As a nation, we are constantly monitoring and appraising 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% to 6.7%, about 2.1 million new jobs were created, consumer confidence increased, and the Dow Jones index rose by 26.5%. 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 healthcare. 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.
Recently published results from the 2013 Gallup-Healthways Well-Being Index show overall well-being in the country has dropped from 66.7 in 2012 to 66.2 (out of an ideal 100). Certain states, like North Dakota, Alaska, and Nevada, have greatly increased their well-being in the past year. North Dakota now ranks highest in well-being (surpassing Hawaii, the frontrunner for the past 4 years). The oil boom in North Dakota may explain, at least in part, the increase in the state’s overall well-being.
Though well-being is certainly related to economic factors, such as job creation, the concept is more comprehensive, including other factors important to happiness, health, and the ability to thrive. As such, Alaska and many of the Plains states have high well-being despite not being the wealthiest states in the nation — rather, these states’ residents endorse supportive work environments, describe high emotional health, and evaluate their lives optimistically.
Well-being also relates to health and longevity. States with the lowest well-being, such as Louisiana, Oklahoma, Ohio, Mississippi, and West Virginia, have some of the highest obesity rates and lowest life expectancies. Efforts to improve well-being may lead to better health outcomes not only by improving health behaviors but also by increasing capacity to engage productively in the workplace and community.
So how might we build a system in which we are collectively accountable for our well-being? To start, we should be attentive to 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 policymakers 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 dinner table, or on the nightly news, we will be discussing not only our economic progress, and the number of new patients enrolled in health insurance programs, but also ways in which leaders, organizations, and communities are improving our nation’s well-being.
Cary Gross is a professor of medicine and co-director, Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program, Yale University. Carley Riley is an RWJF Clinical Scholar. Brita Roy is an RWJF/U.S. Department of Veterans Affairs Clinical Scholar. This article originally appeared in the Human Capital Blog.
