Sunday

Zicam Cold Remedy Nasal Products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Swabs, Kids Size)

From: FDA MedWatch [mailto:fda@service.govdelivery.com]
Sent: Tuesday, June 16, 2009 12:21 PM
To: Trachtenberg, Alan (IHS/HQE)
Subject: MedWatch - Zicam Cold Remedy Nasal Products: Reports of permanent loss of sense of smell with use of these nasal gel or swab products

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166996.htm

MedWatch logoMedWatch - The FDA Safety Information and Adverse Event Reporting Program

Zicam Cold Remedy Nasal Products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Swabs, Kids Size)

Audience: Consumers

FDA notified consumers and healthcare professionals to discontinue use of three Zicam Nasal Gel/Nasal Swab products sold over-the-counter as cold remedies because they are associated with the loss of sense of smell that may be long-lasting or permanent. The FDA has received more than 130 reports of loss of sense of smell associated with the use of the three Zicam products. In these reports, many people who experienced a loss of smell said the condition occurred with the first dose; others reported a loss of the sense of smell after multiple uses of the products. People who have experienced a loss of sense of smell or other problems after use of the affected Zicam products should contact their health care professional. The loss of sense of smell can adversely affect a person’s quality of life, and can limit the ability to detect the smell of gas or smoke or other signs of danger in the environment.

Read the complete MedWatch 2009 Safety Summary, including links to the Public Health Advisory and Consumer Update page, at:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166996.htm

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Health Affairs Special on Mental Health-May/June 2009 - Volume 28, Number 3 Mental Health Care: Better, Not Best

May/June 2009 - Volume 28, Number 3

Mental Health Care: Better, Not Best

Supplemental Data is available for this issue:

[Original Table Of Contents For This Issue]

From the Editor

Mental Health Care In America: Not Yet Good Enough
Susan Dentzer
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Where We Are Now

Sherry A. Glied and Richard G. Frank
[Abstract] [Full Text] [Figures Only] [PDF] [Appendices] [Reprints & Permissions]

Richard G. Frank, Howard H. Goldman, and Thomas G. McGuire
[Abstract] [Full Text] [Figures Only] [PDF] [Appendix] [Reprints & Permissions]
Perspectives
PERSPECTIVE:
David L. Shern, Kirsten K. Beronio, and Henry T. Harbin
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
PERSPECTIVE:
Keith Dixon
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
PERSPECTIVE:
Ken Johnson
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
PERSPECTIVE:
Myrl Weinberg
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
PERSPECTIVE: Patient Assistance Programs: Information Is Not Our Enemy
Niteesh K. Choudhry, Joy L. Lee, Jessica Agnew-Blais, Colleen Corcoran, and William H. Shrank
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Care Continuum
PROLOGUE: Along The Care Continuum
[Extract] [Full Text] [PDF] [Reprints & Permissions]

William H. Fisher, Jeffrey L. Geller, and John A. Pandiani
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

David C. Grabowski, Kelly A. Aschbrenner, Zhanlian Feng, and Vincent Mor
[Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

Marcela Horvitz-Lennon, Julie M. Donohue, Marisa E. Domino, and Sharon-Lise T. Normand
[Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

Samuel H. Zuvekas and Chad D. Meyerhoefer
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
Report From The Field
REPORT FROM THE FIELD: Starvation Diet: Coping With Shrinking Budgets In Publicly Funded Mental Health Services
Steve Bogira
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Perspective
PERSPECTIVE:
Steven S. Sharfstein and Faith B. Dickerson
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
PERSPECTIVE:
Michael F. Hogan and Lloyd I. Sederer
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
Pharmaceuticals
PROLOGUE: Pharmaceuticals & Psychotropic Drugs
[Extract] [Full Text] [PDF] [Reprints & Permissions]

Susan H. Busch and Colleen L. Barry
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

Haiden A. Huskamp, Alisa B. Busch, Marisa E. Domino, and Sharon-Lise T. Normand
[Abstract] [Full Text] [PDF] [Appendix] [Reprints & Permissions]

Julie M. Donohue, Haiden A. Huskamp, and Samuel H. Zuvekas
[Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]
Federal Policy
PROLOGUE: Transforming Federal Policy
[Extract] [Full Text] [PDF] [Reprints & Permissions]

