Goal

One of the greatest challenges to human flourishing is our limited understanding of what flourishing means and how humans are able to flourish in the midst of adversity and suffering. Spiritual and religious traditions maintain that flourishing is possible even in the presence of suffering. However, this has received limited attention in research on human flourishing to date.
Our idea is to examine the meaning, mechanisms, and dimensions of human flourishing in persons experiencing suffering–specifically, individuals with acute illness, chronic disease (physical or mental), or injury. This idea will bring us closer to the goal of understanding–and effectively promoting–human flourishing in the context of vulnerability, suffering, and threats to personal integrity. Unless human flourishing can be understood and cultivated under such conditions, it will be attainable only for the privileged few who rarely suffer.
This goal fits into the Foundation's strategy through: interdisciplinary research to discover the meaning and mechanisms of human flourishing, and to understand how compassion promotes flourishing in the context of suffering, specifically in healthcare; develop interventions to cultivate compassion and foster flourishing among patients, caregivers, and healthcare organizations; and launch large-scale evidence-based programs to promote national health systems characterized by compassionate, high-quality care.

Opportunity

The role of compassion in human flourishing is poorly understood, since research on compassion and flourishing has generally proceeded on parallel tracks. We plan to weave these together through creative collaboration based on VanderWeele's integrated flourishing framework; our work on the epidemiology of compassion; models of compassion in healthcare; interfaith scholarship on compassion and flourishing; insights from contemplative neuroscience; the World Health Organization's framework linking compassion with quality health services; and major commitments (e.g., Ethiopia, Malawi, Scotland) to develop compassionate national health systems. This innovation arises from aligning the work of an extraordinary network of interdisciplinary scientists, scholars, and practitioners.

Roadblocks

● Substantial differences exist among disciplines in the conceptual understanding and measurement of flourishing, suffering, and compassion, requiring transdisciplinary engagement and creative development and adaptation of research methods.
● Medicine and healthcare organizations typically attend to only one domain of flourishing (physical health) in a way that increasingly lacks compassion and does not effectively address suffering.
● Initial work may indicate that fundamental structural changes are needed for health systems to cultivate compassion and promote flourishing in the face of suffering.
● Health systems, driven by influences and outcomes other than compassion, may be resistant to make such structural changes.

Breakthroughs Needed

● Robust transdisciplinary approaches and processes can transform interdisciplinary differences into opportunities for creative breakthroughs and new insights. Our network of collaborators delights in diversity of thought and is fully committed to transdisciplinary work.
● The limited focus of modern medicine on cost containment and physical health underscores an urgent need for the proposed research and highlights the rationale for exploring our fundamental research questions in healthcare settings. As humans, we seek health care primarily when we experience physical or mental suffering, when several domains of flourishing are compromised. Thankfully, some healthcare organizations–and even national health systems–are seeking to become truly compassionate and to promote human flourishing.
● The need for fundamental structural changes provides a creative opportunity for our committed interdisciplinary network of researchers, psychologists, health officials, and systems experts.
● Our network of collaborators is committed to the WHO definition of health: a state of complete physical, mental and social well-being; not merely the absence of disease or infirmity. As such, they are eager to design and test health systems that cultivate compassion and promote human flourishing. Through an intensely collaborative process, we can establish the evidence to scale flourishing health systems characterized by compassion and high-quality care.

Key Indicators of Success

We will assess successes and failures by the extent to which we overcome above-mentioned roadblocks, achieve breakthroughs, and complete activities on the timeline described above. We will also measure success by the extent to which we address the Foundation's strategy of 1) discovering the meaning and mechanisms of human flourishing in the context of suffering, using validated metrics and developing new ones; 2) developing practical interventions and monitoring their uptake, effectiveness, and value; and 3) launching a new vision of flourishing and quality healthcare that is appreciated by patients, accepted by healthcare providers, and adopted by national health systems.

Additional Information

Human flourishing, broadly conceived, is the subject of a vast and ancient literature spanning the disciplines of philosophy, theology, education, the arts, and economics. VanderWeele's integrated model defines human flourishing as "complete wellbeing." In modern society, we tend to view "complete wellbeing" as incompatible with suffering. From a scientific perspective, we know relatively little about human flourishing in the midst of adversity or suffering. Yet, religious and spiritual traditions have maintained for millennia that one can flourish even in the context of suffering.
Our idea seeks to understand human flourishing in the presence of suffering through a deep exploration and transdisciplinary inquiry into the role of compassion in transforming suffering and promoting human flourishing. Nowhere is the absence of compassion and the threat to flourishing more acute or pervasive than in our modern healthcare systems. This represents a significant challenge to human flourishing overall because it is precisely when we are suffering and most vulnerable that we seek health care. The overriding hypothesis of our idea–based on our understanding from the spiritual traditions–is that compassion at the individual and systemic levels can unlock the key to human flourishing in the presence of suffering and adversity. We suggest that the most efficient and profound setting in which to explore and test this hypothesis is within health systems.
Our expectation is that deep transdisciplinary inquiry will lead to conceptual breakthroughs, new metrics, and a series of fundamental research studies. The results of these studies would set the stage for intervention research in health systems in at least six countries, with a goal of transforming these systems towards human flourishing, leading to a new understanding of the potential for global health and practical tools and recommendations to facilitate its transformation.
A rich and diverse transdisciplinary network will be essential to realize this idea. Some of our core collaborators include:
● Focus Area for Compassion and Ethics (FACE), The Task Force for Global Health: lead partner (David Addiss, MD, MPH, and colleagues)
● Harvard University Human Flourishing Program: human flourishing – conceptual frameworks, research and metrics (Matthew Lee, PhD; Katelyn Long, DrPH, MSc) and Initiative on Health, Religion, and Spirituality (Jennifer Wortham, DrPH)
● Emory University: contemplative neuroscience, spiritual health, compassion-based ethics and compassion metrics (Jennifer Mascaro, PhD and colleagues)
● World Health Organization (WHO) Global Learning Laboratory for Quality Universal Health Care: health systems, compassion and quality health services, links to Ministries of Health (Shams Syed, MD, MPH and colleagues)
● Ministries of Health: may include Cameroon, Malawi, Scotland, Ethiopia, and health systems in the United States
● Leapfrog to Value (L2V): value-based health system development and technical assistance (Chintan Maru, MD)
● University of Calgary: compassionate health care; metrics (Shane Sinclair, PhD)
References
1. VanderWeele, T. On the promotion of human flourishing. www.pnas.org/cgi/doi/10.1073/pnas.1702996114
2. FACE. Epidemiology of Compassion and Love. https://taskforce.org/wp-content/uploads/2020/06/Epidemiology-of-Compassion-and-Love-Meeting-Report-final.pdf
3. Mascaro JS et al. Ways of Knowing Compassion: https://doi.org/10.3389/fpsyg.2020.547241
4. Sinclair S et al. Compassion in health care: An empirical model. http://dx.doi.org/10.1016/j.jpainsymman.2015.10.009
5. Addiss DG. Compassion in disasters. https://www.chausa.org/publications/health-progress/article/november-december-2019/compassion-in-disasters