Healthy happiness: effects of happiness on physical health and the consequences for preventive health care

Happiness and longevity in sick people

Researchers in these 11 studies observed 14 effects, of which only four appear to be positive and five negative, while in another five cases no significant effect was found. The positive effects were observed in studies with relatively healthy samples, that is, veterans in an old age home (not a nursing home), heart patients of all ages and people with spinal cord injuries. An exception to this pattern was the positive effect found for cancer patients that had a relapse. The negative effects were observed among incurably ill patients and the very old frail elderly.

Together these results do not suggest that happiness ‘heals’, at least not that happiness can restore health in the case of serious illness. In other words: happiness does not appear to prolong the deathbed.

Happiness and longevity in healthy populations

Researchers in these 19 follow-up studies assessed 24 effects, of which 16 were positive, while in eight cases an observed (positive) effect did not reach statistical significance. In the case of the study done in Japan by Kawamoto and Doi (2002) the non-significance is possibly due to control for activity and social contacts, which is likely to have removed variance in happiness. None of the studies in Table 2 resulted in a negative effect.

The observed positive effects of happiness on longevity are quite sizable and amount to 7.5 years and 10 years. The strongest effect was observed in the longest follow-up, the study among American nuns, which covered their entire adult lifetime. In this study, happiness in young adulthood was measured using autobiographies written by the nuns on entering the convent. Unfortunately baseline health could not be controlled in that study. In the study by Levy et al. among over 50 aged in Ohio USA, the researchers did control baseline health and still found that the happy lived 7.5 years longer.

It is not possible to generalize these finding to a simple statement such as: happy people live so many years longer. This is partly due to technical problems such as the use of incomparable statistics and different cut-off points between more and less happy people. Another problem is that the size of the effect may differ across subgroups of a population, such as among age categories. Still it clear that the effect of happiness on longevity is large. It involves several years and as such is comparable to the effect of smoking or not.

Since we have seen that happiness does not cure serious illness, this outcome means probably that happiness ‘protects’ one against falling ill. That interpretation fits well with the fact that the effects manifest most strongly in the long-term studies.

Healthy lifestyle and happiness

It is not likely that inoculation programs and health screenings will have an independent effect on happiness. However, it is possible that life-style education has. It could be that a healthy life-style is more enjoyable irrespective of its add-on physical health, e.g. that taking regular exercise makes life more satisfying anyway. However it is also possible that healthy living is not particularly enjoyable and that health educators typically try to make us do things that we do not like. What do the available data tell us?

Physical exercise Sportive people tend to be somewhat happier than non-sportive people, and the difference appears to be independent of age, marital status and physical health (Schulz, 1985). There are indications of a causal effect, in particular the effects of jogging on mood (Biddle, 2000). In this case there is synergy between the promotion of health and happiness

Smoking Moderate smokers appear to be no less happy than non-smokers, but heavy smokers are. There are indications for a causal effect of happiness on smoking, a follow-up among American adolescents showing that earlier unhappiness predicts later smoking (Bachman, O’ Malley, & Johnson, 1978), but in a recent follow-up in Russia, happiness appeared not to predict starting or stopping smoking (Graham, Eggers, & Sukhatankar, 2004, p. 18). The available data do not tell us whether smoking cuts back on happiness irrespective of health. So, for the time being, we cannot rule out the possibility that smoking affect health negatively but happiness positively, hence we are not sure that synergy exists on this point.

Drinking Moderate drinkers appear to be happier than teetotallers, the optimum being one or two units of alcohol a day (Ventegodt, 1995, pp. 180–184). As in the case of smoking, heavy drinkers are less happy, that is people who drink five or more units of alcohol per day. The only indication of causality is found in a five-year follow-up in Russia, in which an increase in drinking appeared to be associated with a decline of happiness. Unfortunately the amounts of alcohol involved are not reported (Graham et al., 2004). As in the foregoing case we cannot rule out that heavy drinking may be worse for your health than for your happiness. Only in the case problem drinking is there a clear synergy.

Eating There is a lot of research into the effects of nutrition on physical health, but hardly any research into the effects of diet on happiness. Analysis of a health-survey in the Netherlands showed no relationship between intake of unhealthy food-stuffs (sugar, fats) and happiness, nor with healthy food (fruit), while consumption of meat and dairy-products was slightly positively correlated with happiness (Aakster, 1972). In a study carried out in Denmark the researcher observed that people who often eat fast foods tend to be somewhat less happy (Ventegodt, 1995). In both cases the correlations could be spurious or be due to a causal effect of happiness on food preference rather than the converse. There is not much research either on the effects of how much one eats on happiness. The available data suggest that being slightly overweight does not depress happiness, people with Body Mass Index between 25 and 30 being happiest (Ventegodt, 1995, pp. 232–234). Yet again we lack data on cause and effect. All in all, no clear synergy has been found as yet.

Healthy living environment and happiness

At the institutional level preventive healthcare deals primarily with physical aspects of the living environment, such as proper sewage, removal treatment, providing clean air and standards that must be met for electrical appliances or that detail what constitutes safe stairways. Does this also add to happiness? There is a correlation between quality of housing and happiness, independent of marital state and social class (World Database of Happiness, Correlational findings on Happiness and Living environment, Veenhoven, 2006b). Causality is probable, but not proven as yet. The same holds for working conditions, though we know a lot about the effects of working conditions on health, we are still largely in the dark about the effects of working conditions on happiness.

Sane society and happiness

At the societal level an important spearhead of preventive health care is the control of infectious diseases in the country. This will certainly add to public health, but is unlikely to involve an independent effect on happiness. Another aim is to reduce of accidents in road traffic and workplaces. In this case synergy is more likely, since comparative research has shown a strong negative correlation between mortality from accidents and average happiness (Veenhoven, 1996, p. 34). Causality is likely, but not proven as yet; the correlation can also be due to a greater degree of accident proneness in unhappy countries.

As noted above, considerations of health also play a role in wider social policies such as social security arrangements. Contrary to common expectation, there appears to be no relationship between spending on social security and health outcomes in nations, nor a relationship with happiness (Veenhoven, 2000a). So in this case there is again no synergy.

All in all, it is clear that not all health promotions are likely to further happiness as well. As yet this seems to be the case only for policies that aim at promoting exercise and preventing problem drinking and accidents. This applies to policies that aim at physical health. Synergy may be greater for preventive mental health care.

Evidence-based happiness advice

Happiness depends to some extent on the choices we make in life, in particular in modern ‘multiple-choice societies’. Life-choices are for the most part based on expected happiness, for instance we typically choose a profession we think we will like. Economists call this ‘expected utility’, or ‘decision utility’, and acknowledge that this may differ from later ‘experienced utility’, because decisions are mostly made on the basis of incomplete information. An example of mal-informed choice is the decision to accept a higher paying job that requires more commuting. People typically accept such jobs in the expectation that the extra money will compensate for the travel time, but follow-up research has shown that they are mostly wrong, and that happiness tends to go down in such cases (Frey, 2004).

Research of this kind can help people to make more informed choices. Though there is no guarantee that things will pan out in the same way for you, it is still useful to know how it has worked out for other people in the recent past. Such research is particularly useful if it concerns similar people.

This policy does not involve paternalism; it does not push people into a particular way of life, but it provides them with information for making a well-informed autonomous decision. Paternalism would only be involved if research is manipulated or its results communicated selectively. For instance if the observed negative effect of parenthood on happiness is disguised (World Database of happiness, Correlational findings on Happiness and Having Children, Veenhoven, 2006b).

This approach to the furthering of happiness is similar to current evidence based health-education. As in the case of happiness, we are often not sure about the consequences of life-style choices on our health. How much drinking is too much? Is eating raw vegetables really good for your health? We cannot answer such question on the basis of our own experience and common wisdom is often wrong. Hence we increasingly look to the results of scientific studies that provide us with ever more information.

As yet, the information basis for such a way of furthering happiness is still small. Although there is a considerable body of research on happiness, this research is typically cross-sectional and does not inform us about cause and effect. What we need is panel data that allow us to follow the effects of life-choices over time. Still another problem is that current happiness research deals mainly with things over which we have little control, such as personality and social background. What we need is research on things we can choose, for example, working part-time or fulltime or raising a family or not.

Once such information becomes available, it will quickly be disseminated to the public, though the lifestyle press and the self-help literature. It can also be included in organized health-education, broadened to become education for ‘living well’. The problem is not in the dissemination of knowledge, but in the production of it.

Training techniques for art-of-living

Happiness depends heavily on various skills for living, such as realism, determination, social competence and having some resilience. Consequently, improving such skills can further an individual’s happiness.

As yet, such attempts focus typically on repairing skill-deficits, for instance psychotherapy in case of unrealistic beliefs and empowerment trainings for sub-assertive individuals. Many of the interventions are provided in the context of mental health care and are often paid for by health insurers. This supply caters to the unhappiest part of the population. Recently there has also been a rise in techniques that aim at to strengthen the life-skills of people without problems, in particular the ‘Positive Psychology’ movement (Seligman & Csikszentmihalyi, 2000). There is less institutional support for such ‘positive training’, but the potential audience is much greater.

In this context it would be worthwhile to invest in the development of training that focus on the art of living. ‘Art-of-living’ is the knack of leading a satisfying life, and in particular, the ability to develop a rewarding life-style (Veenhoven, 2003). This involves various aptitudes, some of which seems to be susceptible to improvement using training techniques. Four of these aptitudes are: (1) the ability to enjoy, (2) the ability to choose, (3) the ability to keep developing and (4) the ability to see meaning.

