among both pop-psychologists and serious scientists.  Significant amounts of research have gone into proving that a positive mental attitude, or “happiness” as I will refer to it in shorthand here, is highly predictive of numerous positive attributes.  Notably, people who consider themselves to be generally happy are also those found to be in better physical health.  We can screen all we want for cancer, and diabetes, but screening for happiness appears to be may tell us more about healthiness.

If that is the case, wouldn’t logic tell us that promotion of happiness would also have a direct positive outcome on the physical health of our citizens?  If happiness is a warm puppy, maybe each Medicare member should be issued a beagle instead of a Lipitor?

The promotion of happiness is not an activity that is generally included as part of a standard disease management or health promotion program.  And yet, two significant recent studies have added to the landslide of data that suggests this may be a real oversight.

According to a study released in July 2010 by Emily Shaffer-Hudkins at the University of South Florida, happier youths are also healthier youths. In the study, 400 teenagers were asked to rate of their satisfaction with life based on positive and negative incidents, including episodes that excited them and made them strong and proud (positive affect), as well as incidents that made them feel lonely, guilty, and sad (negative affect). They were also asked about feeling inhibited, anxious, and dejected and about aberrant and violent behavior (all indicators of psychopathology). The teens were also asked questions about their overall physical health.  Analysis of this data revealed that positive feelings and higher satisfaction levels were associated with overall good health among study participants, while teenagers who felt lonesome, guiltier, more apprehensive and depressed were less physically healthy.  The study concluded that, “subjective well-being is a significant, unique, and primary predictor of important physical health outcomes in youth and is more strongly linked to physical functioning than is psychopathology.” In other words, according to the study’s author, “looking at teenagers’ so-called ‘subjective well-being’ could help identify those likely to develop health problems in the future” and enable effective targeting of wellness and prevention strategies.   I know what you’re thinking: a happy non-brooding teenager is about as prevalent as a unicorn.  However, scientists have apparently found ways of locating them—itself a major scientific breakthrough.

In a similarly-focused study, Karina W. Davidson, PhD, of Columbia University Medical Center reported in February 2010 that happiness seems to pro-actively protect the heart from disease. In this study, researchers followed 1,739 healthy adults living in Nova Scotia, Canada for 10 years to determine whether attitudes affected their health.  After accounting for known heart disease risk factors, the researchers found that the happiest people were 22% less likely to develop heart disease over the 10 years of follow-up than people who fell in the middle of the negative-positive emotion scale.  People with the most negative emotions had the highest risk for heart disease and people who scored highest for happiness had the lowest risk.  This observed protection persisted even when naturally happy people were experiencing transient depressive symptoms.

In WebMD Health News, researcher Davidson was quoted as saying that there are several possible explanations for how happiness may protect the heart. They include:

• Healthier lifestyle: Happy people tend to sleep better, eat better, smoke less, and get more exercise. All of these things lower heart disease risk.
• Physiological impact: Happiness may produce a host of positive chemical changes — such as a reduction in stress hormones — that are good for the heart.
• Genetic influences: It could be that people who are predisposed to happiness are also predisposed to have fewer heart attacks.

Notably, Davidson adds, “If we are able to change people’s level of positive affect we may be able to lower their risk for heart disease.”

So if you believe the numerous study findings that happiness leads to healthiness, and believe me, there are a lot of them, maybe government and business, being the principal financiers of healthcare, need to invest more in fostering prophylactic happiness as a way to reduce the level of chronic illness among our populace.  Happiness promotion as preventative health–time to issue regulation clown noses to physicians everywhere.  Cue cheerful carnival music.

Well if this is the plan, we Americans have our work cut out for us.  People who make a living out of measuring happiness throughout the world (how do I get a job like this?) report that America comes in 23^rd in a study of the happiest nations.  This statistic comes from Adrian White, an analytic social psychologist at the University of Leicester’s School of Psychology, who analyzed data on 80,000 people from research published by UNESCO, the CIA, the New Economics Foundation, the World Health Organization, the Veenhoven Database, the Latinbarometer, the Afrobarometer, and the UNHDR to create a global projection of subjective well-being: the first ever World Map of Happiness in 2007.

Sadly, our ranking on this World Map fits right in there with our somewhat pathetic ranking among the healthiest nations of the world (see previous blog post entitled “We’re Number One, Er I Mean Seven”).  For a very competitive folk, we American’s aren’t exactly over-achievers outside the Wide World of Sports.

