Positive Health and the Heart

August 9th, 2011 | Sources: Commentary

For centuries, health providers have focused on the prevention, diagnosis and treatment of disease. This time-honored paradigm has generated phenomenal advances in medicine, especially during the last 60 years. It has also created an image problem for providers, because the paradigm encourages consumers to perceive health care as a negative good – that is, a product or a service that we use because we must, not because we want to. Recent trends towards empowered consumers are a symptom of this problem more than a solution to it, as I described here.

Recently, the concept of Positive Health has emerged as a possible antidote for the malaise.

Pioneered by University of Pennsylvania psychologist Martin Seligman, Positive Health encourages us to identify and promote positive health assets—which Seligman describes as strengths that contribute to a healthier, more fulfilling life and yes, improved life expectancy as well. According to Seligman, “people desire well-being in its own right and they desire it above and beyond the relief of their suffering.”

Proponents of Positive Health have proposed that several social and functional factors are positive health assets. These include optimism, connectedness, a stable marriage and so forth. Scientists, often supported by the Robert Wood Johnson’s Pioneer Program, have begun studying these proposals. Their results have been compelling to say the least.

This post is the first of a series on Positive Health. In each post, I’ll review scientific studies of the matter and as the series unfolds, I’ll  discuss the relationship between this emerging paradigm and the traditional disease-oriented paradigm favored by today’s health providers.

Heart Health Linked to Satisfaction with Life
Most people know that negative psychological states like stress, anxiety and depression are linked to poor health outcomes, including a slew of adverse cardiac outcomes. Does it follow that a state of emotional and cognitive well-being can have a protective effect on cardiovascular health?

To answer this question, Harvard’s Julia Boehm and colleagues reviewed data from the Whitehall II study, which involved nearly 8,000 British civil servants. As part of that study, each participant had assessed his or her satisfaction with several dimensions of life experience including leisure activities, standard of living, job, health, family life, sex life, marital or love relationships and overall feelings about themselves as a person. Participants also provided yes/no answers regarding negative aspects of their lives including the presence of depression, anxiety and so forth.

The Whitehall II study also collected information regarding age, gender and traditional cardiovascular risk factors like cigarette smoking, diabetes and hypertension,. It assessed the incidence of coronary heart disease using three measures, presence of angina, documented heart attacks, and deaths from coronary disease during a 5-year follow-up period after the information had been collected.

Boehm’s team examined these data and found a clear, indirect relationship between satisfaction with each life domain and the risk of coronary heart disease: people reporting higher satisfaction had lower cardiac risk. Specifically, subjects in the highest tertile of satisfaction had a 26% lower risk of coronary events, and those in the middle third had a 20% reduced risk compared with those reporting the lowest levels of life satisfaction.

These trends reached statistical significance in 4 of the 7 dimensions: satisfaction with job, family life, sex life and overall feelings about themselves, and they persisted after controlling for age, gender, health behaviors, blood pressure, and metabolic functioning.

What to Make of This?
The study provides strong, though narrowly focused support for Seligman’s theories about Positive Health. Being satisfied with specific life domains—especially the 4 mentioned above—is associated with lower risk of coronary heart disease, even after accounting for traditional cardiovascular risk factors. If these findings can be validated, scientists should follow-up with studies to determine whether interventions designed to enhance life satisfaction can reduce cardiovascular risk.

Of note, the beneficial effects in this study were localized to angina, one of 3 outcome measures examined by Boehm’s group. There was no association between life satisfaction and the so-called ‘hard’ cardiovascular outcomes like heart attacks and cardiovascular deaths. Reporting bias could explain these findings: people that have favorable feelings about their lives might be more likely to report favorably about their health or have a higher tolerance for pain.

On the other hand, subjects in the Whitehall II study were relatively young (mean age = 50). In the natural history of coronary artery disease, angina frequently becomes manifest before heart attacks and death from cardiovascular causes. Participants in the study were followed for a fairly short time, only 5 years. It’s possible that longer follow-up would have revealed higher incidence of ‘hard’ cardiovascular outcomes.

It’s also possible that–since nearly all patients who sustain heart attacks have coronary artery disease, but only some with atherosclerosis sustain a heart attack—life satisfaction might be associated with increased risk of atherosclerosis but not with the specific factors that predispose to thrombotic events, plaque rupture and other antecedent events to heart attacks.

Further studies are required to sort through these alternative explanations.



  1. Brian Quinn, Team Director, Robert Wood Johnson Foundation's Pioneer Portfolio | 28/07/11

    Your post does a wonderful job of articulating not just the emerging concept of Positive Health, but the desired paradigm shift in medicine that it aims to achieve. Through the disruptive ideas put forward by Martin Seligman – and all of our grantees at the Robert Wood Johnson Foundation’s Pioneer Portfolio – we are seeking to radically change the current health care system into one that empowers patients, improves care and decreases costs. As you’ve discussed before, there’s some work to be done in regards to empowerment. That’s why we are exploring multiple interventions which we hope will move the ball forward, with some already showing a great deal of promise when it comes to providing the data, tools and knowledge people need to be proactive stakeholders in their own care. Positive Health is another way we can reach this end goal, by fundamentally changing the way people perceive health and health care. As with any emerging concept, there are still lots of questions to answer, and we hope the research we’re funding will start to build an evidence base that will help advance the conversation. A question that intrigues us, and one I’d love to get you and your reader’s perspectives on, is how to take these leanings and put them into practice? What will it take for people to start recognizing, embracing and developing these health assets in their day-to-day lives? Thanks for starting a dialogue on this issue, and I look forward to the rest of your thoughts as the series progresses.

  2. Prevent bacterial infection | 3/08/11

    It is true that your physical health is affected by your mental health. No doubt how much fitness freak you are, how healthy food you have and how regular are you with exercises and physical work out. You will not be healthy and fit till you are mentally healthy and happy. So the first step towards a healthy life is to be mentally happy and healthy and stay away from stress and tensions.

  3. dulhemiyan | 10/09/11

    Hi nice article.
    This was really interesting and helpful.
    Thanks for posting.

  4. Peter Bloch@Bloch Healing Cheshire and Manchester | 11/02/12

    Although it is no doubt true that there is a connection between life satisfaction and good heart health (it’s always good to have our “common sense” confirmed – for example, did you know that mother’s milk is better and that risky behaviour shortens average lifespan?)this is only one of many “potentially modifiable” factors.
    As a simple example of this central point, a large study recently published in The Lancet (‘Effect of potentially modifiable risk factors associated with myocardial infarction’, Yusuf et al, Sep 11, 2004 ,Vol. 364 No. 9438 pp 937-952) provides compelling evidence that 90% of heart attacks in men and 94% in women, the biggest killer in the western world, are caused by nine potentially modifiable risk factors, six of them ‘lifestyle’ factors (smoking, drinking, weight, diet, exercise, body fat distribution measured by waist-hip ratio) and the other three, abnormal lipids, hypertension or diabetes and psychosocial stress, are themselves strongly statistically related to lifestyle.
    Although I would not recommend abandoning the further advance of medical science, these figure make it abundantly clear that this is not where we should be looking for the most effective opportunities to enhance personal and public health.
    I have made this point in more detail here, please take a look: http://blochhealing.co.uk/can-bh-cure-disease

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