Childhood, adolescence, even the "twilight years" have been extensively researched and documented. But the vast terrain known as midlife—the longest segment of the life course—has remained uncharted. How physically and psychologically healthy are Americans at midlife? And why do some experience greater well-being than others?
The MacArthur Foundation addressed these questions head-on by funding a landmark study known as "Midlife in the U.S.," or MIDUS. For the first time in a single study, researchers were able to integrate epidemiological, sociological, and psychological assessments, as well as innovative new measures to evaluate how work and family life influence each other.
How Healthy Are We? presents the key findings from the survey in three sections: physical health, quality of life and psychological well-being, and the contexts (family, work) of the midlife. The topics covered by almost forty scholars in a wide variety of fields are vast, including everything from how health and well-being vary with socioeconomic standing, gender, race, or region of the country to how middle-aged people differ from younger or older adults in their emotional experience and quality of life. This health—the study measures not only health-the absence of illness—but also reports on the presence of wellness in middle-aged Americans.
The culmination of a decade and a half of research by leading scholars, How Healthy Are We? will dramatically alter the way we think about health in middle age and the factors that influence it. Researchers, policymakers, and others concerned about the quality of midlife in contemporary America will welcome its insights.
* Having a good life means having good relationships with others to almost 70% of those surveyed. Less than 40% mentioned their careers.
* Reports of disruptive daily stressors vary by age, with young adults and those in midlife experiencing more than those in later adulthood.
* Men have higher assessments of their physical and mental health than woman until the age of 60.
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Orville Gilbert Brim is the former director of the MacArthur Foundation Research Network on Successful Midlife Development. Carol D. Ryff is a professor of psychology and director of the Institute on Aging at the University of Wisconsin-Madison. Ronald C. Kessler is a professor in the Department of Health Care Policy at the Harvard Medical School.From The New England Journal of Medicine:
Despite the past century's fascination with measuring every facet of life, little is known about the "middle years." After all, living into middle age is a relatively recent phenomenon in human history. A white man born in 1900 in the United States had an average life expectancy of 48 years, and a white woman could hope to see 51 years. Consequently, much of the population either never reached or did not remain long in the developmental phase that we would now characterize as midlife. Although the pressing nature of age-related ill health precipitated a welcome and much-needed boom in information about aging, there remained a paucity of knowledge about the middle years. How Healthy Are We? -- which reports on a study called MIDUS (Midlife in the United States) that was funded by the MacArthur Foundation -- makes a robust contribution to addressing this void and, moreover, does so in a holistic manner that incorporates epidemiologic, psychological, and sociological perspectives. As a stellar example of cross-disciplinary collaboration and research, it solidifies an approach that surely must be emulated if we are to deepen our knowledge about wellness and health across the continuum of the lifespan. It encompasses a comprehensive effort at collecting data, including providing information about demographic characteristics, living arrangements, childhood, family background, occupational history, finances, partners, sexuality, parents, children, and parenting. In addition to data about physical, mental, and emotional health, the book also offers psychological assessments and assembles information about religion, spirituality, and social networks. This book, which reports on a general national survey based on sampling and oversampling from five metropolitan areas, includes both sibling and twin subpopulations, allowing for familial and genetic interpretations. The survey underrepresents people who have a high school education or less, blacks, and presumably other racial and ethnic minorities, a failing that follow-up studies in Baltimore, Chicago, and New York aim to correct with the use of quota-sampling techniques. The book, although dense, is organized in a highly readable format, with an overview that provides a concise yet thorough introduction to the 3 sections and 21 chapters. Although this is hardly a book that one reads from cover to cover at one sitting, its consumption is facilitated by the clear direction of readers to chapters that fit their inclinations. Unlike some multiauthored books, this one is unmarred by overlap, inconsistency, and unevenness in format, substance, or style. The broad scope of the MIDUS survey has produced copious data, some of which are covered in this book and more of which are available in multiple journal articles. It is not my objective in this review to highlight any of the major findings, since professionals with various interests will naturally gravitate to what is most meaningful to them, and there is a wealth of offerings in this compilation. However, the book's particular strength is its interdisciplinary approach to the topics covered. As one example, findings show how MIDUS investigators collaborated in discussions about inequalities in health among various populations and demonstrated that such disparities must be approached "from both biomedical and social behavioral perspectives," and that indeed, "the causes of . . . gradient[s] in health lie outside the medical sector." Finally, we can ask: Why should we care about a book such as this? Surely there are many competing offerings that similarly examine an interesting topic, are elegant in research design, present analyses by learned experts, and provide an impetus for future research. Perhaps a compelling rationale is summed up by one of the book's authors, who exhorts us to look beyond "pill-popping" as a panacea for addressing every perceived deviation from wellness without, perhaps, a complete understanding of what the natural histories of human wellness are. Fully integrated studies such as this one can begin to reveal much of what constitutes the norms of human development in this phase of life. Researchers and practitioners from many disciplines can look forward to findings from this study's ongoing partnership with longitudinal studies that include Whitehall II, the National Survey of Families and Households, the Wisconsin Longitudinal Study, and the Nurses' Health Study; from researchers making use of the fact that the data have been made available through the Inter-University Consortium for Political and Social Research; and from a planned 10-year follow-up study to inform them. Meanwhile, this book and its associated publications have done much toward advancing the scholarly illumination of midlife. Sarita Bhalotra, M.D., Ph.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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