The Social Determinants Of Health
Stress and Western Society
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Stress is ubiquitous in Western society, and particularly in Australian society. Stress is a reflection of the individual being overwhelmed by stimuli which he or she cannot cope with. Most people in our society have, allostatic load( an enormous degree of stress which they cannot cope with) This is contributing towards the high incidence of degenerative disease and depression. (ref 1) Stress and Early Childhood Experience It is now known that stress stems from early childhood experiences. In fact, recent studies suggest that it is lack of proper child care during the very early years that inadvertently produces the ever increasing levels of stress in our society. Carol Bellamy, Executive Director of the United Nations Children's Fund on the State of the World's Children, in 1999, said, "The greater the care and stimulation a child receives, the greater the benefit, for the national economy as well as the child. The world is finally recognising that children's rights to education, growth and development, physical, cognitive, social, emotional and moral, cannot be met without a comprehensive approach to serving their needs from birth." It has been found that there is a gradient of proneness to disease, criminal activity and drug and alcohol addiction, which stems from the quality of child rearing in the first twelve months of life. This research emphasises the fact that in the first twelve months of life, the newly born baby undergoes tremendous rewiring of the cortex. What actually happens is that up to 50% of the neuronal mass is actually lost, the newly born baby being born with more than the necessary compliment of neuronal mass to last until adult life. What is significant is the number of connections that the baby has then to form. The number of connections that are formed depend mainly on the infant's social stimulation. (ref 2) David Hubbal, who did pioneering work on vision and the brain, concluded that, "Early deprivation of social interaction such as contacts with the mother may lead to mental disturbances that have their counterparts in actual structural abnormalities in the brain." Things such as whether or not the baby is breast fed, the way the baby is handled, the way the child is taught, and whether or not the child is read to and cuddled, all have a tremendous influence on "wiring" of all perceptual facilities as the child integrates the five senses and creates a pattern of perception and cognition for the future. Studies have shown that if this kind of nurturing is not available, the child is likely to end up illiterate or delinquent and may end up suffering from depression by the age of thirty.
It has been found that educational facilities tend to be somewhat didactic in their approach. In a recent study conducted in Canada, headed by Dr Fraser Mustard (ref 3), special child development and parental care centres were created. In these centres, it was found that the greatest successes were found when the children's parents were involved in the process. It was looked upon, not as being a didactic teaching process, but a process which cultivated play, and therefore, maximum stimulation of the young child's growing brain.
Dr Mustard has said, "One of the best markers as to how well a society is handling rapid change and globalisation, is what is happening to its young children. Because if you don't handle that properly, you are not going to have the quality of population that will be able to compete in the new economy." Dr Mustard recommended quality parenting and Early Child Development Centres that are both parent oriented and child oriented. It has been said that this century will be the century of the brain, and that this millennium will be the millennium of the mind, and indeed, the growing brains of the newly born babies are the key to a nation's wealth and economic success. The Carolina Abecedarian Project was designed to examine the effect of early child education and parental support on child development in socio-economically disadvantaged families. It began just weeks after the child's birth, with a full year centre based intervention, home visits and a teacher ratio of one to three. At the end of the pre-school, the intervention group significantly outperformed the non-intervention group in terms of IQ. The Ypsilanti/High Scope Study demonstrated that a high quality intervention programme with parent participation dramatically changed outcomes when the programme started at age 3. The intervention had tremendous positive effects when children reached young adulthood with respect to participation in labour force, decreased criminality and improved mental health. It was found that with a combination of one facilitator to three to six children, frequent home visits and parental involvement, the results were extremely successful, particularly in lower social economic groups.
