key: cord-1051964-69gihhiz
authors: Biglan, Anthony; Johansson, Magnus; Van Ryzin, Mark; Embry, Dennis
title: Scaling up and scaling out: Consilience and the evolution of more nurturing societies
date: 2020-08-05
journal: Clin Psychol Rev
DOI: 10.1016/j.cpr.2020.101893
sha: 1b37e6a352dbb19bdd07ac16a42c344588358df4
doc_id: 1051964
cord_uid: 69gihhiz

This paper argues that diverse disciplines within the human sciences have converged in identifying the conditions that human beings need to thrive and the programs, policies, and practices that are needed to foster well-being. In the interest of promoting this view, we suggest that this convergence might usefully be labeled “The Nurture Consilience.” We review evidence from evolutionary biology, developmental, clinical, and social psychology, as well as public health and prevention science indicating that, for evolutionary reasons, coercive environments promote a “fast” life strategy that favors limited self-regulation, immediate gratification, and early childbearing. However, this trajectory can be prevented through programs, practices, and policies that (a) minimize toxic social and biological conditions, (b) limit opportunities and influences for problem behavior, (c) richly reinforce prosocial behavior, and (d) promote psychological flexibility. The recognition of these facts has prompted research on the adoption, implementation, and maintenance of evidence-based interventions. To fully realize the fruits of this consilience, it is necessary to reform every sector of society. We review evidence that free-market advocacy has promoted the view that if individuals simply pursue their own economic well-being it will benefit everyone, and trace how that view led business, health care, education, criminal justice, and government to adopt practices that have benefited a small segment of the population but harmed the majority. We argue that the first step in reforming each sector of society would be to promote the value of ensuring everyone's well-being. The second step will be to create contingencies that select beneficial practices and minimizes harmful ones.

versus "slow life" outcomes among humans are evolutionary adaptions of humans to two distinct social and ecological contexts. Environments with high levels of conflict and stress promote a "fast life" trajectory that involves a lack of self-regulation, a high level of risk-taking, the development of antisocial and violent behavior, academic failure, and a greater likelihood of depression, as well as the development of inflammatory processes that contribute to metabolic syndrome, diabetes, cardiovascular disease, and ultimately premature death (Ellis et al., 2012; Ellis & Bjorklund, 2012; Miller et al., 2011) .

Behavior analysis has provided an in-depth understanding of the nature of the environments that lead to "fast life" developmental trajectories (Patterson et al., 1992; Sidman, 1989) . In highly stressful environments, coercive interactions become common. Each person's aversive behavior is reinforced by the cessation of the other's aversive behavior, reinforcing the use of this behavior as a means to resolve conflicts. Research has shown that chronically coercive interactions in families predict the development of the just-mentioned constellation of psychological, behavioral, and health problems (Dishion et al., 1992; Granic & Patterson, 2006; Miller et al., 2011; Van Ryzin & Dishion, 2013) . The consilience of this analysis with evolutionary theory is further shown by the fact that children on this trajectory are more likely to have children at an early age (Ellis et al., 2012) . Apparently, the fast life strategy has had value in our evolutionary history; in a threatening world, you should have your babies early or you may not have them at all.

Clinical research on the treatment of diverse disorders shows that when people are helped to become willing to experience, rather than avoid, psychological or physical aversive sensations and to pursue a set of chosen values, their pain diminishes and the meaning and joy in their lives is enhanced (A-Tjak et al., 2015; Atkins et al., 2017; Jiménez, 2012) . Moreover, it appears that when people are encouraged to freely choose their values rather than adopt the values that they perceive others demand that they live by, they typically choose a set of prosocial values that involve caring relationships with others (Gagné, 2003; Sheldon et al., 2003) .

The importance of nurturance for human well-being is further supported by evidence from prevention science. Over the past forty years, a large body of evidence has accumulated about the family, school, and community interventions that can prevent the "fast life" developmental trajectory (Biglan, 2015; Biglan et al., 2017; Biglan, Van Ryzin, Moore, et al., 2019; Van Ryzin et al., 2018) .

Preventive family interventions grew out of clinical work with children with behavioral disorders (e.g., Patterson, 1974) . Parental behavior is important in affecting the intergenerational transmission of self-regulatory skills or deficits (Bridgett et al., 2015) . Leslie et al. (2016) describe sixteen family interventions that have been shown to prevent most of the common and costly psychological and behavioral problems. In schools, interventions such as PeaceBuilders As our recent experience with the novel coronavirus COVID-19 has shown, the public health framework is vital to any effort to improve human well-being because it demands that we monitor and affect the incidence and prevalence of problems in entire populations, rather than simply focusing on the well-being of individuals (Biglan, 2015) .

