- Paul DalzielPaul DalzielLincoln University
- and Trudi CameronTrudi CameronLincoln University
A strong social gradient in the experience of health means that a person’s health tends to reflect social position. There is strong evidence that average health outcomes in a country tend to be poorer when income inequality is greater. Consequently, public health policy is influenced by a country’s economic situation. Adopting principles in the Helsinki Statement on Health in All Policies, this means governments should pay attention to the public health implications of its economic policies, moving beyond simple analyses of how policy might support growth in gross domestic product.
Since 2009, a global movement has aimed to shift the emphasis of economic policy evaluation from measuring economic production to measuring people’s well-being. This approach is known as well-being economics. Many countries have engaged with citizens to create their own national well-being framework of statistical indicators. Some countries have passed legislation or designed new institutions to focus specific policy areas on promoting the well-being of current and future generations. A small number of countries are attempting to embed well-being in their core economic policies. Further policy work and research are required for the vision of a well-being economy to be realized.
- Environmental Health
- Public Health Policy and Governance
- Theory and Methods
The development of industrialization and bacteriology in the 19th century led to modern public health concerns such as global epidemics, poverty and inequity, climate change, health in all policies, and social factors in health and illness (McQueen, 2017). As this list illustrates, economic conditions have profound impacts on a nation’s health levels that go beyond a simple correlation with per capita gross domestic product (GDP). This has implications for public policy, including economic policy. The Strategic Review of Health Inequalities in England has documented some of these implications. After demonstrating a strong social gradient in health, meaning that a person’s health tends to reflect social position, the review urged action across all social determinants of health such as economic inequality (Marmot, 2010).
That recommendation is consistent with a wider conceptual framework known as Health in All Policies (HiAP). The Helsinki Statement defines HiAP as “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity” (World Health Organization [WHO], 2013). Applying this approach to economics, governments should pay attention to the public health implications of its economic policies. This requires more than simple analyses of how policy might or might not support growth in GDP, especially given that greater economic inequality in a nation is associated with significantly worse health outcomes (Wilkinson & Pickett, 2009).
A strong global movement advocates adoption of measures beyond GDP to evaluate national economic performance. The momentum of this movement increased sharply after the Commission on the Measurement of Economic Performance and Social Progress recommended a shift in emphasis from measuring economic production to measuring people’s well-being (Stiglitz, Sen, & Fitoussi, 2009). Since then, many countries have developed dashboards of statistical indicators to monitor national well-being across multiple dimensions (Exton & Shinwell, 2018). Some countries are also moving to embed well-being into core economic policy, including delivery of the world’s first well-being budget by the New Zealand government in 2019 (Robertson, 2019). This policy approach aims to foster what is being called a well-being economy (Hough-Stewart, Trebeck, Sommer, & Wallis, 2019).
This article provides an overview of well-being economics, with particular attention to public health. The first section (“Well-Being Economics”) explains what is distinctive to well-being economics and focuses on three key elements: human capabilities, planetary boundaries, and future generations. The section finishes with a discussion of recommendations to move beyond GDP as a measure of economic performance. The remainder of the article addresses each of the three key elements in turn. The section on “The Capabilities Approach to Well-Being” focuses on the framework introduced by Amartya Sen, whose work has been influential in designing national well-being frameworks to monitor economic performance using a broad dashboard of statistical indicators across diverse domains of well-being. This is illustrated with examples from Scotland and the Federal Republic of Germany. The discussion on “Planetary Boundaries” presents attempts being made to respond to the impact that economic growth is having on the planet, including the global climate emergency. The discussion on “Future Generations” concentrates on the capital approach to development, and describes seven types of capital stocks with examples drawn from public health. This is important for well-being economics because governments make distinctive contributions to investment in each type of capital. The section “Well-Being Economics and Economic Policy” describes attempts to implement well-being economics into core economic policy and discusses important areas for further research.