There is a marked association, from childhood, between socio-economic groups and the propensity to illness, illiteracy and delinquency (ref 4). Michael Rutter, the famous child psychologist, in his review of youth and anti-social behaviour, stated that, "signals indicating the more serious and persistent forms of anti-social behaviour can be detected as early as age three in the form of oppositional and hyperactive behaviour." It has been found that even within the middle classes, a high degree of dysfunction in the children still occurs. They may be dysfunctional in terms of their intelligence or in their ability to form connections with other children. This is put down to the fact that in our economic-rationalist society, where mothers are forced to go out and work to help make ends meet, staying at home to care for their children is simply not an option, and this lack of personal parental care and lack of attention contributes to the dysfunction.. Nutrition and Brain Development It has been found that as well as parenting and brain stimulation, nutrition in the early years of life, up to adolescence, also plays a powerful determinant role in delinquent behaviour due to its effect on the brain, particularly with respect to polyunsaturated fatty acids. At a recent workshop of the US National Institute of Health, evidence of LS-Polyunsaturated fatty acids on infant brain development continues to accumulate with respect to improvement in visual acuity and perceptual and motor skills. Children's Rights Globalisation puts tremendous stresses on the
younger generation as well as the parents, who are often changing
jobs and adapting to new technologies. (ref 5)
It is my belief that with the new science of brain longevity and the understanding of how the brain contributes to the well-being of the total bio-mind of the human being, we can achieve a more socially sustainable world. Our brain and our total sensorium evolves within and with the environment as our body grows. We are physically attuned to the environment in an inextricable way which both moulds our bodies and our perceptive faculties. In this respect, the total substance of our body contains memory of all trauma and all experiences just as much as the physical structure of the brain does. Although the number of neurones do not increase, the interconnections between them increase at an exponential rate throughout life. There are more neuronal connections in the brain than the number of stars in the universe. Thus we are attuned to our environment and the moving stimuli in it, particularly the electromagnetic and vibrational stimuli and patterns that impinge on our total sensorium as we grow and evolve. The Development of the Human Brain The human brain undergoes two rapid bouts of re-mapping, or reshaping. The one already mentioned is during the neo-natal period. The other occurs during puberty, around the ages of seventeen and eighteen, when 20% of the brain is remodelled, and neurons are lost and replaced, and further connections are made. It therefore seems that the human brain is a very powerful determinant and expression of socio-cultural factors. In fact, it is very clear that once the brain is mapped in a certain way, it is very difficult to change the mapping. Unless children are able to obtain a sense of self esteem and self-worth during the early years of their lives, it is very difficult to achieve this later. A famous experiment has shown that if a child is born with a cataract, the child will still not be able to see with that eye even though the cataract has been removed in the neo-natal period. This is because the appropriate "brain-wiring" for sight has not been allowed to occur in the earlier stages of development. When the brain models itself, it models the apperceptive pointers within the total environment. It is the fusion of the individual and the environment that creates the person. We are not isolated individuals. We are interconnected with, and are intrinsically a part of our society. The key to the future is a society which is positively interconnected with co-operation and compassion. This is a cultural precedent for a successful nation. The Threat of Loss One of the greatest sociological and psychological factors facing an individual child is the threat of loss. The threat of loss or separation is one of the greatest emotional traumas that a human being can face. It may be the threat of separation from parents, family, peers, teacher, friends, from familiar surroundings, from society, and ultimately from life itself. This threat of loss, or feeling of hurt, which is innate in all individuals, is expressed and determined in certain ways depending on early childhood rearing. The child who is nurtured, touched and loved is able to cope with these feelings. But a lot of children are not able to do this and end up with feelings of hurt, shame, guilt, aggression and fear, and this is the theory on which the therapies of psychoanalysis and psychotherapy are based. (ref 7) A Universal Form of Orientation What a society in rapid change and renaissance, or rebirth, needs, is to give everyone the opportunity to connect with each other at a core level which transcends all differences. We would be thus connecting with the basic life giving attributes of the self, which Freud called the Eros.(ref 8) This is a universal form of orientation and devotion based on true value within the community at large. Currently there is a change occurring in the way people view themselves and society. There is a sense in which there is an urgent need for love and truth. This is not necessarily a religious process, but it is certainly based on the deepest recesses of the bio-mind matrix and its connection with the universe itself. This is in fact one of the main research projects that the proposed Centre for Change wishes to investigate. Vaclave Havel, President of Czechoslovakia has said, "Without a global revolution of human consciousness, nothing will change for the better in the sphere of being as humans and the catastrophe towards which this world is headed, be it ecological, demographic, social or the general breakdown of civilisation, will be unavoidable." Faith and the Placebo Effect In some indigenous communities, which still use natural forms of medicine, the ill person is seen as expressing guilt, and there is a need for atonement, or at-one-ment, in order to resolve the illness. This atonement is based on the libation paid to the ancestors, so the entire community can assuage the feeling of guilt. It is with the consensus of the tribe that the individual is then forgiven, the guilt resolved, and the illness cured. The individual is not treated as an isolated entity, but part of the community, because his illness also affects the community. The basic healing process occurring in the above example is faith. The success of many non-traditional approaches is dependent upon the recipients of the treatment believing that it will work. A more wholistic approach to the treatment of human disease, understanding the power which thought processes and expectations can have on the course of the disease combined with traditional medical approaches will yield increasing dividends to medical research and be very cost-efficient. Prof. Hans Eysenck, Professor of Psychology at the University of London, and Professor Herbert Benson, the Harvard Physician, have said that the placebo effect plays an enormous part in the cure of illness, accounting for up to 50% of cures. The patient's belief that the placebo will cure them is another form of faith. Herbert Benson has said that the brain is "hard-wired" for faith, and that if people have a belief in something, they have passion for themselves and for others. This creates a tremendous generative force within the context of their own minds and bodies, as well as in the context of the hearts and minds of others. Dr Candice Pert, one of the pioneers of psycho-neuro-immunology has done innovative research into the mind-body connection. Her research has shown that there are numerous lines of communication between the brain and the body in addition to synaptic nerve connections. Peptides, including hormones, neuro-transmitters, neuro-modulators, growth factors, gut peptides, cytokines and chemokines, are informational substances distributing information throughout the organism. They are found in the body organs and systems as well as in the brain, and are also the basis of emotions, behaviours and memory. Mastery and Control of One's Life The other facility for enabling people to lead secure and fulfilling lives is the matter of control. Professor Michael Marmot did the famous Whitehall study, in which he looked for the reasons for illness in a relatively stable population of civil servants. He found that there was a definite gradient of morbidity based on the position of the individual civil servant within the hierarchy. This gradient was associated with stress indicators such as serum fibrinogen, serum cholesterol, hypertrophy of the heart, obesity and diabetes. It was also related to factors such as lifestyle, and support of family and friends. However, beyond all of this was an extra factor, making up around 60% of the morbidity, which could not be identified. The statistical information was complete when the missing X factor was found to be the degree of control the employees felt they had in their work situation. In fact, the civil servants on level 2 hierarchy were twice as likely to suffer from a life threatening disease than those on level 1; level 1 being the top level. Marmot therefore has defined a new factor in the incidence of stress in adults as being control of destiny. What this means is that if people have a sense
of mastery in their lives, and the commitment to their job, without
feeling imposed upon, enforced or restricted by their superiors,
they are much more likely to be successful and healthy.