Robert E. Drake, Jonathan S. Skinner, Gary R. Bond, and Howard H. Goldman
[Abstract] [Full Text] [PDF] [Appendix] [Reprints & Permissions]

M. Audrey Burnam, Lisa S. Meredith, Terri Tanielian, and Lisa H. Jaycox
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

Philip S. Wang, Christine M. Ulbricht, and Michael Schoenbaum
[Abstract] [Full Text] [PDF] [Supplemental Bibliography] [Reprints & Permissions]
State Policy
PROLOGUE: Evolution In State Policy
[Extract] [Full Text] [PDF] [Reprints & Permissions]

Richard J. Bonnie, James S. Reinhard, Phillip Hamilton, and Elizabeth L. McGarvey
[Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

Saul Feldman
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

Jeffrey Swanson, Marvin Swartz, Richard A. Van Dorn, John Monahan, Thomas G. McGuire, Henry J. Steadman, and Pamela Clark Robbins
[Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]
Health Tracking
MARKETWATCH:
Niteesh K. Choudhry, Joy L. Lee, Jessica Agnew-Blais, Colleen Corcoran, and William H. Shrank
[Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]
MARKETWATCH:
Steven D. Pearson and Sarah R. Lieber
[Abstract] [Full Text] [PDF] [Case Study] [Reprints & Permissions]
MARKETWATCH:
Ursula Giedion and Manuela Villar Uribe
[Abstract] [Full Text] [PDF] [Appendix] [Reprints & Permissions]
MARKETWATCH:
Denise L. Anthony, M. Brooke Herndon, Patricia M. Gallagher, Amber E. Barnato, Julie P.W. Bynum, Daniel J. Gottlieb, Elliott S. Fisher, and Jonathan S. Skinner
[Abstract] [Full Text] [Figures Only] [PDF] [Appendix Exhibits][Erratum] [Reprints & Permissions]
Narrative Matters
Unrecognized Vulnerabilities
Jane Pauley
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Coming Out Of The Shadows
Fred Frese
[Extract] [Full Text] [PDF] [Reprints & Permissions]
DataWatch

Didem M. Bernard, Jessica S. Banthin, and William E. Encinosa
[Abstract] [Full Text] [PDF] [Technical Appendix] [Reprints & Permissions]

Ashish K. Jha, E. John Orav, Allen Dobson, Robert A. Book, and Arnold M. Epstein
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
GrantWatch
GRANTWATCH REPORT:
Ruth Tebbets Brousseau
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
GrantWatch: Outcomes
[Extract] [Full Text] [PDF] [GrantWatch Online 28 May] [Reprints & Permissions]
Book Reviews
BOOK REVIEWS: Cause And Coincidence In Autism
Rick Mathis
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Obesity: Global Causes Require Global Solutions
Cliona Ni Mhurchu
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Overtreated, Or Overregulated?
Richard A. Epstein
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Letters
Medicare And Mental Health Parity
Laysha Ostrow and Ron Manderscheid
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Rewarding Innovation In Drug Discovery
Gilberto Lopes
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Patient Choice: Critical For Obtaining Value
Randall Walker
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Infrastructure For A Learning Health Care System: CaBIG
Kenneth H. Buetow and John Niederhuber
[Extract] [Full Text] [PDF] [Reprints & Permissions]
CaBIG: The Author Responds
Lynn Etheredge
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Medical Device Market: If It Ain’t Broke, Don’t Fix It
Stephen J. Ubl
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Medical Device Market: An Author Responds
Jeffrey C. Lerner
[Extract] [Full Text] [PDF] [Reprints & Permissions]
The Evidence Dilemma And Cultural Change
Neil A. Holtzman
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Evidence Dilemma: The Authors Respond
Muin J. Khoury
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Goals Of Postgraduate Physician Training
Roger K. Howe
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Medicine As A Job, Not A Calling?
Mark Hutchins
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Being There For Patients: Another View
Kimberly D. Manning
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Culture Changes In Teaching Hospitals
Ronen Marmur
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Work Hours: A Resident’s View
Teri Sanor
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Disappearing Doctors: The Author Responds
Janet R. Gilsdorf
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Errata
Erratum
[Extract] [Full Text] [PDF] [Reprints & Permissions]
Web Exclusives