In one sense, well-being economics is simply economics. Economists have always been concerned with human well-being (or welfare as it has been called in the literature). Lessons about the importance of macroeconomic stability and competitive markets, for example, remain essential foundations for public policy focused on people’s well-being. Nevertheless, there has been a tradition in the economics literature to presume that the most important contribution the discipline can make to well-being is to provide knowledge on how to foster economic growth (Lucas, 1988). This inevitably directs policy toward measuring economic production as the primary measure of economic performance. Well-being economics has three elements that distinguish it from that tradition:
The first element comes from an argument articulated by Amartya Sen that policy has to be concerned with what people can or cannot do (Sen, 1983). Thus well-being economics does not focus on economic production for its own sake, but rather focuses on what the economic system allows people to do. Capabilities are more than personal abilities; in this context, the term refers to recognizing social and economic constraints that can limit the opportunities of different groups in a society. Globally, the United Nations Sustainability Development Goals provide a blueprint for expanding capabilities to achieve a better and more sustainable future for all (United Nations [UN], 2020).
The second element comes from the long-standing concern that environmental degradation due to economic growth (including the global climate emergency) threatens the well-being of large numbers of people (Jackson, 2009). The Intergovernmental Panel on Climate Change (IPCC, 2015), for example, has reported unequivocally that anthropogenic greenhouse gas emissions were higher than ever at the beginning of the 21st century, driven largely by economic and population growth. This is an example of wider scientific evidence that human activity is pushing beyond planetary boundaries (Rockström et al., 2009).
The third element comes from the observation that excessive material consumption can compromise the ability of future generations to meet their own needs (Brundtland, 1987). This means that each generation should take account of the legacy it is leaving for the next generation. Physical capital, human capital, and technology are increasing, but care for this legacy must also address environmental, social, and cultural sustainability.
Attempts to estimate national income go back to 1665 (Kendrick, 1970). Research in the first half of the 20th century, particularly in the United Kingdom and the United States, laid foundations for modern national accounting (Carson, 1975; Tily, 2009). This became codified in the UN System of National Accounts (UN, 1953), and it was recognized from the beginning that the system’s core statistics such as GDP did not measure national well-being. An often-cited example comes from the founding researcher in the United States, Simon Kuznets, who observed that the welfare of a nation can scarcely be inferred from a measurement of its national income (Kuznets, 1934).
Nordhaus and Tobin (1972) were the first of many researchers to offer alternatives. They introduced the measure of economic welfare, which aimed to account for some of the more obvious discrepancies between GDP and economic well-being. Daly and Cobb (1989) continued in that tradition with the Index of Sustainable Economic Welfare. These and other similar measures, such as the Genuine Progress Indicator, adjust the national accounts to incorporate social or environmental benefits and costs ignored by GDP (Lawn, 2003).
Waring (1988) made a more forceful critique in a book that helped create the research field of feminist economics (Bjørnholt & McKay, 2014). Waring demonstrated how choices made in designing the UN System of National Accounts resulted in public policy being blind to the environmental damage of economic activities and to the value of essential well-being work within households, predominantly performed by women (Saunders & Dalziel, 2017). Waring concluded that growth in GDP overstates improvements in human well-being. Coyle (2014) argues that the opposite could also be true once account is made of acceleration in the variety and customization of products and in the blurring of the boundary between leisure and work in creative professions.
Against the background of such debates, former President Nicholas Sarkozy of France created a Commission on the Measurement of Economic Performance and Social Progress in 2008. He invited Joseph Stiglitz, Amartya Sen, and Jean-Paul Fitoussi to lead the commission, whose tasks included identifying the limits of GDP as an indicator of economic performance and social progress, and assessing the feasibility of alternative measurement tools. The commission reported in 2009 with a unifying theme that recommended a shift in emphasis from measuring economic production to measuring people’s well-being, placed in a context of sustainability (Stiglitz et al., 2009). Many countries responded to that recommendation by creating national frameworks for monitoring broad sets of statistical indicators of well-being.