Learning to enjoy The ability to take pleasure from life is partly in-born (trait negativity–positivity), but can to some extent be cultivated. Learning to take pleasure from life was part of traditional leisure-class education, which emphasized prestigious pleasures, such as the tasting of exquisite wines and the appreciation of difficult music. Yet it is also possible to develop an enjoyment of the common things in life, such as breakfast or watching the sunset. Training in savoring simple pleasures is part of some religious practices.

Hedonistic enjoyment is valued in present day modern society and figures prominently in advertisements. Yet techniques that help us to gain the ability to enjoy are underdeveloped. There are no professional enjoyment trainers, at least no trainers aiming at improving our general level of enjoyment. There is professional guidance for specific types of pleasures, such as how to appreciate fine arts and often the main goal is to sell a particular product.

Still it would seem possible to develop wider enjoyment training techniques. One way could be to provide training in ‘attentiveness’, possibly using meditation techniques. Another option could be the broadening of one’s repertoire of leisure activities, which could link up with expertise in various stimulation programs. A third way could be looking at ways to remove inner barriers to enjoy, which could be linked to clinical treatment of a-hedonie.

Learning to choose As mentioned above, happiness depends also the choices one makes in life and hence also on one’s ability to choose. The art-of-choosing involves several skills.

One such skill is getting to know what the options are. This aptitude can be improved by learning and this is one of the things we do in consumer education. Expertise in this field can be used for training in the charting of wider life options.

Another requirement is an ability to estimate how well the various options would fit one’s nature. This requires self knowledge and that is also something that can be improved, self-insight being a common aim in training and psychotherapy.

Once one knows what to choose, there is often a problem of carrying through. This phase requires aptitudes such as perseverance, assertiveness and creativity, all of which can be strengthened and are in fact common objectives in vocational trainings.

The next step in the choice process is assessing the outcomes, in term of the above-mentioned distinction, assessing whether ‘expected utility’ fits ‘experienced utility’. This phase calls for openness to one’s feelings and a realistic view on one’s overall mood pattern. Training in mood monitoring is common practice in psychotherapy and could possibly be improved using computed based techniques of experience sampling.

The problem is not so much to develop such training techniques, but to separate the chaff from the corn. That will require independent effect studies. Once such techniques have been proven to be effective a market will develop.

Learning to grow Happiness depends largely on the gratification of basic needs, and an important class of needs is ‘growth-needs’ (Maslow, 1954), also referred to as ‘functioning needs’ or ‘mastery needs’. These needs are not restricted to higher mental functions but also concern the use and development of the body and senses. In animals, the gratification of these needs is largely guided by instinct, but in humans it requires conscious action. Cultures typically provide standard action-patterns for this purpose, such as providing for vocational career scripts or artistic interests but people must also make choices of their own, in particular in multiple-choice societies. Failure to involve oneself in challenging activities may lead one into diffuse discontent or even depression, this for example happens regularly after retirement from work. Thus another art-of-living is to keep oneself going and developing.

Intervention would also seem possible in this case. Mere information will probably be useful and one can also think of various ways to get people going. Once again training techniques can build on available experience, in this case experience in various activation programs. There is already an ample supply of ‘growth trainings’ on the peripheries of psychology but as yet little evidence for the effectiveness of such interventions and certainly no proof of long term effects on happiness.

Helping to see meaning Probably, but not certainly, happiness also depends on one seeing meaning in one’s life. Though it is not sure that we have an innate need for meaningfulness as such, the idea of it provides at least a sense of coherence. Seeing meaning in one’s life requires that one develops a view of one’s life and that one can see worth in it. These mental knacks can also be strengthened and possible one can also learn to live with the philosophical uncertainties that surround this issue. There is experience on this matter in existential counseling and in practices such as ‘life-reviewing’ (Holahan, Holahan, & Wonacott, 1999) and ‘logo-therapy’ (Frankl, 1946). As far as I know, the impact of such interventions on happiness has yet to be investigated.

Professional life-counseling

If we feel unhealthy we go to a medical general practitioner, who makes a diagnosis and either prescribes a treatment or refers us to a medical specialist. If we feel unhappy, there is no such generalist. We have to guess about the possible causes ourselves and on that basis consult a specialist who may be a psychologist, a marriage counselor or a lawyer. Professional guidance for a happier life is unavailable as yet. This is a remarkable market failure, given the large number of people who feel they could be happier.

The size of the demand is reflected in the booming sales of self-help books and the willingness to pay for things that promise greater happiness, such as cosmetic surgery and second homes. The main reason is probably that the knowledge basis for such a profession is still small and that trust in happiness counseling is undermined by the many quacks operating in this area.

Still there seems to be a future for professional counseling for a happier life and for related life coaching and trainings. There is demand for such services, but as yet no proper supply. Much can be gained by developing that supply. One of the ways is to stimulate the professionalization of current activities in that area, amongst other things by following people who use such services to establish what interventions add to happiness or do not. The development of professional life counseling could also profit from the above-advised research into long-term changes in happiness following major life-choices.