By Christina Bethell, PhD, MPH, MBA
Our well-being—individually and as a society—depends on mindfulness. In the early 1970s, my grandmother had a disagreement with the Beatles.
When she heard “All You Need is Love” play on the radio, she would reply, “All you need is inside of you.”
When I was a PhD student in the early 1990s, these messages bounced around in my mind along with my epidemiology and econometrics lessons. It was then that I began amassing evidence that led me to two conclusions: First, public health, medicine and public policy needed to address long-neglected social and emotional determinants of health; and second, we could not medicate our way to health. Rather, our relationships and what’s inside our hearts and minds matter most to health and have everything to do with love. My grandmother and the Fab Four were both right.
The realization that our relationships and experiences in childhood profoundly shape our lives changed my career path. I became determined to put social and emotional well-being on the public health policy agenda.
One of the great touchstones for me is “the largest public health study you never heard of.” In 1996, the CDC and Kaiser Permanente began a long-term study illuminating the consequences of exposure to Adverse Childhood Experiences. ACEs primarily consist of childhood emotional or physical neglect, abuse or household dysfunctions such as alcohol abuse. Fifty publications to date on the study have shown the more ACEs people have, the more likely they are to have chronic physical or mental illness, die early and have children with ACEs.
Without awareness and healing, the trauma and stress from ACEs can accumulate and perpetuate. This only makes sense: Ours is a social brain, and neurons that fire together, wire together. Moreover, ACEs can impact not only early brain development but also lifelong health.
In a December 2014 Health Affairs study, my colleagues and I estimated that half of all U.S. children have ACEs. Nearly a quarter have two or more. As with adult studies, our research found ACEs were linked with higher rates of health problems among kids and youth, including asthma, ADHD, depression, anxiety, obesity and autism spectrum disorders. We also found alarming negative effects on school engagement.
The good news is resilience—self-regulation of emotions, optimism and hope—can trump ACEs. (In fact, regardless of ACE status, children lacking resilience fare worse.) Children with ACEs who also have resilience had one-fifth the odds of having mental or emotional problems like ADHD or depression.
Luckily, a new science of thriving is emerging that suggests that resilience specifically, and well-being overall, can be learned. Mindfulness plays a central role.
As acclaimed Harvard mindfulness researcher Ellen Langer says, “Wherever the mind is, the body will follow.” Mindfulness is a mental state achieved by focusing one’s awareness on the present moment. No small feat.
That’s why it is called a “practice.” Practicing mindfulness helps unlock, integrate and heal embedded stress, interrupt harmful reactions to daily stress, open possibilities to rewire the brain and begin to heal the heart. Based on neuroscience research dating back to the early 1970s, mindfulness meditation is the best-researched method for developing mindfulness. Even after a short while, mindfulness meditation has been shown to engage a cascade of beneficial neurological, physical and mental benefits.
Both the self-reflection and body awareness learned by practicing mindfulness seem to engage what might be called “the presence effect,” which is at the heart of interrupting our autopilot and retraining our nervous system.
Simply put, our well-being—as individuals and as a society—depends on mindfulness. You wouldn’t be the first to raise an eyebrow at that statement, but I’m no advocate of woo-woo pseudo-science. The data are strong and growing. Adding to the neuroscience findings, epigenetic research now demonstrates the role of both negative and positive emotions on gene expression. Nobel laureate Elizabeth Blackburn and colleagues in 2011 found that mindfulness meditation may slow the rate of cellular aging and extend life expectancy. The new science of thriving and the role of mindfulness show us the possibilities to flourish despite adversity.
This brings me back again to my grandmother’s admonition that “all you need is inside of you.” My evidence-based, public-health-oriented take on her sage advice is that we need to really put the “we” in wellness. We need public health approaches and policies that prioritize fostering safe, stable and nurturing relationships in early life, prevent ACEs and promote resilience, mindfulness and positive health in populations.
For those of us already carrying ACEs, mindfulness can help us reduce stress reactivity and harmful emotion-driven health behaviors like “self-medicating” with alcohol, drugs or food. Mindfulness—and addressing our own ACEs—is fundamental for all who are interested in recognizing and helping children, families, adults and communities heal from trauma and interrupt the cycle and effects of toxic and chronic stress. This is so important that we distill our mindful mission this way: Your Being, Their Well-Being.
Globally, mindfulness is gaining traction. An October 2015 British parliamentary report called “Mindful Nation UK” advocates mindfulness across health, education, workplaces and justice. Likewise, the international Organisation for Economic Co-operation and Development has launched an initiative to advance the very social and emotional skills—such as resilience, optimism, perseverance and self-worth—that mindfulness supports.
Public health can increase its impact by recognizing the importance of ACEs and making use of the benefits of mindfulness and resilience. While still focusing on the big picture, public health needs to build mindfulness awareness and skills in individuals, families and organizations. We need to infuse all of our interventions with these mindful, evidence-based approaches. In the new science of thriving, public health has a powerful tool to improve the well-being of populations. Let’s use it.
Christina Bethell, PhD, MPH, MBA, is a professor in Population, Family and Reproductive Health at Johns Hopkins Public Health and director of the Child and Adolescent Health Measurement Initiative.
