Guest blog and report: The Implications of Wellbeing Research on Government Policy

 

kim_engel (no 10 downing street)The Hertford Business & Economics Society, an undergraduate group at the University of Oxford, recently completed a research project looking at wellbeing and government policy. The final report was presented to the Cabinet Office in December 2015. Here, Kim Engel, one of the co-authors of the report introduces its three main proposals.

 

  1. Guidelines for civil servants

Ideally governments would carry out controlled experiments to assess the wellbeing impact of every plausible policy. The most cost-effective policies would be implemented. Then further experimentation would be used to refine those policies.

But in reality experiments require scarce resources like money, time and expertise. And there are still large methodological controversies surrounding the quantitative measurement of wellbeing. This leaves room for organisations such as the Civil Service to adopt other approaches to improving wellbeing.

We proposed the use of a brief, one-page “wellbeing table” for making speedy estimates of wellbeing impact. The table would provide space to describe the probable effects of a policy on key determinants of wellbeing such as employment and mental health. It would come attached to a one-page “information table” highlighting the main conclusions of existing academic research into factors affecting wellbeing.

  1. School and university incentivesHBESoc

A study involving more than 17,000 Britons found that “the most powerful childhood predictor of adult life-satisfaction is [a] child’s emotional health” (Layard et al., 2013). Yet schools currently have limited incentive to prioritise wellbeing. OFSTED assessments cram “Welfare, personal development and behaviour” into one section out of a total of four.

We suggested that a new section on “Pupil Wellbeing” could be introduced to OFSTED reports to give schools credit for adopting proven methods of improving wellbeing such as social and learning (SEL) programmes, healthy eating measures, and the provision of good counselling services.

Universities can also make a big difference to wellbeing in the UK. Above all they must address massive increases in the number of students with mental health problems. HEFCE statistics published in 2015 show a 125% increase in the number of students with mental health problems in the four years to 2012-13, while many universities are reporting double-digit annual growth in demand for counselling services.

We therefore proposed that the National Student Survey (NSS), taken by more than 300,000 students annually, should include a question about satisfaction with university mental health services. This would generate valuable information for prospective students, and give universities strong incentives to up their game.

We also mention the further possibility of adding the “ONS4” wellbeing questions to the NSS. By providing a snapshot of wellbeing at every UK university, this would help researchers and universities figure out “what works” for wellbeing.

  1. Wellbeing reporting

 Businesses can take a variety of evidence-based actions to improve employee wellbeing. These include improving work-life balance, promoting good health, helping employees take greater control over their work, and developing employee’s sense of the social value of their work (New Economics Foundation, 2014). Companies that succeed are likely to enjoy a boost in profits as productivity rises and absenteeism and employee turnover decline, raising economic growth and making everyone better off.

We proposed that the government should mandate large firms to produce an annual report on employee wellbeing. The reports might explain how wellbeing policies are adding value to the firm and disclose expenditure on non-financial wellbeing (e.g. social activities, counselling, physical health programmes). They would alert shareholders, employees and the media to underspending or under-performance on employee wellbeing. Firms would therefore have additional incentive to invest in employee wellbeing.

 Full report: The Implications of Wellbeing Research on Government Policy

→ Response to the report by Ewen McKinnon, a member of the Analysis and Insights Team at the Cabinet Office

Discuss on our forum

References

Jeffrey, K., Abdallah, S., Michaelson, J. (2014). Wellbeing at work. New Economics Foundation.
Layard, R., Clark, A. E., Cornaglia, F., Powdthavee, N., Vernoit, F. (2013). What Predicts A Successful Life? A Life-Course Model of Well-Being. Discussion Paper No 1245. Centre for Economic Performance, LSE.

 

 

 

 

Guest Blog: Bank of England’s Andy Haldane, A Recovery for the Few, Not the Many

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Andrew G Haldane, Chief Economist, Bank of England takes a deeper look at the UK’s economic recovery up to the EU referendum.

 

At least up until the referendum, macro-economists like me would wax lyrical about the UK’s economic recovery.  The numbers spoke for themselves.  GDP was 7% higher than its pre-crisis peak.  More than 2 ½ million extra jobs had been created since 2010.  Almost £3 trillion of extra wealth had been amassed.  The UK was riding high at the top of the G7 growth league table.

