As countries deal with the pandemic’s impact, is there an opportunity to rethink how we measure the value of a country’s wealth? Gross Domestic Product (GDP) is the most commonly used metric. In the USA, over 18% of the GDP is spent on healthcare. Should we measure wellbeing as a function of a countries economic health?
What is wellbeing? Part of the challenge has been to define the components, is it happiness? Is it social welfare or something else? Survey assessments have been used to assess wellbeing and often include domains encompassing life satisfaction. The World Happiness Index released annually includes income levels, health, social support, and life satisfaction. The authors posit these dimensions don’t give a robust picture. What might need to be included?
Ideally, a robust measurement approach can we leveraged to inform policy decisions. Since most countries, government agencies are divided into sectors, is it possible to allocate resources cohesively if they all have unique metrics for success that don’t roll up to a bigger vision? In the healthcare sector, cost-effectiveness is used to determine the value of adding new services as it relates to the potential health outcomes realized. Most commonly assessed via QALYs or qualify of life adjusted years – often unrelated to educational metrics, an education minister might track or their sector.
In the table below, the authors share the distribution of funding in OECD countries in 2019. In the USA, the healthcare sector is 24% of spending compared with Latvia, which is 9%.
Source: doi: https://doi.org/10.1136/bmj.m1874
Experts lean into wellbeing as a metric argue that addressing mental health needs has a positive impact on the overall economy, given the societal costs direct and indirect of depression and anxiety. This pandemic has further challenged in this regard with stress, insomnia, depression, and anxiety is more common as we deal with the uncertainties of the times.
While not without controversy, the timing might be right to explore how wellbeing can be part of the economic picture of the country’s overall financial health. We are seeing what a lack of investment in public health can lead to addressing COVID-19. We also see the impacts of robust social services provision as compared to long lines for food pantries in countries where unemployment payments are low, lacking, or late. How can health outcomes delivered by a health sector benefit other sectors? How might we pay closer attention to measurement and relationships to a broader suite of inter-related areas, so gains are clear?
The authors suggest that health ministries should continue to be in charge of population health efforts using health improvement as a dominant metric to track; they also encourage framing to assess other additional impacts. Mental health is an area for better measurement and impact tracking as the primary example. How do these investments impact education and the use of social services? In the English NHS, Improving Access to Psychological Therapies or IAPT is a stepped care model for addressing mental health needs. This model also looks a social service use, re-entry into the workplace, and school in addition to measuring the burden of suffering depression and other illnesses cause.
We have some countries stepping into defining a broader lens to inform policy decisions and government spending, but we may need many more to see what works well. Moving toward a cohesive understanding of wellbeing as an economic indicator will be important work for the future. One thing is clear; today, our fragmented system does not adequately address an aging planet’s population.
Thanks for reading – Trina
(Opinions are my own)
The economy of wellbeing: what is it and what are the implications for health? BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1874 (Published 16 June 2020) BMJ 2020;369:m1874