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
Healthy Lives Healthy People
2010
• Health and wellbeing
• Physical health and mental health
• Mental wellbeing
– self-esteem
– confidence
– resilience
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
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Autonomy
Self acceptance
Personal growth
Purpose in life
Environmental mastery
Positive relations with others
Ryff 1995
Jahoda 1958
Positive Mental Functioning
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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
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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
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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
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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 ?
The Warwick-Edinburgh Mental Well-being Scale
(WEMWBS)
STATEMENTS
None of Rarely Some of Often All of
the time
the time
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
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
I’ve been thinking clearly
I’ve been feeling good about myself
1
2
3
4
5
1
2
3
4
5
I’ve been feeling close to other people
1
2
3
4
5
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
1
2
3
4
5
1
2
3
4
5
1
2
3
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5
1
2
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5
I’ve been feeling cheerful
1
2
3
4
5
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)336-346
Issues
• Single measure or multiple measures?
• Positive or negative measures?
• Proportion or mean score ?
WEMWBS vs CESD-D
Pearson correlation .842
NHS Direct
• http://www.nhs.uk/Livewell/mentalwellbeing/Pages/five-ways-mentalwellbeing.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