Creating ‘wellbeing societies’: moving from rhetoric to action July 2023, Volume 33, Issue 2

Background

The 21st century has seen a series of complex and interrelated crises – a global pandemic, escalating geopolitical conflicts, economic downturns, natural disasters – many climate-related – with each of these crises affecting countries in different ways. These have had, and will have, profound implications for population health.

The last two decades have also been marked by technological, climate and demographic changes, including urbanisation¹, ageing populations², biodiversity loss, and digital transformation³, which have rapidly changed how societies operate and challenged the health and wellbeing of people and communities across the globe. This is reflected in increasing rates of noncommunicable diseases^4,5and mental health conditions.⁶ The coronavirus disease 2019 (COVID-19) pandemic has exposed the fragility of social and health systems and exacerbated inequities.⁷

The pandemic has highlighted the important role of population health in all aspects of society and elevated recognition that health and health systems are central to a thriving and economically viable nation.⁷ It has strengthened the arguments for investing in health and health systems and the critical role played by multisectoral collaboration and coherent action across government sectors in delivering effective and responsive policy actions and actions that protect and improve population health. Finally, it has reinforced the need for better structures and mechanisms operating at the local level to support the engagement of local authorities and communities.

COVID-19 has also brought into sharp focus that the health of people and planetary health are deeply entwined and cannot be disentangled and that this needs to be the central focus of social, economic, diplomatic and innovation agendas. In recognition of these systemic challenges, the UN Secretary-General António Guterres said that: “The response to the pandemic, and to the widespread discontent that preceded it, must be based on a New Social Contract and a New Global Deal that create equal opportunities for all and respect the rights and freedoms of all… [This] New Social Contract, between governments, people, civil society, business and more, must integrate employment, sustainable development and social protection…”⁸

As emphasised in the World Health Organization (WHO) Geneva Charter for Well-being, this new social contract must better account for the things that matter to people, such as health, education, employment, social welfare, safety and security, family and social connections, reliable access to shelter and food, and a healthy and biodiverse environment. In doing so, it should also focus less on economic measures and indicators, such as gross domestic product. Such a contract would then enhance the trust between people and their governments and help mitigate the mass protests and disruption that occurred during the pandemic, and seen more recently in countries such as France.

The United Nations Research Institute for Social Development (UNRISD) has further developed the social contract proposal to recognise that this new contract must also be between people and planet and has introduced the notion of the “eco-social contract” as a strategy for tackling the twin crises of inequality and the environment. The Institute has argued that: “only if we rebalance existing power structures and create new alliances can we achieve transformative change. Progressive political leaders, inclusive coalitions, active citizens and social movements need to come together to co-create a new eco-social contract for climate and social justice”.⁹

A key concept that helps drive the move towards a new social (or eco-social) contract is the term “wellbeing”. It can act as a rallying cry in our interconnected world as it can potentially translate the aspirations embedded in the United Nations 2030 Agenda for Sustainable Development¹⁰ and support improved governance, policy coherence and sustainability in ways that do no harm and leave no one behind.

Creating ‘wellbeing societies’

The WHO has always acknowledged the value of the concept of wellbeing and framed it as a positive and holistic approach. This is evidenced in its definition of health, first released in 1948. The WHO Constitution defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.¹¹ This goes beyond the previously dominant biomedical model to reflect a comprehensive understanding and holistic approach to health, influenced by biological, social, and environmental determinants.

Recent years have seen a renewed interest by WHO in the notion of wellbeing as a unifying concept to build on the strategies of health promotion and the social determinants of health, and engage other sectors and communities, to accelerate action on the Sustainable Development Goals (SDGs). Early references to the wellbeing economy and the SDGs were made in the 2016 Shanghai Declaration and its Guide to national implementation, stating: “Transforming policy orientations entail a series of approaches that will drive policy and together constitute a different approach to measuring societal progress. Recent literature on the concept of a ‘well-being economy’ as a new economic paradigm provides a deeper understanding of the different types of transformations that are essential elements of the Agenda 2030 process”.^12,13

