What Causes Wellness ? Sir Harry Burns

[ via youtube auto transcript]

Okay the title of this session is

”The Common Wealth’

and Katherine and I thought
I would play around with the title
because the Commonwealth has connotations
of money and riches and economic growth
and to be perfectly honest

I’m fed up hearing
about it

So that’s what I thought…

we talked about the Common Welth
well as in wellness

Adam Smith talked about this
not in his book The Wealth of Nations

but the book he wrote a few years earlier
what was it called again?

The Theory of Moral Sentiments

in which he talked about the fact that
there is something in us that requires us
to see the happiness of others

even although we derive
no profit from it
except the pleasure of seeing it

he said at one end of the scale
he saw people behaving for their own good
in terms of their involvement with the market

and at the other end of the scale
he saw people behaving for the good of others

and there’s clearly a spectrum
between either end he said even

‘the greatest ruffian, the most abject violator
of the laws of society is subject to this notion of sympathy’

he called it,

He didn’t actually mention bankers
but I guess they’re probably in there somewhere.

So what I thought I would do  is
to pose the question:

What Causes Wellness ?

What is it that creates wellness in society ?

What is it that makes us well ?

and you’re probably sitting there thinking:  

“Stupid question,  isn’t this guy a doctor ? “

Doesn’t he know that what causes wellness
is avoiding the causes of illness ?

Doesn’t he know
that what makes us well
is not  being sick  ?

Well that’s fair enough for you to believe that
because we have
for the last hundred and fifty years
been brainwashed into thinking

that what matters is not being ill

but the reality is there is a spectrum here,
just as there was in Adam Smith’s thinking

about well-being and wealth

there’s a spectrum between
pathogenesis at one end
and salutogenesis at the other.

Doctors are trained exclusively in pathogenic thought:  
the causes of disease.

We’re trained to diagnose it

We’re trying to take histories to detect it

We’re trying to treat it

We’re trained to even sometimes – if we go into public health – try and find ways of preventing it

That’s a disease focus.


… on the other hand is a term that comes from Salas.
Salas was the Roman goddess of well-being.

also interestingly,
Roman goddess of safety
-interesting combination of thought there.

The idea that there is a spectrum
first occurred to me best part of 30 years ago
when I went to work in the Royal Infirmary
as a surgeon
and I was there for about two weeks
and I noticed something strange
they took longer to heal their wounds
than all the East End hospitals I had worked in previously

If we did an abdominal incision,  
by about eight to ten days it was healed up and they could go home

At the Royal it was about ten,  eleven days.

Subtle, but wasn’t just me

Others had noticed it
and we put it down to the fact that,  well,
they smoke or eat the wrong kinds of food,
 and so on.

That will slow down healing.

Over the next few years it became very plain
to me that that wasn’t the cause

and since then, in the last twenty five years
our analysis has shown that

– now don’t get me

Wrong, smoking is very, very bad for you okay?
 if anyone here smokes
stop it at once.

but we cannot ascribe the gap
between rich and poor
to the commonly held beliefs of
smoking, fatty diet –

These have an effect

but they don’t explain nearly enough of it

so I began to look for other theories
that would begin to explain what it is

that was missing in the lives of people

in the poorest parliamentary constituencies in Britain

At the lowest life expectancy,
what was it that they didn’t have
that others had ?

and that’s when I stumbled on the notion of

and I’ll just mention one or two theories.

Emily Varner, for example, is a psychologist
who studied the health of children
living in a particular island in the Hawaiian archipelago
where there was a high level of alcoholism,  child abuse,
just general chaos in life.

She found that

70% of the children grew up to have serious difficulties
followed their parents into these particular patterns of living

but 30% of them survived and did well

and what she said was they acquired resilience,
and what allowed them to acquire resilience
was they had developed the positive attributes:
they were outgoing, positive, optimistic, bright
they had a significant relationship
with a sensible adult
– who may have been a parent or a grandparent-
but it was a mentor there to help them
and they received support
within the community from their peers.

Another theory came from Viktor Frankl

Viktor Frankl was an Austrian psychotherapist
who spent the war years in Auschwitz
and he wrote a book. He went on to live till he was 95.

He wrote a book entitled
Man’s Search For Meaning

and the introduction to it says if you have a Why ? to live
then you can deal with almost any how

Meaning and purpose allows you to hang on to life
and make the best of it
no matter how miserable the circumstances are

and if you think about the way meaning and purpose
and lives began to disappear in West Central Scotland:
Yards closed when the steel foundries disappeared,
when men suddenly had no jobs that gave their lives
meaning and purpose

another notion is the notion of flourishing q

Quarry Keys an American psychologist
who talks about flourishing as a cause of well-being.

People who flourish are happy, satisfied,

they see themselves as having a purpose,
they are optimistic
they have a degree of mastery,
they have a sense of control over their lives
and they have a degree of self-esteem,
they accept themselves for what they are

all of these themes run through all of the different theories of well-being

but it was when I came across an American sociologist called Aaron Antonovski
that things began to make sense
because I was looking for a link between
psychology and biology.

When I was a surgeon at the Royal Infirmary
I would sign death certificates all the time
but I never signed a death certificate that said
he died because he was unemployed,

You died of a molecular event.

So what was the link between the social circumstances
and the increased risk of molecular events,  
like thrombosis, and malignancy,  and so on ?

