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The New Science of Thriving

By Christina Bethell
Christina Bethell is a professor in Population, Family and Reproductive Health and director of the Child and Adolescent Health Measurement Initiative at the Johns Hopkins Bloomberg School of Public Health.
Our well-being—individually and as a society—depends on mindfulness.

In the early 1970s, my grandmother had a disagreement with the Beatles.

When she heard “All You Need Is Love” play on the radio, she would reply, “All you need is inside of you.”

When I was a PhD student in the early 1990s, that message bounced around in my mind along with my epidemiology and econometrics lessons. It was then that I began amassing evidence that led me to two conclusions: First, public health, medicine, and public policy needed to address long-neglected social and emotional determinants of health; and second, we could not medicate our way to health. Rather, our relationships and what’s inside our hearts and minds matter most to health and have everything to do with love. My grandmother and the Fab Four were both right.

The realization that our relationships and experiences in childhood shape our lives changed my path. I determined to put social and emotional well-being on the public health policy agenda.

One of the great touchstones for me is “the largest public health study you never heard of.” In 1996, the CDC and Kaiser Permanente began a long-term study illuminating the consequences of exposure to adverse childhood experiences. ACEs primarily consist of childhood emotional or physical neglect, abuse, or household dysfunctions such as alcohol abuse. The studies showed that the more ACEs people have, the more likely they are to have chronic physical or mental illness, die early, and have children with ACEs.

Without awareness and healing, the trauma and stress from ACEs can accumulate and perpetuate. This makes sense: Ours is a social brain, and neurons that fire together, wire together. Moreover, ACEs can impact not only early brain development but also lifelong health.

In a December 2014 Health Affairs study, my colleagues and I estimated that half of all U.S. children have ACEs. Nearly a quarter have two or more. As with adult studies, our research found ACEs were linked with higher rates of health problems among youth, including asthma, ADHD, depression, anxiety, obesity, and autism spectrum disorders. We also found alarming negative effects on school engagement.

The good news is resilience—self-regulation of emotions, optimism, and hope—can trump ACEs. Luckily, a new science of thriving is emerging that suggests that resilience specifically, and well-being overall, can be learned. Mindfulness plays a central role. Mindfulness is a mental state achieved by focusing one’s awareness on the present. No small feat. That’s why it’s called a “practice.” Practicing mindfulness helps unlock, integrate, and heal embedded stress, interrupt harmful reactions to daily stress, open possibilities to rewire the brain, and begin to heal the heart. Even after a short while, mindfulness meditation has been shown to engage a cascade of beneficial neurological, physical, and mental benefits.

Our well-being—as individuals and as a society—depends on mindfulness. You wouldn’t be the first to raise an eyebrow at that, but I’m no advocate of woo-woo pseudoscience. The data are strong and growing. Adding to the neuroscience findings, epigenetic research now demonstrates the role of both negative and positive emotions on gene expression. Nobel laureate Elizabeth Blackburn and colleagues in 2011 found that mindfulness meditation may slow the rate of cellular aging and extend life expectancy. We can flourish despite adversity.

This brings me back again to my grandmother’s admonition that “all you need is inside of you.” My evidence-based, public-health-oriented take on her sage advice is that we need to really put the “we” in wellness. We need public health approaches and policies that prioritize safe, stable, and nurturing relationships in early life, prevent ACEs, and promote resilience, mindfulness, and positive health in populations.

For those of us already carrying ACEs, mindfulness can help us reduce stress reactivity and harmful, emotion-driven health behaviors like “self-medicating” with alcohol, drugs, or food. Mindfulness—and addressing our own ACEs—is fundamental for all who are interested in recognizing and helping children, families, adults, and communities heal from trauma and interrupt the cycle and effects of toxic and chronic stress. This is so important that we distill our mindful mission this way: Your Being, Their Well-Being.

Public health can increase its impact by recognizing the importance of ACEs and making use of the benefits of mindfulness and resilience. While still focusing on the big picture, we need to infuse all our interventions with these mindful, evidence-based approaches. In the new science of thriving, public health has a powerful tool to improve the well-being of populations. Let’s use it.

Photography by Marshall Clarke

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