Drawing on a variety of demonstrated correlations between happiness (or “wellbeing”) and health, John Appleby recently argued that “improving individual, and hence national, wellbeing might best be achieved through improving people’s health.” While I appreciate any suggestion of policies or interventions that might boost health, I also think it worth considering whether the argument may actually work the other way round.

Does health produce happiness? Or does happiness produce health? The data documenting a relationship between happiness and health are dramatic, yet only document correlation—not causation. This leaves me wondering, which is the chicken, and which the proverbial egg?

For example, we know that exercise is helpful for addressing symptoms of depression. There is also evidence that forgiveness may improve symptoms of fibromyalgia for some people and even reduce “anger induced myocardial ischemia” for people with coronary artery disease. Moreover, training in resilience can improve measures of diabetic control, and it even turns out that training others in resilience can reduce symptoms of trauma and stress for the trainers themselves.

Richard Smith recently proposed that the causes of health include optimism, a sense of control, meaning and purpose, and supportive and nurturing relationships. The Book of Proverbs even teaches that “If you want to be happy, be kind to the poor; it is a sin to despise anyone.” On a personal note, I can testify to how much better (happier and healthier) I feel on the days I’ve started my morning with a good, hard run.

In truth, the relationship between happiness and health is hardly one way in either direction—rather, I suspect it is a complex system of multiple interacting factors that all influence each other.

Nevertheless, I think the influence of happiness on health needs attention. Attempting to arrange policies and interventions that promote health, to thereby improve happiness, could promote a passive approach—leaving the alleged beneficiaries of our policies and interventions as recipients and not active agents.

Instead, there is a need to focus on factors that promote happiness and wellbeing (and resilience, purpose, and connected relationships). By promoting these, we will hopefully not only engage those in our society in creating better individual and social lives, we may also promote good health along the way too.

So if you want to be happily healthy, maybe you should . . .

• Go for a walk or take a run
• Forgive someone
• Give something away
• Reflect on why you do what you do (even when it’s hard to do!)

William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: “I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare—but I do think running is one of the best medicines!”