Jonathan B. Oberlander and Barbara Lyons
(published online 17 March 2009)
[Abstract] [Full Text] [PDF] [Reprints & Permissions]
INTERVIEW: Eliminating Neglected Diseases In Poor Countries: A Conversation With Andrew Witty
Susan Dentzer
(published online 19 March 2009)
[Extract] [Full Text] [PDF] [Reprints & Permissions]

Rick Curtis and Ed Neuschler
(published online 24 March 2009)
[Abstract] [Full Text] [PDF] [Table Of Contents] [Reprints & Permissions]

Rick Curtis and Ed Neuschler
(published online 24 March 2009)
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

Marian R. Mulkey and Mark D. Smith
(published online 24 March 2009)
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

Kannika Damrongplasit and Glenn A. Melnick
(published online 31 March 2009)
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

Tewarit Somkotra and Leizel P. Lagrada
(published online 31 March 2009)
[Abstract] [Full Text] [PDF] [Annex 1] [Reprints & Permissions]

Peter J. Pronovost, Christine A. Goeschel, Kyle L. Olsen, Julius C. Pham, Marlene R. Miller, Sean M. Berenholtz, J. Bryan Sexton, Jill A. Marsteller, Laura L. Morlock, Albert W. Wu, Jerod M. Loeb, and Carolyn M. Clancy
(published online 7 April 2009)
[Abstract] [Full Text] [PDF] [Appendix Figure 1] [Reprints & Permissions]

Peter J. Cunningham
(published online 14 April 2009)
[Abstract] [Full Text] [PDF] [Reprints & Permissions]

Tara Sussman, Robert J. Blendon, and Andrea Louise Campbell
(published online 21 April 2009)
[Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]
TRENDS:
Stephen Zuckerman, Aimee F. Williams, and Karen E. Stockley
(published online 28 April 2009)
[Abstract] [Full Text] [PDF] [Appendix Table] [Reprints & Permissions]

Guidelines for Authors

Mental health, resilience and inequalities Dr Lynne Friedli of the World Health Organization (WHO)

