Well-Being: Expanding the Definition of Progress
Alonzo Plough
288 pages, Oxford University Press, 2020
As communities work aggressively to stop the spread of COVID-19 and look toward recovery, it is vital that resulting policies and practices do more than bolster economies and pursue economic indicators of progress. Our rebuilding approaches must also ensure racial equity and well-being for all people as both our aim and our metric for success.
We have much to learn from other countries that have taken a well-being approach to decision-making, budgets, and policies. In these contexts, well-being is a broad and holistic view of how people are doing. It encompasses basic needs like food, housing, safety, education, employment, and income. It includes social and emotional needs like sense of purpose, belonging, and life satisfaction. And it is tightly linked with the well-being of our communities and our planet.
Well-Being: Expanding the Definition of Progress, based on insights from practitioners, researchers, and innovators from 19 countries and a wealth of perspectives, illustrates what it takes to shift the metrics of success from economics-only concepts to more balanced measures of progress. By exploring how well-being approaches play out in a range of contexts—from Palestine to Nova Scotia, New Zealand to Bhutan—it surfaces insights on measurement, narrative, grassroots engagement and shifts in power, and cross-sector collaboration. Essays by leading US practitioners apply the volume’s insights to the US context.
We hope this book both adds to the science and practice of well-being approaches and provides instructive examples and questions to consider across sectors. — Alonzo Plough
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The Rationale for a Well-Being Approach
Discussion and Case Studies From Bellagio
A well-being approach—that is, establishing well-being as the goal and measure of what matters in order to create a future in which people, communities, and the planet can all thrive—provides a new compass for decision-making, resource allocation, social narrative, and even consciousness. The arrow points to a more comprehensive notion of health, one that focuses not only on disease prevention, but on creating the best opportunity to thrive in all aspects of life. It points away from the idea that money and consumption are the only pathways to progress, and toward a more holistic view of what matters. It shows how policies and actions affect people and communities differently, illuminating unique needs and gaps instead of being satisfied with aggregate numbers. “The focus on inequity [in well-being] is important because that brings in assessment, evaluation, and notions of justice, which is, there’s something wrong with this picture,” says Bellagio participant Jennifer Prah Ruger, Amartya Sen professor of health equity, economics and policy at the University of Pennsylvania.
By defining progress differently—designing new measures of what matters informed by people across the community and building aligned practices, policies, and actions—cities, nations, and society at large can radically expand the definition and pursuit of progress and create more equitable and environmentally sound conditions.
"We all share the feeling that being human, enjoying a good life, and enjoying good health is more than just money and more than just disease. So let’s work together." — Carrie Exton, Head of Section for Monitoring Well-Being and Progress, Organisation for Economic Co-operation and Development, France
The conversations at Bellagio, informed by diverse perspectives spanning geography, perspective, and sector, illustrated the potential for ideas, actions, policies, and authentic engagement of diverse stakeholders that, when combined, can create a powerful pathway to advance well-being and equity. “We’re all critical and we’re all calling for change,” says Bellagio participant Rita Giacaman, professor at Birzeit University’s Institute of Community and Public Health in Palestine. “And that’s very good. But what I think is also important is the realization that we are not alone.”
"I look around and I see so many similarities—not only from southern countries but others as well. But to create change, what we need to do is get together and organize. And this is the first step in doing that. We give power to each other." — Rita Giacaman, professor, Institute of Community and Public Health, Birzeit University, Palestine
Well-Being Benefits and Outcomes
Across the conversations at Bellagio, participants repeatedly highlighted the benefits, positive outcomes, and potential for transformation via a well-being approach. Some of the key points, further explored in this chapter and throughout the book, include the ability of a well-being approach to:
- Shift the focus to things that matter most to people and communities, deeply informed by grassroots engagement.
- Create more urgency to address inequities and shift power by illuminating conditions often masked by other measures and aggregate data.
- Break down structural barriers and “silos” to encourage cross-sector collaboration.
- Link human well-being and environmental sustainability.
- Create a new expectation, demand, and accountability for a well-being approach and a more equitable concept of progress.
- Focus on the future through long-term agendas and intergenerational leadership.
