Sir Harry Burns lecture on wellness

Sir Harry Burns presented the inaugural BEFS lecture on 24 February 2014 on the subject of ‘Wellness and what causes it…’ Drawing on research, study findings and statistical evidence Sir Harry wove a compelling narrative to make the link between wellbeing and the built environment.

In his introduction he noted that the health agenda has tended to focus on ill health and disease rather than wellness. Wellness is not a settled ‘binary state’ (in / out) but is something that people move in and out of throughout their day, and is influenced by the environment and other factors.

Whilst Scotland’s life expectancy in general has improved, the gap between rich and poor has widened with disadvantaged communities experiencing a slower growth in wellness. When compared with other European countries, Scotland’s traditional mid-table life expectancy now ranks the lowest.

This relatively recent phenomenon predominantly affects the younger male population, and is most evident in west central Scotland, where 30% of males die before age 65 through four prime factors: drugs, alcohol, suicide, and violence.

Sir Harry traced the origins of the problem back to a period of social dislocation when the closure of traditional jobs in the 1950s resulted in a loss of purpose, meaning and self esteem amongst working males.

This was exacerbated by 1960s/70s housing improvement programmes that dislocated communities and particularly affected women of that generation who lost community networks and social structures.

The current 15-45 male age group with lowest life expectancy are the children born to those people most detrimentally affected by psycho socio economic factors in the 1950s to 70s. Various sources were drawn on to illustrate and emphasise key points.

Victor Frankl (1902-1997)

Viktor Frankl, an Austrian psychiatrist and holocaust survivor, emphasised the importance of having purpose and meaning in life and wrote: “Those who have a ‘why’ to live can bear with almost any ‘how’”.

Antonovsky (1923-94)

Antonovsky studied the health of adults who had endured concentration camps and noted that the 30% who remained relatively healthy despite their ordeal had acquired in childhood a strong sense of coherence; perceiving their environment as being structured, explainable, predictive and relating cause and effect.

Maslow's hierarchy of needs

Maslow’s theory of a hierarchy of need describes the pattern that human motivations generally move through; suggesting that if you do not feel safe and secure in an environment you will not want to spend time there (chronic stress is identified as increasing in an orphanage as time increases).

Rene Dubos (1901-1982)

Rene Dubos studied how environmental and social factors affect human welfare and proposed that global problems are conditioned by local circumstances and choices, and that man needs to socially adapt to his existing environment.

What can we take away from these sources?

The conclusion is that those who identify their lives and environments as being comprehensible, manageable and meaningful develop strong coping mechanisms; those who do not are liable to experience chronic stress. People with control over their lives will be less stressed; high levels of control equate to a lower death rate. Low levels of control point to a risk of death brought on by hopelessness.

A direct biological connection was traced between environmental factors and wellbeing. Humans need to make sense of the world around them and to learn basic cues. Exposure to adverse effects in early life leads to changes in brain development that process human responses and which trigger defence mechanisms.

If the world is perceived as unpredictable this will stimulate fight or flight responses. Chronic elevation of stress response brought about by environmental factors is known to lead to heightened levels of cortisol – verified by differing levels of cortisol being measured and distinguished across affluent and deprived communities.

Wellness is therefore a real biological consequence and not a matter of opinion. The way we structure society and support young people has knock-on biological effects. We need to actively create conditions that foster wellness and wellbeing, and support resources to enhance resilience e.g. family; nurturing; intelligence; work; identity; cultural stability; stable set of answers; optimism.

Sir Harry reinforced the message that wellness is created and lived by individuals every day through their ability to care for oneself and others, being able to take decisions, and having a sense of control. These factors depend upon strong social networks and high levels of social connectedness.

Although recognising the need for people to gain control, we do the opposite through public policy: where people are passive recipients of services instead of being in control. We should be assisting communities to gain control over their own issues through mechanisms such as co-production. We need to avoid impeding connections and instead ask “what can we do to help you?”

We need to support measures that connect and bring people together, and projects such as the High Line in New York (managed by Friends of the High Line) and Copenhagen cycling initiatives illustrated how people can have an enhanced sense of control of their environment.

Sir Harry urged putting theory into practice by using the predictive iterative method that builds change from the bottom up, as it is not correct to impose ideas and expect people to take them on. The method involves:

• setting goals
• being bold
• taking risks
• working together
• sticking with it
• getting people involved
• obtaining the facts
• getting out there
• working with people stories

Through a continual cycle of testing and modification the concept is checked and validated. Try things and if they work, promote and develop them further, always through involvement of the community. Work to establish simple things such as a place to:

• play
• enjoy being in the sunshine
• enhance social wellbeing
• support communities to be all they can be – strive to succeed

There was recognition that this way of working represents a form of investing for the future and it may take time before benefits are properly seen. However this method is known to work and, as a form of proactive planning, aids preventative spend. There was a plea to “do the right thing because it’s the right thing to do”, and also a sense of frustration: “If we’re not transforming a country of 5.5m people then we’re not trying very hard”.

A call to action to invest in our future

Echoing Jimmy Reid’s 1972 Glasgow University Rectorial Address, Sir Harry finished with a call to action to “Do the right thing for fellow Scots; … don’t take no for an answer; …the method is there: let’s do it!”

Jimmy Reid’s 1972 Glasgow University Rectorial Address was described by the New York Times as:

“the greatest speech since President Lincoln’s Gettysburg address. It is most commonly remembered for the passage: A rat race is for rats. We’re not rats. We’re human beings. Reject the insidious pressures in society that would blunt your critical faculties to all that is happening around you, that would caution silence in the face of injustice lest you jeopardise your chances of promotion and self-advancement. This is how it starts and before you know where you are, you’re a fully paid-up member of the rat-pack. The price is too high. It entails the loss of your dignity and human spirit. Or as Christ put it, 'What doth it profit a man if he gain the whole world and suffer the loss of his soul?'”