It will be impossible to increase the prevalence of nurturing environments if we do not understand the evolution of economic conditions and their impact on human well-being. In the United States, and increasingly around the world, we have evolved a form of capitalism that makes the maximization of profits the singular goal of business enterprises (Biglan, 2020a) . The well-being of employees, customers, and communities has been subordinated to the pursuit of profits. This is the result of extensive and stealthy advocacy for the theory that the individual and corporate pursuit of economic gain will necessarily benefit others (Mayer, 2016) . This way of thinking has permeated every sector of society. Our ability to evolve societies that nurture the well-being of every person will be limited if we do not reform the values and priorities of each sector of society (Kasser et al., 2007) .

Although there are many other terms that might be used to communicate the vast, interdisciplinary network of findings that help us understand what humans need to thrive, we have labeled this synthesis the "Nurture Consilience" based on our own work on this issue (Biglan, 2015; Biglan et al., 2012; Komro et al., 2011) . We acknowledge that there are many other ways that one could refer to this consilience.

It would be valuable for the scientific community to agree on a label. There is a strong need to bring diverse disciplines together around a shared understanding of what humans need to J o u r n a l P r e -p r o o f Journal Pre-proof thrive and how we can evolve societies that support their well-being. The labeling of this consilience is vital to communicating its importance. If the scientific community intends to make use of this knowledge to evolve societies in nurturing directions, it will be important to get not only the scientific community, but societies as a whole to understand and embrace this analysis.

Thus, a first step in advancing this understanding would be to settle on a label for this effort.

Although it has not been defined with precision, prevention science has developed a concept known as scaling up that refers to the process of moving from an individually focused intervention to the application or dissemination of that intervention to affect an entire population.

As prevention science has accumulated a large array of tested and effective interventions, the field has increasingly turned to the question of how those interventions could be so widely applied that they affect entire populations. Examples of these efforts include (a) the implementation of the PAX Good Behavior Game in more than 40,000 elementary school classrooms worldwide that grew out of the studies by Sheppard Kellam and colleagues (Kellam et al., 2012) , which showed the long term benefit of the Good Behavior Game; (b) the efforts of Wilson, Atkins, and Hayes to disseminate the Ostrom Principles by integrating behavior change techniques from clinical psychology (Polk & Schoendorff, 2014) , to help small groups function more effectively (Atkins et al., 2019); (c) the extensive work that is being done to disseminate clinical interventions derived from Acceptance and Commitment Therapy (Hayes, et al., 2016) that focus on promoting psychological flexibility (Brown et al., 2016; Hayes, 2019; Tol et al., 2020) ; and (d) our own efforts to increase the prevalence of nurturing environments by enhancing the developmental contexts of children and youth (Biglan, J o u r n a l P r e -p r o o f Journal Pre-proof 2020a; Biglan, Van Ryzin, & Westling, 2019; Van Ryzin et al., 2016; Van Ryzin, Roseth, & Biglan, 2020) .

Although the emphasis in this work has generally been on scaling up to affect an increasing proportion of the population via a single channel (e.g., schools, the health care system, the mental health system, the criminal justice system), there is another facet of dissemination that might be labeled scaling out. This involves creating an impact in sectors of society other than the one in which the intervention or practice originated. Aarons et al. (2017) suggest three variants of scaling out; (a) targeting the same population as the intervention was developed for, but using a different delivery method; (b) targeting a different population, using the same delivery method;

(c) changing both target population and delivery method. Our use of the term "scaling out" is clearly related, but also more general in that we advocate spreading practices that lead to similar outcomes -increased levels of nurturance -across all sectors of society.

For example, the rapid expansion of the PAX Good Behavior Game to elementary schools around the USA and around the world has recently begun to be accompanied by attention to how the generic practices of PAX could be useful in families, the criminal justice system, and business (Johansson et al., in press). The same evidence-based kernels that work in the classroom, for example, may also work in families, after-school settings, and community settings serving children (Embry & Biglan, 2008; E. P. Smith et al., 2016 E. P. Smith et al., , 2018 The principles emerging in the above-described consilience are increasingly accepted within the human sciences. However, this view of life is far from the dominant understanding of the human condition in most sectors of society. Instead, the dominant view is that people are selfish maximizers and that society benefits from their having that orientation (Biglan, 2020a) .

Until that view is supplanted by the consilience we have described, it will be impossible to create the nurturing conditions that people need in every facet of their daily life. To achieve this shift and promote consilience, it is important to understand how free-market ideology has permeated every sector of society and how that has undermined not only human well-being but the conditions needed to nurture well-being.

Advocates of free-market theory used Adam Smith's metaphor of the invisible hand to promote the view that if everyone in the marketplace pursued their own economic well-being, it would benefit everyone. Smith gave the example of the baker who, in simply trying to make bread that would satisfy their customers, are motivated to make better or cheaper bread, which then benefits everyone (A. Smith, 1776) . There is some truth to this idea. Market competition selects innovative and frequently beneficial practices. However, in the hands of free-market advocates, the view has morphed into the belief that we will all be better off if everyone just pursues their own economic well-being without regard to the harm to others. The result has been that the primary consequence selecting organizational practices throughout society has been profit maximization, while government oversight has diminished together with responsibility for the long term consequences of business practices (Biglan, 2009 ).