Focusing on What Matters Most
Well-being measures and practices have a unique ability to focus on and quantify essential elements of life that are left out of purely economic frameworks and other models. For example, Bellagio participants discussed the importance of human potential, cultural pride, and sense of purpose as crucial indicators of and goals for progress. These elements are front and center in Nova Scotia, where efforts are underway to replace the deficit-based story of sluggish economic and demographic growth with a mindset of abundance, based on the province’s natural beauty, strong sense of community, high levels of education, and satisfaction with life. This asset-based definition of progress and community identity has the potential to buoy a new sense of collective optimism and inform programs and policies that build on Nova Scotia’s positive attributes.
"We lack clarity and confidence about our place in the world, in part because 'the good life' has been equated with fast economic growth." — Danny Graham, CEO, Engage, Nova Scotia, Canada
In New Zealand, the Indigenous Māori people’s perspective of well-being prioritizes knowing one’s ancestry, exercising rights to knowledge, and expressing culture through acts such as recounting traditional narratives. After engaging people from the Māori tribes and other groups, New Zealand included cultural identity as a well-being domain in its Living Standards Framework.
For Australia’s Indigenous peoples, a well-being approach would show that advancing economic benefits alone isn’t enough. A meaningful life focuses on “the relationship between Mother Earth, our homeland, and ourselves, our kin, our future, and our ancestors,” says Bellagio participant Romlie Mokak, CEO at the Lowitja Institute in Australia. “If the denial of our cultures and our identities results in us only enjoying the same economic outcomes of others, that’s completely sub-optimal, because we’ll lose ourselves as Indigenous peoples to get there,” he says.
In the warlike conditions of Palestine, on the other hand, Giacaman and colleagues are developing new indicators related to suffering, such as humiliation, human insecurity, and deprivation. These critical measures of ill-being can make the often “invisible wounds” of trauma, isolation, conflict, and displacement visible, informing new programs and practices that support people to persist and endure. This radically different approach to well-being can be created only by engaging people to understand what matters to them in their unique situation.
Bellagio participants shared these examples, among others, of how a well-being lens can identify culturally-specific priorities and needs—as well as inequities and injustices—that can be masked by other indicators. This expanded definition of what matters can inform new approaches and create accountability for governments, businesses, and other actors.
This definition can only be created, however, through deep engagement of the grassroots. Listening to people and building trusting relationships with them is key in the iterative and dynamic grassroots engagement process, said multiple conference participants.
"From the lens of our own experiences we can identify clearly the key drivers of change and priorities for our actions at a community and a national level." — Jose Molinas Vega, Minister-Secretary of Planning for Economic and Social Development, Republic of Paraguay
Confronting the Roots of Inequity: Racism, Colonialism, and Protection of the Status Quo
In many parts of the world, inequities are caused by racism, colonialism, gender bias, and other forms of marginalization, which perpetuate structures, systemic inequities, cultural expectations, and narratives that protect and justify the status quo. Part of that status quo is a dominant narrative of economic growth, wealth, and consumption as the ultimate indicators of progress, which tacitly accepts a level of inequity as a norm. This, in turn, has shaped mindsets and behaviors and led to policies and systems that support economic inequality and the denial of basic human rights. Communities of color, Indigenous communities, and others subjected to persistent racism are denied voice and power, creating a generational cycle of oppression that impedes both current and future well-being.
"The status quo is the problem. It’s not just an economic argument." — Jennifer Prah Ruger, Amartya Sen Professor of Health Equity, Economics, and Policy, University of Pennsylvania, United States
A focus on well-being has the potential to disrupt this status quo and to build currency for more equitable indicators of progress, shifting the narrative in powerful ways and driving changes in actions, policies, and practices that address inequity.
“Equity should be considered as a meta-indicator for all dimensions of well-being,” says Éloi Laurent, senior economist at the Sciences Po Centre for Economic Research in France. Laurent stressed the need for disaggregated data that expose inequities along gender, racial, age, socioeconomic, and other dimensions to be useful and accurate for policy. “The way we choose to see, measure, and value these inequities (as opposed to the ones that remain invisible) depends on normative judgments and priorities that should be explicit.”
Well-being data and concepts, designed in a collaborative way with communities, can show how inequities thwart progress, setting the stage for new narratives, policies, and other actions that advance both the well-being framework and equity.
