So, what causes wellness? Life expectancy trends Portugal Scotland.

So, what causes wellness?

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

All cause mortality,men 65-69

0

500

1000

1500

2000

2500

3000

3500

4000

4500

SIMD quintile

Mo

rtal

ity

per

100

,000

1665

3951

Slope index of inequality

0

500

1000

1500

2000

2500

3000

3500

4000

4500

SIMD quintile

Mo

rtal

ity

per

100

,000

2763

Mean =2694

X

XX

XX

All cause, M65-692763/2694 = 1.025

Male inequalities, all causes, all ages

0.0

0.5

1.0

1.5

2.0

0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+

Age

Slo

pe

ind

ex o

f in

equ

alit

y d

ivid

ed b

y m

ean

ra

te

Slope index of inequality breakdown by cause of death

0

500

1000

1500

2000

2500

3000

3500

4000

4500

S IMD quint ile

0

500

1000

1500

2000

2500

3000

3500

4000

4500

S IMD quintile

0

500

1000

1500

2000

2500

3000

3500

4000

4500

S IMD quint i le

SII=2763

SII=792

SII=1971

All cause IHD Other causes

Male inequalities, all ages, by cause

0.0

0.5

1.0

1.5

2.0

0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+

Age

Slo

pe

ind

ex o

f in

equ

alit

y d

ivid

ed b

y m

ean

ra

te

IHD

All other causes

Relative inequalities in mortality by causeMen, Scotland 2000-02

0.0

0.5

1.0

1.5

2.0

0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+

Age

Slo

pe

ind

ex

of

ine

qu

alit

y d

ivid

ed

by

me

an

ra

te

Chronic liverdisease

All neoplasms

Disorders due touse of drugs

All other causes

Suicide

Assault

Accidents

Disorders due touse of alcohol

Chronic lowerrespiratory diseases

Cerebrovascular disease

Ischaemic Heart Disease

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

It is inequitably distributed by socioeconomic status We have been pretty unsuccessful in narrowing gaps Drugs, alcohol, suicides and violence cause 60% of

excess premature deaths The problem is psychosocial Wellbeing consists of success across all aspects of

life

Emily Werner and resilience

1. Personal attributes: outgoing, bright, and positive 

2. The family: having close bonds with at least one family member or an emotionally stable parent

3. 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:

Comprehensible Manageable Meaningful ......or the individual would experience

chronic stress

00-046

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0 10 20 30 40 50

Months of Orphanage Rearing

*linear trendline

Evening Cortisol Levels Increase withMonths of Orphanage Rearing *

The Founders’ Network

STRESS AND GRADE OF EMPLOYMENT: MEN

0

2

4

6

8

10

12

14

16

18

2008

-8.3

0

10-1

0.30

12-1

2.30

14-1

4.30

16-1

6.30

18-1

8.30

20-2

0.30

22-2

2.30

nmol

/l Higher GradeLower Grade

Salivary Cortisol

Time of DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

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

“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;108:2693-2698

©2011 by National Academy of Sciences

Adverse childhood events study

Physical/sexual/emotional abuse Neglect (physical/emotional) Domestic substance abuse Domestic violence Parental mental illness Parental criminality

Adverse childhood events risk of alcoholism

Hillis et al 2011

Adverse childhood eventsrisk of perpetrating violenceBoys experiencing physical abuse

Duke et al 2010

heart dise

asecancer

depression

alcoholic

IV drugssuicid

e1

3

5

7

9

11

13

ACE and morbidity(adjusted odds ratio, 4+

ACE)

circu

latory

system

all ca

ncers

exter

nal cau

ses

suicid

e

alcohol

drugs

100

120

140

160

180

200

220

240

260

Glasgow excess mortality(cause-specific SMR,

compared to Liverpool & Manchester)

The drive to aggression

The case of Phineas Gage

Impact of mindfulness on the brain

Brain region Impact 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:10.1038/nrn3916

Health improvement or life improvement?

Health is a characteristic which emerges in individuals living in a fair and civilised society.

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.

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

WorklessnessPoverty

In education offending

healthChaotic 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 Boyle

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

What do you mean, “it’s a bit muddy”?