Yet for those of us who have toured the country, speaking not just to businesses but to public sector companies, charities and communities, the picture often painted was a far from rosy one.  For many of them, there had been no discernible improvement in their incomes and wellbeing.  The language of “recovery” simply did not fit their facts.

This posed something of a conundrum for me in my day-job as Chief Economist at the Bank of England.  Was this a healthy and wealthy recovery, as the headline numbers suggested?  Or was it an insipid, or perhaps even non-existent, one as anecdote implied?  Digging into the headline numbers began to provide some reconciliation of this puzzle.

If we look not at headline GDP but at households’ disposable income, a somewhat different picture emerges.  Not one of a relentless rise over the past three years, but of disposable incomes flat-lining for the better part of 10 years.  Perhaps as many as half of UK households have experienced a “lost decade” of income growth.

Dividing-up this income pie – regionally, socio-economically, inter-generationally – paints an even more nuanced, and uneven, picture of recovery.  For example, at present there are only two regions across the UK – London and the South-East – where GDP per head currently exceeds it pre-crisis peak.  In others words, in all bar two UK regions, there has been no real recovery even in GDP terms.

The distribution of this income across rich and poor is no less striking.  Although the distribution of incomes across the UK may well have narrowed since 2008, patterns of wealth have diverged remarkably.   While the lowest 20% of earners have been their wealth fall by around 20% since 2008, the highest-earning 20% have seen wealth rise by over 15%.

Age may have been a key driver of these patterns.  All of the £3 trillion rise in net wealth since 2008 has been harvested by those over the age of 50 and two-thirds by those over the age of 65.  While pensioner incomes comfortably exceed their pre-crisis levels, the same cannot be said for working families.  These are huge inter-generational transfers, from young to old.

So when it comes to asking “Whose recovery?”, the answer is reasonably clear:  those living in London and the South-East, those earning higher incomes, those aged over 50 and those owning their own home.  This has been a recovery for the few, rather than the many.

This pattern of gains and losses across the economy is relevant for making sense of the past and for fashioning the future.  For example, these distributional patterns may help explain why global and UK growth has remained fairly anaemic over recent years, despite large amounts of monetary policy stimulus.  Large chunks of society are feeling no better off, and hence are no more willing to spend, than a decade ago.

Looking ahead, these distributional fault-lines – regional, inter-generational, socio-economic – are not ones which can be ignored.  For growth to be sustainable and strong it needs to be inclusive and comprehensive.  There is a role for public policy, over time, to seek to close these fault-lines to achieve inclusive and sustainable rises in societal well-being.

→ Whose Recovery? speech in Port Talbot, Wales on 30 June 2016

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Guest blog: NPC’s Dan Corry on Wellbeing over the life-course

 

Dan Corry, Chief Executive of NPC and What Works Wellbeing board member, reports from the Wellbeing over the Life Course one day conference run by our Cross Cutting Team led by Lord Layard at London School of Economics (LSE).

DanThe Wellbeing juggernaut is well and truly ploughing on in the academic world as evidenced by a full day conference held recently at the LSE. Here, some of the best academics around presented draft chapters of a book due to come out soon, looking at wellbeing in many different ways. These included Richard Layard, Andrew Clark and Andrew Steptoe. Equally powerful academics, like Alan Manning, Jane Waldfogel and Tim Besley, discussed them and the audience – of which I and several of my What Works Centre for Wellbeing colleagues were part – chipped in.

The book, and the day, looked at wellbeing issues as they affect young people and are influenced by the early years; at those of working age; and at the wellbeing of older people too. They used a number of different data sets and were all focused around the causes and correlates with subjective wellbeing, a controversial issue in its own right but one that conference organiser Richard Layard still thinks is the best measure for us to use however imperfect it inevitably is.

There was a lot to take in, but here are some of the particular things that struck me. None are ground breaking, but all are of interest.

