“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
The World Health Organization, this definition has not been amended since 1948.
“Health is a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.” The World Health Organization 1986.
2001 The World Health Report – Mental Health: New Understanding, New Hope2011 National Prevention Strategy- America’s Plan for Better Health and Wellness
2005 Status Syndrome: How Social Standing Affects Our Health and Longevity. By Michael Marmot
2010 Fair Society, Healthy Lives: The Marmot Review –Strategic Review of Health Inequalities in England
My qualifications when I began teaching in the early seventies were a degree in chemistry and a post graduate certificate in education in Physical Education, the health of the children was of immediate concern and interest. Apart from P.E. (sport) there seemed to be no interest, concern or measurement in any form of health (physical or mental) of the children (mainly teenagers) in my school, but as I observed and listened to more and more students, it became clear that most had a variety of health concerns. Both my brothers, my sister and I had good health as teenagers, and we were rarely absent from school but I soon discovered that this was not applicable to many of the children I taught. Even the children in my sports teams, seemed to be less healthy and more absent than I recalled from my youth. Although it was a nuisance having students missing from my sports lessons or practices, when they were absent from my science or maths lessons it caused huge problems because they usually struggled to catch up or cope in the next lessons. Consequently, I began trying to research the health of children, mainly by discussion with students and staff as in those days I was not really interested in reading or had access to books for study.
Towards the end of the seventies, my father had his first heart attack, at the age of 54. He had been a smoker since his early teens and had a very stressful job as a bus driver in London. At the start of the eighties, my father died as a result of his heart problems and my mother then died from a brain tumour, both were in their early sixties. Consequently, my interest, concerns and research into health was increased and for the first time in my life I applied to get on an in-service training course, a Diploma in Education in Personal, Social, Health Education. I was successful and began this two year part-time course, involving attendance to college (soon to become a university) one evening per week. The course provided access to discussion groups and books for learning about the factors affecting human (child) development, particularly health and well-being.
As a result of my research and concerns I began teaching PSHE – Personal, Social, Health Education, a subject created at the time to try to address key concerns in these areas and help them acquire the knowledge and skills that they would need after leaving school. Teaching PSHE provided me with the opportunity for extensive research and learning with numerous students in a wide range of areas relating to health and well-being.
Although I began to have an interest and access to reference books there was not a huge amount of statistics on the numbers of young people suffering from the concerns I had discovered from my own research, eg. Depression, eating disorders, strong feelings of anger, self-harm, suicidal thinking, substance (drugs, solvents) abuse, alcohol abuse. Furthermore, the huge daily news headlines and articles that we now see were not occurring in those days, so I struggled to convey the level of concern that I felt.
In 1987, I transferred to a new school and a new role, from head of department, to become responsible for the learning, health and wellbeing of 250 pupils throughout their first five years in high (secondary) school. I had already become quite alarmed at the number of teenagers that I discovered seem to suffering from very high and very low moods (now called bipolarity), excessive fear, worry, or anxiety (OCD?), social withdrawal (depression?), eating disorders (binge eating and anorexia?), sleep disorder, strong feelings of anger, self-harm, suicidal thinking, substance (drugs, solvents) abuse, alcohol abuse.
I began searching for newspaper articles relating to health concerns in young people, displaying them on the wall outside my office and using them for discussions in lessons. The feedback (research evidence) from all this was very powerful and as the end of the century approached the media seemed to be publishing many more of these articles. My role allowed me to interview and study many (most) of the 250 pupils in my year group regularly throughout their five years in our school, frequently with their parents and often in their homes. The section on reports, references and profiles provides further information and explanation as to how the assessment of the pupils developed. This research increasingly demonstrated that the health, wellbeing, behaviour and learning were all very clearly interrelated and essential in realising how their development of the 8 skills was central to their health, wellbeing and behaviour. It was becoming clear that poor health, wellbeing and behaviour were invariably symptoms of poor development of the 8 skills.
The internet had also grown throughout the nineties and I finally had access to lots of research evidence to illustrate the seriousness of my concerns relating to the health of young people and how the poor development of the 8 skills explains it.
The World Health Organisation-Social Determinants of Health
The World Health Organisation has been a huge asset in providing evidence to illustrate the extent of the health concerns worldwide, and invaluable in demonstrating the rapidly increasing health problems with young people. A particularly good example of this was a booklet first published in 1998 Social Determinants of Health: The Solid Facts, edited by Richard Wilkinson and Michael Marmot. This extract from the introduction provides an outline of why it is so helpful.