The Capabilities Approach to Well-Being
In order to move beyond GDP as the primary measure of economic performance, it is necessary to determine what constitutes people’s well-being. At any detailed level, there can be no single definition. Different communities, and different persons within a community, hold different values. At a higher level, a framework known as the capabilities approach has been influential in addressing this question. The capabilities approach was introduced by economist Amartya Sen (1983, 1993).
The capabilities approach is founded on the idea that authentic development addresses what people can or cannot do; “attention is thus paid particularly to the expansion of the ‘capabilities’ of persons to lead the kinds of lives they value—and have reason to value” (Sen, 1999, p. 18). This often-quoted formulation incorporates some important principles.
Most important, the focus is on individuals exercising personal agency to create well-being. Hence, well-being is not treated as a gift of public policy, but comes from actions made by persons (Dalziel, Saunders, & Saunders, 2018). This begins with the choices made by individuals and extends to collective collaborations. Thus, humans are born into families, grow up in households, and then form families and households as adults. People come together in institutions of civil society to expand their capabilities for well-being. Participation in the market economy is an important source of well-being. In the public sector, local government and the nation-state provide distinctive goods and services for well-being. Intergovernmental organizations, nongovernmental organizations, and multinational corporations organize collaborations on a global scale.
Consistent with the focus on agency, the capabilities approach respects the right of persons to express their own values in their lives; it is not legitimate for policy advisers to make values choices on behalf of communities. Further, the final phrase recognizes that humans live in social relationships, in which reason is an important arbiter in public debates about values. Finally, Sen’s formulation recognizes that lives are constrained by capabilities that depend on social and economic contexts. Public policy can make distinctive contributions to expanding these capabilities, opening up new opportunities for persons to lead valued lives.
Sen is concerned with respecting the right of every community to determine its own reasoned values, and is therefore reluctant to support defining a universal set of core capabilities for leading valued lives (Sen, 2004). In contrast, Nussbaum (2003) draws on the Human Rights tradition to claim certain capabilities are fundamental entitlements of every person. To illustrate, Article 25 of the Universal Declaration of Human Rights states that everyone has the right to a standard of living adequate for the health and well-being of themselves and their family (UN General Assembly, 1948). Thus, the economic capability to sustain health and well-being can be regarded as a fundamental entitlement.
Consequently, it is not difficult to apply the capabilities approach to public health (Pithara, 2020; Saith, 2011). Good health is part of living a valued life. Good public health policies can make distinctive contributions to improving individual and community health. Access to quality medical services and to validated knowledge on health issues are examples of essential capabilities for persons to create well-being for themselves, their families, their households, and their communities.
National Frameworks for Measuring Well-Being
Many countries have responded to the call to shift emphasis away from measuring production to create a national framework for measuring well-being (Exton & Shinwell, 2018). Drawing on the capabilities approach, standard practice is to ask citizens and organizations to identify elements considered important for leading a valued kind of life in the particular country. This section discusses two examples—Scotland and the Federal Republic of Germany.
Scotland was an early mover in adopting a dashboard of statistical indicators for monitoring national performance. Reestablished in 1999, the Scottish Parliament had prepared the first version of its National Performance Framework by 2007 (Wallace, 2019). It set out the government’s purpose: To focus government and public services on creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth (Scottish Government, 2016). This was supported by high-level targets and strategic objectives, monitored by a series of 45 statistical indicators.
The National Performance Framework passed into law through the Community Empowerment (Scotland) Act 2015. Public consultation on the national outcomes involved more than 16,000 participants in public events and more than 40,000 people through social media and other platforms (Wallace, 2019). The framework was refreshed in 2018, with a tighter focus on well-being (Scottish Government, 2019). Figure 1 presents the purpose statement, the values statement, and the 11 national outcomes (supported by 81 statistical indicators, not shown here) in the 2019 version.
