Happiness As A Priority Health Outcome

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Written by Michael DeDominicis (c2019), Photography by Michael DeDominicis (c2019)

I read an article1 recently that suggested some physicians have been mislead by the World Health Organization’s definition of health: a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity2. The article indicated that physicians, inspired to achieve health in all its newly delineated forms, may now be overextending into patients’ lives and the broader spheres of social welfare to advocate for change. To dissuade these professionals from playing the part of life coach or politician, the authors of the article boldly asserted that health is distinct from other societal values such as subjective happiness. I repeat: they asserted that health is distinct from subjective happiness. I reread this line of the article several times to try to understand how it could be true, but for some reason my gut remained fiercely opposed to the notion. As a future physician, whose practice will look different depending on whether he believes that health and happiness are distinct, I felt I had to explore the topic further.

Happiness is important to all of us; whether it is in the form of pleasurable activities or a general sense of life satisfaction, it is a major end-goal of all that we do. Why is that? Is it simply because it feels good to be happy? If that is all there is to it, then the article I read was absolutely right: physicians have no right palpating their patients’ subjective experience of happiness.

As a science student, I have come to learn that few anatomical structures and physiological processes exist without purpose. This is true to the point that whenever I come across a structure or process that has no apparent purpose, I inevitably ask, “Why would the body have that?” As Darwin has taught us, evolution is always, slowly but meticulously, selecting features that will promote survival and disposing of anything else that impedes it3. So what about happiness? What about happiness has saved it from evolution’s ruthless spring cleaning? Addressing the question at a macroscopic level, there is evidence that happier seniors (i.e., those with positive moods) live longer than their less-happy counterparts4. Consistent with these findings, negative moods have been found to lead to more respiratory illness than positive moods5. Taken together, these findings suggest that we may be seeking happiness, not just to feel good, but to improve health and survival too.

Though happiness may seem like nothing more than a nebulous, intangible feeling, at its roots are specific neuronal circuits within the brain. When a sensory stimulus activates these circuits, many things happen: we feel the pleasure commonly associated with being happy, we learn and become motivated to repeat the stimulating behaviours6, and further signaling causes physiological changes to take place downstream in the body. These downstream changes are likely responsible for a number of health benefits including: the improvement of immune function and sleep quality, the reduction of stress hormones in the blood, and an increase in oxytocin, growth hormone, and endogenous opioids7. Further, because pleasure triggers a motivation to seek out more pleasurable stimuli, happiness will naturally perpetuate itself. This helps to prevent negative affective states that can lead to mental health disorders8, which are conversely associated with a number of detrimental health effects9. As illustrated, the experience of happiness is just the tip of the iceberg; it is simply the emotional manifestation of the many positive physiological processes going on beneath the surface.

The stimulus that causes happiness varies between individuals and is therefore subjective; however, there are certain things that seem to affect happiness universally. Positive social conditions, where one feels supported by peers and is able to participate in leisure activities, are generally associated with increased happiness10. A work environment that is challenging and provides employees with a sense of autonomy is associated with increased job satisfaction, a measure that is strongly correlated with overall happiness10. Socioeconomic conditions, including how one perceives their place in society and the opportunities available to them based on income, education, and occupation, are also positively associated with happiness10.

These conditions represent the social determinants of health, and the physiology of happiness represents a key mechanism by which they take their salubrious effect (e.g., through the reduction of stress hormones associated with the “fight or flight” reaction11). There are other ways that the social determinants influence health, such as through family or peer support of positive health behaviours12 or by influencing access to nutritious food and exercise13. Therefore, a patient’s happiness can serve as a flag to physicians to investigate adverse social conditions that could be affecting a patient’s health in other ways. Sometimes these social conditions cannot be helped by the individual and may require policy change at the institutional or governmental level. In these and other such cases, the CanMEDS guidelines say that physicians should engage in advocacy14.