In each sector of the economy, values having to do with wealth accumulation have tended to replace values having to do with concerns about others and one's community (Biglan, 2020a) . Business. Jane Mayer provides an excellent historical overview of the fifty-year advocacy for free-market economics that was conducted by a network of wealthy business people primarily in the U.S. (Mayer, 2016) . It encouraged businesses to make the maximization of profits their singular goal. The appropriateness of this goal was propounded by the Nobel laureate in economics, Milton Friedman (1970) . By 1997, the Business Roundtable, which includes the largest American corporations, formally adopted this principle (The Business Roundtable, 1997).

Advocates for free-market ideology called for minimum regulation of business and reduction in the size of government. Their success in minimizing regulation is shown by the many ways in which corporations are engaging in business practices that harm large proportions of the population. They include 480,000 people a year who die of smoking-related illness (Biglan, 2020e ; Centers for Disease Control and Prevention, 2018), the opioid epidemic that has killed more than 350,000 people (Biglan, 2020b ; National Institute on Drug Abuse, 2019), the marketing of unhealthful food that has created an epidemic of obesity and diabetes (Biglan, 2020c; Moss, 2013) and is shortening the life expectancy of children (Olshansky et al., 2005) , the practices of the financial industry that resulted in the 2008 Great Recession (Lewis, 2010) , and the failure to reduce greenhouse gas emissions in the face of scientific consensus on the dangers of climate change (Biglan, 2020a (Biglan, , 2020c ).

The healthcare system. During the time in which free-market advocacy came to dominate society, we have experienced a dramatic increase in health care expenses and a reduction in American's health. Most parts of the health care system have worked to maximize J o u r n a l P r e -p r o o f their profits. In the U.S., salaries of physicians have risen faster than inflation and are higher than in any other country (Daggett, 2017; Rampell, 2009 ). Health insurance company profits and executive salaries have increased dramatically in recent years (Herman, 2017; Small, 2017) . The same is true of the pharmaceutical industry (Krantz, 2016) . The over-prescription of opioids, anti-depressive medication, psychostimulants for children, and antibiotics has increased even as research documented the harm of such practices (Gotzsche, 2013) .

Presently, the contingencies of reinforcement do not favor the actual health of the patients or the larger community. Atul Gawande provided an example of how a local healthcare system can be finely attuned to how well its practices are increasing revenues, while at the same time, being clueless about the impact of their practices on the health and well-being of the population (Gawande, 2009). Figure 1 shows how a huge bureaucracy has evolved during the ascendancy of free-market advocacy and the accompanying reduction in American longevity. In short, the players in the health care system have selected practices that benefit them, but have ignored their impact on the nation's health (Reinhardt, 2019) .

Higher education. Colleges and universities are not acting in light of their impact on the prevalence of well-being. Over the past fifty years, business schools and law schools have educated a generation of MBAs and lawyers who embraced free-market theory and worked to help businesses maximize profits and shield them from government regulation and/or accountability to their community or country (Biglan, 2020a) . In keeping with developments in the rest of society, we see a dramatic escalation in university administrators' salaries (Vedder, 2016) at the same time that student debt is soaring (O'Day, 2019). In addition, the contingencies J o u r n a l P r e -p r o o f Journal Pre-proof of many private enterprise higher-education entities were deliberately designed to take advantage of students.

More generally, higher education is not educating the workforce that is needed to help communities and sectors of society advance nurturance (Grant, 2016) . Traditionally, higher education has made great contributions to the development of technology, medicine, and basic scientific understanding. However, the problems we face now will not be solved by new technologies, but by the broad application of the science of human behavior. The behavioral sciences receive less than 10% of federal funding for research (Biglan, 2020a ), yet it is the science of human behavior that has the knowledge to educate a generation of young people to acquire the skills and competencies to evolve more nurturing societies.

Criminal justice. The U.S. has the highest level of incarceration of any country in the world ("List of countries by incarceration rate," 2019). Incarceration has intergenerational effects. Our punitive system undermines family well-being by incarcerating people who could be breadwinners for their family and by traumatizing the children of adults caught up in the system (Morsy & Rothstein, 2016 ). The punitive system results in high levels of recidivism, and this system remains in place despite the fact that more nurturing practices have been found to be far more effective (Lipsey et al., 2000) .

This situation is not entirely due to free-market advocacy. However, the privatization of prisons encouraged by free-market advocates has done nothing to improve the system (Simon, 2016) . The private correction industry has become a major political lobbying entity, which helps to maintain our punitive and ineffective criminal justice system. Moreover, economic policy has increased poverty, which contributes to crime.

