A Call for Better Measures: The Well-Being of a Population is Consequential
Cary Gross, MD, is a professor of medicine and co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at Yale University. Carley Riley, MD, MPP, is an RWJF Clinical Scholar and Brita Roy, MD, MPH, MS, is an RWJF/U.S. Department of Veterans Affairs Clinical Scholar. This post is part of the “Health Care in 2014” series.
As a new year begins, we are inundated with information summarizing the prior year: the top 10 movies, most newsworthy moments, and worst Hollywood breakups. Yet the topic that draws the most attention is the economy and our financial health. We gather a tremendous amount of information to assess this. The Census Bureau randomly selects 60,000 households each month, unleashing a swarm of 2,000 field representatives to track down the selected participants and assess their employment status. The Bureau of Labor Statistics surveys 500,000 businesses to estimate job creation. Approximately 5,000 “consumers” are surveyed each month to gauge their confidence. And so on.
So there you have it: we know that in 2013, the unemployment rate decreased from 7.9 percent to 6.7 percent, about 2.1 million new jobs were created, consumer confidence increased, and the Dow Jones index rose by 26.5 percent. Certainly, the health of the national economy is important, but is this the type of health that really matters most? When envisioning a healthy life, many people think about the sort of health that allows us to engage in enjoyable activities, maintain strong interpersonal relationships, and feel that our lives have purpose. A full assessment of health—of individuals, communities, and the country—should assess these dimensions.
Aren’t we already awash in data about health and well-being? Yes and no. There are abundant data concerning insurance status, prevalence of diseases, and utilization of health care. Additionally, large national survey efforts through the Centers for Disease Control and Prevention gather information on disease risk factors and health behaviors. But well-being is not captured by these data. Well-being is a comprehensive construct accounting for interwoven facets—such as physical, mental, and social health—that together comprise a global assessment of true health. It refers to a positive state of health that allows for the pursuit of meaningful activities, formation of a cohesive social network, planning for the future, and coping with, overcoming, and even growing from negative events.
A few efforts to assess the well-being of populations are underway, such as the Gallup-Healthways Well-Being Index, the Organisation for Economic Co-operation and Development (OECD) Better-Life Index, and the Quality of Well-Being Scale (which was recently added to the National Health Interview Survey). These indices incorporate multiple components of well-being, including emotional and physical health, work-life balance, community evaluation, civic engagement, health behaviors, and life satisfaction, into composite measures that can be tracked over time.
Well-being of a population is not only measurable—it is consequential. International leaders are starting to pay more attention. In 2011, the OECD Better-Life Index began to compare well-being among nations. Countries with high well-being—such as Switzerland, Norway, and Australia—enjoy greater income equality and social trust as well as better physical health with lower mortality, infant mortality, cardiovascular disease incidence and obesity. Notably, these countries invest more in health care, education, job training, transportation, and stress-reduction programs.
Compared to other OECD nations, the United States ranks low in many components of well-being.
How might we build a system in which we are collectively accountable for our well-being? To start, we should actively measure multiple dimensions of health, to assess well-being at the local, state, and national levels. Imagine if we had a monthly report on health and well-being that became a part of the national discourse. This would not only hold policy-makers and organizations accountable but also provide information to fuel innovation in legislation and programs that would promote well-being and raise all of our health.
So perhaps at the end of 2014, we will be discussing not only our economic progress, and the number of new patients enrolled in health insurance programs, but a top 10 list of ways in which leaders, organizations, and communities are improving our nation’s well-being.