Perceptions of well-being in public health practice Approaches to measurement Sarah Stewart-Brown Professor of Public Health

Descartes was wrong The mind and body are one Debate about the meaning of wellbeing focuses on mental wellbeing

Health and wellbeing Physical health and mental health Mental wellbeing – self-esteem – confidence – resilience Healthy Lives Healthy People 2010

Contributions Philosophers – Western: Aristotle Epicurus – Eastern: Buddhism, Hindu, Islam Psychologists – Psychological functioning, – Positive psychology – Flourishing Wellbeing is something that is cultivated by the individual

Psychological Well-being (Eudaemonic) Functioning well /flourishing Autonomy Self acceptance Personal growth Purpose in life Environmental mastery Positive relations with others Ryff 1995

Jahoda 1958 Positive Mental Functioning Autonomy Environmental mastery Self actualisation Integration Attitudes towards self Perceptions of reality

Ryan and Deci (2001) Basic Psychological Needs from Self Determination Theory Autonomy – I have a say in what happens to me and can voice opinions Competence – I feel very capable and effective Relatedness – I feel loved and cared about

Seligman (2002/2011) Authentic Happiness Pleasure Engagement Meaning Relationships Accomplishment

Contributions Social Scientists Wellbeing is something that is determined by social conditions – GDP – Income, wealth, poverty – Government – Services Education Health Social

Subjective Wellbeing (Hedonic) feeling good/happiness/ affective well-being Feeling good Life satisfaction Happiness Diener 1993

DEFRA, OECD Measures of wellbeing Poverty Educational failure Unemployment Homelessness Determinants of mental illness

Both matter Internal states External conditions

Both matter Functioning Feeling

Diener 2010 Purpose in life, Positive relationships, Engagement, Competence, Self-esteem, Optimism Contribution towards wellbeing of others

Keyes 2002 Mental Health Continuum Canada Holland Happiness Psychological wellbeing (Ryff) Social wellbeing – Social acceptance – Social actualisation – Social contribution – Social coherence – Social integration

Huppert 2011 European Social Survey Competence : Most days I feel a sense of accomplishment Emotional stability: In the past week I felt calm and peaceful Engagement: I love learning new things Meaning : I generally feel what I do is valuable and worthwhile Optimism: Positive emotion: how happy would you say you are ? Positive relationships – people in my life who really care about me Resilience: when things go wrong takes a long time to get back to normal Self esteem: I feel very positive about myself Vitality In the past week I had a lot of energy to space

New Economics Foundation Emotional wellbeing Satisfaction with life Vitality Resilience and self esteem Positive Functioning

Measurement in UK

Office of National Statistics: Approach Overall how satisfied are you with your life nowadays? Overall how happy did you feel yesterday ? Overall how anxious did you feel yesterday ? Overall, to what extent do you feel things you do in your life are worthwhile ?

STATEMENTS None of the time RarelySome of the time OftenAll of the time I’ve been feeling optimistic about the future I’ve been feeling useful I’ve been feeling relaxed I’ve been feeling interested in other people I’ve had energy to spare I’ve been dealing with problems well I’ve been thinking clearly I’ve been feeling good about myself I’ve been feeling close to other people I’ve been feeling confident I’ve been able to make up my own mind about things I’ve been feeling loved I’ve been interested in new things I’ve been feeling cheerful The Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

Issues Single measure or multiple measures? Positive or negative measures? Proportion or mean score ?

WEMWBS vs CESD-D Pearson correlation.842

WEMWBS cf PHQ-9 Pearson correlation.74

Positive or Negative Great majority of measures of mental health focus on the negative/ disease / distress Focusing on the positive is an intervention in its own right. – ‘What you pay attention to is what you get more of’ Public and patients prefer positive measures Crawford et al. Selecting outcome measures in mental health. J. Mental Health 2011(20)

Issues Single measure or multiple measures? Positive or negative measures? Proportion or mean score ?

WEMWBS vs CESD-D Pearson correlation.842

NHS Direct wellbeing/Pages/five-ways-mental- wellbeing.aspx wellbeing/Pages/five-ways-mental- wellbeing.aspx 5 Steps to Mental Wellbeing Wellbeing self assessment

Summing up Perceptions of wellbeing derive from diverse disciplines Opinions are converging Currently available measures vary, but are good enough for: – Monitoring population wellbeing – Evaluating interventions – Studying determinants We have focused for too long on the negative and therefore know more about the determinants of illness Time to change