The Pursuit of Happiness in Global Health Systems

The way we define health has changed radically in the past century. In 1966, the Alma Ata Declaration brought forward the concept of health for all, without discrimination [6]. This concept was furthered by both the Millennium Development Goals and the Sustainable Development Goals that aimed to encourage direct action to lower mortality and decrease the rates of both communicable and non-communicable diseases worldwide [10]. With a growing understanding of health equality also came an awareness of the social determinants of health and a better understanding of how environments and socioeconomic factors play a role in shaping an individual’s health and life [8]. More recently, researchers and health economists have moved towards the inclusion of happiness and well-being into health system frameworks. 

Although happiness is understood in multiple contexts, when it comes to global health, we are specifically looking at ways of improving health treatments and interventions to work in favour of an individual’s happiness and well-being [9]. But how exactly can we define happiness and determine whether a person is living happily? 

This question has been central to the science of subjective well-being, which has emerged over the past four decades and forms the basis of what is known as well-being economics today. It includes data from surveying residents in 150 countries and asks the life satisfaction question: “taking all things into account, how satisfied are you with your life these days on a scale of zero to ten?” [4] The data collected from this survey, in addition to economic and social measures, can be analyzed to identify predictors and determinants of life satisfaction [1]. Of course, many are initially skeptical of the use of subjective responses and statistical evaluations to provide information about people’s happiness in any meaningful way. However, this data has proven to be incredibly insightful, and has become the focus of many research groups and large scale projects, including the Happiness and Well-Being Policy Report, which is published annually to recount the increasing number of economists and policymakers that explicitly focus on human well-being instead of more traditional progress indicators such as Gross Domestic Products (GDP). 

Although this might seem completely opposed to the value of objectivity that comes along with medicine and the sciences, the subjectivity that comes with happiness is similar to that of self-reported health, which emphasizes the important expectations that a population may have of their healthcare system and broader social services [3]. It is also similar to how pain and different symptoms are reported in hospitals and other medical settings. It is still important to note that measures of happiness do not naively rely on these subjective self-proclamations of happiness-they consider multiple methods and standards relating to an individual’s environment and experience.

Comparing countries by their level of happiness in this way has led to a movement towards inclusion of happiness and well-being into public policy. According to a study from the Health Economics Review, there is an observable relationship between a country’s health systems efficiency with its associated happiness index [7]. This study resonates with reports from the World Health Organization stating that happiness leads to a longer, healthier life and indicates a serious need to move and redirect health systems in this direction [9].

Interestingly, different results have been reported when looking at the relationship between happiness and health, while using comparisons of a country’s income. When lower- and middle-income countries (LMICs) experience periods of economic growth and an increase in capital, we see almost immediate improvements in the treatment of infectious and non-communicable diseases as well as in decreasing mortality rates [2]. However, when happiness and satisfaction with one’s health are involved, LMICs do not report lower indicators of happiness. As described by Carol Graham from Health Affairs, “once a certain level of longevity is achieved, there is no consistent cross-country relationship between health and happiness” [3].  This is in no way to discredit the value of approaching health through the lens of happiness, but to understand the areas in which this perspective can be applied to make health systems more adaptable to societal changes. It also points to the important cultural differences associated with standardizing happiness in this way. 

The issue of happiness poses a particularly interesting question for those interested in health policy and health systems worldwide. It raises questions of what exactly is being prioritized within global systems. Even though healthcare expenditure has historically served as a way of containing disease and diminishing rates of mortality and sickness, this association has the potential to change this priority [5]. Health economists today are slowly moving to incorporate happiness as a general outcome for all healthcare, with a focus on satisfaction, end of life care, and a more holistic consideration of mental health [9].  Changing the ways in which priority setting takes place is a central outcome of examining health issues through a lens of happiness. 

Emphasizing happiness in healthcare expenditure has the potential to address health issues, while moving global health away from traditional goals of development. The global movement away from GDP and towards measures of well-being should be reflected and supported by global health. 

References

[1] Barrington-Leigh, C. (2017). Sustainability and Well-Being: A Happy Synergy. Development, 59(3-4), 292–298. https://doi.org/10.1057/s41301-017-0113-x

[2] Deaton, A. (2004). Globalization and Health. In Brookings Trade Forum: Globalization, Poverty, and Inequality. Washington, DC: Brookings Institution Press.

[3] Graham, C. (2008). Happiness And Health: Lessons—And Questions—For Public Policy. Health Affairs, 27(1), 72–87. doi: 10.1377/hlthaff.27.1.72. 

[4] Helliwell, J. F., Layard, R., & Sachs, J. (2012). World Happiness Report 2012. Retrieved from https://worldhappiness.report/ed/2012/.

[5] Peasgood, T., Foster, D., & Dolan, P. (2019). Chapter 3: Priority Setting in Healthcare Through the Lens of Happiness. In Global Happiness Council (Ed.), Global Happiness and Well-Being Policy Report. Retrieved from http://www.happinesscouncil.org/

[6] Rifkin, S. B. (2018). Alma Ata after 40 years: Primary Health Care and Health for All—from consensus to complexity. BMJ Global Health, 3(Suppl 3). doi: 10.1136/bmjgh-2018-001188.

[7] See, K. F., & Yen, S. H. (2018). Does happiness matter to health system efficiency? A 

performance analysis. Health Economics Review, 8(1). doi: 10.1186/s13561-018-0214-6.

[8] WHO. (2010, December 1). Health Impact Assessment: The determinants of health. World Health Organization. Retrieved from https://www.who.int/hia/evidence/doh/en/.

[9] WHO. (2011). The Happiness Effect. Bulletin of the World Health Organization, 89, 246-7. doi: 10.2471/BLT.11.020411.

[10] WHO. (2015, December 8). From MDGs to SDGs, WHO launches new report. World Health Organization. Retrieved from https://www.who.int/en/news-room/detail/08-12-2015-from-mdgs-to-sdgs-who-launches-new-report.