Wellbeing and being well

What does being healthy mean? What it does not mean—according to the well worn World Health Organization definition—is the absence of disease.1 More positively than that, as the WHO definition clarifies, health is a “state of complete physical, mental, and social wellbeing.” This classic definition of what it means to be healthy is great—as far as it goes. But what does wellbeing mean? And—at the risk of getting into a definitional loop—is wellbeing essentially the same as being well?

Traditional, largely economic measures—gross domestic product, unemployment rates, etc—have long been recognised as providing only a partial picture of a nation’s progress or wellbeing. But since 2011 (and following an early commitment by the coalition government in 20102) the Office for National Statistics (ONS) has reported on an annual UK-wide survey covering around 160 000 members of the public designed to elicit views about their wellbeing.3 4 The survey asks about satisfaction with life, the extent to which the things they do in life are worthwhile, and how happy and how anxious they feel (box). It also gathers data on personal characteristics and self assessed ratings of health. Data from these subjective surveys of individual wellbeing are now increasingly combined with more traditional measures to provide an overview of national wellbeing.6

Trends in three wellbeing measures show statistically significant improvements over the five years to 2015-16. However, the latest survey suggests that ratings for life satisfaction and doing things in life that are worthwhile have remained statistically unchanged in 2015-16 compared with 2014-15. Whether the increase between these years is meaningful remains moot (fig 1⇓).

Fig 1 Trends in measures of wellbeing and self assessed health in UK, 2011-12 to 2015-16 (95% confidence intervals). Anxiety also improved significantly, falling from an average score of 3.1 in 2011-12 to 2.9 in 2015-165

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There are also statistically significant differences in levels of wellbeing between population groups. Perhaps surprisingly (though the correlates of happiness are not always straightforward), Northern Ireland recorded the highest happiness levels of the four UK countries in 2015-16 (fig 2⇓). Within England, the East Midlands was significantly happier than the North East. And across age groups, happiness levels reduce for 16-24 year olds to a nadir for 45-54 year olds before rising to a peak for 65-74s and then falling again for older age groups. Again, whether the absolute differences—for example, around 0.2 (on a 0 to 10 scale) at the extremes for regional variations—are meaningful or important is moot.

Fig 2 Happiness ratings from 0 (worst) to 10 (best) by UK region, sex, and age group in 2015-16 (95% confidence intervals)5

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But what underlies these differences and trends in wellbeing? International comparisons of life satisfaction suggest that people’s health (as they assess it) is positively associated with their ratings of satisfaction with life (fig 3⇓ 7). And as fig 1⇑ shows, trends in wellbeing measures are mirrored by similar trends in the UK’s average self assessed health rating.

Fig 3 Association between self assessed good health and life satisfaction in selected countries in the Organisation for Economic Cooperation and Development (OECD), 20147

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These suggestions turn out to be an indication of a more solid relation between wellbeing and being well. A study by the ONS controlling for other factors thought to influence levels of wellbeing shows a definite and significant relation between wellbeing and health.8 As fig 4⇓ shows, relative to those rating their health as “good,” lower ratings on four wellbeing measures are correlated with poorer levels of self-assessed health (the reverse for anxiety). In fact, of the factors tested by the ONS study, self assessed health was the most influential.

Fig 4 Association between self assessed health (with those reporting “good” health as the reference) and four measures of wellbeing, UK, 2011-128

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It would seem that improving individual, and hence national, wellbeing might best be achieved through improving people’s health. Whether this would be more cost effective than, say, improving people’s earnings (positively correlated with life satisfaction) remains to be seen.