Introduction by Croakey: Whether we look to our toxic virtual environments, our polluted and besieged physical world, or the stressed and often harmful systems within which we live, work and play, it is clear that the wellbeing of people and planet is under attack from multiple directions.
A new book by University of Adelaide academic Dr Matthew Fisher, How to Create Societies for Human Wellbeing: Through Public Policy and Social Change, examines how a comprehensive public health approach could help improve wellbeing, as the author outlines below.
Matthew Fisher writes:
From global agencies to national governments, the importance of wellbeing is receiving close attention – but efforts to promote wellbeing could benefit from greater engagement with a comprehensive public health approach.
The World Health Organization (WHO) has long defined health as a ‘state of physical, mental and social well-being’. More recently, other organisations such as the OECD have called for governments to go ‘beyond GDP’ to recognise wellbeing as the defining goal of public policy.
The UN Sustainable Development Goals include a goal to ‘ensure healthy lives and promote well-being for all at all ages.’ Several governments around the world have sought to apply concepts of a wellbeing economy or instituted frameworks intended to measure wellbeing, again on the premise of going beyond GDP as a proxy indicator of social progress.
Is all this talk of wellbeing and wellbeing policy worthwhile?
Well, I would say yes, very much so. Wellbeing really is inherently valuable to all people, whether they know it or not.
As a target for advocacy, activism and policy change, wellbeing has potential to challenge both neoliberal economics and biomedical dominance, to revitalise primary prevention and health promotion, and moderate epidemics of psychological distress and harmful social behaviours. It can complement goals of sustainability and planetary health.
However, all this important potential is held back by a weakness in current theory and research on wellbeing.
As I show in my new book, How to Create Societies for Human Wellbeing, published with Policy Press, this limitation lies in a failure to explain the causal relationships between social and economic conditions and psychosocial wellbeing.
Instead, most current theoretical constructs conceive the nature and ‘making’ of wellbeing in a relentlessly individualised way and thus are poorly placed to explain social and cultural determinants of mental health and wellbeing. Policy built around those constructs may help individuals while leaving the social causes of ‘ill-being’ untouched.
Thus, the aim of the book is to develop a comprehensive public health approach to wellbeing addressing four key questions:
- What is wellbeing?
- How does wellbeing work in the body and brain?
- How is wellbeing shaped by social conditions?
- What policies and practices are needed to promote wellbeing equitably?
I suggest that all the pieces of evidence needed to build such a theory are already available, but are rarely brought together, because they sit under different disciples.
Wellbeing itself and the harms we do
To theorise wellbeing, I start with the role of acute stress in everyday social intelligence, drawing on evidence in the cognitive sciences. I describe the kinds of social conditions which act to ‘push’ acute stress into a pattern of chronic stress, which we know is harmful to mental health and increases risk of several forms of non-communicable disease.
Appreciating the nature and causes of chronic stress is then key to explaining the population-scale impacts of social determinants of mental health such as financial and housing insecurity, insecure employment conditions, exposure to discrimination, adverse childhood conditions, and social isolation, just to name a few.
Cumulative exposures to social stressors in childhood and in adult life help to explain the high rates of psychosocial distress and common forms of mental ill-health in Australia. Population differences in exposure to stressful conditions help to explain inequities in mental health/wellbeing.
Building on this foundation, I define wellbeing as consisting in seven ‘wellbeing abilities’, combining elements of constructive goal-directed behaviour, exercising skills, having personal and social resources to cope with minor stressors and avoid chronic stress, positive social relatedness, creativity, and present-moment awareness, including through contact with nature.
I also explore parallels between my approach and Indigenous holistic conceptions of wellbeing including cultural-relational elements such as connection to community, culture and country. In particular, I discuss commonalities between present-moment awareness and the concept of dadirri or ‘deep listening and quiet, still awareness’ as taught by Aunty Miriam-Rose Ungunmerr-Baumann of the Ngangikurungkurr people from Daly River country.
To extend this view of wellbeing into the realm of public policy and social change, I then specify ten essential social conditions (or determinants) needed for the realisation of wellbeing abilities:
- Supportive family environments for early child development
- Meaningful, secure work
- Positive social connections
- Connection with and care for nature
- Healthy, sustainable food
- Housing access and healthy neighborhoods
- Comprehensive primary healthcare
- Education for lifelong learning
- Opportunities for creative practices
- Having time available.
Political principles and policies for wellbeing
The first half of How to Create Societies for Human Wellbeing is about developing a theory of psychosocial wellbeing.
The second half is about public policy and social change to promote wellbeing, with two main parts to the argument. One of these, of course, is about the things that governments can and should do to reduce exposure to social stressors and increase access to supportive conditions.
I propose that the actions of a ‘wellbeing government’ have to start with a basic ethical commitment to wellbeing as a matter of fundamental public interest. Further, the whole emphasis of social and health policy must shift away from crisis-driven remedial responses toward a principle of human development.
From there I discuss the multiple kinds of policy changes needed to promote wellbeing equitably in areas such as early childhood, health, education, employment and welfare, digital media, and environment.
However, my second main argument about policy and social change is that calls for adjustments in status quo policy settings, funding priorities or what have you to strengthen social conditions for wellbeing, even if heard and taken seriously, are unlikely to be enough.
Even with the best will in the world, top-down actions by governments and public agencies alone are unlikely to deliver universal access to supportive conditions for wellbeing.
In the spirit of the Ottawa Charter for Health Promotion, it remains as true as ever that health and wellbeing are made in the places people grow live, work and play, and necessarily demand engagement of individuals and communities as active participants.
Thus, I argue that social policy for wellbeing will be better enacted via a widespread shift to what is now referred to as ‘place-based’ policy involving a government-community partnership and codesign approach tailored to meet needs within particular community places. In Australia, Indigenous communities have also led the way in arguing for these approaches.
Local governments have an important role to play, and many are already implementing localised strategies for wellbeing – but these need to go further. Many communities themselves are already taking self-determining actions relevant to wellbeing.
Interestingly, the Federal Government, along with philanthropic organisations, recently launched a new national centre for place-based strategies.
This is all about public support for localised strategies to build supportive conditions for wellbeing such as those listed above. In the book, I refer to this as a process of building wellbeing communities as the necessary foundation for the wellbeing societies recently called for in the WHO Geneva Charter for Wellbeing.
If in these arguments I am reiterating some of the longstanding principles of health promotion, I’m fine with that and would be surprised and concerned if I wasn’t doing so.
The point for me is to re-prosecute and strengthen the case for those principles, within a contemporary, comprehensive theory of public wellbeing, literate on psychosocial stress and wellbeing.
• How to Create Societies for Human Wellbeing: Through Public Policy and Social Change is available through Policy Press and other popular book outlets.
Author details
Dr Matthew Fisher is a Senior Research Fellow with the Stretton Health Equity research team at University of Adelaide. His research tackles questions of how Australian public policy does or does not address social determinants of health and health equity. He has a longstanding interest in public health perspectives on stress, mental health and wellbeing and has published several articles on the topic, including ‘A Theory of Public Wellbeing’ inBMC Public Health. His new book, How to Create Societies for Human Wellbeing: Through Public Policy and Social Change’ brings this work together in a new public health-based approach to individual and societal wellbeing.
See Croakey’s archive of articles on the social determinants of health
