Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
If you’re like me, your thoughts on the past two years are understandably tainted with a degree of weariness, as the pandemic has taken a toll on all of us. Still, I remain hopeful for what is to come — this year and beyond.
As a nation, and as a world, we have faced trying times before. War, disease, financial calamity — these are part of our history, as are the myriad displays of perseverance exhibited in the midst of each struggle. These displays of “stick-with-it-ness” are part of what it means to be resilient.
While these past experiences can’t offer consolation for people we’ve lost or things we’ve sacrificed to remain healthy during the pandemic, this history does offer some encouraging reminders of our inherent capabilities and human ingenuity in response to significant challenges. We didn’t just survive such calamities. Often, we moved forward as we recovered, and in many cases we made new and greater progress.
Work is already underway to make just such a recovery a post-COVID-19 reality. This work is aiming for an improved level of well-being and resilience. It’s equitably putting enhanced resilience front and center — and making resilience imperative for recovery.
COVID-19 has clearly demonstrated what we already knew at some level to be true: a diminished baseline level of resilience is reflected not just in a single person’s vulnerabilities but also in the risks to family, friends, and community. The pandemic has also made clear that previous approaches to recovery — typically with a focus on returning to the pre-crisis state — are insufficient and will not lead to enhanced resilience. Any intention of returning to the pre-crisis state of 2019 binds us to deeper inequities and unnecessary vulnerabilities when future crises hit. Instead of pursuing this approach, we have an opportunity for renewal in a transformational way — with our eyes now wide open to the importance of individual and community resilience.
To make real progress, we must start at the root of understanding what resilience is and how we can recognize and achieve enhanced resilience as individuals, families, communities of increasing scale, and even as a nation. It is widely accepted that resilience is not a process, a single measure, or a static state of being. Resilience is a dynamic and demonstrable outcome of an individual’s, family’s, or community’s ability to cope with uncertainty, access needed resources, and adjust or bounce back in an often hazardous environment.
Resilience is therefore a fluid and evolving reflection of an individual’s or community’s ability to adapt to the environment. Building resilience happens within individuals and in community with others — predominantly at a local level but arguably up to a global level. The hyperlocal level is where we leverage our own personal capabilities and most directly and routinely interact with our community network. It’s where our decisions most affect us in personal terms and affect others in terms of civility — and where our life circumstances most significantly influence our choices. One prominent framework defining this interplay of one’s life circumstances, choices, and resilience — and that of their community — is the Seven Vital Conditions for Health and Well-Being.
The balance of research over the decades demonstrates the importance of community members having real power in decisions that affect development of long-term resilience. Our relationships and networks of support, or social capital, are critical to individual and collective resilience and are richest at the community level. However, we know that social determinants of health (SDOH) — or the conditions in the environments where people are born, live, learn, work, play, worship, and age — are not equally weighted and are not equitably supportive of greater resilience.
This suggests 2 demands for building individual and community resilience. First, the responsibility for resilience-building and the power to decide how it is achieved must ultimately rest with us as individuals and as community members. Second, the process of building resilience must equitably address both the particular needs of a given community and the broader challenges facing society. These 2 requirements are in dynamic tension with each other because they require individuals to have perspective and act beyond their own self-interests. As a whole, there is an onus on society to ensure equity.
While Healthy People 2030 provides guidance on the needs of people and their communities within the context of SDOH, our work to date in recovery and resilience-building has demonstrated that we need an additional framework to adequately address the application of resources to needs.
This need for an intentional shift to organize resources to achieve long-term resilience led to identifying the Seven Vital Conditions for Health and Well-Being as the organizing structure for addressing long-term recovery and enhancing resilience. The framework was selected because it:
- Provides an actionable approach to improving SDOH and addressing inequities
- Articulates the role all sectors of society and federal agencies have in furthering health and well-being
- Fosters a principle that places the needs of communities at the center of policies, programs, and resource allocation
This framework identifies levers for community change and improvement and shows how the needs of individuals and communities define systemic approaches to foster well-being. The framework identifies these 7 conditions that are vital for well-being:
- Meaningful work and wealth
- Reliable transportation
- Lifelong learning
- Belonging and civic muscle
- Humane housing
- Basic needs for health and safety
- A thriving natural world
By focusing on these 7 conditions, we can see how the needs of the individual form an interconnected web that influences how people and places thrive collectively. When a vital condition goes unfulfilled, it can compound other existing conditions, including outcomes in individual health and well-being.
Importantly, the vital condition of “belonging and civic muscle” sits at the center of the framework, as key to well-being. Cultivating this specific vital condition is critical to building capacity for communities, particularly those that are traditionally underserved and underrepresented. In this model, inclusion means not only holding space at the leadership table but also having the opportunity and influence necessary to “set the table” in the design of an equitable, thriving, and resilient future across all the other vital conditions.
So where does our office, ODPHP, fit into all of this, and what is to come in building equitable resilience?
ODPHP’s mandate is to conduct research focused on understanding the needs of individuals and communities across diverse populations, determining how to equitably address their needs in terms of health and well-being, and providing nuanced, evidence-based guidance to support those needs.
Health and well-being are essential to individual and community resilience and thriving. Promoting enhanced individual and community resilience is foundational to equitable long-term recovery and resilience for the nation. It is also central to ODPHP’s mission of encouraging all Americans to lead healthy and active lives. Our work in support of this mission includes:
- Establishing national health priorities, measures, and objectives through the Healthy People initiative
- Translating science into policy and guidance through the Dietary Guidelines for Americans, the Physical Activity Guidelines for Americans, and the National Youth Sports Strategy
- Using plain language and evidence-based communication best practices to provide clear and actionable health information through the Move Your Way campaign, MyHealthfinder, and health.gov — our award-winning website
- Cultivating partnerships through our work in healthy aging, in support of the President’s Council on Sports, Fitness & Nutrition, and through other programmatic partnerships — such as our Healthy People 2030 Champions and NYSS Champions initiatives
- Supporting the development of a whole-of-government federal plan for equitable long-term recovery and resilience that’s aligned with the Seven Vital Conditions for Health and Well-Being framework
The only meaningful recovery from the pandemic will be one based on ensuring the entire population has an equitable opportunity for improved health and well-being — one that promotes and sustains enhanced resilience for all—far above the level we knew in 2019. I am optimistic that we can achieve just such a result if we act intentionally and realize that we must make a sustained commitment over a long time.
I am optimistic because of a renewed national focus on the imperative of health and the degree of raised consciousness that our nation hasn’t known in generations. With this, we can increase our attention to improved resilience for all in a way that’s inclusive of not just better health, but thriving in all aspects of our lives. I am optimistic that this collective mindfulness will create a more universal understanding of the interconnectedness we all share, and the importance of our individual and organizational roles in improving well-being.
For now, I ask that you get vaccinated and boosted, mask up, get active, and make healthy eating a priority. There is more work to come, and success will be more likely if we are all at our best.
Yours in health,
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis