Dr. Darwin Labarthe, Positive Health researcher and former director of the Division for Heart Disease and Stroke Prevention with the Centers for Disease Control and Prevention (CDC), recently wrote an essay about the shift in the field of cardiology to focus on building cardiovascular health—beyond just preventing heart disease, stroke, and other cardiovascular events. Labarthe is part of an increasing number of experts in the health and health care communities who are focusing on health assets—strengths that can contribute to a healthier, longer life. This new framework is increasingly referred to as Positive Health, founded by Dr. Martin Seligman, Pioneer grantee and director of the Positive Psychology Center at the University of Pennsylvania. Below, Labarthe explains this shift, which he considers revolutionary, and places it in historical context.

By Darwin Labarthe, MD, MPH, PhD

Public health has seen three distinct revolutions. The first, more than a century ago, addressed communicable diseases. The second was heralded by the 1979 launch of Healthy People, the United States’ science-based initiative. Healthy People shifted the focus of the Department of Health, Education and Welfare (now Health and Human Services) from its longstanding emphasis on disease prevention to health promotion, defined by the World Health Organization (WHO) as “the process of enabling people to increase control over, and to improve, their health.” Finally, in 1986, WHO’s Ottawa Charter for Health Promotion triggered what some consider the “wellness revolution,” emphasizing that health was “a resource for everyday life, not the objective of living.” In other words, it advanced the notion that health was about more than the absence of disease, or staying alive—it was about thriving.

In my essay, I wrote about a current shift in focus from cardiovascular disease to cardiovascular health. I would posit that this may portend a broader fourth revolution: a “positive health” revolution.

In December, we asked our readers to tell us about the health care problems they felt were most in need of innovation—the tough problems, the crucial ones, maybe even those they’d seen firsthand. The number of comments we received was encouraging. It has also challenged our thinking, and generated a great deal of discussion on our team.

One thing is certain: The conversation that ensued from that post confirmed that our team needs to do more listening—listening to patients, caregivers, health care professionals, innovators, thought leaders—the list goes on and on.

We saw some common themes in the problems you shared. A few of them are reflected in areas in which the Robert Wood Johnson Foundation is already working. Clearly there are problems that, despite the intensive efforts of many really smart people, resist conventional solutions. Other themes showed us how important it is to always be examining what we’re doing from perspectives other than our own. 

So where do we go from here?  

In the Pioneer Portfolio, we’re all about ideas—big ones and little ones—the ones that will help solve some of the toughest problems in health and health care. We have clearly articulated our strategy for investing in innovations and innovators who have the potential to transform areas such as the health care delivery system, the patient-provider relationship, and the education of health care professionals. That strategy has yielded some significant breakthroughs, and the hope for much more to come. 

But we’re still missing a big piece of the puzzle. Why? Because right now, we only hear from the folks who have solutions to offer. That approach, by its very nature, limits the number of problems we know about. Those of us who work on the Pioneer team only see health care from the proverbial 30,000-foot vantage point. We are not on the front lines, so we don’t see firsthand the issues health care providers, patients, and families struggle with every single day.

Few diseases invoke more fear in patients and families than dementia (e.g., Alzheimer’s Disease (AD), progressive multiple sclerosis, Pick’s Disease). Surveys have shown the fear of dementia—especially AD—far outweighs concerns of a diagnosis of cancer, stroke, or cardiovascular disease. Perhaps this fear arises from two concerns: (1) dementia robs us of what makes us human—memory, reasoning, emotions, language—and (2) in most cases there are no effective treatments to cure or palliate the disease. While diagnostics for certain forms of dementia are progressing—allowing us to sort out the reversible causes of dementia, such as hydrocephalus, electrolyte or blood sugar imbalances, brain tumors, and brain injuries—once the diagnosis of AD or Pick’s disease is made, there is little we can do aside from manage the comfort and safety of the patient and family.

What if we could prevent or delay dementia?

I had the recent good fortune to attend an Institute of Medicine Roundtable workshop on the Promotion of Health Equity and the Elimination of Health Disparities called Leveraging Culture to Address Health Inequalities: Examples from Native Communities.  The Robert Wood Johnson Foundation supported the November 14, 2012 Seattle event.  The meeting was a gathering of American Indian, Alaska and Hawaiian Native health and health care leaders, all talking about health and culture.  They told stories of resilient, strong, vibrant, conquered yet not vanquished people.  Their tales were wondrous and sad—troubling, provocative, sometimes angry, often humorous.  

One might think the IOM was doing a good, almost charitable, thing by shining some precious attention on these people. How nice for experts to listen politely to those stories of past cultures struggling against waves of current change.  Well, it was a good thing—but not necessarily just for the natives.  There was immense, quiet wisdom and power there—for everybody.