Last month I attended the latest seminar run by King’s Health and Society Centre on the subject of measuring well-being – a topic I have written on briefly here before. With several expert speakers it promised to be a lively forum for the discussion of a politically hot but conceptually complex topic. There is no doubt that there is now a significant groundswell of research and interest surrounding the notion of well-being, with conceptual, ethical, empirical and political questions ranging around what well-being is, how it could be measured and what good (if any) could come of the UK government being interested in, and attempting to centre policy decisions, around it.
The chair of the event, Gregor Henderson, suggested that this new focus on well-being signifies a cultural shift in the way health, at least as far as the provision of health services is concerned, is being conceptualised: rather than an absence of illness or disease, emphasis has shifted towards positive, enhancing elements conducive to a healthy, well-lived life. I use the term ‘elements’ here reluctantly because I’m not sure how else to describe the innumerable factors, behaviours, capacities, virtues, environments, dispositions and so forth that contribute towards the well-being of people, families and communities.
And this seems to be the primary difficulty with attempts to conceptualise and measure well-being. It’s relatively straightforward to identify and flag up what might be risk factors for diminishing or eroding one’s sense of well-being: illness, poverty, social marginalisation, poor interpersonal relationships, abuse, lack of educative opportunity and unemployment. Obviously poor mental health increases the risk of detriment to one’s sense of well-being, though as the recovery movement demonstrates, coping in the face of adversity and building resilience might lead to better well-being in the long term, so it is not a simple correlation. But the point I wish to make here is a conceptual one that might forewarn of a pitfall in the measurement of well-being and attempts to improve it in the general population. Much has been made of the need to switch focus away from deficit, illness, incapacity and so forth, in an attempt to emphasise the positive: people’s potentials and capacities to overcome difficulties. This is a laudable aim, rooted in the positive psychology movement. However, one thing that struck me during the seminar was just how all-encompassing the term “well-being” could be, with everything from poor health outcomes to income levels to access to green spaces falling under the domain of well-being measurement and, therefore, within the jurisdiction of local authority-led efforts to improve well-being (which obviously stretches way beyond the domain of the NHS). Isn’t there a risk, therefore, that an unintended consequence of this shift of focus towards positive characterisations of “improving well-being” is that the concept becomes bloated and dangerously close to meaninglessness, for all pragmatic purposes? In meaning everything to do with making people’s lives better/happier/more fulfilled/etc, it ends up meaning nothing at all. Or at least, nothing that can serve a practical purpose of driving policy and implementation in any coherent, focused and waffly rhetoric-free manner.
In the words of J.L Austin1, it may well be that “the negative concept that wears the trousers” here: great insights can be achieved when we consider not what well-being is but what it isn’t. The aim of positively characterising all the myriad, complex, possibly idiosyncratic things that contribute to well-being, which might differ vastly across populations and communities, could end up being just impossible to complete. Of course there are some reliable measures, but there are questions around their cross-cultural validity and applicability in different communities (women in patriarchal communities might not consider themselves to “be in control of my own life”, but this would not be of detriment to their feeling of well-being, for example). There is, therefore, a perhaps unseen advantage to the focus on risk factors and detriments to well-being: we can at least gain some clarity about the things that are definitely bad for our well-being, even if we have no hope of capturing successfully what well-being actually is.
Paul Allin, of The Office of National Statistics was very keen for contributions to the ONS’s continuing discussion on well-being so, as a quick plug here, please take a look at their website if you’re interested in this debate: www.ons.gov.uk/well-being.
1 Austin, J. L. (1956–57) “A plea for excuses”. Proceedings of the Aristotelian Society 57:1–30. Reprinted (1968) in The philosophy of action, ed. A. R. White. OUP.