Running Commentary

Under the leadership of APA Past President Norine Johnson, the APA membership approved a change in our bylaws that added "promoting health" as one of the objectives of the association, along with advancing psychology as a science and a profession and promoting human welfare. The revision in our bylaws reinforces our relevance not only to mental health, but also to the understanding, prevention and treatment of illnesses such as diabetes, cancer, heart disease and musculoskeletal diseases, among others.

What is the basis for making such a reframing in who we are and what we aspire to be as an organization? The basis lies in the acknowledgement that the science of psychology---and behavioral and social science more generally---has progressed to a point where our contributions to wider world of health are unequivocal. From a scientific perspective, psychology got its foot in the health door on the basis of decades of research on behavioral risk factors for illness (e.g., unhealthy diet, physical inactivity, smoking). But our aspiration to move toward the center stage of health has been facilitated by research demonstrating that psychological and social factors, in addition to behavioral ones, are predictive of a host of illnesses and biological outcomes. A new perspective on the determinants of health and longevity is warranted. It includes at least six key dimensions.

The six dimensions

I chose six dimensions because I believe most of the research can fit into these categories. But the number is not important. The important thing is that psychological and other sciences are showing us, through prospective longitudinal studies and randomized clinical trials, that health is more than biology.

  • Thoughts and actions. The importance of actions (e.g., "lifestyle" factors) to health is well-known. But what is less recognized is that thought processes and how we view the world can also be predictive of health outcomes. For example, optimists, who tend to expect more positive outcomes and interpret the past in ways that are more uplifting, have been found to live longer, recover faster from surgery, have lower mortality from cancer and fewer chronic illnesses than pessimists. Another example is that people who write deeply and thoughtfully about traumatic experiences have fewer health problems than those who do not.

  • Emotions and stress. Negative emotions such as depression, anger and anxiety are predictive of illness and death, especially from heart disease. High levels of negative emotions and chronic stress, along with hostility, can lead to a two-fold to seven-fold increase in risk for mortality, heart disease and a host of illnesses. New research is evolving that suggests that positive emotions may counter some of these effects.

  • Relationships and environment. Having a supportive social network is predictive of lower mortality, faster recovery from heart attacks, fewer common colds, slower progression to AIDS in persons who are HIV-positive and less atherosclerosis in the coronary arteries.

  • Personal achievement and equality. People who have lower levels of educational attainment, income and occupational status--which together have been labeled socioeconomic status--are at greater risk for early mortality compared to those higher on these scales. In addition, the greater the distance between the rich and the poor in a country or a state, the greater the annual mortality in everyone.

  • Meaning and faith. Although a relatively new area of health research, studies have shown that people who are able to find meaning, or even recognize benefits, following severe adversity have better psychological adjustment, fewer recurring heart attacks and lower mortality than those who are not. Religious participation, which is partly a way many people find meaning, has been associated with decreased mortality in a large number of longitudinal studies.

  • Biology. The five dimensions above affect biology in profound ways and have been demonstrated to alter the immune, cardiovascular, neuroendocrine and central nervous systems, and even gene expression.

Now that the scientific foundation for psychology as a health profession has been established, the challenge for us is to move to the center of health-care delivery systems and be viewed as health-care providers more generally. We must assure appropriate training in health psychology for those of us who wish to pursue this course. We must work to alter medical school curricula to include nonbiological dimensions of health. We most work to change the public's view of health and the role of psychologists. Our work has really just begun.

Further Reading

Anderson, N.B., & Anderson, P.E. (2003). Emotional longevity: What really determines how long you live. New York: Viking.