http://www.euro.who.int/document/e92227.pdf

Summary
‘Although the risks and contradictions of life go on being as socially produced as ever, the duty and
necessity of coping with them has been delegated to our individual selves.
Zygmunt Bauman 2007a p. 14
This report explores the wealth of evidence that mental health influences a very wide range of outcomes for individuals and communities. These include healthier lifestyles; better physical health; improved recovery from illness; fewer limitations in daily living; higher educational attainment; greater productivity, employment and earnings; better relationships with adults and with children; more social cohesion and engagement and improved quality of life. These outcomes are not just or necessarily a consequence of the absence of mental illness, but are associated with the presence of positive mental health, sometimes referred to as ‘wellbeing’. Improving mental health is a worthwhile goal in itself: most people value a sense of emotional and social wellbeing; in addition, good mental health has many other far reaching benefits.
Mental health is a fundamental element of the resilience, health assets, capabilities and positive adaptation that enable people both to cope with adversity and to reach their full potential and humanity. Mental health is also the key to understanding the impact of inequalities on health and other outcomes. It is abundantly clear that the chronic stress of struggling with material disadvantage is intensified to a very considerable degree by doing so in more unequal societies. An extensive body of research confirms the relationship between inequality and poorer outcomes, a relationship which is evident at every position on the social hierarchy and is not confined to developed nations. The emotional and cognitive effects of high levels of social status differentiation are profound and far reaching: greater inequality heightens status competition and status insecurity across all income groups and among both adults and children. It is the distribution of economic and social resources that explains health and other outcomes in the vast majority of studies. The importance of the social and psychological dimensions of material deprivation is gaining greater recognition in the international literature on poverty and informs current efforts to develop indicators that capture the missing dimensions of poverty.
For this reason, levels of mental distress among communities need to be understood less in terms of individual pathology and more as a response to relative deprivation and social injustice, which erode the emotional, spiritual and intellectual resources essential to psychological wellbeing. While psycho-social stress is not the only route through which disadvantage affects outcomes, it does appear to be pivotal. Firstly, psychobiological studies provide growing evidence of how chronic low level stress ‘gets under the skin’ through the neuro-endocrine, cardiovascular and immune systems, influencing hormone release e.g. cortisol, cholesterol levels, blood pressure and inflammation e.g. C-reactive proteins. Secondly, both health-damaging behaviours and violence, for example, may be survival strategies in the face of multiple problems, anger and despair related to occupational insecurity, poverty, debt, poor housing, exclusion and other indicators of low status. These problems impact on intimate relationships, the care of children and care of the self. In the United Kingdom, the 20% - 25% of people who are obese or continue to smoke are concentrated among the 26% of the population living in poverty, measured in terms of low income and multiple deprivation of necessities. This is also the population with the highest prevalence of anxiety and depression.
III
Summary
Mental health, resilience and inequalities
A greater understanding of inequalities is also crucial to recognizing the limits of what promoting positive mental health can achieve. Positive mental health does confer considerable protection and advantage, but it does so predominantly among those with equal levels of resources. In other words, among poor children, those with higher levels of emotional wellbeing have better educational outcomes than their equally poor peers. However, richer children generally do better still, regardless of emotional or cognitive capability. Among well off students, high positive affect is associated with improved employment outcomes, but among poorer students, parental income is a more significant determinant. Emerging evidence suggests that the same pattern may be true for resilient localities: high levels of social capital may help to explain why one poor neighbourhood has lower mortality than other equally deprived areas, but these poorer, resilient communities still tend to have higher mortality than affluent areas.
The significance of mental health and its role in our survival confirms the importance of humans as social beings: levels of social interaction are universal determinants of wellbeing across all cultures. But the unique nature of each person’s mental character also reminds us of the power of the individual: “no one survives without community and no community thrives without the individual”. Progress in improving public mental health will also mean drawing on lessons from the user/survivor and recovery movements, with their emphasis on empowerment and respect for what each individual needs to hold on to or regain a life that has meaning for them.
This report highlights the importance of policies and programmes to support improved mental health for the whole population. Just as we know that a small reduction in the overall consumption of alcohol among the whole population results in a reduction in alcohol related harm, so a small improvement in population wide levels of wellbeing will reduce the prevalence of mental illness, as well as bringing the benefits associated with positive mental health. Priorities for action include:
• social, cultural and economic conditions that support family and community life
• education that equips children to flourish both economically and emotionally
• employment opportunities and workplace pay and conditions that promote
and protect mental health
• partnerships between health and other sectors to address social and economic
problems that are a catalyst for psychological distress
• reducing policy and environmental barriers to social contact.
While there is much that can be done to improve mental health, doing so will depend less on specific
interventions, valuable as these may be, and more on a policy sea change, in which policy makers across all sectors think in terms of ‘mental health impact’. It is already evident that the relentless pursuit of economic growth is not environmentally sustainable. What is now becoming clear is that current economic and fiscal strategies for growth may also be undermining family and community relationships: economic growth at the cost of social recession. This means that at the heart of questions concerning ‘mental health impact’ is the need to protect or recreate opportunities for communities to remain or become connected.
IV
Summary
Mental health, resilience and inequalities
Across the 53 Member States of the WHO European Region, tackling inequalities is the major challenge. Understanding the importance of mental health can help us to think more critically about the limits of economic growth and what wealth can achieve and to promote greater awareness of the benefits of reducing inequalities. This is not about utopian visions: the comparison between Sweden and the United Kingdom shows that relatively small differences in levels of inequality can have very significant effects on health. While there is no evidence that people can adapt psychologically to high levels of inequality, there is considerable evidence that opportunities for co operative social relationships are protective and that this is the case across all social classes. Both high and low income populations benefit in more equal societies.
A focus on social justice may provide an important corrective to what has been seen as a growing over-emphasis on individual pathology. Mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual solutions. A focus on collective efficacy, as well as personal efficacy is required. A preoccupation with individual symptoms may lead to a ‘disembodied psychology’ which separates what goes on inside people’s heads from social structure and context. The key therapeutic intervention then becomes to ‘change the way you think’ rather than to refer people to sources of help for key catalysts for psychological problems: debt, poor housing, violence, crime. There is a need to think more critically about the relative contribution to mental wellbeing of individual psychological skills and attributes (e.g. autonomy, positive affect and self efficacy) and the circumstances of people’s lives: housing, employment, income and status. This also involves recognizing that ‘happiness’, ‘positive thinking’
and ‘trust’ are not always adaptive responses.
How things are done (values and culture) and how things are distributed (economic and
fiscal policy) are the key domains that influence and are influenced by how people think,
feel and relate. Mental health promotion has made and continues to make a significant contribution
to our understanding of the wider determinants of health and the crucial relationship between
social position and emotion, cognition and social function or relatedness. Evidence to this
effect needs to inform current thinking about how individuals (including children) respond
to stressors and appropriate promotion, prevention and treatment strategies across the spectrum
of mental health problems.
Mental health is fundamental to the future of the countries of Europe. Mental health underpins the social and intellectual skills that will be needed to meet the new challenges of the 21st century. It is also becoming increasingly clear, notably in campaigns on the environment and sustainable development, that communities across Europe place a high value on wellbeing. The limitations of consumerism are being more widely reflected upon, especially in relation to children and family life and the basis of civic society. We will have to face up to the fact that individual and collective mental health and wellbeing will depend on reducing the gap between rich and poor. At the same time, reducing inequality is not a sufficient policy response, important as that is. What is also needed is
a shift in consciousness and a recognition that mental health is a precious resource to be promoted and protected at all levels of policy and practice.