  • This area is growing fast. The fact that questions about wellbeing (along the lines of the four ONS questions) are being added to many surveys makes this analysis much more possible. We are seeing economists and other disciplines getting into the area using cross section and panel data.
  • Expectations matter. Subjective wellbeing is all about how you feel and so is bound to include how you feel you are faring relative to how you expected or want to feel. One finding for instance (from a recent DCLG survey) that shows that wellbeing is not diminished by living in a damp, over-occupied property seems to suggest that people living in such conditions are comparing themselves to those who have nothing, not those in fancy houses. The media also becomes important in this space, helping set norms – often very unrepresentative and misleading ones.
  • Peer effects matter too. One of the bits of research suggested that while being unemployed is detrimental for wellbeing (indeed one of the worst things that can happen to you), being in an area where there are a lot of other people unemployed means it is less bad. On the other hand it makes those in employment feel a bit worse. One needs to be careful on policy prescriptions therefore – the fact that one could improve short term wellbeing by making all the unemployed live in the same area, would do nothing for longer term wellbeing.
  • Some impacts of bad things are temporary – some go on and on. Research presented suggested that while a separation in a relationship is pretty bad for wellbeing, after a few years wellbeing moves back to the level it was before. The same happens with losing a spouse. Even the boost from deciding to have a child and becoming a parent appears not to last! But other things do have a lasting impact – being in a relationship or partnership is a good example.
  • People adapt – sometimes with strange affects. Women used to do poorly paid, low status work. Many now have better jobs. But the wellbeing associated with the job appears to be no better – or sometimes worse. If we had been making decisions based on wellbeing we might have said this change is of no value and should be resisted – which feels completely wrong.
  • There are externalities at play with profound implications for policy making based on wellbeing. The analysis suggests for instance that my income going up is good for my wellbeing, but may make you feel worse. Same if I get a job. So maximising society wellbeing is not at all the same as pushing up individual wellbeing.
  • The wellbeing lens is putting a new emphasis on some issues – like mental health and early action, something emphasised by former Cabinet Secretary and wellbeing enthusiast Gus O’Donnell. There is a danger that we get into a tautology in some of this – naturally those who are depressed or have anxiety related conditions are likely to say they have low wellbeing; we surely did not need wellbeing data to tell us this! But nevertheless the focus this agenda has given to mental health has been very valuable and  the same sort of thing applies to relationships, something I have written about elsewhere .
  • A focus on the most unhappy is sometimes useful. Looking at the bottom 10% in terms of wellbeing for instance really helps us see who we should perhaps be looking to help most. Looking at the average can obscure the things we really want to get at and we want to also explore changes in wellbeing inequality alongside changes in average wellbeing.
  • How you are considered matters to your wellbeing. Alan Manning alluded to the Brexit vote and the fact that while a job in a service industry might be as well paid as a job in the mines it is unlikely to carry the same sense of worth or status.
  • Psycho-social factors in childhood matter more to wellbeing than academic ones. This raises issues about schools policy and parental behaviour, as well as putting a big focus on the mother’s mental health. We also need to get some data on genetics into the analysis to see how much, if any, this is driving.
  • There are inevitably lots of interactions that will bedevil the search for key drivers of wellbeing. For instance separation is associated with lower wellbeing, but at least some of this is due to income dropping not separation per se.
  • We need to dig harder on gender. The research presented to us rarely distinguished between men and women. That seemed to most a big gap – as there is no real reason to think the drivers of wellbeing will always be the same across genders.
  • The old are not less happy than the young. As Andrew Steptoe noted, given all the things that happen to you health and relationship-wise as you get older, this is perhaps surprising. In addition physical health seemed to be less important for older people than emotional health and ‘social’ issues.
  • We can’t use this version of wellbeing for deciding on things like climate change. Perhaps obviously, subjective wellbeing is not a good way to make decisions on things that are about the future and – implicitly – about assessments of future risks and discount rates.

As I hope this summary shows, this whole agenda is raising many fascinating issue. Many are familiar, a few are surprising, but all are making us think harder about the world and how to make it a better place.  And that cannot be bad for the wellbeing of all of us.

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What can we learn from £40M invested into wellbeing?

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Here, the Centre’s Ewan Davison takes a look at the Big Lottery Fund’s Wellbeing 2 programme and evaluation.

Following the recent publication of the Wellbeing 2 final evaluation we’ve gathered an overview of the programme, links to evaluations and a series of case studies together as a learning resource 

Wellbeing 2 followed the £160m Wellbeing funding, continuing to support communities to create healthier lifestyles and improve their wellbeing. It funded interventions to improve levels of healthy eating, activity and mental health. But wellbeing is much wider than one particular aspect or determinant, it means a lot of different things to different people – as we’ve learnt from talking to people across the UK about what matters to them. At a high level it’s their quality of life. So, improving quality of our lives and our wellbeing should be the ultimate aim of policy.