Journal Pre-proof

The political system. Behavioral scientists have traditionally been loath to get involved in politics, at least in their role as scientists. However, our political system consists of a set of cultural practices whose evolution can be understood in the same way that other aspects of society can. Over the past forty years, policymaking has increasingly come under the control of interests that make policies for their own benefit, while often diminishing the well-being of many others (Aligica & Tarko, 2014; "Crony capitalism," 2019; Khatri et al., 2006) . This too is a matter of selection by consequences. Wealthy individuals and corporations have invested heavily in the selection of political leaders who would act in their interests. That their investment has reaped benefits is documented by Figure 2 , which shows the increase in income of the top one percent of households (Alvaredo et al., 2017) compared to the bottom 50%. Advocacy for policies that benefit the wealthy has been richly rewarded and it is undermining our democratic system.

The impact of public policy on general well-being needs to be routinely scrutinized and widely reported. We also need to articulate the contingencies that have allowed a small group of the very wealthy to have such influence on policymaking, and we need to support research and practical action on how we can change those contingencies.

Evolving societies that advance nurturing conditions will require three things. First, we need to promote prosocial values throughout society. Second, we need to evolve a system in which every sector routinely analyzes the degree to which it is advancing the general well-being.

Third, we need to create contingencies that select practices on the basis of their impact on wellbeing.

Journal Pre-proof

An airline passenger does not need to know anything about the science of aviation in order to enjoy the benefits of that science. The same cannot be said about the science underpinning the Nurture Consilience. The beneficiaries of effective clinical and preventive interventions adopt an orientation that is consistent with that scientific consensus. They reduce their use of coercive behavior in their relationships with others, they become more compassionate toward themselves and others and become more oriented toward prosocial values and outcomes. Much of the spread of these values and behaviors is resulting from the scaling up of these interventions. However, it will be further advanced if the leaders of each sector of society are explicit in their adoption of these values, goals, and practices.

In a kind of reverse engineering of the free market ascendancy, we need to influence the major sectors of society to understand and promote the Nurture Consilience. We can learn from the free-market advocates who funded programs promoting their views in major universities and through the cultivation of careers in academia, business, and the media of people who were skilled at promoting business-friendly views (Mayer, 2016) . Similarly, behavioral scientists and practitioners need to educate a generation of people who understand and can advocate for the science of human well-being and its implications for every sector of society. We need advocates in medicine, business, education, entertainment, and media who are skilled in explaining the benefits of values, goals, norms, and practices that advance the general well-being.

Although we are arguing that research shows the benefits of creating nurturing conditions, we are not arguing that science can dictate our values. In other words, we are not saying that prosocial values are the one TRUE set of values. You might explain to a person the benefit to the general well-being of prosocial values, but that person would be free to respond J o u r n a l P r e -p r o o f Journal Pre-proof that they understand that prosociality, as opposed to self-centered values, will benefit a larger proportion of society, but they still want to have a society in which some people are able to amass huge wealth, even if others' well-being is diminished.

Although we cannot claim that science proves that prosocial values are the one true set of values, we can advance these values by educating people about their benefit. The evidence is that when we work to improve the well-being of others, it benefits all of us (Fredrickson et al., 2008; Fredrickson & Joiner, 2018) .

One thing that could contribute to a rebirth of prosocial values in American society would be an effort to close the divide between the secular and religious communities. As American society has become more secular, a gulf between religious and secular communities has arisen (Putnam & Campbell, 2012) . The promotion of prosocial values would be facilitated if secular and religious organizations that share the values of ensuring everyone's well-being came together to promote these values. In sum, we believe that scaling up and scaling out the framework of the Nurture Consilience across all sectors of society will contribute to the wealth, safety, health, freedom, and political stability of any nation that makes use of this knowledge.

Using public health practices, we can readily measure the degree to which any given practice is (or is not) harming people. We already do this for cigarettes, guns, alcohol, unhealthful foods, and some aspects of economic policy. We have systems for monitoring psychological, behavioral, and physical health as well, but they are generally not available at the level of communities and are not linked to the impact of public policy and organizational practices to the extent that they need to be.

Consider what could happen if every sector of society examined how its practices were affecting well-being. In the healthcare sector, this would consist of health care providers and communities monitoring the well-being of the entire population and pinpointing practices that do or do not contribute to improved public health (Biglan & Embry, 2013) . Careful monitoring of the well-being of the population would enable a business to identify which of its practices affect population well-being; examples include the degree of well-being of its employees, the marketing of unhealthful products, and support of the business community for the private and public sector efforts to make effective preventive interventions widely available. The criminal justice system could be charged with monitoring the rate of juvenile and adult crime, the rate of recidivism, as well as the harm to children who are affected by parental involvement in the system. Such data would direct their attention to these issues and lay the groundwork for selecting strategies to move these numbers in the right direction.

