A Quiet Revolution in Cardiovascular Health

Apr 11, 2013, 2:00 PM, Posted by Pioneer Blog Team

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 aliveit 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.

This shift centers on the idea that people can have not just risk factors, but also health assets—mental, physical, and social characteristics that improve, rather than hinder, their health. Martin Seligman’s work in this area is key. He and his research team are exploring the concept of Positive Health by investigating whether health assets promote longer life, lower morbidity, lower health care expenditure, better prognosis when illness strikes, and/or higher quality of life. The focus is not on mitigating disease risk factors that have already developed, but on how building positive health assets—such as optimism, stable employment, or low blood pressure—can lead to higher levels of mental and physical well-being throughout the life course. This approach differs from preventive interventions that address health liabilities. Health assets are desirable for their own sake, not only for the sake of preventing illness or epidemic disease—so they may be more effective and sustainable.

I’m certainly seeing a shift toward Positive Health in my area of specialty. In 2010 the American Heart Association adopted a 2020 Impact Goal, for example, that emphasizes overall cardiovascular health, not just cardiovascular disease: “to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.”

We are at a turning point in understanding how we achieve and maintain good health. A revolutionary idea takes commitment, but the American Heart Association has demonstrated a dedication to the shift to positive cardiovascular health, and the Robert Wood Johnson Foundation’s Pioneer Portfolio is providing the resources to investigate and evaluate its validity. I believe you will see the Positive Health revolution burgeon and grow, and we will all benefit.

What if we focused on the positive? Do you agree with how Labarthe characterizes recent revolutions in public health? What changes would you suggest—and what revolution do you think we need next?

This commentary originally appeared on the RWJF Pioneering Ideas blog.