Some people like to think that being wealthier leads to greater happiness.  Yet this assumption flies in the face of a plethora of research and clearly contradicts America’s ranking on the happiness scale.  Our per capita income exceeds that of every country in the world, including the first ten countries on the happiness map, which are:

1. Denmark
2. Switzerland
3. Austria
4. Iceland
5. The Bahamas
6. Finland
7. Sweden
8. Bhutan
9. Brunei
10. Canada

Really?  People in Canada are happier than people in the United States despite the fact that we call Canada “America’s hat”? The Bahamas I understand…who wouldn’t be happy all day on the beach holding an umbrella-laden rum drink, but Iceland?  Have they noticed that their country is bankrupt and they’re buried up to their nostrils in volcanic ash?  Let me get this straight:  Americans spend the most money in the world on healthcare and yet we rank anywhere from 7^th to 41^st, depending on how it’s measured.   Furthermore, we are the wealthiest nation in the world on a per capita basis and we can’t even crack the top 20 on the happiness map.  Cue pathetic funereal music.

I recently read a terrific book called The Geography of Bliss, by Eric Weiner (recommended to me by Kaveh Safavi, Vice President and Global Lead of the Cisco Internet Business Solutions Group Healthcare Practice.   In the book Weiner seeks to find what defines happiness in different parts of the world.  In the chapter on America he states that there is evidence that our nation is less happy today than ever before as measured by increases over the last 40 years in teen suicide rate, divorce rate, rates of violent crime despite greater wealth (and thus ability to better provide for ourselves).  Further, there is evidence of a measurable increase in (not just increase in reporting of) depression, anxiety, and other mental health disorders.  In other words, if we don’t get cracking on improving our national happiness quotient, we are going to be looking up at Burundi on the World Map of Happiness, which will be hanging over our hospital beds the way things are going.

Thankfully, most of the research done strongly suggests that happiness CAN be improved and is not solely based on lucky genetics.  According to University of Michigan professor of medicine Bertram Pitt, MD, research into happiness and how it impacts health, known as “positive psychology”, is relatively new.  Apparently “it was long-believed that most people are hardwired to be either naturally happy or not, regardless of life events.  But this view has changed in recent years as more becomes known about the science of happiness,” states Pitt in this WebMD article.  Pitt also writes that interventions that focus on improving social skills and decreasing social anxiety may lower heart disease risk and he cites numerous strategies that could help naturally negative people become happier, including:

• Express gratitude on a regular basis.
• Practice being optimistic.
• Engage in frequent acts of kindness.
• Visualize one’s best self.
• Savor joyful events.
• Practice forgiveness.

“Finally, regular exercise and sexual activity and good sleep are all associated with increased self-reported happiness,” Pitt adds.  Sounds like a plan to me.

According to Emily Shafer-Hudkins (the one who did the teen study), the best route to improved happiness is the devotion “of at least 15 to 20 minutes a day to doing something enjoyable and relaxing. And make sure this activity is not the first thing to be abandoned on a busy day. You have to commit to it,” she says. “Schedule the time and stick to it.”

I personally believe that these prescriptions give our healthcare system’s sponsors a lot to work with.  A vast amount of money is spent educating people about heart disease—how to prevent it, how to manage it, how to live with it.  Yet, I bet that if we studied the literature provided to patients by health insurers, CMS or physicians, very little of it would include tips that reflect the points above.  And that is a shame, because all of those things are basically free.  It wouldn’t cost our healthcare system much to better train people to express gratitude or practice forgiveness, aside from the letter giving them some tips on how to do it.  In contrast, we spend about $503 Billion per year on healthcare interventions and lost productivity directly related to cardiovascular disease. Wouldn’t it be amazing if could get back even 1% of that cost by teaching people how to be happier?  That alone would be $5 billion, so it is probably worth an experiment in public health. $5 billion would pay for a lot of important things, like upgrading schools, adding new primary care physicians to our overtaxed primary care system, or 5 billion chocolate chip cookies (my personal investment recommendation).

At a minimum, programs that focus specifically on teaching tools to improve personal happiness could play a part in our evolving government healthcare reform initiative.  In that the Center for Medicare and Medicaid Innovation (CMI) has funding to try some out-of-the box thinking, perhaps this is a worthy area of exploration.

I know this sounds very Marin County-ish (I admit to being there physically, but I am not currently hugging a tree or writing from my hot tub while eating an organic bean sprout sandwich, I swear).  However, real, actual researchers, physicians and psychologists have thought about this before.   According to Adrian White (Mr. Happiness Map), “There is increasing political interest [in the United Kingdom] in using measures of happiness as a national indicator in conjunction with measures of wealth. A recent BBC survey found that 81% of the population thinks the Government should focus on making us happier rather than wealthier.”

Clearly Americans wouldn’t want those two things to be mutually exclusive, but it couldn’t hurt to think about how we could transition just a bit of our resources from, say, corn subsidies, to the subsidization of a happiness promotion platform that contributes to the improved health of our nation.   Cabinet Secretary of Health and Happiness Services? Why not?