England’s Health Index and subjective wellbeing – exploratory analysis

How healthy we are matters for individual, community and national wellbeing. To better understand the relationship between different health factors and people’s subjective wellbeing, we have analysed data from the Office of National Statistics’ (ONS) Health Index for England. 

By looking at how indicators interact, we can provide insights for healthcare policymakers, practitioners and others.

Here, we present findings from our exploratory analysis, alongside recommendations for using the Health Index and our research.

Health is a strong driver of wellbeing. Our experience and perception of our mental and physical health is the biggest single factor that explains, on average, how we rate our wellbeing.  

The relationship between health and wellbeing is also bidirectional with each influencing and impacting on the other. Acute health problems affect wellbeing the most, and long term chronic ill health puts people at increased risk of low wellbeing.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”¹The World Health Organisation constitution.

Health as an indicator of national progress

Indicators related to health are vital to our understanding of how we’re doing as a nation. 

In its Levelling Up the UK White Paper, the UK Government lays out Health as one of its missions: “By 2030, the gap in Healthy Life Expectancy (HLE) between local areas where it is highest and lowest will have narrowed, and by 2035 HLE will rise by five years.”

Increasing life expectancy is often viewed as a goal for improving lives, and is considered as important as GDP. However, changes in life expectancy can be slow to emerge in data, and often don’t tell us how healthy people are currently, their quality of life, or wider experiences such as living with a long term condition or at the end of life. 

The Health Index

The Health Index offers a mechanism to track progress in a more detailed and nuanced way, beyond life expectancy alone. Using multi-metric frameworks to measure, monitor, and drive social progress offers a way to shift from treatment to prevention. 

The Index is a tool that measures a broad variety of health outcomes and risk factors over time and for different geographic areas in England at local authority, regional and national levels. It provides a value that indicates the health of a place and can show how health changes over time. 

The Index can be broken down to focus on specific topics. It consists of three overarching domains, with a total of 56 indicators: 

1. Healthy People
2. Healthy Lives 
3. Healthy Places 

For a list of all subdomains, see the ONS website.

The Health Index creates a value of health that can be used by different groups in society, creating a common language and fostering a more integrated approach. 

This shared dialogue about health means the same data can be used by communities, local areas, regions, or central government and is useful for conversations on health improvement strategies across different administrative levels, ensuring a unified approach to public health initiatives and strategies.

Our analysis

To increase national wellbeing, we want to grow understanding about how health, and the indicators of progress towards good health in the Health Index, interact with the ONS4 subjective wellbeing measures. 

“Taken together, these missions will help achieve the overarching ambition to improve well-being in every area of the UK, with the gap between top performing and other areas closing (Mission Eight).” ²Levelling Up the UK White Paper, Exec Summary pg 12.

The drivers of subjective wellbeing include:

• Jobs, education and living standards 
• Health 
• Relationships
• Our social and institutional capital

All of these are influenced by the places we live and work, and what we experience in our day to day lives. Knowing what makes the biggest difference to people’s lives in each area will help us make effective use of time, effort and resources. 

Our approach included:

• A summary of the published literature – see table 1 in the full report.
• A descriptive analysis of subjective wellbeing variables over time.
• A correlation analysis between the subjective wellbeing variables and the indicators within the Healthy People and Healthy Lives domains, to spot any connections or relationships.
• A panel data analysis over the period 2015-2021 with subjective wellbeing variables as dependent variables and the indicators from the domains of Healthy People and Healthy Life as regressors.

We focused on ‘Healthy People’ – which includes areas such as disability and health conditions – and ‘Healthy Lives’ – which refers to behaviours, risk factors and prevention.

Key findings

A positive correlation indicates that higher wellbeing scores, for some or all measures, were observed with these health factors. 

Negative correlations show lower wellbeing scores, for some or all measures, were observed with these health factors. 

Dementia – lacks a significant correlation with subjective wellbeing variables. It is important to note that how people with dementia score their wellbeing can be influenced by a variety of factors like emotional state, physical health, psychological resources, and social environment, the severity of dementia, and their ability to manage daily life or access health services. 

Although, we can not determine from these findings that one causes the other, investigating these relationships is valuable and important, and can form the basis for further research. 

For full details and discussion of findings, read the full report.

Using the data and insights

The Health Index provides a comprehensive overview of health. Through better understanding of the influence of policies on health, it is possible to prioritise actions that enhance wellbeing and reconsider those that potentially harm it. 

How can we use these tools?

• To describe progress and understand the local picture.
• Use as a common language for communities, local areas, regions and central government to talk about health and how to maximise it.
• To join up the conversation on improving health at local, regional and central level and who is best placed to act. 
• To build local data where there are gaps. 
• To connect it with other building blocks of health and prosperity, for example relationships and living standards in the levelling up missions, UK Measures of National Wellbeing, Wales’ Wellbeing of Future Generations Goals, or Scotland’s National Performance Framework. 

We have made the Stata do code available on the What Works Centre for Wellbeing GitHub as an open source tool. This is part of our ambition to reduce the cost and improve quality of future analysis, making it easier, cheaper and quicker for ourselves and others.