So, what causes wellness?

Life expectancy trends Portugal Scotland

All cause mortality,men

Slope index of inequality 2763 Mean = 2694 X X X X X All cause, M /2694 = 1.025

Male inequalities, all causes, all ages

Slope index of inequality breakdown by cause of death SII= 2763 SII= 792 SII= 1971 All causeIHDOther causes

Male inequalities, all ages, by cause IHD All other causes

Relative inequalities in mortality by cause Men, Scotland

Chronic liver disease, including cirrhosis Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012

Workers in the 1950s

More liveable housing?

What we know about wellbeing in Scotland u It is inequitably distributed by socioeconomic status u We have been pretty unsuccessful in narrowing gaps u Drugs, alcohol, suicides and violence cause 60% of excess premature deaths u The problem is psychosocial u Wellbeing consists of success across all aspects of life

Emily Werner and resilience Personal attributes: outgoing, bright, and positive The family: having close bonds with at least one family member or an emotionally stable parent The community: receiving support or counsel from peers

Corey Keyes and Flourishing They are happy and satisfied; they tend to see their lives as having a purpose They feel some degree of mastery and accept all parts of themselves They have a sense of personal growth and are always growing, evolving, and changing They have a sense of autonomy and an internal locus of control They chose their fate instead of being victims of fate.

“.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement." Sense of coherence....

For the creation of health the social and physical environment must be: u Comprehensible u Manageable u Meaningful u......or the individual would experience chronic stress

STRESS AND GRADE OF EMPLOYMENT: MEN Salivary Cortisol Time of Day Steptoe et al. 2003, Psychosomatic Medicine, 65,

What happens during early brain development? Reprinted with permission – Prof Peter Seeman

Average brain white matter volume in children in care

The molecular biology of a hug

Economic cost of child maltreatment u u “The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion in 2010 dollars. This economic burden rivals the cost of other high profile public health problems, such as stroke and Type 2 diabetes (Fang et al., 2012).”

The Dunedin cohort  1000 children recruited in late 1972/3  At age 3, “at risk” children identified on the basis of chaotic circumstances, emotional behaviour, negativity and poor attentiveness  As adults, those “at risk” were more likely to :  be unemployed  have criminal convictions (especially for violence)  been pregnant as a teenager  have a substance abuse problem  exhibit signs of insulin resistance and metabolic syndrome

Self-control gradient and health outcomes Moffitt T E et al. PNAS 2011;108: ©2011 by National Academy of Sciences

Adverse childhood events study u Physical/sexual/emotional abuse u Neglect (physical/emotional) u Domestic substance abuse u Domestic violence u Parental mental illness u Parental criminality

Adverse childhood events risk of alcoholism Hillis et al 2011

Adverse childhood events risk of perpetrating violence Boys experiencing physical abuse Duke et al 2010

The drive to aggression

The case of Phineas Gage

Impact of mindfulness on the brain Brain regionImpact of Mindfulness Anterior cingulate cortex (self regulation of emotion)Enhanced activation Prefrontal cortex (attention and emotion)Enhanced activation Posterior cingulate cortex (self awareness)Enhanced activation R side Insula (awareness and emotional processing)Enhanced activation Amygdala (emotional processing)Decreased activation R side Nature Reviews Neuroscience 16, 213–225 (2015) doi: /nrn3916

Health improvement or life improvement? u Health is a characteristic which emerges in individuals living in a fair and civilised society. u Individuals who live in such a society understand how it works, can manage the challenges they face and participate fully in the life of the community. u Such individuals are likely to feel in control of their lives and are likely to be healthy and feel well and succeed in life.

The cycle of alienation Worklessness Poverty In education offending health In education offending health Chaotic early years Unequal outcomes Consequences Alienation Initial event Mental health problems Loss of self efficacy, esteem, control

Fr Greg Boyle “Here is what we seek: a compassion that can stand in awe at what the poor have to carry rather than stand in judgment at how they carry it.” ― Gregory BoyleGregory Boyle

“At the end of the day, love and compassion will win.” Terry Waite

What do you mean, “it’s a bit muddy”?