1. Introduction
This report sets out the contribution that mental health and mental illness make to a wide range
of health and social outcomes and shows how a greater focus on mental health as a determinant can help to explain outcomes, for individuals and for communities, which cannot be wholly accounted for by material and other factors. The limitations of classical risk factors e.g. health behaviour, lifestyle and low income have prompted a growing interest in what protects health in the face of adversity and in the determinants of health, as distinct from the determinants of illness (Harrison et al 2004; Bartley et al forthcoming). This report aims to contribute to that literature by looking at mental health as a fundamental element of resilience, health assets and the capabilities that moderate risk and influence life chances and outcomes for individuals, families and communities.2
It is already well established that mental illness, across the spectrum of disorders, is both a direct cause of mortality and morbidity and a significant risk factor for poorer economic, health and social outcomes, although these adverse outcomes vary by type of disorder and socioeconomic status (WHO 2005; 2006).3 However, it is now becoming clear that the presence or absence of positive mental health or ‘wellbeing’ also influences outcomes across a wide range of domains. These include healthier lifestyles, better physical health, improved recovery, fewer limitations in daily living, higher educational attainment, greater productivity, employment and earnings, better relationships, greater social cohesion and engagement and improved quality of life (WHO 2004b; Barry and Jenkins 2007; Jane-Llopis et al 2004).
The importance of mental health as a determinant raises a number of questions. Firstly, there is a need for a greater understanding of why mental health is so significant: what are the key pathways through which mental health and wellbeing influence so many different dimensions of the lives of individuals and communities and how do these intersect with other determinants? Secondly, what conditions are necessary to create optimum mental health and wellbeing and what policy initiatives and interventions will produce these conditions?
Some of the factors to consider in assessing the significance of mental health relative to other influences are evident in reflecting on a familiar scenario: the long haul flight (Lynch et al 2000). Clearly, there are important differences in the experience of first class and economy travellers.
The question is, what influences outcomes for passengers in each class? For those in economy, is it the material fact of less space, poorer food, limited leg room, proximity to others, sleeping upright rather than reclining, limited opportunities for walking around etc. that makes the difference? Or, is it the knowledge that other people are enjoying first class status and perks, while you are not doing so, combined perhaps, with subtle differences in the attitude of the cabin crew in economy class?
To what extent is our experience of material conditions mediated by our emotional and cognitive responses? What is the contribution of the psychobiological pathways through which stressful social conditions are written on the body, becoming evident in cholesterol, cortisol and blood pressure levels? What role do individual genetic and life histories, expectations, aspirations, religious and
cultural beliefs play in how we interpret and react to adversity or advantage? What difference does
2 Amartya Sen defines capabilities as people’s real freedoms to enjoy beings and doings that they value and have reason
to value (Sen 1985; see also Zavaleta 2007)
3 Outcomes may vary significantly by country, for example people with schizophrenia may have better outcomes in some
developing countries (WHO 2003).
Introduction
Mental health, resilience and inequalities
02
it make if discomfort and difficulties are shared by everyone?4 These questions lie at the heart of current debates about the social determinants of health, the relative contribution of material,
psycho-social and biological factors and the effects of inequalities (Lynch et al 2000; Wilkinson and Pickett 2006; Dahlgren and Whitehead 2006).5
A growing body of international data shows strong contextual effects for material factors, for example people at the same level of income will have lower mortality if they are in more, rather than less, equal states (Wilkinson and Pickett 2007a). One explanation for this and for the strong social gradient in health is that relative deprivation is a catalyst for a range of negative emotional and cognitive responses to inequity. These are both conscious and unconscious reactions, influencing health through physiological reactions, through the impact of low status on identity and social relationships, as well as through a range of damaging behaviours that are a direct or indirect response to the social injuries associated with inequalities (Wilkinson 2005; Rogers and Pilgrim 2003). In this analysis, mental health is fundamental because levels of inequality have a strong impact on how people feel and how people feel, their emotional wellbeing, is a powerful indicator:
