interact, leading to accumulating physiological risk and a broad range of disease outcomes.
A critical counterpoint to understanding pathways to disease is the need to advance knowledge of positive health, which includes not only the absence of illness but also the presence of wellness. Understanding the etiology and promotion of positive health outcomes requires expanded scientific agendas on resilience and resistance to disease processes as well as recovery and differential survival from illness. Greater emphasis must be given to primary prevention and positive health promotion as routes to extending disability-free years for larger segments of the population. Sustaining or regaining optimal health requires a focus on behavioral (e.g., positive health practices), psychological (e.g., optimism, purpose, mastery, positive affect, religion/spirituality), social (e.g., relational affect and intimacy, emotional support), and environmental (e.g., positive work settings, supportive community programs) factors. Explicating the biological substrates of these components and their role in delaying the onset of morbidity and mortality represent major research opportunities of the future.
To advance the positive health agenda, NIH should:
target new research on the neurobiological mechanisms (e.g., allostasis —variation in the internal milieu to meet external demands, balance of anabolic and catabolic systems, neurogenesis and expression of neurotrophins) through which positive behavioral and psychosocial factors (e.g., exercise, enriched environments, quality social relationships, psychological well-being) influence health;
establish new priorities focused on the etiology (at genetic, behavioral, environmental levels) of disease resistance, particularly in contexts of known risk;
increase support for the study of the protective resources (optimism, meaning and purpose, social and emotional support, and related neurobiological mechanisms) that promote recovery and increased survival rates;
initiate new investigations that will advance knowledge of resilience in the face of life adversity, giving particular emphasis to longitudinal studies;
advance the science of primary prevention, giving particular attention to overcoming persistent maladaptive behaviors (e.g., drinking, smoking, sedentary lifestyles, poor stress management);
develop new population-based initiatives, implemented at local community levels, that promote health via the teaching of positive life practices and the provision of environmental supports to sustain them.