Schools are already tracking the academic and, to a lesser extent, the social development of students. To the degree that they do, they are already in a position to use the data to select increasingly effective practices. In particular, attention is needed to the extent to which schools are reducing disparities in academic and social development. Higher education could pay greater attention to whether it is training people who have the skills to promote the evolution of greater nurturance. It should also attend to how well it is promoting the success of poor or minority students, and the degree of indebtedness of students. We can also assess the degree to which news and entertainment media are contributing to the promotion of nurturance or are increasing division, hate crimes, and false beliefs.

Finally, there is government. One of the most important things government can do is increase the use of effective monitoring systems. Most of the data on population well-being gives J o u r n a l P r e -p r o o f Journal Pre-proof us information at the national or state level. Few communities have accurate and timely data on the psychological, behavioral, and physical health of its communities. Our goal needs to be to have such data for every community so that communities pay greater attention to well-being and can evolve increasingly nurturing practices. If this seems well beyond what is possible, we would simply note that the performance of our economy has long been tracked at the community level and that the data have been used to guide policymaking. Why should we not have similar data on the well-being of the people in our communities?

As people in each sector come to understand the Nurture Consilience, they can begin to advocate for practices in each sector that improve the general well-being. Armed with accurate and timely data on population well-being, it will become possible for each sector of society to select better and better policies and practices. In every case, it will be a matter of creating consequences that select beneficial practices and eliminate harmful ones.

Let's start with some business practices that are clearly harmful to a large proportion of the population-the marketing of unhealthful food and substances. Progress has been made in curtailing the marketing of tobacco to young people, but alcohol and unhealthful food continue to be widely marketed to young people (Biglan, Van Ryzin, & Westling, 2019) . Moreover, the public health system has failed to prevent the marketing of vaping products to young people.

Many of the efforts to prevent these harms have focused on stopping specific forms of marketing such as the use of billboards to promote tobacco use. However, a much more effective strategy would be to simply tie the success of companies in marketing harmful products to young people to the companies' profits. We can assess the proportion of young people who begin using any specific product-a brand of cigarettes, alcohol, or sugar-sweetened beverages for example.

Journal Pre-proof Indeed, Pierce, Gilpin, and Choi (1999) were able to estimate the percent of youth who would begin smoking Camel cigarettes or Marlboro cigarettes. They were also able to estimate the number of those youth who would eventually die of smoking-related illness due to each of these brands. Using such methods, it would be possible to fine a company for every percent of the youth population that is using a specific product. If the fines were set so that they confiscated all of the profit from that marketing, it would curtail such marketing far more successfully than any prohibition on a specific form of marketing (Biglan, 2020a) .

Contingency management can also select beneficial business practices. In the business sector, there are already two movements to reform business practices in the direction of a focus on well-being. The Conscious Capitalism movement (Mackey & Sisodia, 2013) and the B Corp movement (Loewenstein, 2013) are both advocating that businesses evaluate their practices in terms of their impact not only on investors, but on employees, customers, suppliers, and society as a whole. Even the Business Roundtable has abandoned its position that the only goal of a corporation should be to maximize profits. Instead, it recently articulated the principle that businesses should benefit all of these constituencies (Gelles & Yaffe-Bellany, 2019).

In health care, practices would increasingly be selected by their impact in improving health, rather than only curing illness. Policy could be adopted that makes system funding contingent on reductions in the incidence and prevalence of psychological, behavioral, and physical health disorders. This would motivate these organizations to fund the kind of family and school preventive interventions that we described above. It is already the case that a number of accountable care organizations and state Medicaid authorities are investing in school-based interventions such as the Good Behavior Game because of its proven benefit in preventing substance use, depression, and other expensive conditions.

Higher education needs to train MBAs and lawyers who understand and promote the importance of nurturing conditions for health and societal well-being. We need more people who are trained to disseminate and implement the treatment and prevention programs that can significantly improve health. Traditionally, educational priorities have been selected by government and private funding and by requirements for obtaining professional credentials. To the extent that an increasing proportion of the leaders of each sector are focused on advancing well-being, they will implement contingencies to increase the preparation of a new generation of people who are committed to advance nurturance. The criminal justice system needs to select practices such as prosecution, incarceration, and probation on the basis of their impact on crime and recidivism. If we take seriously the idea that the criminal justice system has responsibility for the total rate of crime, that system will need to invest more heavily in prevention together with other sectors in society. Law enforcement will need to work with health care, human services, and education to support and promote practices in those areas that have proven benefit in preventing crime (Biglan, 2015) .

To fully accomplish the scaling up and scaling out that we propose, we need a coalition of organizations in society pursuing goals that are consistent with the Nurture Consilience. For example, we have advocacy organizations working to reduce harms such as tobacco and alcohol use. We have organizations working to reduce child poverty, organizations working to reduce discrimination, organizations working to improve health or cure or prevent specific diseases.

