Across the spectrum of inquiry on resilience, recovery, prevention, and positive health promotion, we underscore the fundamental importance of behavioral, environmental, psychological, and social factors. Research implicates these factors in the pathogenesis of multiple disease outcomes. Thus, reducing profiles of risk associated with negative behavioral, environmental, and psychosocial influences must be a key target for avoiding adverse health outcomes or delaying their onset. The positive health focus, however, calls for more, namely, the promoting of positive behavioral, environmental, and psychosocial factors viewed as protective influences in “salutogenesis ” (Antonovsky, 1987)—the etiology of optimal health and well-being. A key implication of the shift toward positive health promotion is that it will require going beyond strategies targeted at high-risk groups to broader goals of health enhancement for the population at large (Rose, 1992). In the latter context, the goal is to shift entire population distributions toward better health, not just to intervene with special groups showing high risk.

From a historical perspective, we underscore the limited attention given to promotion of positive health, as contrasted with efforts to prevent, treat, or alleviate negative health outcomes. Despite the long-standing imbalance, current studies document that those with psychosocial strengths show delayed onset of symptoms as well as extended survival (e.g., Taylor et al., 2000), and the underlying mechanisms for such findings are poorly understood. Critically needed are future investigations of the physiological mechanisms (pathways) through which positive behavioral and psychosocial factors promote health, well-being, and longevity.

The preceding chapter on predisease pathways describes cumulative physiological risk as illustrated by the concept of allostatic load. Focusing on positive biological mechanisms, the concept of allostasis captures the capacity of the organism to adapt over the life course to oncoming challenges, thereby preventing the unfolding of pathophysiological processes (McEwen and Stellar, 1993). Allostasis emphasizes that the internal milieu varies to meet perceived and anticipated demands. That is, systems like the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system exhibit large variations that actually help maintain other homeostatic systems (e.g., pH, body temperature, oxygen tension). This maintenance of “stability through change” (i.e., allostasis) promotes adaptation and appears to be importantly linked to social and behavioral factors, although current knowledge must be greatly expanded to understand the scope of these effects and how they come about.

Going beyond effective management of challenge and stress, the focus on positive health also points to the promise and potential of salubrious biobehavioral linkages. For example, recent findings on exercise and plasticity of the brain show that physical activity in rats increases BDNF, a



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