In December 2010, the German Parliament (Bundestag) set up an Enquete Commission, which is a body composed of an equal number of parliamentarians and external experts to advise on complex, long-term, special issues (Strunk, 2015). This commission was asked to report on growth, prosperity, and quality of life, which it did in 2013 with a recommendation to implement a system for measuring and monitoring social wealth and welfare. This was forwarded to the federal government, which launched a national dialogue on well-being in Germany between April and October 2015, involving some 15,750 people (Federal Government of Germany, 2017). After analysis of the results by an independent academic team, and with the assistance of a six-member scientific advisory board, the government developed a national well-being framework with 12 well-being dimensions supported by 46 statistical indicators (see the Well-being in Germany interactive report).
The first dimension, Healthy Throughout Life, has five statistical indicators:
Life expectancy at birth
Prevalence of obesity
Number of residents covered by a general practitioner or general specialist
Quality of care (a placeholder, since the statistical data are not yet available)
Ratio of self-reported health and income
These examples illustrate how national well-being frameworks are created, with room for differences in domains and statistical indicators. It can then be difficult, however, to embed well-being considerations into a country’s core economic policy. In 2010, for example, the United Kingdom launched its Measuring National Wellbeing program, but also introduced austerity measures with severe impacts on children and their households (Lambie-Mumford & Green, 2017). The remainder of this article discusses how well-being economics can be incorporated into policy, especially through investment in different types of capital stocks.
The scientific evidence is compelling that human activities are driving the global climate emergency (IPCC, 2015). The Paris Agreement that came into force on December 4, 2016, included a commitment by participating countries to undertake ambitious efforts to limit the global average temperature increase to 1.5˚ Celsius above preindustrial levels. Within the well-being economics framework, this commitment is an example of a key concern that the global economic system must operate within planetary boundaries (Rockström et al., 2009).
This is a challenge for economics. For most goods and services, a binding constraint is reflected in the item’s market price. Climate change, however, is an example of market failure, meaning that enterprises responsible for greenhouse gas emissions face little private incentive to reduce their emissions or to invest in creating new technologies that would address the problem (Newell, 2010). This means that public policy is required, with all of the difficulties this implies, to achieve a coordinated and effective global response.
The global climate emergency is only one example of human activity exceeding planetary boundaries. In a framework termed “doughnut economics,” Kate Raworth has integrated this concern with the issue of human capabilities (Raworth, 2017). The outer circle of the doughnut model is defined by the nine planetary boundaries analyzed by Rockström et al. (2009). The inner circle is defined by 12 dimensions of minimum social standards (which are akin to the idea of fundamental capability entitlements, using the language of Nussbaum, 2003) drawn from the Sustainable Development Goals. Raworth offers the doughnut model as a monitoring framework for defining an environmentally safe and socially just space where humanity can thrive between social and planetary boundaries.
Future Generations: Sustainable Well-Being and Capital Stocks
The Commission on the Measurement of Economic Performance and Social Progress recommended that measuring people’s well-being should take place in a context of sustainability (Stiglitz et al., 2009). This includes monitoring environmental sustainability, of course, but their report argued it also means paying attention to a range of different types of capital stocks that matter for human lives. Implementing that recommendation is an example of the capital approach to sustainable development (Working Group on Statistics for Sustainable Development, 2008).
The commission focused on four types of capital: physical, human, natural, and social. With slight variations on the name of the first category (sometimes labeled economic capital, produced capital, human-made capital, or physical and financial capital), these four capitals have become standard in sustainable well-being frameworks (e.g., Organisation for Economic Co-operation and Development [OECD], 2020). Other types of capital are also important, including knowledge capital, cultural capital and diplomatic capital (Dalziel et al., 2018). This section discusses these seven capitals and provides examples relevant to public health before presenting a capitals-based framework for well-being economics and public policy.
The Four Capitals
“Physical capital” refers to human-made, enduring assets that either contribute to economic production or provide some other service for well-being. Examples include commercial buildings, domestic homes, vehicles, roads, railways, machinery, tools, and some forms of intellectual property. A nation’s stock of physical capital increases through investment expenditure by private and public owners. This impacts on well-being since the neoclassical growth model famously demonstrated how the share of economic production devoted to investment, amplified by the state of technological progress, determines material living standards (Solow, 1956). Ownership of physical capital is distributed through nominal assets such as shares, stocks, debentures, loans, bank deposits, and cash, which are all examples of financial capital. The term “economic capital” is used when considering physical and financial capital together, and is an essential aspect of public health. Physical capital includes hospitals, medical clinics, and ambulances. Access to affordable health insurance (an example of financial capital) impacts access to medical services (Miller & Wherry, 2019).