There are organizations working on climate change, gun violence, and human trafficking. If there is measurable harm to human well-being, there is probably an organization working to address that harm.

Although these organizations work for the benefit of others, we believe that they are not as effective as they could be. Specifically, they are not well coordinated and do not speak with one voice. They need to see that each of the problems they are attempting to address is to a great extent the product of a society that has become dominated by the belief that each person should pursue their own economic well-being regardless of the harm to others. That belief, in turn, has contributed to high levels of poverty, economic inequality, and discrimination, as well as poorly regulated business practices. The Nurture Consilience provides a framework for creating a coalition among all the organizations that are working to advance human well-being. It would be bound together by prosocial values and the realization that each of the problems targeted by these organizations are products of the same set of non-nurturing conditions.

The Nurture Consilience can also improve the efficiency and cost-effectiveness of prevention. Many prevention efforts are directed at a single problem, despite the evidence that non-nurturing environments contribute to multiple problems (Biglan et al., 2012; Boles et al., 2006) . The result is a plethora of narrowly focused prevention programs. For example, schools have separate programs on bullying, alcohol, tobacco, drugs, suicide, trauma, depression, and obesity. All of these problems are made more likely by stressful environments, which are, in turn, made more likely by poverty, economic inequality, discrimination, and harmful marketing (Van Ryzin, Fishbein, & Biglan, 2018) . Evidence from universal prevention programs like the Good Behavior Game shows that a comprehensive elementary school program to reduce punishment and threat, limit opportunities and influences to engage in problem behavior, and richly reinforce diverse forms of prosocial behavior can generate clearly measurable benefits across a broad array of behaviors many years later (Kellam et al., 2011) .

The full benefit of what we have learned will not be realized unless we also adopt public policy that has the potential for much deeper, more substantial, and sustainable change. For example, there is extensive evidence that a wide range of psychological and behavioral problems result from poverty and economic inequality (Hair et al., 2015; Jachimowicz et al., 2020; Patel et al., 2018; Wilkinson & Pickett, 2017; Yoshikawa et al., 2012) . There are at the same time policies such as the earned income tax credit or universal basic income, that can significantly improve well-being and prevent problem development (Braga et al., 2019; Calnitsky & Gonalons-Pons, 2020; Hoynes, 2019; Widerquist, 2019) .

This last point is a good example of why behavioral scientists need to play a leadership role in the scaling up and scaling out of the framework for the Nurture Consilience. Much of dissemination and implementation work is focused on getting evidence-based practices widely adopted, which is very important. However, it is also important that the behavioral science community speak with one voice in public discussion and with policymakers.

To the extent that opinion leaders and policymakers throughout society come to believe that human well-being is fostered by nurturing conditions, there will be greater support for the policies and programs that are needed. The recent work of the National Prevention Science Coalition to Improve Lives in conducting Congressional briefings and writing op-eds is a good example (National Prevention Science Coalition to Improve Lives, 2019).

Journal Pre-proof

Admittedly our analysis has been U.S.-centric. However, we think that at the very least it is a cautionary tale for the rest of the world because free-market theory and policy have been adopted in so many places. For example, Sweden, a country known for its success in nurturing the well-being of most people (Lakey, 2016) , has since the early 1990s quite rapidly moved from a welfare system almost completely predominated by the public sector, to allow for the establishment of private for-profit providers and privatization of public operations, funded by taxes and pre-set rates of reimbursement. Several welfare areas were opened up for market competition in a similar manner. These reforms originated from the 1980s emerging Swedish right-wing think tanks, inspired by the governments of Reagan and Thatcher (Svallfors & Tyllström, 2017) . The Swedish right-wing political parties are all in favor of the current system with unregulated profits in the welfare sector, even though most of their voters don't agree with this position (Svallfors & Tyllström, 2017) .

Evaluations of the changes in Swedish school systems have shown increased segregation between schools in terms of students' socio-economic status, ethnicity and performance (Böhlmark et al., 2016; Holmlund et al., 2014) , while average performance has not increased (Hennerdal et al., 2018; Hinnerich & Vlachos, 2017) . Similarly, market competition in the One might reasonably ask whether there is any evidence that such a massive change in the cultural practices of societies can be achieved. Although the evidence is admittedly limited, there are several trends that are favorable to the cultural evolution we are calling for.

A recent report from the National Academies of Sciences, Engineering, and Medicine (2019) enumerated examples of progress that has been made in promoting programs and policies that improve family, schools, and community support of child and adolescent development.

Among the examples of progress being made in this area were  Eleven federal efforts that range from pregnancy prevention to workforce development.

 Efforts in six states to systematically implement evidence-based family, school, and community interventions to prevent the development of child and adolescent problems. 