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A really encouraging part of this study was the use of personal wellbeing as a measure; simply put it was asking individuals how they feel using the ONS 4 wellbeing questions. Across the Wellbeing 2 portfolios adults reported an increase in their levels of life satisfaction from 6.2 (on a scale of 0-10) at the start of the interventions to 6.5 at the end to 7.0 at three months post intervention. Life satisfaction is a key measure for wellbeing. There were also positive change reported in feelings of being worthwhile, happiness and anxiety levels. For example: 54% of young people reported a positive change in their mental wellbeing.

For those of us interested in policy, the wellbeing 2 evaluation report is important. We need to look beyond the numbers to try and identify what works, and what doesn’t in delivery and measurement. The report shares a real wealth of qualitative data, insights from projects on what worked across delivery, promoting behavior change, achieving systems change and sustainability.

The key points to take away from it are:

  • The importance of ensuring engagement in design and delivery (such as using peer educators).
  • Taking asset-based approaches which work with local settings.
  • Developing the skills of staff and partners along with volunteers.
  • For some portfolios, working with local systems to enable sustainability and change to those systems, such as basing staff in local authorities and working with authorities (and communities) to meet outcomes identified in their Joint Strategic Needs Assessments.

The importance of time when evaluating

Another key finding from this report and the follow up round table was that time is a very important factor (perhaps a luxury which this funding has allowed). It enables a test, learn, and adapt approach in delivery and in terms of measuring impact. Policy makers need to make time to engage people in the design of delivery and evaluation to keep activities relevant and effective.

There is some great work going on out there (as shown by this report) and as a nation we’re spending a lot of money and effort on activity so we need to learn from it collectively and in a systematic way. We need to measure with enough consistency to enable a meaningful comparison across interventions which looks at impact and cost, and reflects the strength of evidence. We can also use existing activities and management data to make running trials easier and cheaper, which in turn make the research findings more useful to practice and decision making.

We all need to get better at capturing learning on wellbeing impacts and growing the evidence base. This is the start.

What are your issues with evaluating wellbeing? With wellbeing impact often being a secondary outcome- or not the primary focus of funding a project – how can we create a measurement instrument sensitive enough to capture changes without becoming overwhelming  or a burden to providers/participants? → Join our forum to discuss

overview of the Wellbeing 2 programme, links to evaluations case studies 

Full evaluation on Wellbeing 2 along with  Big Blog

 

 

Guest blog: The benefits of healthy advice?

Here, James Sandbach, Research Manager for the Low Commission reflects on the impact advice services can have on our wellbeing and health.

IMG_0388(3) (1)The VCSE (Voluntary, Community, Social Enterprise) review on partnerships for health and wellbeing has been the latest in a number of strategic studies looking at how bringing in a wider range of community based services into the health system can contribute to improving health, wellbeing and care outcomes.

The recent Kings Fund report on “Supporting integration through new roles and working across boundaries” is also an important piece of work highlighting some of the issues about the interface between non-clinical support workers and health professionals within the health system. As new care models emerge outlining different strategies to provide the right services by the right teams at the right time targeting individual needs and delivering place-based population health systems, searching questions are being asked about what sort of partners should commissioners and provider bodies be working with to deliver social value and reduce health inequalities.

An important sector that tends to get overlooked in this debate is the contribution of the advice sector, ie organisations providing free welfare, money/debt and legal advice, information and assistance. Evidence for example of the value of placing a local Citizens Advice service outreach within GP surgeries has long been amassing for several decades.[1] However it is only in the past couple of years, especially as ideas around social prescribing have taken root, that there has been any discernable interest in looking more systematically about how advice services can add value or support improved health and wellbeing outcomes in health settings and contexts. Last year the Low Commissionimage001 (2) – an independent Commission on the future of the advice sector – undertook an extensive evidence review on the relationship between advice and health outcomes, and models of good practice in collaboration and service delivery. It found that:

The effects of welfare advice on patient health are significant and include: lower stress and anxiety, better sleeping patterns, more effective use of medication, smoking cessation, and improved diet and physical activity.”