“Human capital” refers to embodied skills acquired by a person through education, training, work experience, and good health. People with higher skills are more productive in the workplace. Consequently, investment in education is another important source of higher living standards in the neoclassical growth model (Mankiw, Romer, & Weil, 1992). Knowles and Owen (1995) provided evidence that better health in a population also has positive impacts. Since health features in the definition of human capital, public health policy is directly relevant; indeed, Knowles and Owen (1995) motivated their study by citing efforts to improve health in developing countries to boost productivity and economic performance. Public health policies also include provision in school curricula to develop skills in personal and community health care (St. Leger, 2001).
“Natural capital” refers to aspects of the natural environment that contribute to human well-being (Helm, 2015). Thus, natural capital is said to provide ecosystem services, such as clean water provision, which people use in conjunction with services from other capital stocks to create well-being (Fisher, Turner, & Morling, 2009). As noted already, tracking trends in natural capital is important for sustainability because of evidence that human activity is pushing beyond planetary boundaries (Rockström et al., 2009). Environmental factors are major contributors to global ill health (Smith, Corvalán, & Kjellström, 1999). There is also evidence that access to greenspace such as parks and woodland can have positive impacts on physical and mental well-being in diverse ways (Lachowycz & Jones, 2013).
“Social capital” refers to shared obligations and expectations, a communal environment of trustworthiness, community networks for sharing information, and shared norms enforced by community sanctions (Coleman, 1988). Strong social capital facilitates collaborations for mutual benefit within a community, making it an asset for creating well-being. Social capital declines if people become less connected with each other (Putnam, 1995). Kawachi, Kennedy, Lochner, and Prothrow-Stith (1997) present evidence from the United States that income inequality is related to lower social cohesion, which is in turn associated with increased mortality. The New Economics Foundation in the United Kingdom collated evidence that social relationships are critical for well-being and for acting as a buffer against poor mental health, leading the foundation to identify connecting with people as one of its five ways to well-being (Aked, Marks, Cordon, & Thompson, 2008).
Knowledge, Cultural, and Diplomatic Capitals
Building on Solow’s neoclassical growth model, Romer (1986, 1990) introduced endogenous growth theory, which demonstrates the unique ability of the discovery and utilization of new knowledge to drive ongoing growth in average living standards (Jones, 2019). This is possible because knowledge is nonrival in consumption, meaning the same knowledge can be used simultaneously by different people, and because new knowledge builds cumulatively on what is already known. Consequently, knowledge is an asset that people can use to sustain well-being, leading to the concept of knowledge capital (Arrow, Dasgupta, Goulder, Mumford, & Oleson, 2012). There are some challenging policy issues concerning this type of capital, such as how to support the creation and fast adoption of new knowledge, how to ensure that access to knowledge important for well-being is equitable, and how to protect indigenous knowledge systems (Stiglitz, 1999). These issues are relevant for public health policy, which relies heavily on the validation and dissemination of new knowledge (LaRocca, Yost, Dobbins, Ciliska, & Butt, 2012).
The human capacity to use language and engage in symbolic thought results in evolving human cultures passing down from generation to generation (Wilson, Hayes, Biglan, & Embry, 2014). A person’s cultural heritage (which might draw on more than one cultural tradition) is recognized as a necessary resource for the well-being of individuals and of communities (Taçon & Baker, 2019). The UNESCO Universal Declaration on Cultural Diversity 2001, for example, states that cultural diversity is as necessary for humankind as biodiversity is for nature. The 2005 Convention on the Protection and Promotion of the Diversity of Cultural Expressions amplifies that statement, describing cultural diversity as a rich asset for individuals and societies that needs protection, promotion, and maintenance for the benefit of present and future generations. Consequently, this heritage can be described using the metaphor of cultural capital providing services for well-being.
