By Dr Elizabeth Bailey

Today, (4^th July 2021) is #Thankyou day in the UK¹, an initiative which has emerged from the global pandemic. This will be the first UK day of collective focus for celebrating gratitude. Many countries have annual festivals of Thanksgiving, often linked to autumn harvests, and many cultures and belief systems support the practice of appreciation and expressions of gratitude and so this pause to reflect on thankfulness will be a familiar concept to many. During 2020, we saw a new emergence of public displays of gratitude². Applause and singing on doorsteps and balconies in coordinated displays of thanks for the efforts of key workers, provided some of the most emotive and memorable moments of the early months of the pandemic². Gratitude is an acknowledgement of our connectedness, a recognition of human societal needs³. Gratitude has been explored as a beneficial well-being practice, in a similar way to mindfulness, to bring psychological benefits, encourage cohesion and team working, and maybe even reduce workplace burnout^4,5,6. Public health initiatives may be strengthened by appreciative approaches, identifying community assets, active volunteers and health champions⁷. Gratitude may bring change through upstream reciprocity⁸, or the ‘pay it forward’ effect; this can have potential in change management and improvement approaches that seek to exploit this positive and aspirational approach to driving change, such as Appreciative Inquiry⁹. There are lots of reasons to be Thankful and the many examples of community and personal action have given us good reason to reflect on the positives.

However, the wider impacts of the pandemic have further exposed existing health inequalities and has widened some of the existing socio-economic gaps. This week a report in the UK outlined that the life-expectancy of the urban North-West of England has declined by 3 years due to the impact of COVID-19 and that wealthier parts of the UK recorded 5 times lower COVID deaths¹⁰. This is further to the now widely recognised disproportionate impact associated with ethnicity¹¹. In research from the BBC this week we have heard how deaf and disabled people have felt ‘forgotten’¹². The recognition of these inequalities can give rise to dissatisfaction with the system and the structures that perpetuate injustice and can create conflict with appreciative viewpoints. So how do we balance gratitude with dissatisfaction? An appreciative attitude is often associated with optimism, however optimists are susceptible to anger and frustration when those optimistic aspirations are not met¹³. Dissatisfaction leads to the questioning of the status quo and the quest to find answers, and can lead to actions to drive change¹⁴. So how do we keep a healthy balance with gratitude and dissatisfaction? And, which will prove to be the most effective driver for change? Do we seek to realise our optimistic vision of a positive future through appreciation and building cohesion, or do we fuel activism to drive a more disruptive force for change? Can we see the glass as half full, but also demand answers on what needs to be done to raise the level in the glass?

So on this #Thankyou day I will be appreciative of the collective efforts of so many that lessened the burden of the pandemic on a personal, community and national level and be mindful to practice gratitude in my life. In the weeks that follow, I will reflect on the injustice and then ask; where does the change need to come and how can our dissatisfaction turn into positive and effective action?

1. https://thankyouday.org.uk/
2. The Washington Post; In fight against coronavirus, the world gives medical heroes a standing ovation 26 March 2020 https://www.washingtonpost.com/world/europe/clap-for-carers/2020/03/26/3d05eb9c-6f66-11ea-a156-0048b62cdb51_story.html
3. Liao KY, Weng CY. Gratefulness and subjective well-being: Social connectedness and presence of meaning as mediators. J Couns Psychol. 2018 Apr;65(3):383-393. doi: 10.1037/cou0000271. PMID: 29672087.
4. Bartlett MY, Arpin SN. Gratitude and Loneliness: Enhancing Health and Well-Being in Older Adults. Res Aging. 2019 Sep;41(8):772-793. doi: 10.1177/0164027519845354. Epub 2019 May 1. PMID: 31043126.
5. Riskin A, Bamberger P, Erez A, Riskin-Guez K, Riskin Y, Sela R, Foulk T, Cooper B, Ziv A, Pessach-Gelblum L, Bamberger E. Expressions of Gratitude and Medical Team Performance. Pediatrics. 2019 Apr;143(4):e20182043. doi: 10.1542/peds.2018-2043. Epub 2019 Mar 7. PMID: 30846617.
6. Caragol JA, Johnson AR, Kwan BM. A gratitude intervention to improve clinician stress and professional satisfaction: A pilot and feasibility trial. Int J Psychiatry Med. 2021 Jan 20:91217420982112. doi: 10.1177/0091217420982112. Epub ahead of print. PMID: 33472468.
7. Iriss and East Dunbartonshire Council Using an assets approach for positive mental health and well-being https://www.iriss.org.uk/resources/reports/using-assets-approach-positive-mental-health-and-well-being
8. Nowak MA, Roch S. Upstream reciprocity and the evolution of gratitude. Proc Biol Sci. 2007 Mar 7;274(1610):605-9. doi: 10.1098/rspb.2006.0125. PMID: 17254983; PMCID: PMC2197219.
9. Watkins S, Dewar B, Kennedy C. Appreciative Inquiry as an intervention to change nursing practice in in-patient settings: An integrative review. Int J Nurs Stud. 2016 Aug;60:179-90. doi: 10.1016/j.ijnurstu.2016.04.017. Epub 2016 May 1. PMID: 27297379.
10. Michael Marmot, Jessica Allen, Tammy Boyce, Peter Goldblatt, Joana Morrison (2021) Building Back Fairer in Greater Manchester: Health Equity and Dignified Lives. London: Institute of Health Equity https://www.instituteofhealthequity.org/resources-reports/build-back-fairer-in-greater-manchester-health-equity-and-dignified-lives
11. Financial Times; Nations look into why coronavirus hits ethnic minorities so hard 29 April 2020 https://www.ft.com/content/5fd6ab18-be4a-48de-b887-8478a391dd72
12. BBC 01/07/2021 Disabled people forgotten during Covid, BBC research reveals https://www.bbc.co.uk/news/uk-57652173
13. Lerner JS, Keltner D. Fear, anger, and risk. J Pers Soc Psychol. 2001 Jul;81(1):146-59. doi: 10.1037//0022-3514.81.1.146. PMID: 11474720
14. Tim Kastelle Dissatisfaction drives innovation http://timkastelle.org/blog/2010/09/dissatisfaction-drives-innovation/