By: Caitlin Beddows, Posted on: December 21, 2016

Public health focuses in large part on contagion, pollutants, violence, and innumerable other sources – both natural and human – of illness, disability, and premature death; yet it also focuses on the emotional, relational, behavioral, and environmental aspects of well-being that contribute to individual and public flourishing. While public health most obviously concerns the amelioration of disease and dysfunction, primary prevention will often involve efforts to enhance human well-being (i.e., happiness), often through pro-social and altruistic (other-regarding) behaviors.

In both the European Union and the United States, self-reported happiness has been flat over the last 50 years, or has even slightly declined since 1936, despite each generation having more material wealth than did the preceding one; depression and anxiety rates have risen dramatically even when corrected for lower detection and reporting in the past. While those whose basic material needs are met are happier than those who struggle in poverty, once basic needs are met, increased material prosperity does not bring increased happiness. This is in part because people tend to assess their level of relative prosperity by making comparisons with those who have more, and thus always perceive themselves as wanting (Easterbrook, 2003). In addition, financial capital does not equate with social capital. Americans today, while better off materially than their forebears, now report having only two very close friends, whereas 20 years ago they had three. This loss of ‘social capital,’ which occurs despite material prosperity, has been described in terms of ‘bowling alone’ (Putnam, 2001). Psychologist Dan Kindlon (2001)addresses the problem of ‘affluenza’ in his nationwide survey of American teens, discovering that high levels of depression and anxiety are associated with low engagement in positive helping behaviors, loss of meaning, and material as well as emotional overindulgence by parents. The United States, despite its relative wealth per capita, ranks 23rd among nations in the first-ever ‘world map of happiness,’ (see Relevant Website) which is based on self-reported life satisfaction.

Feeling Well by Doing Good

In response to the above problematic issues, researchers have begun to focus on the benefits to the agent of altruistic or ‘other-regarding’ behavior in the domains of families, neighborhood, and society. Rowe and Kahn (1998) point to the public health benefits of volunteerism for older adults. They point out that older adults for the most part agree with these two statements: ‘Life is not worth living if one cannot contribute to the well-being of others’; ‘Older people who no longer work should contribute through community service’ (p. 178). They also point out that less than one-third of all older men and women work as volunteers, and those who do spend on average a bit less than 2 h per week. Midlarsky (1991) posed five reasons for benefits to older adults who engage in altruistic behavior: enhanced social integration; distraction from the agent’s own problems; enhanced meaningfulness; increased perception of self-efficacy and competence; improved mood or more physically active lifestyle.

The idea of encouraging positive prosocial behavior as a means to well-being and health is not a new idea. For example, the transition in the 1820s in the United States and England from the maltreatment of mentally ill individuals – usually bound in shackles and physically abused – to ‘moral treatment’ was based not only on treating the insane with kindness and sympathy, but also on occupying their time with helping behaviors in the community and cultivating the love of nature. This evidently was quite successful, giving rise to the sweeping grounds of the Connecticut Retreat for the Insane (founded in 1822) in Hartford, now known as the Institute of Living; McLean Hospital in Belmont, Massachusetts; and several other sister institutions in eastern cities in the United States. Residents would do everything from milking cows and harvesting gardens to washing the dishes and sewing gifts for the needy (Clouette and Deslandes, 1997). Another example of the therapeutic use of altruism can be found in the 12 Steps of Alcoholics Anonymous. Step 12 requires the recovering alcoholic to help other persons with alcoholism. The framework is one of paradox. The recovering individual who helps others with this disease is to do so freely and with no expectation of reward:

And then he discovers that by the divine paradox of this kind of giving he has found his own reward, whether his brother has yet received anything or not.

Alcoholics Anonymous (1952: p. 109).

The AA member finds ‘no joy greater than in a Twelfth Step job well done’ (1952: p. 110). Those experienced with recovering alcoholics will widely attest as to how important such individuals feel that helping others is with regard to their own continued recovery, however much such helping behavior is in effect an AA recruitment activity.

To cite a more controversial instance of disinhibited altruism in relation to well-being, psychiatrist Mark Galanter, based on two decades of research, concluded that young people – often from middle-class or affluent families – who joined demanding new religious movements in the 1970s and 1980s had in general a somewhat more significant history of substance abuse than the general population, and were relatively socially isolated. In joining such groups, they reported relief from anxiety, meaninglessness, and depression through being members of communities requiring self-sacrifice and service, however much they may have been subject to authoritative manipulation and misplaced utopian idealism. Disillusionment and attrition after a year or two was the norm, but many still felt that they had discovered a more satisfying way of living (Galanter, 1999).

Most healthy people, however, are not so altruistically inhibited, at least in self-reported sentiment. The US National Opinion Research Center’s (NORC) landmark survey, the General Social Survey (GSS), has been administered across a US national sample 24 times since 1972. Its 2002 administration, with support from the Fetzer Institute, included an item developed by epidemiologist Lynn G. Underwood regarding unselfish love:

‘I feel a selfless caring for others.’ Based on sample methods of the U.S. population that enjoy the highest level of confidence across a highly diversified sample pool, the following results were found with regard to the above question: many times a day (9.8); every day (13.2); most days (20.3); some days (24.0); once in a while (22.3); never or almost never (10.4) (Fetzer Institute, 2002).

There is a caveat – when caring for others is overwhelming and itself a cause of stress, the agent experiences negative health consequences, as is well-documented in caregivers of persons with dementia (Kiecolt-Glaser et al., 2003). However, rather than harping on ‘the burden of care,’ as is characteristic of the gerontological literature, it needs to be stated that giving to others under ordinary circumstances seems to have significant benefits for the agent. A relevant study (Schwartz et al., 2003) points to health benefits in generous behavior, but with the important proviso that there are adverse health consequences associated with being overly taxed.

Read more in the article Happiness, Health and Altruism by Stephen G. Post, Case Western Reserve University, Cleveland, OH, USA

This excerpt was taken from the chapter Happiness, Health and Altruism from the recently published International Encyclopedia of Public Health (Second Edition), an authoritative and comprehensive guide to the major issues, challenges, methods, and approaches of global public health.