Two movements in public health address the importance of cultural capital for good health (Curtis et al., 2019). Cultural competency aims to improve the ability of health practitioners, and of the health system as a whole, to provide better health care to minority groups with the aim of reducing ethnic health disparities. Cultural safety goes further, based on recognition that barriers to clinical effectiveness arise from inherent power imbalances between providers and patients. These power imbalances can be addressed only if practitioners engage in critical self-examination to analyze the potential impacts of their own cultural heritage on interactions with patients.
Some well-being issues require coordinated global action. Climate change and pandemics are obvious examples. Institutions and norms designed to foster cross-cultural collaborations at a global level are a type of diplomatic capital, similar to social capital within countries (Dalziel et al., 2018). The WHO, for example, fosters cross-cultural collaboration in public health. Its global influenza surveillance and response system involves 144 National Influenza Centres in 114 member states collaborating to detect emerging viruses as quickly as possible (WHO, 2018).
A Capitals-Based Framework for Well-Being Economics and Public Policy
Some frameworks for well-being economics and public policy have incorporated a capitals-based approach. The most influential is the well-being framework created by the OECD for its Better Life Initiative launched in 2011 (OECD, 2020). The initiative identifies 11 key dimensions of current well-being, supported by the standard four capitals (natural, human, economic, and social) as key resources for future well-being. The New Zealand Living Standards Framework incorporates the same four capitals, but includes an additional dimension of current well-being, labeled as cultural identity (New Zealand Treasury, 2018).
Figure 2 presents a capitals-based framework for well-being economics and public policy (Dalziel, 2019). It incorporates the features of the OECD framework, but expands on that framework in two ways. First, the figure highlights human agency, which is an essential element in the capabilities approach. Thus, the ovals at the heart of the figure represent different ways in which people take individual and collaborative action to create well-being. Second, the figure expands the number of capital types from four to seven, including cultural, knowledge, and diplomatic capitals.
The framework observes that a country’s total wealth, made up of the different capital stocks, provides services that are used by people to create well-being, monitored by statistical indicators organized into domains. Figure 2 presents the 12 domains in New Zealand’s Living Standards Framework, but the domains from any national well-being framework could be used. The figure also shows that the level of well-being feeds back into people’s capabilities for action. In order to sustain well-being into the future, some part of human actions must include reinvestment in the capital stocks that make up total wealth.
The framework in Figure 2 highlights that public policy implemented by the nation-state is just one way in which people collaborate to create well-being. Nevertheless, public policy makes distinctive contributions to well-being that individuals, households, communities, and the market economy cannot achieve on their own. The next section presents examples of governments that have begun to pursue well-being economics in their core economic policies.
Well-Being Economics and Economic Policy
Well before the formation of the Commission on the Measurement of Economic Performance and Social Progress (Stiglitz et al., 2009), the Royal Kingdom of Bhutan had rejected GDP as a suitable measure of development, adopting a strategy based on promoting gross national happiness (GNH; Verma, 2019). Emerging from Bhutan’s unique history and culture, an explicit vision of happiness-oriented development began to be articulated within the country in the early 1970s. This led to a unifying conceptual framework built on four pillars: sustainable and equitable socioeconomic development, good governance, environmental conservation, and the preservation and promotion of culture. The framework continues to guide policy design, including Bhutan’s national five-year plans, monitored by a GNH Index comprising 33 indicators clustered into nine domains: health, education, living standards, time use, good governance, ecological diversity and resilience, psychological well-being, community vitality, and cultural diversity and resilience (Ura, Alkire, Zangmo, & Wangdi, 2012).
Governments seeking to embed well-being economics into public policy have pursued three major mechanisms: (a) passing legislation requiring particular policy areas to consider the well-being of current and future generations; (b) creating new public institutions that focus on well-being; and (c) reforming the annual budget process to ensure core economic policy supports the well-being economy.