This booklet discusses ten different but interrelated aspects of the social determinants of health. They explain:
- the need for policies to prevent people from falling into long-term disadvantage;
- how the social and psychological environment affects health;
- the importance of ensuring a good environment in early childhood;
- the impact of work on health;
- the problems of unemployment and job insecurity;
- the role of friendship and social cohesion;
- the dangers of social exclusion;
- the effects of alcohol and other drugs;
- the need to ensure access to supplies of healthy food for everyone; and
- the need for healthier transport systems.
Together the messages provide the keys to higher standards of population health in the developed industrial countries of Europe. These messages are intended to point out how social and economic factors at all levels in society affect individual decisions and health itself.
Probably for the first, I had discovered some evidence that supported my own research that a strategic approach (requiring systems thinking) is essential in explaining and solving the wide range of health related problems with young people in the developed countries. This next extract from page 1 “The Social Gradient” in the booklet conveys this clearly.
“People’s social and economic circumstances strongly affect their health throughout life, so health policy must be linked to the social and economic determinants of health.”
Poor social and economic circumstances affect health throughout life. People further down the social ladder usually run at least twice the risk of serious illness and premature death of those near the top. Between the top and bottom, health standards show a continuous social gradient, so even junior office staff tend to suffer much more disease and earlier death than more senior staff.
Most diseases and causes of death are more common lower down the social hierarchy. The social gradient in health reflects material disadvantage and the effects of insecurity, anxiety and lack of social integration.
Disadvantage has many forms and may be absolute or relative. It can include: having few family assets, having a poorer education during adolescence, becoming stuck in a dead-end job or having insecure employment, living in poor housing and trying to bring up a family in difficult circumstances. These disadvantages tend to concentrate among the same people, and their effects on health are cumulative. The longer people live in stressful economic and social circumstances, the greater the physiological wear and tear they suffer, and the. and the less likely they are to enjoy a healthy old age.
Life contains a series of critical transitions:
- emotional and material changes in early childhood,
- the move from primary to secondary education,
- starting work, leaving home and starting a family,
- changing jobs and facing possible redundancy, and eventually retirement.
Each of these changes can affect health by pushing people onto a more or less advantaged path.
People who have been disadvantaged in the past are at the greatest risk in each transition. This means that welfare policies need to provide not only safety nets but also springboards to offset earlier disadvantage.
Good health involves reducing levels of educational failure, the amount of job insecurity and the scale of income differences in society. We need to ensure that fewer people fall and that they fall less far.
Policies for education, employment and housing affect health standards.
Societies that enable all their citizens to play a full and useful role in the social, economic and cultural life of their society will be healthier than those where people face insecurity, exclusion and deprivation.
To see “Good health involves reducing levels of educational failure” is such an important statement, since the correlation between the health concerns of the young people and their development of the 8 skills is central to my conclusion.
Status Syndrome: How Social Standing Affects Our Health and Longevity One of the editors of the WHO booklet, Michael Marmot, had a book published in 2005, entitled “ Status Syndrome: How Social Standing Affects Our Health and Longevity.”, This is an excellent book, containing more than thirty years of research linking health and social circumstances and throughout the book and lots of great reference material.
Reading it with an understanding of the 8 skills, meant it provides vast quantities of evidence to illustrate the need for societies to focus on development of the 8 skills. For example, consider this brief extract from page 197,
“I have been constructing the case that the degree to which you have control over your life and your opportunities to participate fully in society are powerful determinants of health, quality and length of life” would be interpreted as ‘control over your life’ refers to our self-management and motivation skills, while ‘participate fully in society’ refers to empathy and relationship skills.”
Once the 8 skills are understood, this section can be interpreted as,
- ‘control over your life’ – relates to our self-management and motivation skills,
- ‘participate fully in society’ – relates to empathy and relationship skills.
I am tempted to quote huge chunks from Michael Marmot’s book, since his ‘immodest aims’, as he writes on page 7, are not dissimilar from mine.
“My immodest aim is to help change understanding of the wider effects of having control over one’s life and opportunities for full participation in society. A changed consciousness is an important step in leading to profound change for individuals and societies.”
His book contains so much scientific evidence to support the conclusion that our position in the development of the 8 skills is likely to be greatly influenced by our position in society (our families and environment) and so will have a huge effect on our health and wellbeing. On page 257, there is a section entitled, What is to be done? Which begs the answer – “Societies need to focus on developing and measuring what really matters in life – the 8 skills of healthy, happy successful people.