I think the initial statement that subjective happiness is distinct and should be considered separately from medical practice represents a habit of neglecting anything that seems to lie beyond the strict bounds of biomedical ideology. It arises innocently enough, out of training to look for hard evidence and to be careful and efficient in delivering healthcare. However, this routine of medical practice needs to always be challenged by an open, curious mind, one that is willing to explore hazy concepts and look for the hard roots connecting them to health. Having identified connections between social conditions and happiness, happiness and positive physiological changes, I think it is safe to say that happiness has said roots.

It is on that note that I would like to counter the aforementioned authors’ statement: health and subjective happiness are not distinct from one another, but are intimately bound. As such, I believe that physicians should be gauging and promoting patient happiness in the clinic on a regular basis and within broader spheres of social influence when necessary. This is where I currently stand. For the sake of anyone who still believes that subjective happiness is distinct from health, I would like to end this article with a radical thought, one that may irritate you, but make you think a little more about the topic, and potentially land you somewhere closer to the often-correct middle ground of debate. Instead of pushing it to the back of their minds, maybe physicians should make patient happiness a priority health outcome.

References:
  1. Ahmed S, Shuster A. Should a definition of public health include social welfare. University of Western Ontario Medical Journal. 2014;83(2):13–14. http://www.uwomj.com/wp-content/uploads/2014/12/v83no2_05.pdf. Accessed November 4, 2016.
  1. Constitution of WHO: Principles. World Health Organization. http://www.who.int/about/mission/en/. Accessed October 31, 2016.
  1. Darwin C. On the origin of species. 6th ed. Feedbooks; 1872. http://libarch.nmu.org.ua/bitstream/handle/GenofondUA/5143/2c570b7c361f0e6d493199208158762e.pdf?sequence=1. Accessed October 30, 2016.
  1. Deeg DJH, van Zonneveld RJ. Does happiness lengthen life? The prediction of longevity in the elderly. In: Veenhoven R. How harmful is happiness? Consequences of enjoying life or not. The Netherlands: Universitaire Pers Rotterdam; 1989:29–43.
  1. Evans PD, Edgerton N. Mood states and minor illness. British Journal of Medical Psychology. 1992;65(2):177–186. doi:10.1111/j.2044-8341.1992.tb01697.x.
  1. Kringelbach ML, Berridge KC. Towards a functional neuroanatomy of pleasure and happiness. Trends in Cognitive Sciences. 2009;13(11):479–487. doi:10.1016/j.tics.2009.08.006.
  1. Cohen S, Pressman SD. Positive affect and health. Current Directions in Psychological Science. 2006;15(3):122–125. doi:10.1111/j.0963-7214.2006.00420.x.
  1. Watson D, Clark LA, Carey G. Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology. 1988;97(3):346–353. doi:10.1037//0021-843x.97.3.346.
  1. Cohen S, Rodriguez MS. Pathways linking affective disturbances and physical disorders. Health Psychology. 1995;14(5):374–380. doi:10.1037//0278-6133.14.5.374.
  1. Argyle M. Is happiness a cause of health? Psychology & Health. 1997;12(6):769–781. doi:10.1080/08870449708406738.
  1. Raphael D. Social determinants of health: present status, unanswered questions, and future directions. International Journal of Health Services. 2006;36(4). http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.824.7107&rep=rep1&type=pdf. Accessed October 29, 2016.
  1. Viner RM, Ozer EM, Denny S, et al. Adolescence and the social determinants of health. The Lancet. 2012;379(9826):1641–1652. doi:10.1016/s0140-6736(12)60149-4.
  1. Woolf SH, Braveman P. Where health disparities begin: The role of social and economic determinants–and why current policies may make matters worse. Health Affairs. 2011;30(10):1852–1859. doi:10.1377/hlthaff.2011.0685.
  1. The royal college of physicians and surgeons of Canada: CanMEDS role: Health advocate. http://www.royalcollege.ca/rcsite/canmeds/framework/canmeds-role-health-advocate-e. Accessed October 30, 2016.

 

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