Well-being: An Overused Term, Now Poised to Transform Healthcare

A healthcare system that prioritizes maintaining health over fighting disease needs behavioral health at its core. Why? The answer is best captured in the slogan that there is no health without mental health. A slight modification of this, that there is no health without well-being, has more global appeal since many countries find the concept of well-being more palatable than mental health.

The World Health Organization (WHO) launched this focus in 1948 by defining health as more than the absence of disease and highlighting well-being. The Robert Wood Johnson (RWJ) Foundation has expanded this work by studying best practices globally in promoting a culture of health. This culminated recently in major conferences and publications on well-being. Our industry is not paying adequate attention.

The economics of waiting for diseases to develop never made sense, and RWJ thought leaders are insisting that health must now be our focus. Our field can have a pivotal role through the concept of well-being. This is unique since diagnosis generally drives the focus in healthcare, and our diagnostic conditions are stigmatized. Yet well-being is celebrated, and we know many keys to unlocking it.

The first challenge is to highlight this as a scientific issue, not a feel-good, humanistic crusade. There are many ways for our field to take ownership of well-being, but measuring the concept is a good start. We can debate definitions (using related terms like contentment or thriving), but a sturdy measure may be more valuable than a neat definition. We are well-equipped for this psychometric work.

Therapists may guide people through despair, and yet they realize that positive self-esteem and emotional resiliency do not appear once depression, anxiety or substance use diminish. We all desire a sense of well-being, and the reality is that there are skills for building psychological assets just as there are skills to dismantle negative psychological states. Well-being is more than the absence of distress.

Few among us are as versatile as the eminent psychologist Martin Seligman. His earliest work gave us landmark studies of depression, followed by the creation of a new paradigm, positive psychology. This flexibility in outlook is precisely what a dedication to health demands. We must understand not only how trauma damages children, but also how parental warmth and vitality shapes healthy children.

Most issues in healthcare are framed by diagnosis. This is the launching pad for the medical model. Yet well-being does not originate in disease and pathology. It is the world of assets and positive health outcomes. Our traditional focus on identifying risk factors and mitigating deficits must shift to exploring how to build strengths and improve overall health. Humility is needed since we have much to learn.

We have behavioral health clinicians with expertise in positive psychology, and they tend to work in isolation from those focused on the burden of clinical disorders. Each has skills and knowledge, and we need to support specialization within a context where both orientations get prioritized and funded. Every clinician should know something about both psychological domains.

Healthcare is a wealthy industry with political battles for control like any other. Well-being is an opportunity for us to gain influence in the healthcare system. The WHO definition of health as “physical, mental and social well-being” was prescient. Behavioral healthcare hardly existed then. Our field is poised to ride the mission of well-being into a healthcare world now welcoming this expertise.

A focus on well-being is also a useful bridge between behavioral and primary care. While behavioral health conditions may present the most significant strain on the well-being of a person or population, the greatest opportunity to implement population-wide prevention strategies is within the primary care setting. This is another reason for having an ample supply of primary care therapists or PCTs.

Another benefit of focusing on well-being is that it helps our field address issues of health equity. Well-being is increasingly being considered as a marker of progress. It reflects how well people or groups are getting their needs (as in Maslow’s hierarchy of needs) met. RWJ has examined these social issues across many countries. Their report summarizes the value of well-being in this way:

One of the fundamental benefits of using well-being as a definition of progress is that it builds in increasing equity (ensuring that everyone has what they need) and addressing inequities (unfair, avoidable differences in opportunity) as a core goal and driver for policy and practice choices. (page xii)

RWJ views well-being as a critical way of defining and measuring progress for populations. They want to go beyond the usual economic measures to assess how well populations thrive and show resiliency in the face of stress. Progress may soon be tracked as changing levels of wealth and well-being. This could be not only a new way to understand progress, but also a welcome new phase for our field.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.