Today, wellbeing is framed within the broad definition of 1948 and as a positive, aspirational aim.¹⁴ The notion of wellbeing has been extensively discussed in recent decades, with several frameworks and measurements developed to capture the multidimensional nature of this concept, such as the Organisation for Economic Co-operation and Development’s Economy of Wellbeing¹⁵ and the Report by the Commission on the Measurement of Economic Performance and Social Progress.¹⁶ The breadth of the concept, which covers physical, mental, and social parameters, can lead to diverse views and contested definitions. At the heart of the concept is the quality of life experienced by all people. In recent times, the role of planetary health has been included, as without a viable planet, it is impossible to live a quality life and experience positive wellbeing. Many of the wellbeing frameworks that have been developed share common principles, such as: universal human rights; social and environmental justice; sustainable development; solidarity; equity; bioethics; gender and inter-generational parity; interculturality; and peace.

The shift to societal wellbeing and the development of a new social contract captures the various dimensions of society: the natural environment; the social fabric; economic development and the innovations that serve people and the planet; and the interplay of diplomatic relationships. Current and widely accepted economic and governance models have shown their limitations, and many scientists and expert commentators suggest there is no choice but to shift our current models to ones more reflective of societal needs and more responsive to the needs of people and the planet.^17,18 International agencies will play an important role by supporting countries to reorient their structures, budgets, and accountability measures to align with this new paradigm.

Evidence shows that some nations – including New Zealand, Scotland, and Finland – are beginning to embrace the notion of wellbeing and using it to frame budget and policy decisions through ‘wellbeing budgets’ and other mechanisms.¹⁹ Reorienting traditional economic models away from an over-reliance on gross domestic product (GDP) and other macroeconomic indicators is essential. The wellbeing economy movement proposes new models and pathways to support nations in making these critical shifts, to help create a more sustainable and just society. The movement seeks to builds innovative, adaptive and responsive systems that are collaborative and multisectoral by nature, working across boundaries to deliver joined-up responses to societal challenges and opportunities.²⁰

Shaping a global agenda on achieving wellbeing through health promotion

Within this global context and building on the legacy of the wellbeing economy movement, the social determinants of health²¹, and primary health care²², the WHO has engaged in several initiatives over the past few years that collectively aim to achieve wellbeing at both the individual and societal levels.²³ At the individual level, the Definition and Framework for Adolescent Well-being²⁴ was developed in 2020 by WHO with the Partnership for Maternal, Newborn & Child Health and in collaboration with the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being. The Framework comprises five interrelated action domains underpinning adolescent wellbeing and calls for multi-sectoral policy and programming actions.

At the societal and governance level, the WHO Council on the Economics of Health for All was established in November 2020 by the WHO Director-General to reframe how health and wellbeing are measured, produced, and distributed across the economy. The Council calls for “a new narrative that transforms financing for health from an expenditure to an investment in a ‘healthy society’”²⁵ and works towards reframing the value of health, put simply: “no amount of tinkering with GDP as the measure of progress can address the fundamental schism between the goal of Health for All and what our society values today. Instead, the things that we ought to value must take centre stage in decision-making”.²⁶ Furthermore, the WHO European Office for Investment for Health and Development in Venice, Italy (the Venice Centre) underscored the need for a paradigm shift to reconsider the relationship between health and the economy. In March 2023, the Centre hosted a high-level forum on health in the wellbeing economy, with the intention of issuing a call for action from participants entitled “Shifting to well-being economies – investing in healthy, prosperous lives for all”.²⁷

In December 2022, following the WHO 10th Global Conference on Health Promotion, “Health Promotion for Well-being, Equity and Sustainable Development”, and participants’ endorsement of the Geneva Charter for Well-being²⁸ at the 75th World Health Assembly (WHA), Member States requested the WHO Director-General to develop a framework for achieving wellbeing. From a health promotion perspective, this framework aimed to build on the 2030 Agenda for Sustainable Development with its 17 Sustainable Development Goals (SDGs). Since then, extensive consultations have been held with Member States to develop a global framework for integrating wellbeing into public health using a health promotion approach. In May 2023, the Global Well-being Framework²⁹ was presented and adopted at the 76th WHA.³⁰