Wales has been described as being at the global forefront of passing legislation on sustainable development (Wallace, 2019). The Welsh Assembly passed the Well-being of Future Generations (Wales) Act 2015, which made it the first national legislature to impose a legal duty on public bodies to safeguard the well-being of future generations (Davies, 2016). The act requires all public bodies to carry out sustainable development, including by setting and publishing specific objectives for itself that are designed to maximize the body’s contribution to achieving seven national well-being goals listed in the legislation:
A prosperous Wales
A resilient Wales
A healthier Wales
A more equal Wales
A Wales of cohesive communities
A Wales of vibrant culture and thriving Welsh language
A globally responsible Wales
These goals were determined after a year-long National Conversation on “The Wales We Want” (Commissioner for Sustainable Futures, 2015). The legislation describes five ways of working in accordance with the sustainable development principle, such as balancing short-term needs with the need to safeguard the ability to meet long-term needs, including taking action to prevent problems from getting worse, while pursuing integrated, participatory, and collaborative approaches. It also established 21 public services boards, one for each local authority area, with a statutory requirement to improve the economic, social, environmental, and cultural well-being of its area. A key element of the act was the creation of new position, a future generations commissioner, to hold public bodies to account and to make recommendations that carry weight (Davies, 2017). The commissioner is required to publish a major assessment every five years the first of which was published in May 2020 (Commissioner for Sustainable Futures, 2020).
A major difficulty for countries wanting to move beyond measuring well-being is the absence of a clear consensus on what role central government should play in promoting well-being, and on what policies demonstrably improve well-being. In this sense, well-being is a “wicked problem” (Bache, Reardon, & Anand, 2016). In October 2014, the U.K. government announced it was contributing funding, alongside the Economic and Social Research Council and other partners, for a new institution addressing that issue: the What Works Centre for Wellbeing (Bache, 2019). It belongs to a larger What Works Network created in 2013 with the aim of ensuring that spending and practice in public services is informed by the best available evidence (What Works Network, 2018).
The mission of the What Works Centre for Wellbeing is to identify and communicate evidence on what works to improve well-being, in order to support decision-makers seeking to inform policy and practice in the United Kingdom (Hardoon, Hey, & Brunetti, 2020). As part of work to collect evidence on well-being in the workplace, for example, the it supported research on the benefits of good people management for performance and well-being in England’s National Health Service Trusts. This found that trusts making the most extensive use of good people management practices, compared to those that made the least use, were more than twice as likely to have staff with the highest levels of job satisfaction and more than three times more likely to have staff with the highest levels of engagement (Ogbonnaya & Daniels, 2017).
In 2015 and 2016 respectively, legislation was passed in France and in Italy requiring annual reports to Parliament that track trends in a small set of statistical indicators reflecting economic, social, and environmental progress (Stiglitz, Fitoussi, & Durand, 2018). These reports are part of the budget process. In May 2019, the New Zealand government attracted international attention for delivering the world’s first well-being budget (Anderson & Mossialos, 2019). Echoing the language of the capabilities approach, the budget defined well-being as when people are able to lead fulfilling lives with purpose, balance, and meaning to them (Robertson, 2019). The well-being budget described three ways in which it departed from traditional ways of work in the public sector:
Breaking down agency silos and working across government to assess, develop, and implement policies that improve well-being.
Focusing on outcomes that meet the needs of present generations at the same time as thinking about the long-term impacts for future generations.
Tracking progress with broader measures of success, including the health of the country’s finances, natural resources, people, and communities.
The budget data on well-being measures to identify five priority areas with the greatest opportunities to improve the lives of New Zealanders: taking mental health seriously, improving child well-being, supporting Māori and Pasifika aspirations, building a productive nation, and transforming the economy. Ministers had to demonstrate how budget proposals would contribute to these five priorities to create a collaborative whole-of-government package. For child well-being, the government passed legislation requiring it to publish measures of child poverty with targets for improving them. An amendment in 2020 to the Public Finance Act 1989 imposes requirements on the government to report annually on its well-being objectives, and to table a report on well-being prepared by the Treasury every four years.