Shifting Power
The lens of well-being brings problems into focus, provides early warning signs of conditions that can spiral into crises, and clearly shows how groups do not share equally in access to prosperity and in positions of power. These are the “stories that the standard numbers often do not tell,” as Bellagio participant Carol Graham, Leo Pasvolsky senior fellow at the Brookings Institution, and a professor at the University of Maryland, discusses extensively in chapter 3.
A well-being approach also clarifies power distribution, identifying groups that lack both representation and the full inclusion and power that make representation meaningful. For example, the aboriginal and Indigenous peoples of the world—making up about 370 million people in more than 70 countries—need a “voice with teeth,” says Bellagio participant Walter Flores, executive director of the Center for the Study of Equity and Governance in Health Systems, based in Guatemala and working globally.
"We can’t advance a global agenda of well-being if we ignore 370 million Indigenous people that think differently than we think." — Walter Flores, executive director, Center for the Study of Equity and Governance in Health Systems, Guatemala
As an illustration of how lack of inclusion and power among Indigenous peoples leads to exclusionary policies that harm well-being, Flores says, “You cannot experience well-being unless your territory and the environment are being protected, because your survival depends on that.” In Latin America, for example, Indigenous peoples told the government that they do not want destructive industries in their territories, citing the record of pollution in rivers and lakes. This can set up a clash between the quest for economic growth and the needs of the people. A well-being approach can encourage governments to listen to these groups, respect and act upon their preferences, and, ultimately, to shift power dynamics to include their voices in leadership and decision-making.
Fostering Collaboration
A well-being approach can bring together people in fields such as health, economics, housing, education, and environmental protection, and can link the private and public sectors. “The well-being message and the well-being program are widely supported by lots of different groups in society,” says Bellagio participant Tim Ng, deputy secretary and chief economic adviser of The New Zealand Treasury. As a commonly accepted framework for measuring progress, well-being brings diverse partners to the table and can lead to the development of equitable practices, programs, and policies that enable all people to lead the best lives possible. In Nova Scotia, for example, people from environmental groups, industry, anti-poverty groups, sports, academia, government, and community groups are working together to enhance the province’s well-being framework.
By creating space for collaboration and alignment—a space where everyone can see themselves and their contributions—a well-being approach creates an opportunity for far more efficiency and impact. This includes the opportunity to link networks, social movements, agendas, financial and investment models, and other efforts, and a safe space to experiment. Benefits include encouraging open deliberation by governments and public participation in policymaking, deeply engaging grassroots organizations, and identifying opportunities for change.
Linking Well-Being of People and the Environment, Symbiotically
A segment of emerging well-being measurement, particularly in Western cultures, tends to be anthro-centric, looking first and foremost at the human condition. But for eternity, many Indigenous communities and environmentally focused cultures have taken an eco-centric approach, tightly connecting human well-being to environmental sustainability and the intrinsic value of the land to a culture or community.
Bellagio participants discussed the ways that well-being approaches, with their more holistic view of progress, can seamlessly link human and environmental conditions more effectively than other models. For the Indigenous peoples of Australia, Latin America, New Zealand, and North America, human well-being is inextricably linked with environmental sustainability and the intrinsic value of the land to the community. In Bhutan, a key component of the well-being approach is the interdependence of people and the natural world in the web of life, a perspective that has led to landmark environmental protection policies and resulted in Bhutan being the first carbon-negative nation.
As a result of climate change and other environmental crises, more attention is being given to the intersections of environmental and human health, the disparities of environmental justice, and the opportunities created by approaches that sustain health, life, and resources. Bellagio participant Laurent wrote about this connection in a paper he prepared for the Bellagio gathering: “Inequality increases the need for environmentally harmful and socially unnecessary economic growth, increases the ecological irresponsibility of the richest, diminishes the resilience of communities and societies, and weakens their collective ability to adapt to accelerating environmental change. It reduces the ability to offset the potential socially-regressive effects of environmental policies.”
Creating a New Expectation, Demand, and Accountability for Well-Being
As countries and cities prioritize well-being thinking and take different actions, individual and collective consciousness shifts toward the well-being of people, communities, and the planet. Consciousness shifts from a priority on economies that grow whether people thrive, to a priority on creating equitable and sustainable conditions for people to thrive that does not depend solely upon economic growth. Rather than being pulled by immediate and short-term gains, the compass will be guided by an intergenerational approach that plans for the future.