The just-described trends are largely examples of scaling up. However, we take the position that well-being will best be advanced if the nurturing conditions we describe come to characterize all of the sectors of society. To do this, the sectors that are currently and explicitly promoting nurturance must influence the values and practices in other sectors. This is happening to some extent. As described above, segments of the business community are embracing more nurturing practices and segments of the criminal justice system are beginning to reduce punitiveness and adopt more nurturing and evidence-based rehabilitation practices (Biglan, 2020a) . There are also efforts within the healthcare system to reform the system so that it prevents disease by ameliorating adverse conditions, rather than waiting until people have chronic diseases. There are also comprehensive community interventions that organize multiple sectors of the community to work together to address problems in family well-being and child and adolescent development. For example, in Colorado, marijuana tax revenue is funding the implementation of the Communities that Care (CTC) program in 48 communities. CTC brings together community leaders from the various sectors of the community, educates them about the risk and protective factors that contribute to multiple problems in adolescence, and assists them in implementing school and family interventions that can prevent problem development. CTC has been shown in multiple randomized trials to significantly reduce adolescent substance use and antisocial behavior, including violent behavior (Brown et al., 2014; Hawkins et al., 2008; Oesterle et al., 2018) . Its implementation in Pennsylvania contributed to a significant reduction in juvenile crime throughout the state (Feinberg et al., 2010) .

Other examples of scaling out abound in the U.S. and around the world. For example, the Centers for Disease Control and Prevention funded six projects to experimentally evaluate J o u r n a l P r e -p r o o f Journal Pre-proof comprehensive interventions to reduce violence in neighborhoods of concentrated disadvantage (Kingston et al., 2016) . The rationale for this effort was that violence and other problems are multiply determined and a comprehensive intervention that involves schools, family services, the healthcare system, and community organizations is more likely to prevent problems.

In Switzerland, Andrew Gloster and colleagues have tested self-help interventions aiming to improve psychological flexibility Wersebe et al., 2018) , arguing that it could be a malleable factor for improving public health (Gloster et al., 2017) . Based on similar theoretical underpinnings, self-help has been used to reduce psychological distress in Uganda (Tol et al., 2020) . Globally, there is a worldwide movement to promote prosocial functioning of groups (Atkins et al., 2019) that is based on the principles that were articulated by Elinor Ostrom, who received the Nobel Prize in economics for her work . One example of its application is to combat the spread of the Ebola virus in Sierra Leone (Honick, 2020). Overall, although the portion of the population being reached remains relatively small and the effective collaboration among sectors of the society is still limited, these are significant efforts to advance well-being by broad networks of people and organizations who are essentially on the same page about what human beings need to thrive.

As discussed above, many sectors of society in the U.S. have come to be dominated by the belief that maximizing profits and income should be the major goal of people and organizations. This has fostered high levels of materialism throughout society at the same time that it undermined prosocial or communitarian values (Biglan, 2020a) . If we are going to evolve societies that steadily increase general well-being, we need to reduce harmful practices and promote beneficial ones through the implementation of new selection pressures. These pressures J o u r n a l P r e -p r o o f Journal Pre-proof can be promoted through the enhanced availability of information on general well-being and the subsequent application of consequences that reduce harm and promote well-being.

Foundational for this evolution is the scientific synthesis that we have labeled the Nurture Consilience. As scientific understanding of well-being and the conditions that contribute to wellbeing expands, we will have an increasingly compelling basis for translating this knowledge into public policy. One of the most important strands in this effort is the scaling up of programs so that they reach an increasing proportion of the populace. However, as we hope we have made clear, even if evidence-based practices become widespread in clinical, human service, and school settings, we will have a limited impact on well-being if the other sectors of society-business, healthcare, criminal justice, higher education, and the political system-continue to be guided by the materialistic value that pursuing one's own well-being will always benefit everyone. In short, pursuing the well-being of every person needs to become the foundational value for every sector of society. 

The critical role of nurturing environments for promoting human well-being

Evolving a more nurturing society to prevent adverse childhood experiences

The socialization of boys and men in the modern era: An evolutionary mismatch

A public health framework for the regulation of marketing

Blueprints for Healthy Youth Development

Parental choice, neighbourhood segregation or cream skimming? An analysis of school segregation after a generalized choice reform

Relationships among negative and positive

Long-term effects of the Positive Action(R) program

Looking Forward: The Promise of Widespread Implementation of Parent Training Programs

Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources

Reflections on Positive Emotions and Upward Spirals

The Social Responsibility Of Business Is to Increase Its Profits

The Role of Autonomy Support and Autonomy Orientation in Prosocial Behavior Engagement

Psychological flexibility as a malleable public health target: Evidence from a representative sample

Deadly Medicines and Organised Crime

Toward a comprehensive model of antisocial development: A dynamic systems approach

More Evidence That Learning Economics Makes You Selfish

Association of Child Poverty, Brain Development, and Academic Achievement

Konkurrensens konsekvenser: Vad händer med svensk välfärd

Testing Communities That Care: The Rationale, Design and Behavioral Baseline Equivalence of the Community Youth Development Study