And Antonovski began to fill in that space.
He said unless we learn that the wonders
comprehensible manageable meaningful
unless we learn that we can make sense
of the one then we can control to a certain extent
events round about us
and want to engage with that we would
experience a state of chronic stress an

Antonovsky derived that thought from
interviewing many hundreds of concentration camp survivors

he found that 70% of them are unhealthy
but again 30% same as Verna’s discovery

30% of those adults as children had been in concentration camps survived,
he said,

children who don’t acquire that sense
see all the events around about them as noise
not as information
and they become stressed by it

and, I don’t have time to go into the detail,
but we’ve followed through
in great detail the biological consequences of social chaos

and I’ll just show you one example
the way in which stressful events and early life
change the way brain structures develop

We know that even from the earliest  months children living in children’s homes,
a  Canadian study,
the longer a child is being looked after away from a single significant parent,  
the greater the stress hormone levels are

and they grow up to have changes in structures in the brain
– that squiggly bit in the middle of that brain picture is
an area called the hippocampus,  
that’s the bit of the brain that among other things
allows you to learn and remember appropriately,

but it allows you to suppress the stress response.

We know from measurement of the volume of the hippocampus
and affluence- deprived people
not just in the west of Scotland  but in other parts

that chaotic early life leads to
a reduced ability to manage stress

regulation of stress responses
reduced ability to  learn
reduced ability to make sense of the wound
round about you
and behave appropriately

The biology is very clear:

chaotic difficult circumstances
lead to increased risk of physical ill health

So let’s not spend a fortune trying to find drugs to fix that

let’s change the chaotic and difficult circumstances
so that they don’t happen.

In 1971 I was a medical student when we elected the great Jimmy Reed,  Lord rector of Glasgow University.

His Rectoral  address was reprinted and full in the New York Times,  which called it
“the single most important speech since the Gettysburg Address”

and those of us who were there thought that comparison rather flattered Abraham Lincoln to be perfectly honest .

Reid’s speech was about alienation.


Which he defined as

“the cry of men,  
the victims of blind economic forces
beyond their control

the feeling of despair and hopelessness

that pervades people

who feel with justification
they have no say in shaping

or determining

their own destinies “

This is what I think is happening in West Central Scotland

The cycle of alienation that may begin with chaotic early years
leads to mental health
and childhood leads to behavior problems at school

or, and by the way,

When a child who is becoming alienated
has behavior problems at school what do we do ?

We exclude them from school:
alienating them even futther

I heard recently about a kid who was permanently truanting.
What did they do ?
They excluded them from school !

  • Madness !

They fail in education.
The end up, often, in prison.

When I visit the young men in Pullman,  
I say to them:
“what are you’re going to do when you get out?”

 “I’ll never get a job “

So what are you going to do ?””

“I’ll just sit at home and watch telly
and drink.

The lives are ended, aged 18.

The consequences of that are
poverty which feeds even more
into the sense of alienation.

We think if only we fix poverty
it will all be alright.

Poverty is part of a cycle
and poverty can often be as much a consequence of this cycle
as a cause of it.
Action that is required has to happen
across the whole of that life course:

we have to deal with early years
we have to deal with teenagers
we have to help young people who are being alienated even further
we have to help older people who become isolated

and we’re doing it
we’re doing things in Scotland that the rest of the world is looking on enviously.

Tomorrow down in the SECC
we will have their fifth meeting of
the collaborative brings together
800 practitioners plus
some senior people
one of the guys in the foreground is
the permanent secretary
in the Scottish Government
who comes to all of these things

cause he thinks if he comes then
ministers come they come and they stay
they don’t just do the 20 minute speech
and go away
and what’s happening as
practitioners have decided
that they will change childhood
that they will stand up
and they will walk out what’s happening

they will test things for example:
you improve attachment between parent and child
you improve cognitive function by bedtime stories.

I was probably the only chief medical officer
in the world who knew from one day to the next
how many children in Scotland
got bedtime stories
because we counted

If this is a nursery that says
ok we’ll ask all the kids
“did they get their own story ?”

and if it falls below 90%
we’ll do something to make it better

and just like the British cycle team
made huge performance improvements
by attention to lots of little details
those bedtime stories
those breastfeeding
those-  the smoking cessation-
there’s a whole range of things going on
across the whole of Scotland
to make Scotland the best place in the world
for children to grow up

With will and with method we can transform Scotland.

Last April I went to visit a lady called Roseanne Haggerty in New York

In 2010 Roseanne decided to set out find a hundred thousand homes for homeless people

I checked this morning, the counter on her website shows that
she has found homes for ninety nine thousand six hundred and fourteen people.

Four years later she found that
by connecting with people, volunteers would go out
walking up folks sleeping under bridges and ask them the names
and once they had asked them the names
connections are cut and they found them homes.

These people had been homeless for an average seven years
and she’s doing it.

and I’ll just finish by a court quoting this guy…

The guy in the middle with the daft grin on his face
is a priest who thirty years ago was sent to a parish in South Los Angeles

the police told him he would be lucky to survive a week,  
because of the gang warfare that was taking place

Thirty years on he is surrounded by adoring fans
because he connected with them.
He just went out and asked them their names
and he found that the thing was
they felt as if they had no meaning and purpose.

So he got a rich friend of his to buy a disused bakery  
and Homeboy Bakeries was born.

He employed them.
He quickly found he had to start a second enterprise
called Homeboy Tattoo Removal

Many had gang tattoos and they were all fighting with each other
so a plastic surgeon friend of his gave him a laser
and showed two or three of the gang members
how to take tattoos off.

Greg came to Glasgow a few months ago
at the request of the violence reduction unit
and I took him to visit a school at lunchtime.

He told me that the 14 and 15 year olds he spoke to there
asked far harder questions than most academics asked.

but I just want to leave you with one final comment
that he made to these kids

and it’s the comment that should drive us
to strive harder to fix the broken bits of Scotland

What he said to them was

“What we need is
a compassion that stands in awe
at the burdens the poor have to carry
rather than stand in judgment
of the way they carry them.”

If we live by that
we will make Scotland
a much better place.

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