The examples given in this article illustrate that progress has been made in advancing a well-being economics agenda, but more research and policy experimentation are required. Five years after the Commission on the Measurement of Economic Performance and Social Progress published its influential report (Stiglitz et al., 2009), for example, the OECD agreed to host a High Level Expert Group to continue its work. The group recognizes the substantial changes that have taken place since 2009, but also points out the significant challenges in sustaining the movement toward well-being in economic policy (Stiglitz et al., 2018). Policies that better support sustainable and inclusive growth are likely to negatively impact some production sectors that can be expected to resist. One example given in the report is the U.S. coal industry lobbying Congress during the Clinton administration. The report also notes the criticism that a focus on well-being may divert attention away from what is commonly viewed as the fundamental contribution of economic growth. This can be particularly influential after an economic crisis, when governments tend to embrace traditional instruments to restore economic growth and job creation (Bleys & Whitby, 2015).
Researchers have identified ideological resistance to the concept of well-being, including complaints that the pursuit of happiness is futile and childish (Frijters, Clark, Krekel, & Layard, 2020). There are doubts in the literature about the ability of people to predict their subjective future well-being, even following major life events such as widowhood, unemployment, disability, marriage, separation, or divorce (Odermatt & Stutzer, 2019). The use of multidimensional, objective indicators of well-being involves the issue of how to weight different domains for policy purposes (Weijers & Morrison, 2018), although public decision-makers may welcome a more comprehensive, multidimensional, accurate portrayal of social progress (Adler & Seligman, 2016). Designing public policy to address multiple well-being dimensions is not easy. It requires integrated collaboration across government agencies and avoids progress in one domain achieved at the expense of other domains (McCartney, Fenton, Morris, & Mackie, 2020).
A further issue is identifying the distinctive role that public policy plays in supporting sustainable well-being, alongside the agency of individuals, families, households, civil society, and the market economy (as represented in Figure 2). Scott (2014), for example, has argued that the well-being discourses of central government in the United Kingdom after 2010 did not include proper reference to structural inequalities and were in danger of supporting neoliberal narratives of individual or local aspiration and enterprise as solutions to social problems. The contribution of market firms is important because of the strong evidence that unemployment is damaging to people’s well-being and the promising evidence that the increase in well-being after re-employment depends on job quality (What Works Wellbeing, 2017a, 2017b). Market firms also bring together resources to provide goods and services that expand the capabilities of their customers to create well-being for themselves and others (Dalziel et al., 2018).
There are unresolved tensions about how a national well-being approach works in multicultural environments where different communities might express very diverse values in creating lives they value and have reason to value. In New Zealand, for example, there is general recognition that indigenous approaches to well-being within a Māori worldview can be quite different in some aspects from the approach taken in the government’s living standards framework (New Zealand Treasury, 2018). This is reflected in examples such as the Te Whare Tapa Whā model of well-being created by Durie (1998).
Strong political leadership can be beneficial in promoting well-being in public policy, although this can be a double-edged sword following a change in leadership (Exton & Shinwell, 2018). This can be addressed by creating institutions for sharing knowledge about effective policies to promote well-being. In November 2018, for example, the governments of Scotland, New Zealand, and Iceland (which adopted its well-being framework of 39 statistical indicators in April 2020) launched the Wellbeing Economy Governments partnership. Wales joined the partnership in May 2020. These four members are collaborating to bring well-being into the heart of policy making with a focus on advancing three key principles: living within planetary boundaries; ensuring equitable distribution of wealth and opportunity; and efficiently allocating resources, including environmental and social public goods (Coscieme et al., 2019).
Global crises, such as the Covid-19 outbreak of 2020, highlight the strong connection between well-being economics and public health. This connection is demonstrated in the tensions between public health policies needed to control the spread of infections and economic policies needed to maintain livelihoods and access to essential goods and services. Some advocates argue that such crises also offer opportunities to “build back better” in ways that prioritize human well-being, reduce inequality, and respond to the climate emergency (Büchs et al., 2020).
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