Acceptance and Commitment Therapy: Model, processes and outcomes

Acceptance and Commitment Therapy, Second Edition: The Process and Practice of Mindful Change

Competition and School Performance: Swedish School Leavers from 1991-2012

Cultural group selection, coevolutionary processes and large-scale cooperation

The sky-high pay of health care CEOs

The impact of upper-secondary voucher school attendance on student achievement. Swedish evidence using external and internal evaluations

Self-help for stress and burnout without therapist contact: An online randomised controlled trial

Decentralisering, skolval och fristående skolor: Resultat och likvärdighet i svensk

Primary Health Care: Potential Home for Family-Focused Preventive Interventions

An Examination of The Transdiagnostic Role of Delay Discounting in Psychological Inflexibility and Mental Health Problems

Examining psychological inflexibility as a transdiagnostic process across psychological disorders

The behavioral management of anxiety, depression and pain

The Big Short: Inside the Doomsday Machine

Effective Intervention for Serious Juvenile Offenders (NCJ 181201) [Data set

Benefit Corporations: A Challenge in Corporate Governance. The Business Lawyer

Conscious Capitalism: Liberating the Heroic Spirit of Business

Dark Money: The Hidden History of the Billionaires Behind the Rise of the Radical Right

Psychological Stress in Childhood and Susceptibility to the Chronic Diseases of Aging: Moving Towards a Model of Behavioral and Biological Mechanisms

Mass incarceration and children's outcomes: Criminal justice policy is education policy

Salt Sugar Fat: How the Food Giants Hooked Us

An Applied Contextual Model for Promoting Self-Regulation Enactment Across Development: Implications for Prevention, Public Health and Future Research

Reducing Aggression and Impulsivity Through School-Based Prevention Programs: A Gene by Intervention Interaction

Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda

Overdose Death Rates

National Prevention Science Coalition

Nurse-Family Partnership

Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities

The history of student loan debt and soaring tuition rates

Delay Discounting: I'm a k, You're a k

Long-Term Effects of the Communities That Care Trial on Substance Use, Antisocial Behavior, and Violence Through Age 21 Years

A Potential Decline in Life Expectancy in the United States in the 21st Century

Income inequality and depression: A systematic review and meta-analysis of the association and a scoping review of mechanisms

Retraining of Aggressive Boys by Their Parents: Review of Recent Literature and Follow-up Evaluation

Antisocial boys

Sharing the blame: Smoking experimentation and future smoking-attributable mortality due to Joe Camel and Marlboro advertising and promotions

How Much Do Doctors in Other Countries Make? Economix Blog

Priced Out: The Economic and Ethical Costs of American Health Care

Promoting early adolescents' achievement and peer relationships: The effects of cooperative, competitive, and individualistic goal structures

Search of the Organismic Valuing Process: The Human Tendency to Move Towards Beneficial Goal Choices

Psychological threat and extrinsic goal striving

Coercion and its fallout

DOJ: Private prisons are more dangerous than government prisons -for inmates and guards

Highest-paid health insurance CEO earned $22M in 2016

The Wealth Of Nations

Promoting Nurturing Environments in Afterschool Settings

Promoting Afterschool Quality and Positive Youth Development: Cluster Randomized Trial of the Pax Good Behavior Game

Lobbying for Profits: Private Companies and the Privatization of the Welfare State in Sweden (Working Paper 2017:1). Institute for Future Studies

From Helpless to Hero: Promoting Values-Based Behavior and Positive Family Interaction in the Midst of Covid-19

Statement on Corporate Governance

Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: A cluster randomised trial. The Lancet Unleashing the Power of Prevention

From antisocial behavior to violence: A model for the amplifying role of coercive joining in adolescent friendships

The promise of prevention science for addressing intergenerational poverty

Effects of cooperative learning on peer relations, empathy, and bullying in middle school

Mediators of effects of cooperative learning on prosocial behavior in middle school

A componentcentered meta-analysis of family-based prevention programs for adolescent substance use

Evaluation of a School-Based

Preventing conduct problems and improving school readiness: Evaluation of the Incredible Years Teacher and Child Training Programs in high-risk schools

The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention

The Palgrave International Handbook of Basic Income

The enemy between us: The psychological and social costs of inequality

Consilience: Making contextual behavioral science part of the United Ivory Archipelago

This View of Life: Completing the Darwinian Revolution

Evolution as a general theoretical framework for economics and public policy

Evolving the future: Toward a science of intentional change

Evolutionary theory and cooperation in everyday life

Human prosociality from an evolutionary perspective: Variation and correlations at a city-wide scale

Generalizing the core design principles for the efficacy of groups

Rethinking the theoretical foundation of sociobiology

Quantitative relationships in the systematic desensitization of phobias

The effects of poverty on the mental, emotional, and behavioral health of children and youth: Implications for prevention