Global Approaches to Well-Being: What We Are Learning
Jul 29, 2019, 11:45 AM, Posted by Alonzo L. Plough
What can we learn from other countries about advancing well-being—a notion of health that extends beyond the absence of disease?
Three years ago, it dawned on me that the concept of “well-being” might lead to a world of learning opportunities that could deepen and broaden the Robert Wood Johnson Foundation's (RWJF) work to build a Culture of Health. I was in Copenhagen, at the World Health Organization Regional Office for Europe, for a meeting about the United Nations Sustainable Development Goals and developing measures for well-being. As I listened, I realized that many of us in the United States who were working toward improved well-being were not considering what others around the globe were learning as they incorporated well-being into policy and practice.
We were missing out on insights, for example, from years of research and community engagement underpinning New Zealand’s well-being indicators and recently announced national well-being budget. Officially introduced in 2018, the country’s Living Standards Framework redefines the national government’s priorities and measures of progress. It expands beyond economics to also consider policy impacts on human and environmental well-being.
And just a week after the New Zealand budget made international news, the United Arab Emirates was in the headlines with its National Strategy for Wellbeing 2031, which aims to promote social cohesion and prosperity by improving quality of life.
The idea of well-being has been integral to RWJF’s vision for a Culture of Health from the outset. In the spirit of the World Health Organization’s 1948 definition of health as a “state of complete physical, mental and social well-being, not merely the absence of illness or infirmity,” we have used concepts of well-being to broaden mindsets and strategies to improve health.
For RWJF, well-being includes people’s physical, mental, and social health, and the opportunities they have to create meaningful futures. It considers basic needs, like food, housing, education, employment, and income. It includes social and emotional needs, like sense of purpose, safety, belonging and social connection, and life satisfaction. And it is tightly linked with the well-being of our communities, our environment, and our planet.
But my Copenhagen trip prompted my colleagues and me to dive even deeper into what well-being means around the globe. Knowing that good ideas have no borders, we sought to identify promising practices that could help advance well-being in our own country. We were especially interested in building equity, as well-being approaches require inclusive processes and corresponding shifts in power. Well-being is also an important framework for equity because it is not a finite resource. While economic prosperity for some is often related to growing poverty for others, higher levels of individual well-being tend to increase group well-being.
As we continue our learning journey, we are seeking to understand the impact of these approaches. What do they add to efforts focused on social determinants of health, like income and education levels?
Here are some early considerations to share.
A Holistic Vision
By laying out a wide range of indicators that cross disciplines, a well-being driven approach demands collaboration and yields more holistic, integrated strategies. Rather than focusing narrowly on economic and health outcomes, well-being helps us see a more comprehensive picture, including early warning signs of crises to come.
Think of the isolation, disconnection, and deep worry that preceded the opioid crisis here in the United States. While we focused on job losses and economic declines and time-lagged vital statistics, we overlooked early signs of despair. Had we been measuring indicators of well-being, we might have focused on mental health support and community connection in addition to job creation, which may have led to dramatically different outcomes.
Though every well-being effort is multidisciplinary, formulas for success vary and are customized to account for geographic, cultural, and political context. In Singapore, for example, decades of economic growth resulted in a strictly financial definition of personal success. As people focused solely on building wealth, their health declined. Even the Ministry of Health couldn’t capture attention when it declared a “War on Diabetes.” Eventually, the Ministry of Health and two universities recognized that reversing health crises required a shift in mindsets. Their new “health and wealth” narrative initiative aims to cultivate a cohort of university graduates who embrace this value system, leading to different personal, organizational, and societal decisions.
In the radically different context of Occupied Palestine, most people have spent their entire lives in warlike conditions. There, Birzeit University and its cross-sector partners are using community-based pilot programs to address the trauma of war and its impact on collective well-being. By addressing trauma as a holistic, socio-political issue, rather than an individual “problem to be treated,” advocates are alleviating social isolation and stigma and developing new indicators related to suffering, such as humiliation, insecurity, and deprivation.
To truly promote thriving individuals and communities, well-being approaches incorporate insights from psychology, sociology, economics, public health, and other disciplines. Metrics used to assess well-being encompass not only objective factors like income, but also people’s self-reported life satisfaction. Looking beyond objective data is vital, because simply checking off data boxes does not mean that an individual will experience well-being.
For example, according to one recent study, what people most want from the U.S. Medicaid system is not different interventions or coverage; rather, they want to be treated with respect and dignity regardless of their income, ethnicity, or insurance status. Unfortunately, these lived experiences, which have an undeniable impact on well-being, are not always measured or prioritized.
To ensure that subjective experience is taken into account, an NGO in the United Kingdom—Happy City—combines an objective Thriving Places Index with a simple, five-minute online survey. The Happiness Pulse employs user-friendly technology to measure the emotional, behavioral, and social well-being of individuals, groups, organizations, and communities. This tool is used to map strengths and needs and to evaluate impacts across projects and places.
The idea of well-being draws our attention to the fact that that we are essentially all in this together, even when we do not recognize it. Well-being approaches—including their sensitivity to the profound impacts of issues such as social isolation and injustice—shift our attention and action toward our interconnectedness.
Policies grounded in well-being also draw our attention to interconnection between people and the larger natural world. In Bhutan, for example, since the 1970s, Gross National Happiness (GNH) has provided a more holistic definition of progress than Gross Domestic Product (GDP) can alone. A key component of GNH is the recognition that all beings in the natural world are interdependent, and that the well-being of non-human life on Earth has intrinsic value. Using well-being assessments to guide decision-making, Bhutan has developed innovative natural resource and tourism policies and become the world’s first carbon-negative country.
What RWJF is Doing
In 2018, one of RWJF’s first steps on our learning journey was to convene thought leaders from five continents and 19 countries at the Rockefeller Foundation’s Bellagio Conference Center. The examples I cited above are all based on the work of people we met there. Since then, the participants—many of whom hadn’t met each other or RWJF before—have continued to collaborate, including on a recent Academy Health webinar on leveraging well-being measurement to shift narratives about what matters. We recently published a report based on those global insights and, as part of our Culture of Health series with Oxford University Press, will release a related book in 2020.
We are continuing to observe, test ideas, and explore how to integrate these insights from around the world into how we build and measure a Culture of Health across the United States, from our most rural communities to our largest cities.
Questions to Expand Well-Being Thinking
We encourage you to consider how these insights apply to your work and place. How are you, your organization, your city, or your country defining and pursuing progress? Does that encompass well-being? Who is missing from decision-making about what we value as a society? How does what we measure and report shape our narrative about what matters?
Learn more and sign up to be alerted when free copies of our Oxford University Press volume on well-being become available next year.