Health and Well-Being: Broadening Terminology, Improving Total Health

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A newly-published paper by researchers from Health Partners and Kaiser Permanente challenges the health policy community to broaden its perspective by focusing on “well-being” as the ultimate goal of health. The paper, “Well-Being in All Policies: Promoting Cross-Sectoral Collaboration to Improve People’s Lives,” by Thomas Kottke, Matt Stiefel, and Nicolaas Pronk, was published jointly by the National Academy of Medicine and the Centers for Disease Control’s Preventing Chronic Disease initiative. In it, the authors illustrate the need for policies that promote well-being, rather than physical health narrowly defined.

Kottke, Stiefel, and Pronk describe the evolution of the concept of well-being in health policy. For many decades, the World Health Organization (WHO) has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In 1986, the WHO’s Ottawa Charter for Health Promotion concluded that “health” should be viewed as a means to an end, and that “well-being” should serve as the ultimate aim for each individual. In a seminal paper in 1990, Evans and Stoddart concluded that “well-being is or should be … the ultimate objective of health policy” and that health policies should always contribute to the well-being of the population served.

Kottke and colleagues also highlight research showing that individuals who achieve a state of well-being — what the researchers described as “flourishing”—experience fewer health limitations and greater life satisfaction. These individuals have fewer missed days of work, fewer limitations on activities of daily living, and higher psychosocial functioning (for example, resilience, intimacy, and clearly defined life goals). A related study found that after 10 years, the risk of death for individuals categorized as “languishing” is 60 percent greater than for those described as flourishing.

Next, the paper describes how both Kaiser Permanente and Health Partners have incorporated this broader view of health into their organizational missions and practice. For example, Kaiser Permanente focuses on “total health,” using an innovative framework that draws on wide-ranging organizational assets to maximize the physical, mental, and social well-being of its members and the communities in which it operates. The framework includes workforce wellness initiatives for employees and customers as well as efforts to reduce the organization’s own carbon footprint, promote physical activity in schools, and improve low-income communities’ access to healthy foods.

Finally, the paper describes the need for policies and activities that go beyond the clinical encounter to promote well-being. As a starting place, broadening the language from physical health to “well-being” allows for greater movement in this direction and invites greater participation in sectors beyond health care.

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