The review looked at provision of welfare advice provision in primary health settings, mental health services and also in secondary and tertiary care settings for example in supporting the discharge planning process and rehabilitation. Evidence of the value of advice based interventions were particularly strong in the mental health context, perhaps unsurprisingly given the amount of empirical data collected in recent years focussing on the relationship between indebtedness and poor mental health, and also in areas like homelessness prevention, income maximisation, community support and reduced in-stays and repeat appointments. Of course as you might expect the evidence base is somewhat varied, with much of it in the “grey literature” territory, but also some more robust data emerging from advice services capturing specifically capturing health outcomes generally gathered from before and after follow up assessments with clients, most commonly using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS).

Critically from a policy perspective the research found considerable variation across commissioners in their approach to engaging the advice sector or requirements when commissioning services; at one end of the spectrum there are examples of commissioning partners making considerable investments in advice services to address deprivation and health inequalities and at the other end of the spectrum advice service providers are struggling to engage key commissioners, and services are being decommissioned due to financial pressures. I’ll leave it to readers to study the report and decide for themselves about whether welfare advice in health settings is a good example of “what works in wellbeing,” but it is worth repeating Michael Marmot’s clarion call from the report’s foreword “to broaden our thinking in the future if we are really to put patients and their whole experience and needs at the heart of everything we do.”

James Sandbach was Research Manager for the Low Commission which ran from 2013-2016 

[1] Veitch T. & Terry A. (1993) Citizens’ advice in general practice. Patients benefit from advice. British Medical Journal 307, 262.

→Review: the VCSE’s role in improving wellbeing

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Guest blog: Alcohol, wellbeing, and subtle policy -does drinking make us happy?

benbaumberggeiger

Ben Baumberg Geiger, Senior Lecturer in Sociology and Social Policy at the School of Social Policy, Sociology and Social Research (SSPSSR) at the University of Kent  poses some questions about drinking and our wellbeing….

 

There has been an increasing interest in wellbeing among alcohol policy researchers. Recent studies have estimated wellbeing-related impacts such as ‘harms to others’, while the world-leading Sheffield Alcohol Policy Model estimates a 50p minimum price would lead to wellbeing benefits worth more than £2bn over 10 years.

Yet strangely these studies have ignored the main reason that people drink – the pleasure of drinking. Conversely, those few studies that have estimated the value of the pleasure of drinking have made wildly optimistic assumptions about its wellbeing-enhancing effects, which ignore the impaired rationality of people when drinking – something that most of us drinkers can vouch for – or its addictive nature.

To try to spur a more careful consideration of alcohol and wellbeing, George MacKerron and I recently published a paper in Social Science and Medicine that looks empirically at how people’s wellbeing changes as their drinking changes over time. We used two different datasets:

  • The more conventional analysis was to use the British Cohort Study 1970, looking at how people’s life satisfaction changes between the ages of 30, 34 and 42, and how this is associated with changes in their drinking.
  • The more unusual analysis was to use George’s ‘Mappiness’ data – over two million observations from over 30,000 people, collected by buzzing them twice a day on their iPhones. We were able to look at whether people report being happier at moments that they are drinking.

We found that drinking does seem to make you happier. People report being happier at moments that they’re drinking compared to other moments (controlling for what else they’re doing, who they’re with, and what time of day it is). And while it’s impossible to completely rule out reverse causality – that people drink more when they’re happier – we did control for people’s happiness earlier that day, and still found that people were happier when they’re drinking.restaurant-alcohol-bar-drinks.jpg

Yet at the same time, this happiness doesn’t spill over much to other moments (in Mappiness), nor do people say they are more satisfied with life in years that they drink more (in BCS70). Indeed, if people develop alcohol problems then they become (unsurprisingly) less satisfied with life.

What does all this mean for wellbeing-focused policymakers and researchers?

The first point is that this is an area that could desperately use more research. We would assume that different patterns of drinking are associated with different wellbeing impacts for different people – but sadly the only alcohol-related information that Mappiness includes is whether or not people were drinking (and this only for the relatively advantaged groups with iPhones in 2010-2013). A more alcohol-focussed app-based project would undoubtedly uncover more complex patterns of practical significance.