“How people feel is not an elusive or abstract concept, but a significant public health indicator;
as significant as rates of smoking, obesity and physical activity”
United Kingdom Department of Health 2001
Although definitions vary, positive mental health is generally seen as including:
• emotion (affect/feeling),
• cognition (perception, thinking, reasoning)
• social functioning (relations with others and society)
• coherence (sense of meaning and purpose in life).
These individual attributes and skills can be measured through a range of wellbeing scales and a growing number of longitudinal studies confirm their power to predict outcomes, for example, longevity, physical health, quality of life, criminality, drug and alcohol use, employment, earnings and pro-social behaviour (e.g. volunteering) (Pressman and Cohen 2005; Lyubomirsky et al 2005; Dolan et al 2006). These findings have inspired considerable optimism about the role of positive psychological attributes in enabling people to flourish, notwithstanding adverse circumstances, and to a renewed interest in cognitive behavioural therapies, with their focus on transforming how a person thinks about their life (Diener and Seligman 2002; Seligman 2003; Ryan and Deci 2001; Ryff and Singer 2002).6
4. Responses to adversity are strongly patterned by culture, with notable differences between individualistic and collectivist traditions (Christopher and Hickinbottom 2008)
5 “Under a psychosocial interpretation, these health inequalities would be reduced by abolishing first class, or perhaps by mass
psychotherapy to alter perceptions of relative disadvantage. From the neo-material viewpoint, health inequalities can be
reduced by upgrading conditions in economy class.” (Lynch et al 2000)
6 For a series of papers reflecting critically on these issues and the concept of a ‘disembodied psychology’ see Clinical
Psychology Forum 162, June 2006
Introduction
Mental health, resilience and inequalities
An extensive body of research suggests that psychological assets do confer resilience and protection and do so at both an individual and an ecological level (Bartley 2006; Fagg et al 2006; Sacker and Schoon 2007). The optimism, self esteem, self efficacy and interest in others that contribute to a child’s success at school are also characteristics of resilient neighbourhoods and communities, where norms of trust, tolerance, support, participation and reciprocity may provide some protection from the effects of deprivation. At the same time, there are significant and important caveats: emotional and cognitive advantages are generally trumped by material advantage. Such evidence highlights the importance of moving beyond an exclusive focus on individual mental health status, to identify and understand the context for people’s emotional and cognitive responses. Surveys of positive affect,
self efficacy, subjective wellbeing or life satisfaction also need to provide a context for considering the potential sources of these attributes and feelings. For example, Alkire has argued that the literature on agency has focused too much on ‘own’ rather than ‘other regarding’ agency (Alkire 2007). Others have suggested that an undue emphasis on the individual self reflects cultural bias and a limited world view (Christopher and Hickinbottom 2008).
The wide range of benefits associated with mental health demonstrates the relevance of wellbeing to sectors beyond health, notably those concerned with the policy challenges presented by education, social cohesion, demographic change, sustainable economic development and environmental protection across the WHO European Region. It is hoped that this report on understanding mental health as a determinant will provide renewed evidence of the crucial importance of mental health to policy and practice, will strengthen existing efforts to tackle factors already known to be toxic to the mental health of populations and will contribute to wider debate about effective strategies for achieving social justice.
The report is structured as follows:
• Section Two outlines the aims and objectives
• Section Three describes the policy environment for mental health in Europe and the contribution
promoting public mental health can make to ongoing policy challenges
• Section Four looks at mental health in relation to current debates about the social determinants of health and the work of the Commission on the Social Determinants of Health
• Section Five provides definitions of key terms and concepts widely used in the literature
on mental health and positive mental health
• Section Six summarises the outcomes associated with positive mental health
• Sections Seven, Eight and Nine describe the contribution that mental health makes to outcomes
by exploring three different pathways of influence: resilience, the life course and inequalities
• Section Ten concludes the report and makes some recommendations for future action