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Aug 17, 2023 | by Nancy Hey

A Covenant for Health: Taking a wellbeing approach to health

The recently released report, ‘A Covenant for Health’, provides recommendations for a healthier nation, with a focus on improvement and prevention.

Our Executive Director, Nancy Hey, contributed a perspective and analysis on the crucial link between health and wellbeing. Here, you can read the piece, originally published in the appendices section of the full report, and more about a new strategy targeting major health conditions.  

Subjective wellbeing and mental and physical health

What is wellbeing? 

Wellbeing is how we’re doing as individuals, communities and as a nation, and how sustainable that is for the future. It encompasses the environmental factors that affect us and how we function in society, and the subjective experiences we have throughout our lives. Wellbeing can be used to go ‘Beyond GDP’ to measure progress and the success of nations. Personal wellbeing is whether we are feeling good and functioning well. National Wellbeing Approaches use personal subjective wellbeing measures, especially life satisfaction, as an indicator of success. 

What the evidence tells us about wellbeing and health

How you feel about your health is consistently one of the biggest correlations with subjective wellbeing as measured by life satisfaction. Life satisfaction is one of four personal wellbeing measures used by the Office for National Statistics (ONS). Our 2018 analysis of longitudinal survey data from Australia, Britain, Germany and the US provides strong evidence that the top driver of individual wellbeing is health. 

At a national level, healthy life expectancy is the third biggest indicator of high wellbeing nations after GDP and “Having someone to rely on in times of trouble”. We know that people are least happy when being ill in bed, and that time taken to manage ill health contributes to lower wellbeing. In contrast, physical and mental health can be improved over time through physical activity, supporting subjective wellbeing through experiential enjoyment and sense of purpose, as well as increased resilience. 

Analysis by the ONS reveals that self-reported very bad or bad health is the strongest factor associated with the poorest personal wellbeing, and those self-reporting a disability are almost twice as likely to have the poorest personal wellbeing as those who said they were not disabled.

The picture is nuanced: people can have the same physical and mental health conditions and their quality of life can vary. The implication is that we can improve the quality of life for those with long term illnesses, chronic conditions, disability and at the end of life.

We can use subjective wellbeing as a common currency across departmental priorities to understand and value the impact each sector and department has. The Levelling Up White paper introduced a broader definition of Human Capital that expanded it beyond the value of the qualifications people have to include health too. The HMT Green Book supplementary guidance on wellbeing, used in the White Paper, provides a more consistent way of using this across departments and valuing it.

By making overall happiness the goal and shifting from “wealth creation” to “wellbeing creation”, distinctions between sectors of government become fairly arbitrary, and cross-sector prioritisation is important for making the best use of resources.

Health creation, promotion and prevention is at the core of a wellbeing approach. If we want to reduce misery and improve wellbeing, an area for policy, delivery and research prioritisation is mental health. This requires accelerated scaling up of effective interventions and significant investment in research. We are already seeing evidence-informed systematic change, for example the inclusion of wellbeing as a topic in the ‘Mental Health & Wellbeing JSNA’ OHID public health profile. This shift in focus does not negate physical health, which remains important.

Change is now possible; we can create a future we want and make progress.

About the report

Published in July 2023, A Covenant for Health: Policies and partnerships to improve our national health in 5 to 10 years proposes a cross-party government commitment to building a healthier nation over a generation, bringing together business, the NHS, communities and individuals.

The report was led by Geoffrey, Lord Filkin CBE with Professor Kate Ardern; James, Lord Bethell; David Buck, The King’s Fund; Dr Paul Corrigan CBE, former Health Adviser, No 10; Professor Sian Griffiths CBE; and Professor David Halpern CBE, Behavioural Insights Team, with project support from The King’s Fund.

What’s next?

“The health of the nation is critical for the health of our economy, our public services and, above all, the wellbeing and life chances of all our citizens.”

This week, the Department of Health and Social Care (DHSC) published a new interim report on a Major conditions strategy, setting out a framework for change to improve outcomes and transform lives. The strategy identifies six categories of major health conditions where focus should be targeted: cancer, heart disease, musculoskeletal disorders, mental ill-health, dementia and respiratory diseases.  

It considers overall health, prevention, early diagnosis and treatment, and living with these conditions. Improving wellbeing is weaved throughout as an aim and desirable outcome. It recognises the value of health for overall wellbeing, and the resilience and sustainability of the nation. The strategy is also concerned with palliative and end of life care. One way in which we are already supporting work in this area is by building the collective knowledge of wellbeing at the end of life, including living with terminal illness, and work and terminal illness.

The strategy also marks progress towards greater parity between the consideration and treatment of mental and physical health. Tackling the mental health of those with physical health conditions, and vice versa. 

The DHSC strategy follows The Hewitt Review, reiterating the importance of Integrated Care Systems (ICS) as an opportunity to “make meaningful long-term improvements to populations’ health and wellbeing”. Specifically, the new strategy includes a commitment to an “impact assessment tool to support policymakers to consider the mental health and wellbeing impact of all policies.” The effectiveness of impact assessment tools in policymaking is currently unclear. For more evidence based approaches, see our project on the use of wellbeing in place based approaches and policy tools that support the HMT Green Book Wellbeing Supplementary Guidance.


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