Still, our research already suggests that the wellbeing impacts of alcohol are subtle – they are not simply positive or negative, but rather depend on the time frame and wellbeing measures that you are interested in. And if they also depend on other factors (such as patterns of drinking or cultural associations), then this opens up the possibility of subtle policymaking that particularly reduces the drinks that are least beneficial (or even harmful) to wellbeing. For example, policies could ‘nudge’ intoxicated people into better decisions through smaller serving sizes or regulations on the pub/bar environment.1MZGVQHJT0

Rather than being the final word, we hope our study prompts other researchers and policymakers to think further about alcohol policy and wellbeing, rather than falling back to the two untenable positions that we set out at the outset.

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Ben is also Co-Director of the University of Kent’s Q-Step centre, and member of the editorial board of the Journal of Poverty and Social Justice

What wellbeing inequalities tell us about the EU Referendum result

Inequalities of wellbeing in the UK can help us understand the EU referendum result

  • High wellbeing inequality was a strong predictor of an area voting to leave.
  • Wellbeing inequality is driven by unemployment rates and ‘governance’.
    • Governance is how people view the quality of society, its functioning and its institutions. This includes voice, accountability, satisfaction with government & the economy, trust in institutions or the control of corruption.
  • Areas with high average wellbeing had higher turnout.

Lord Gus O’Donnell, Patron of the What Works Centre for Wellbeing

“This research demonstrates the importance of inequalities in explaining why people voted to leave. It provides strong supporting evidence for the views expressed by the Archbishop of Canterbury in the Lords this week. It is also an excellent example of how viewing the world through the wellbeing lens provides vital insights into what is really worrying people.

Personal wellbeing is measured by how satisfied people say they are with their life in the ONS statistics.

saamahAnalysis & Comment by Saamah Abdallah from the Centre’s Community Wellbeing team:

The causes of the referendum result are deep-rooted and complex. Economic inequality has been touted by many as the main cause, whilst others have focused on the alienation of the white working classes.

One factor which has not been discussed much is wellbeing. Might low wellbeing explain the decisions of many to turn over the apple cart and vote to leave the EU? Previous research at the LSE has shown, for example, that low average wellbeing predicts the likelihood that an incumbent government will be voted out in an election.

At the New Economics Foundation we looked at data from the Annual Population Survey, which asks over 160,000 people a year a set of four wellbeing questions, including a question asking how satisfied they are with their life, using a scale of 0 to 10. Looking at the voting pattern across the country, it turns out that places with lower average wellbeing did not have a different pattern of voting, but they did have lower turnout.

As part of our work for the What Works Centre, we are also exploring how to measure wellbeing inequality – how much variation in levels of wellbeing there is in a particular place.  Just as looking at average income can hide important disparities in the distribution, so too can looking at average wellbeing. We’ve used an indicator called ‘mean pair distance’ – if you take two random people in an area, what’s the average difference between them in terms of how satisfied they are with their life? Doing so, we found that high wellbeing inequality was a strong predictor of an area voting to leave.

Referendum WB fig

Differences in wellbeing inequality range from 2.4 in Blaenau Gwent in the Welsh valleys, to 1.5 in Cheshire East and Falkirk. Overall, we found that those areas such as Blaenau Gwent that had high levels of inequality overwhelming voted to leave, whereas those with low levels of inequality voted to remain. On average, in the 20 most unequal places in Britain, 57% of voters opted to leave. In the 20 most equal places, only 43% voted to leave.

We found that wellbeing inequality was associated with voting behaviour even when taking into account the percentage of residents with higher education (which has already been highlighted in the Guardian as the most important predictor of voting behaviour), and the percentage of the population that categorises itself as ‘White British’, thus controlling for ethnic diversity.

Higher local income inequality (measured using the 80:20 ratio) was not at all associated with voting to leave.

More research will be needed to explore the reasons for this relationship, but this year’s World Happiness Report argues that wellbeing inequality captures the subjective experience of inequality better than objective measures of income inequality. And it seems it is this subjective experience of inequality that has driven many people to feel dissatisfied and frustrated with seemingly distant elites.

How can wellbeing inequality be reduced?  We’ll be exploring that question further as part of the What Works Centre for Wellbeing.  In previous research, looking at data across Europe, we found that levels of wellbeing inequality were predicted by levels of unemployment and the quality of governance, particularly voice and accountability.

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