Trevor Hancock: Does mental health matter most?

There is an interesting common thread underlying many of my recent columns. It is the question in the headline: Does mental health matter most?

By which I mean, in high-income countries in the 21st century, does mental health matter more than physical health? Which in turn means, in terms of public health, do mental-health promotion and the prevention of mental disorders matter more than preventing heart disease, cancer and other physical disorders?

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There are many threads to my emerging argument. To begin with, the 70 year-old definition of health from the World Health Organization is that health is a state of complete physical, mental and social well-being. Since social wellbeing is primarily about how we feel about and respond to our links to and relationships with others in our families and communities, it means a significant part of the definition is really about our mental well-being.

Add to this the relationship between the mind and the body — our state of mind affects our neuro-hormonal and immune systems, and the latter is involved in allergy, auto-immune disease, and the detection and elimination of both infection and abnormal cancer cells — and our state of mind assumes an even greater importance.

Another important issue is the changing pattern of disease and death. The WHO noted last year: “Depression is the leading cause of ill health and disability worldwide.” Depression, we should note, is only one form of mental ill health.

WHO also notes there are “strong links between depression and other non-communicable disorders and diseases” and that “depression increases the risk of substance-use disorders and diseases such as diabetes and heart disease,” while pointing out that “the opposite is also true … people with these other conditions have a higher risk of depression.”

We can also see the importance of mental health in the decline in life expectancy in the U.S. in each of the past two years, the first time this has happened in more than 60 years. That decline is driven not by physical disorders such as heart disease and cancer, but from the “diseases of despair”: alcohol and drug use and suicide, which are largely mental and social disorders.

And as I pondered in my last column, we might need to consider whether the growing concern about the state of our environment is adding to that despair.

Another factor to consider is the impact of poverty and inequality. Absolute poverty is unhealthy because people lack the basic necessities for life and health — clean water, food, shelter and so on — and we have some of that in Canada.

But for the most part our problems are now those of relative poverty. Kate Pickett and Richard Wilkinson, in their book The Spirit Level, showed that in high-income countries, a range of health and social outcomes are not related to national income per person, but to the degree of inequality.

It seems that being lower in the pecking order of society is harmful to health because we experience inequality as a lower sense of self-esteem and self-worth, relative powerlessness and even helplessness. All of which are mental and social experiences that, again, can translate into physical conditions.

The implication is that if we want to have a healthy population we need to pay much more attention to mental and social well-being than we have been doing. We need to provide more funding to research focused on understanding the root causes of mental- and social-health problems, and to policies and programming for preventing those problems, as we do to understanding and preventing heart disease and cancer — because we have under-invested on the mental-health side.

Beyond that, we need to give at least as much attention to promoting mental and social well-being as we do to promoting physical well-being and fitness, recognizing that they are mutually beneficial.

What would it take to create mentally healthy families, schools, workplaces, colleges and universities? How do we help people maintain mental well-being in the face of adversity, or as they age? How do we refocus our society — including public health — to ensure mental health matters at least as much as physical health — maybe more.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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