The way that people interpret data and conditions and develop solutions is likely to change under this new consciousness. “Me-first” behaviors, such as amassing tremendous personal wealth or making choices about natural resources that deplete the environment, will become less appealing as a well-being consciousness takes hold. Measures and definitions of progress will better align incentives with collective benefit, such as funding strong education systems and planning growth in ways that facilitate global sustainability and equity.
Bellagio participant Claire Nelson, lead futurist of the Futures Forum in the United States and the Caribbean, imagined life in 2030 under a well-being framework. “There’s been a positive shift in our consciousness of who we are as humans to something that’s global, planetary, and collective,” she envisioned. If evolutionary, or eco-centric leadership and planetary consciousness were to become common ideas that people understood and took for granted, the use of resources to achieve a culture of well-being globally could be significantly improved, she says. A G-7-like organization focused on advancing well-being instead of economic growth could be established. Leaders in global organizations, such as the World Bank and the United Nations, could be trained, and future leaders could be groomed to work for the benefit of human and planetary well-being rather than personal gain.
"Let’s throw out some of the old ideas of what leadership looks like and teach them what it means to be a leader in a global planetary society." — Claire A. Nelson, Lead Futurist, The Futures Forum, United States and the Caribbean
With this shift in consciousness and expectation comes a collective challenge to historic assumptions and systems, and the tipping point to a focus on a well-being approach. “Very few radical shifts in society have taken place because of measurement or because we had data. It has usually required a social movement and people organizing in order to shift power,” says Bellagio participant Mallika Dutt, founder and director of the global initiative Inter-Connected.
"The most important task is to build the constituency that will be demanding and putting pressure on the authorities about a well-being agenda." — Walter Flores, executive director, Center for the Study of Equity and Governance in Health Systems, Guatemala
Nelson noted the power of the grassroots as a force in creating a well-being culture. It takes just 10 percent of a population to be committed to an idea for that idea to spread, according to a study by researchers at Rensselaer Polytechnic Institute.1 This means that about 700 million of the world’s 7 billion people would need to be committed to well-being. With about 370 million Aboriginal/ Indigenous people who already believe in well-being, Nelson reasoned, that’s about half of the people needed to create change. “So now it doesn’t seem so impossible,” she said.
Grassroots engagement is vital in both defining meaningful indicators and building community expectations for implementing a national well-being approach. If that engagement has been built, then “Once a country is ready to consider well-being indicators, a lot of the work will have already been done, and a lot of the politicians and others will already be on board,” says Julia Kim, program director of the GNH Centre Bhutan, and Bellagio participant.
Focusing on the Future and Intergenerational Leadership
“We’re trying to create an elbow in the road that is fundamentally different from what had been before,” says Bellagio participant Danny Graham, CEO at Engage Nova Scotia. “We’re in the very early days of that elbow in the road. And in 50 years’ time, it’s probably still going to be very early in the days, given the size and complexity of this work.” Bhutan, for example, first implemented its well-being approach in the 1970s and continues to refine and expand its application today, adapting to shifting realities and needs of its population in a global society. Well-being is not an end point, a destination to reach and declare victory. It evolves and emerges as “what matters most” changes, always with an eye toward the future.
A well-being approach facilitates this kind of long-term agenda setting. The New Zealand Treasury’s well-being framework is a good example of this. Introduced in 2011, the Living Standards Framework informs policy development and resource allocation across the government. The Treasury’s 2014 statement on the fiscal position for the next 40 years included future well-being challenges and considerations. The New Zealand government’s 2019 well-being budget was designed to address the needs of both current and future generations.
"If you are serious about future generations, then you need to recognize the tradeoff between drawing down capital to fund initiatives for the current population at the expense of future populations." — Tim Ng, Deputy Secretary and Chief Economic Adviser, The New Zealand Treasury
To be truly future-oriented, a well-being approach must commit to intergenerational leadership, both to inform policies that will affect today’s young people now and in the future, and to prepare future leaders to stay the course. Young people in their teens and twenties must be part of determining what matters most and developing and implementing well-being measures and actions, working alongside wise elders and experienced practitioners to question the status quo and existing assumptions.