Professor Marmot produced ten social determinants
of health for the World Health Organisation, which are: The Problem of Stress The incidence of stress in our society is rising, and scientists in general, and doctors in particular, do not understand the effect the mind can have on reducing and controlling stress. They do not understand the significance of early childhood rearing, and the fact that the pointers to a person's destiny are found within the way they are reared in the first twelve months of life. These pointers are not only to educational attainment, but also to delinquency, criminality and morbidity. The problem of stress is further compromised by the stresses that occur within the context of society, as previously discussed, particularly in the work situation. If people are forced to work in situations which are controlling and restrictive, and in which they are not allowed to contribute to decisions and management, they will get sick! A Substantially New Manner of Thinking- The Software of Genes and Creativity The future of our planet lies not so much in hardware, but in software, particularly in genius and creativity, and that requires new kinds of individuals who are open and cosmopolitan in nature. Albert Einstein said, "If humankind is to survive, there has to be a substantially new manner of thinking." A more rounded culture seeks to unlock the powers of the mind and the brain in order for people to speak from their hearts. Health Statistics The major killers in our society, which are cardiovascular disease, cancer, diabetes, obesity, osteoporosis and arthritis are all related to stress, and this often has its origins in the very early developmental years of our patients. A quarter of Australian men do not reach the age of 65. The majority of these die of heart attacks and cancer. The average Australian male aged between 25 and 45 has a one in ten chance of having a heart attack, or getting cancer and a four in ten chance of being disabled by an accident or illness by the age of 65. (ref 10) The cost of our health service is enormous and it cannot continue to rely on band-aid approaches, particularly as the mass of the populace is becoming more aware of the importance and significance of wholistic medicine and the way that rapport and understanding from a genuine health professional can help them heal. It is predicted that by the year 2015, one in three people will be suffering from a form of depression which will be severe enough to require medication. It has been said quite simply by Professor Montgomery at Bond University in Queensland, that depression can also be treated by psycho-social means, without the use of drugs whatsoever. Surely this would be a better option. Medicine is tremendous in its ability to cater for the acute emergency or illness, but when we see that the majority of our population is suffering from degenerative diseases, and will, as they age suffer from more chronic problems, such as dementia, we realise that there must be other ways of healing. Healing and the Centre for Change for Humanity This healing must come from a basic change in the Western psyche. The aim of the Centre For Change is to deal with these questions and look at ways in which we can solve this problem. There are certain fundamental factors that need
to be understood in healing. These are:
These four factors are essential for the health and well being of the individual in society. Mastery of life also includes: challenge, participation, commitment and control. It has been found particularly that when people are challenged, whether they are small children or adults, they rise to the occasion much more effectively if they are not spoon fed. A sense of involvement and participation in the community is another form of healing as it empowers the individual. This is one of the ideologies underlying the creation of development and parental centres for children, in which children and parents work together in a process which enables them to create unified families and a productive and positive future. The New Economics The dominance of the market system has meant that the GNP does not include environmental costs and benefits, or social indicators. A new economics of sustainability should include such social indicators as literacy, education, women's rights, crime, suicide health and illness. The GNP does not reflect the way people feel about themselves, or society. In this respect, we need a new index which encompasses quality of life and wellbeing for a nation in rapid transition and renaissance. ----------------------------------------------------------------------- References Protection and Damaging Effects of Stress Mediators,
McEwen B.S., New England Journal of Medicine, 1998 Mechanisms of Brain Development - Developmental
Health and the Wealth of Nations - Cynader and Frost, Book 1999 Early Years Task Force Study Report for the Government
of Ontario, Canada -April 1998 The Selected Works of Melanie Klein and The Undiscovered
Self, Carl Jung Conclusions About the Assessment and Management
of Common Mental Disorders in Australian General Practice, School
of Psychiatry, University of New South Wales, MJA, July 2001 Men's Health Paper, Prof. Avni Sali, Head of
Graduate School of Medicine, Swinburne University, Victoria, 2000 ----------------------------------------------------------------------- Dr Michael Ellis
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