In November 2008, In England, Professor Sir Michael Marmot was asked by the Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The final report, ‘Fair Society Healthy Lives’ was published in February 2010, and concluded that reducing health inequalities would require action on six policy objectives:
- Give every child the best start in life
- Enable all children, young people and adults to maximise their capabilities and have control over their lives
- Create fair employment and good work for all
- Ensure healthy standard of living for all
- Create and develop healthy and sustainable places and communities
- Strengthen the role and impact of ill-health prevention.
In brief, the answer again simply seems to be –
“Societies need to focus on developing and measuring what really matters in life – the 8 skills of healthy, happy successful people.”
In 2001 the World Health Organisation published The World Health Report – Mental Health: New Understanding, New Hope succinctly summarised by this news article from the BBC.
Mental problems ‘hit one in four’
One in four people around the world will suffer from mental health problems at some point in their lives, according to a report from the World Health Organisation (WHO). It says 450 million people world-wide, currently suffering from mental or neurological illnesses, are being failed by their communities, many of which have no mental health policies in place.
The report, “Mental Health: New Understanding, New Hope” urges governments around the world to invest more in the community care of its mental health patients rather than placing them in large institutions. It says depression, which is most prevalent in poorer communities, is currently the fourth most common illness in the world. And mental health disorders are expected to rank second behind heart disease by 2020.
Dr Gro Harlem Brundtland, director-general of the WHO, said: “Mental illness is not a personal failure. In fact, if there is a failure, it is to be found in the way we have responded to people with mental and brain disorders. I hope this report will dispel long-held doubts and dogma and mark the beginning of a new public health era in the field of mental health.”
When ,as a teacher in the seventies, I was expected to assess, group, and categorize children, I heard a variety of terms being used such as remedial, retards, special needs, slow, disabilities, thick, dopey, aggressive, angry, dreamer, moody, weird, abnormal, subnormal, withdrawn, hyperactive, stroppy, and many others. I did not really understand these terms or find any scientific evidence to explain clearly. Therefore I was keen to discover terms to accurately assess children and understand how I could help them most effectively. At that time I had no knowledge of mental health, in fact I cannot even recall it the term being used, after 10 years of studying, interviewing, having discussions with students and research, by the end of the seventies my self-awareness had developed so much in this area that it was obvious to me that many children actually had undiagnosed problems.
This report provided a 21st century approach to mental health which greatly supported my own research and the evolution of the 8 skills as these extracts from page 5 illustrate:-
“Concepts of mental health include subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one’s intellectual and emotional potential, among others.
In recent years, new information from the fields of neuroscience and behavioural medicine has dramatically advanced our understanding of mental functioning. Increasingly, it is becoming clear that mental functioning has a physiological underpinning, and is fundamentally interconnected with physical and social functioning and health outcomes.”
“The World Health Report 2001 appears at an exciting time in the history of neuroscience. This is the branch of science which deals with the anatomy, physiology, biochemistry and molecular biology of the nervous system, especially as related to behaviour and learning. Spectacular advances in molecular biology are providing a more complete view of the building blocks of nerve cells (neurons).”
“The understanding of the structure and function of the brain has evolved over the past 500 years. As the molecular revolution proceeds, tools such as neuroimaging and neurophysiology are permitting researchers to see the living, feeling, thinking human brain at work. Used in combination with cognitive neuroscience, imaging technologies make it increasingly possible to identify the specific parts of the brain used for different aspects of thinking and emotion.”
At the start of the eighties I had become alarmed at the number of (adolescent) children that I encountered as a teacher researcher that had ‘symptoms of mental disorder’, (at the time I did not use this term), such as:-
- Confused thinking
- Long-lasting sadness or irritability
- Extremely high and low moods
- Excessive fear, worry, or anxiety
- Social withdrawal
- Dramatic changes in eating or sleeping habits
- Strong feelings of anger
- Delusions or hallucinations (seeing or hearing things that are not really there)
- Increasing inability to cope with daily problems and activities
- Thoughts of suicide
- Denial of obvious problems
- Many unexplained physical problems
- Abuse of drugs and/or alcohol
- Changes in school performance, falling grades
- Changes in sleeping and/or eating habits
- Excessive complaints of physical problems
- Defying authority, skipping school, stealing, or damaging property
- Intense fear of gaining weight
- Long-lasting negative mood, often along with poor appetite and thoughts of death
- Frequent outbursts of anger
- Persistent disobedience and/or aggressive behavior
This list is almost identical to the symptoms of mental disorder from the National Institute of Mental Health. © 2014 WebMD, LLC.
Throughout the eighties and nineties the statistics on the symptoms of mental disorder became more available, especially as the internet became established. By the end of the century the following definition pasted from the World Health Organisation (website) had become accepted.
“Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
This definition or explanation of mental health is crucial as it clarifies that when people are healthy they
- cope with the normal stresses of life
- work productively and fruitfully
- contribute to her or his community
A key aspect of my own research had been focusing on ‘what we need to learn to achieve healthy lives’ and this provided clear criteria of good health. Crucially the World Health Organisation supported my own research of almost 30 years and I was confident that there had been a steady increase in the number of children (adolescents mainly) displaying ‘symptoms of mental disorder’. Throughout the nineties statistics on some these symptoms became available, confirming this increase in the numbers exhibiting poor mental health. For example here is some Key Data on Adolescence 2013 from the Association for Young People’s Health in the UK.
- 1 in 10 children and young people aged 5 – 16 suffer from a diagnosable mental health disorder – that is around three children in every class.
- Between 1 in every 12 and 1 in 15 children and young people deliberately self-harm
- There has been a big increase in the number of young people being admitted to hospital because of self-harm. Over the last ten years this figure has increased by 68%
- Nearly 80,000 children and young people suffer from severe depression .
- Over 8,000 children aged under 10 years old suffer from severe depression .
- 72% of children in care have behavioural or emotional problems – these are some of the most vulnerable people in our society .
- 95% of imprisoned young offenders have a mental health disorder. Many of them are struggling with more than one disorder.
- The number of young people aged 15-16 with depression nearly doubled between the 1980s and the 2000s.
- The proportion of young people aged 15-16 with a conduct disorder more than doubled between 1974 and 1999.
Furthermore throughout the nineties I discovered and researched a number of symptoms of poor mental health some of which have been addressed separately in this book, such as ADHD, Addictions, Anxiety, Autism, Aspergers, Bipolar, Bullying, Depression, Conduct (Anti-social Behaviour) Disorder, Eating Disorder (Anorexia and Obesity), OCD, Sexual (Promiscuity) Dysfunction, Self-harm, Substance Abuse, Suicide.
Improving Mental Health with the 8 Skills
The research question “what do we need to learn to achieve healthy lives?”, in terms of mental health can now be rephrased as:-
What do we need to learn to cope with the normal stresses of life, work productively and contribute to our community?
The 8 skills can now be simply and clearly used as assessment of our mental health by asking the following 8 questions:-
How well do we –
- Learn and cope with new things? (Effective Learning)
- Concentrate and communicate? (Communication)
- Understand and solve problems? (Cognition)
- Know ourself and what to improve? (Self-awareness)
- Manage our feelings and behaviour? (Self-management)
- Cope with difficulties and setbacks? (Motivation)
- Show respect and empathise with others? (Empathy)
- Relate and cooperate with others? (Relationship/Social)
We can see if an individual has developed the 8 skills well they will probably have good mental health, consequently if developing the 8 skills became a priority for a society and assessed regularly, then the outcome will be better health. In 2011, the USA introduced “National Prevention Strategy –America’s Plan For Better Health and Wellness and this approach could easily be seen as the solution to this concern. The following extracts should clearly illustrate this:-
Page 7 – The National Prevention Strategy aims to guide our nation in the most effective and achievable means for improving health and well-being. The Strategy prioritizes prevention by integrating recommendations and actions across multiple settings to improve health and save lives. This Strategy envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society and work together to achieve better health for all Americans.
Page 22 – People are empowered when they have the knowledge, ability, resources, and motivation to identify and make healthy choices. When people are empowered, they are able to take an active role in improving their health, support their families and friends in making healthy choices, and lead community change.
Page 23 – Without employment and education, people are often ill-equipped to make healthy choices. Education can lead to improved health by increasing health knowledge, enabling people to adopt healthier behaviors and make better-informed choices for themselves and their families.
Page 47 – Positive mental health allows people to realize their full potential, cope with the stresses of life, work productively, and make meaningful contributions to their communities. Early childhood experiences have lasting, measurable consequences later in life; therefore, fostering emotional well-being from the earliest stages of life helps build a foundation for overall health and well-being.
Enhancing problem-solving and coping skills and improving relationships supports mental and emotional well-being. Social developmental strategies (e.g., enhancing social and life skills, positive peer-bonding) can enhance self-esteem, help people handle difficult social situations, and empower people to seek help when needed.
Once again, the answer simply seems to be –