Well-being initiatives around the world are focusing on engaging youth and intergenerational leadership. In Singapore, the Ministry of Health and two major universities are collaborating on a national initiative to develop future leaders who will adopt a “health and wealth” mindset over the dominant “wealth-first” mindset. Schools in Bhutan have a Gross National Happiness (GNH) curriculum to help young people understand GNH and to counteract increased exposure to a materialist culture through social media. Initiatives like these are “creating a new generation of people with a different value system,” says Bellagio participant Kee-Seng Chia, founding dean of the National University of Singapore’s School of Public Health.
The Path Ahead and the Vital Need to Ensure Equity
While participants agreed that a well-being approach can, and in many cases already does, provide many benefits and positive outcomes, we must “be careful to think about the enabling conditions for well-being in the local context,” says Kim. Key among these are truth telling about history and experiences, and ensuring that benefits are equitably shared.
Truth Telling Is Essential
A well-being approach must address underlying causes of inequity, including systemic and structural racism. Truth telling is an important first step in the process. Only by revealing the truth of history, experience, and impact can there be healing and creation of a different future together. Blocking the truth cuts off power, as seen worldwide in the inaccurate and detrimental anti-migration narrative that continues to gain ground. Inequities due to racism have gotten far too little attention. “Since nobody wants to talk about racism, can we, as a proxy, use well-being as a variable in the Americas?” asks Nelson.
"Communities of color historically continue to be on the short end of the stick with respect to structural oppression." — Anita Chandra, vice president and director RAND Social and Economic Well-Being, RAND Corporation United States
Truth telling also involves reconciling cultural narratives and policies that have been unfavorable to some groups of people for many generations. For example, the Aboriginal and Torres Strait Islander people in Australia, whose cultures have existed for more than 60,000 years, have been living under colonization since the 1770s. According to Mokak, Australian governments try to steer the aboriginal people toward a Western lifestyle, ignoring their right to self-determination and their well-being directly connected to environmental sustainability. “There’s very little trust between governments and Indigenous peoples,” says Mokak.
"Those who have arrived on our lands are not willing to own up to the truth of the history of the country." — Romlie Mokak, CEO, Lowitja Institute, Australia
Well-Being’s Potential to Illuminate and Address Inequities
“We have plenty of evidence showing that with new policies, the better-off benefit. It takes years for the worse-off to benefit from a new policy,” says Flores. Carol Graham makes the argument that focusing on well-being may help mitigate this. While increases in average income often reduce the well-being of those below the average, she says, higher levels of average well-being tend to increase total well-being for all.
Still, great care is needed to ensure that well-being measures, policies, and actions are created collectively, with many voices and an inclusive power structure. Measures, policies, and actions must also be designed to illuminate and address inequities. They must reflect what matters most to people and communities, and not be another top-down approach. “We must ensure that one person’s well-being doesn’t supplant the well-being of others within the society,” says Bellagio participant Richard E. Besser, president and CEO of the Robert Wood Johnson Foundation.
Conclusion: Well-Being Is an Imperative Now
“The well-being agenda isn’t one that we’ve invented in different places. It is deeply embedded in the wisdom and traditions of people and in the lived experiences, aspirations, hopes, and values of people all over the world,” says Dutt.
There is growing interest in the well-being approach as a way to define progress and to drive policies and practices based on what matters most to people and communities. Significant progress has been made in well-being measurement and its application to improve lives. International bodies have refined indicators and global commissions have advocated for including well-being in measures of progress. Some cities and countries are beginning to use well-being indicators to set policy and measure progress. “This is the moment to use the huge body of evidence on well-being and why things like equity matter,” says Carol Graham.
And there is increasing urgency for a shift. In this time of great human conflict, displacement, and deaths of despair, there is a tremendous need for improved well-being. Economic indicators alone have failed to quantify and address increases in inequity, grave disparities in lived experiences, unsustainable draws on natural capital, and serious damage to intergenerational prosperity. Mounting measures of despair, and the nearly unprecedented levels of global migration due to violence and environmental change, demand a change in approach and an urgency for action.
Taking a well-being approach has the potential to inform choices that address inequity; improve the health and vitality of people, communities, and planet; and increase intergenerational equity. The time to move from measuring well-being to taking actions to improve well-being is now. “Could well-being be that creative emergent space for us to build the world that we all hold in our hearts differently than the structures that have gone before?” asked Dutt.