(Notes from Bill Mahoney, PhD)
I will start at the end of the causal path and work backward. The end is health outcomes at the individual level (which aggregated = population health). We are starting with the fact that a large proportion of the variability across individuals in health outcomes is explained by behavioral factors. It is the “behavioral factors” we are explaining in this logic.
Why do less than optimum health outcomes from behavior happen? I think the answer is summarized in activation and the voluminous research showing the relationship between activation and health.
- Believing that health is my responsibility not that of health care professionals. Not believing this reflects being socialized to believe that health is dependent upon health professionals.
- Knowledge. Must know things such as what lipids are, why they are important, what your lipid numbers are, why they are that, what is your recommended weight, etc. The most important piece of knowledge is knowing the truth about health care and health care professionals and that they are not all knowing and do make mistakes and are generally far too busy to have an all encompassing focus on you and your health situation.
- Confidence that one can know and do.
- Doing. Actually taking behavioral change steps such as diet, exercise.
- Doing in difficult times. This is having resilience to the deactivating effects of stress and set backs; being able to stay the course when sliding back to old patterns would seem easier.
For most people improving their health management behavior in almost any way involves adopting a new way of thinking about health and health care. This change can be close to a transformational change that is needed. From this change in thinking comes change in behavior.
How does this change come about? It comes about when people flourish and it cannot come about when they do not flourish. The reason for this is that the more positive the affect ratio people are/have the:
- More likely they are to be open to new ideas.
- More likely they are to be open to changing behavior.
- More interested they are in learning new things.
- Better able they are to learn and learn more and more quickly.
- More open they are to interaction with and connection to other people (enhancing flourishing spurs network creation).
- More confident in their ability to manage their health.
- Physiological states that directly, biologically, enhance health and healing.
So the pathway to health outcomes starts with increasing flourishing because this leads to the possibility and probability of behavioral change. Trying to create behavior change without flourishing as the focus (e.g., education alone) is simply a waste of time .