One of the things that is only recently being recognized is how inter-connected psychological, behavioral and physical health are. As recognition of this fact and the fact that non-nurturing environments influence all of these problems we are beginning to evolve a health care system that is appropriate to these facts. It might be useful to think about the progress to be made in terms of four facets of our cultural practices: (a) values and goals; (b) monitoring wellbeing; (c) evidence-based programs and practices; and (e) policies.
Values and Goals
By 2065, I predict that we will have evolved societies that explicitly embrace values and goals for ensuring the wellbeing of every person. Research over the past 40 years has already shown that most aspects of wellbeing including physical illness and psychological and behavioral disorders are intertwined (Biglan, 2015). It is already clear that if our only interest is in preventing physical illness, we will have to prevent problems like depression, drug abuse, and academic failure, because these problems make illnesses such as cancer and cardiovascular disease more likely (e.g., Thorndike & Regotti, 2009). Moreover it is increasingly clear that all of these problems are made more likely by environments that fail to nurture the many facets of wellbeing (Biglan, 2015). In this sense, simply starting with the premise that we want to prevent life-threatening illness we will, on empirical grounds, end up embracing a broad goal of enhancing wellbeing.
Simply starting with the premise that we want to prevent life-threatening illness we will, on empirical grounds, end up embracing a broad goal of enhancing wellbeing.
This way of thinking is already guiding ambitious efforts to improve the successful development of young children in Oregon, where I live. Under the leadership of Governor Kitzhaber, Oregon created an Early Learning Council, which articulated what young children need to thrive. It is now widely understood among those with the responsibility to strengthen early childhood development that we must strengthen supports for families from the prenatal period through early childhood and Oregon has begun to construct the infrastructure needed to make this happen.
I have in mind an evolution that goes beyond simply having the traditional components of the existing health care system embrace the goal of comprehensive wellbeing. In my view, in this and most other areas of society, we need to make our most deeply held values much more prominent in public discussion. The questions we need to keep asking are whether we choose to make our society one that makes the nurturance of every person one of our highest values and whether the priorities we set as a society will be guided by this value.
Explicit adoption of values and goals will also contribute to pragmatic policymaking. The merit of any policy or program can be evaluated in terms of its contribution to wellbeing. As Wilson et al. (2014) have argued, explicit goals become the criteria for evolution; we will select practices on the basis of their contribution to our goals and values.
Monitoring Wellbeing
If we measure key aspects of wellbeing in the context of clear goals we will select increasingly effective practices. We are already well on our way to evolving a society in which many aspects of the wellbeing of the population are monitored in ways that can guide further improvements in wellbeing. The Centers for Disease Control and Prevention monitors numerous aspects of adult and adolescent behavior relevant to health in representative samples in each state. Eventually, l believe that every community will want estimates of wellbeing (Mrazek, Biglan, & Hawkins, 2005).
In Oregon, the Early Learning Division is putting in place assessments of the readiness of every kindergarten child. Thus we will have annual data on the proportion of children who are ready to learn and ready to succeed socially. As counties and communities ramp up the supports for young children’s development, we will be able tell whether their efforts are increasing the proportion of children who are likely to succeed in school. Where progress is slow, it will prompt new initiatives. Where progress is clear, it will enable other counties to adopt what is working and will promote public support for Oregon’s historic efforts.
In fifty years, I predict that every community will have timely and accurate data about the wellbeing of its population and these data will guide policy making and program implementation.
Evidence-Based Programs and Practices
In my new book, The Nurture Effect (Biglan, 2015), I describe numerous family and school programs that have a beneficial effect in nurturing prosocial behavior and preventing myriad problems. The Institute of Medicine report on prevention concluded that we already have the potential to ensure that virtually every young person develops successfully. Think how much better we will be at this in fifty years. Just as computer science has transformed our world over the past 50 years, so too will behavioral science in the next fifty.
Just as computer science has transformed our world over the past 50 years, so too will behavioral science in the next fifty.
The big challenge will be to evolve a system that reaches every family, school, or individual with low cost, effective programs and practices.
Here in Oregon, we are doing a number of things to move forward. Oregon has created Coordinated Care Organizations which are not only providing health care coverage for low income families, but are organizing health care to ensure that every family has a medical home, that patients are routinely screened for psychological, behavioral, and health problems and get the care they need. To this end, CCOs are funding clinics to integrate behavioral health and primary care so that physicians can make a warm and immediate hand off to a behavioral health specialist for people who need help changing behavior.
In the case of young children, this means having a growing proportion of children getting annual developmental screenings and any interventions that those screenings suggest are needed. But the system will not just depend on primary care to see that this is done. Every county in Oregon is working to increase the quality and availability of childcare and to get good family interventions to families through preschools, and other family support organizations.
In fifty years, I expect that our programs and practices will be stronger, readily available, and reaching virtually every family that could benefit. The result will be much lower levels of psychological, behavioral, and health problems than we have ever seen.
Policies
Many of the structural developments I envision will require good policy. We need policies like the ones being implemented in Oregon that further the goals and values of having a healthy, thriving population. We need requirements and funding to be sure effective interventions are made available. We need ongoing evaluation of outcomes to know if we are succeeding and to prompt improvements when we are not.
We also need policies that curtail practices that are harmful to health. The harmful effects of the marketing of cigarettes and alcohol are well established. Yet we have not done enough to prohibit harmful marketing. The same is true of the marketing of many unhealthful foods. The impact of policy making on practices like these is best illustrated by huge reductions in cigarette smoking that have already been achieved. Think what fifty years of policy making could do to further reduce the harmful impacts of marketing on our health and wellbeing.
In Oregon, the policies that have created the Coordinated Care Organizations and Early Learning Division and the local “Hubs” it funds are helping to create an infrastructure for health care that can measurably increase not only the availability and quality of traditional heath care, but also improvements in the extent to which we make people’s environments more nurturing in ways that go well beyond treating illness.
References
- Biglan, A. (2015). The Nurture Effect: How the Science of Human Behavior Can Improve Our Lives and Our World. Oakland, CA: New Harbinger
- Mrazek, P., Biglan, A., & Hawkins, J. D. (2005). Community-monitoring systems: Tracking and improving the well-being of America’s children and adolescents. Falls Church, VA: Society for Prevention Research.
- Thorndike, A. N. & Rigotti. N. A. (2009). A tragic triad: coronary artery disease, nicotine addiction, and depression, Current Opinion in Cardiology, 447-53.