The Global Well-being Framework presents six strategic directions to promote societal wellbeing. It ties these together with suggested effective policy orientations drawn from the global health community and country-level experience. This Framework lays the foundation for engaging multiple sectors and stakeholders to join forces, act coherently and coordinate, and build societal wellbeing by promoting the health of people and the planet sustainably and equitably. It calls for joint actions that trigger mutual benefits by working towards a shared goal of creating a society that is conducive to the wellbeing of all. For example shifting agricultural production from tobacco leaves to sustainable food production. It also recommends six strategic directions that focus on:1) nurturing planet Earth and its ecosystems; 2) designing social protection and welfare systems based on equity, inclusion and solidarity; 3) designing and supporting implementation for equitable economies that serve human development; 4) promoting equitable universal health coverage through primary health care, health promotion and preventive services; 5) promoting equitable digital systems that serve as public utilities, contribute to social cohesion and are free of commercial interest; and 6) measuring and monitoring wellbeing. It calls for joint actions that trigger mutual benefits by working towards a shared goal of creating a society that is conducive to the wellbeing of all.

To generate the expected impact, these strategic directions should constitute part of a national governance system based on a ‘whole-of-government’ and ‘whole-of-society’ approach.

From rhetoric to action

The global movement towards wellbeing is building a strong narrative that includes wellbeing economies, social protection, and individual wellbeing, as well as protection of the environment and the planet. The choice to move to a ‘wellbeing society’ is a political decision, just as “health is a political choice” as stated in Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development. The future of humanity and the planet are critical ethical decisions and should not just be a matter of return on investment or value for money.

Several countries have started integrating wellbeing into national development agendas and have developed national policy strategies, mainly to address environmental and social equity imperatives, including climate change, preservation of biodiversity and social protection. These actions have been translated into new models of governance that bring all sectors together to define the problems and solutions to be part of the equation and to reorient financing systems. Hence, they are able to better reflect and account for what is important.

Research shows that various countries have approached the integration of a wellbeing agenda at the governance level through³¹:

1. Measuring national progress to serve as a more sensitive barometer to track progress towards societal wellbeing, in countries such as Bhutan, Bolivia³², Ecuador and Iceland
2. Rethinking economic models to restore harmony between human societies and the natural world, to ensure a fairer distribution of resources and to build more resilience, for example, in Finland, Iceland and the United Arab Emirates
3. Building on traditional Indigenous knowledge of promoting health and wellbeing through education and the provision of services in the ancient traditions, with respect to the planet, for example, in India and Ecuador³³
4. Resource allocation and budgeting processes, for example, in New Zealand and China.³⁴

Although these country’s approaches differ and are tailored to their specific contexts, there is a common thread – the wellbeing concept. It brings various sectors together to act in a coherent manner, it mainstreams the importance of the planet and human health for the current and future generations, and it should be supported by a governance system guided by a whole-of-government and societal approach.

Conclusion

The complexity of the challenges affecting public health has no borders and requires a multifaceted response. A wellbeing approach provides a critical pathway to bring various sectors and stakeholders to act in a coordinated and coherent manner as suggested by the SDGs.

While there is a growing recognition of the need for a paradigm shift by countries and decision makers, particularly since the COVID-19 pandemic, still much is needed to bring about a positive transformation in terms of building a common understanding and consensus around the wellbeing approach. Building more equitable, accountable, resilient societies and communities requires adapted governance systems, progressive political leadership and participatory decision-making processes.

WHO will support high-level advocacy, convene expert consultations, support research and develop resources for policy advocacy and capacity enhancement through effective partnership, research and capacity development.

Acknowledgements

VL is a member of the PHRP Editorial Board International Panel. She had no involvement in the review or decisions on this manuscript. CW is Founding Director, WHO Collaborating Centre for Advancing Health in All Policies Implementation.

Peer review and provenance

Internally peer-reviewed, invited.

Copyright:

© 2023 Ben Abdelaziz et al. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms.