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Why we need wellness networks
We tend to think of wellness as an outcome: but emphasising its qualities as a process and system offers new directions and opportunities
Being well is something that concerns us all – indeed there are surely few more pressing issues for humans than our health and wellness. There is a huge investment to underpin this: the NHS costs the UK almost £200 billion, and McKinsey estimates the private wellness market to be worth $1.5 trillion globally, with an annual growth of 5 to 10 percent. The scale of this spend reflects the way that health and wellness are issues that have long been the concern not only for all of us but health practitioners, policy makers, marketing strategists as well as science and technology companies.
The challenge for those with an interest in wellness is that is a slippery term and a hard topic to pin down – there are numerous definitions of what it is and many different considerations of how to achieve it. For example, the ONS have five different measures for being well covering the individuals’ satisfaction with life, whether they feel the things they do in life are worthwhile, their positive and negative emotions, and their mental health. They also identify 44 indicators, such as relationships, health, how we spend our time, where we live and so on.
Whilst of course this is invaluable, perhaps this complexity suggests we could locate other ways of looking at this issue: might other ways of approaching the issue offer more simplicity and directness in how to tackle the challenge?
To do this, we highlight two key considerations. The first is definitional: what do we mean by wellness? Despite the ease with which we use it in everyday life, it is a surprisingly hard concept to pin down. The second related issue is measurement: what are we actually measuring when we ask people about it?
From this starting point we set out the case for challenging some of the thinking on these related issues and offer fresh perspectives on what it is and how we measure it: and with that, what we do to enhance wellness individually and societally. We draw on the work of Iza Kavedzija to make the case that we can reframe the issue and rather than think in terms of outcomes and causes, perhaps it could be helpful to consider wellbeing as a process.
Definitions: wellness and wellbeing
There are two terms commonly used in this area – ‘wellness’ and ‘wellbeing’. While they are used interchangeably, they have very different histories (note that we are using the term wellness in this article for simplicity). This is useful to understand as they reflect quite different traditions in terms of what it is believed people need to ‘be well’.
The term ‘wellness’ has its roots in the biomedical—and frequently physical—as the “absence of any disease or impairment” and this continues to be the dominant way in which the term is used in public health. However, the notion of ‘wellness’ has gradually gained in popular usage since the 1960s as the responsibility for being well has been increasingly been assigned to the individual, giving them tools, devices and drugs to manage their own happiness and efficiency.
This has also led to people seeking to be the best possible version of themselves, to be as productive and ‘perfect’ as possible. With the freedom from extrinsic control (as society become overtly relaxed) came instead a more powerful set of internalised intrinsic controls on ourselves, so that we demand of ourselves that we continuously improve. This has been accompanied by a rise in technologies and solutions suggesting we can be a better version of ourselves.
Whilst ‘wellness’ has increasingly been associated with individual ways to optimise mental and physical outcomes, at the other end of the spectrum ‘wellbeing’ has often been associated with the notion that group-level factors are important for us to be well. As such this will include themes such as mutuality, belonging, mission, justice, relational growth, effective leadership, and trust. In fact, the World Health Organization defines health as “a state of complete physical, mental and social wellbeing”.
In summary then, we can then see that there are some very different traditions reflected in the terms ‘wellness’ and ‘wellbeing’. Wellness is typically being associated with individual ways in which we are not only free from disease but also we are the best possible version of ourselves, physically, mentally and lifestyle wise. Wellbeing on the other hand is often related to our embedded, social and communal lives, associated with the conditions in which we are able to feel secure and happy and able to flourish and thrive.
Definitions are inevitably tied up with measurement approaches. A traditional approach to measurement would focus on disparity using a range of ‘objective’ indicators such as household debt, health, other welfare measures, reflecting a narrow view of being well (being physically and mentally healthy). However, it is long been argued that we also need Subjective Wellbeing Measures that are better able to reflect a more nuanced view of wellbeing, reflecting how happy or satisfied we are. Socio-economic data may offer a range of insights into the circumstances of the population, but they do not necessarily tell you what people are thinking or feeling. Indeed, as leading policy expert Gus O’Donnell sets out:
“…an austerity programme or a recession will cause some people to have lower incomes, which economists regularly measure through the change in GDP, or to lose their jobs, which we measure through unemployment rates. But we rarely take into account the worry, stress, or anger that people feel in dealing with these things.”
If we simply measure what people are doing rather than how they feel, or how they think about things, there is a danger that we fail to represent what really matters to us. That led to an opening-up of the being well debate to a broader set of disciplines, reflecting a willingness to embrace a more nuanced (and with this inevitably more contested) approach to the topic.
There has been a huge amount of activity in the measurement of wellness which is of course to be welcomed as much continues to be achieved by this focus. And we see the ‘wellness’ versus ‘wellbeing’ debate reflected in the different forms of measurement with people such as Sarah C. White pointing to the way that Western societies have stress individual responsibility, including for their own happiness. This culturally shaped mindset seems to come through in many of the attitudes people report on their own being well.
We speculate that we are in the midst a shift from more individual considerations of wellness to a recognition of its more relational characteristics – from ‘wellness’ to ‘wellbeing’. But there is something a little nuanced and perhaps more even more important that we can also add to this.
The move to self-report measures may well have led to a focus on measuring outcomes: this is not unreasonable and is very much in the social scientists repertoire: we can then examine the way in which different inputs influence our wellbeing. But this assumes wellness as reflecting something we have – that there is a quantity within us individually that we can account for. And even if you take a more ‘wellbeing’ perspective (focusing on the social / relational determinants of being well), this still assumes the primacy of the individual level measurement of being well, albeit weight is given to the way this is influenced by social / relational factors. But the notion that wellness is something that we can have certain amounts of is not quite as safe assumption as we might have assumed.
From outcomes to systems
To help unpack this a little, we turn to the work of Lisa Feldman Barrett who has developed a huge body of research on emotion. One of the core concepts that she uses to reference the way emotion works is ‘allostasis’, the process for the way the brain regulates the body according to costs and benefits, efficiently maintaining energy regulation. This has some fairly radical implications for our purposes: namely that brains did not evolve for subjective wellbeing outcomes but rather that our wellness is a useful by-product of effectively managing our allostatic load.
If this is the case, then there is an argument we are looking in the wrong place to measure wellness – what we need to understand it is less an outcome and more as a process.
While anthropologist Iza Kavedzija’s work does not explicitly reference allostasis, it does highlight the importance of processes for wellness. The proposal is to shift the focus away from individuals and to think of people as continuously made up of interactions and their caring relationships with others. This moves us away from a focus of wellness as an outcome or an achievement – it is not something we seek to attain or possess. It is a quality of how multiple relationships that make up our lives unfold over time.
This means that to tackle wellness we need to think of the way we are all the result of our ‘relations of care’. To maintain this means we need to attend to ‘networks of care’ that might be in need of support or repair – and we therefore need ‘scaffolding’ that allows these caring relations to function effectively. As the landscape we inhabit changes, then so does the way in which these networks of relationships are managed. The impact of the cost of living crisis is important here: we can see how this can devastate the way networks of care operate, resulting in much poorer wellness communities.
We need to recognise the importance of our entanglements with others as we seek to live well together: this reliance on others means that when we want change to happen, then we are not doing this individually but as a more collective endeavour. We can therefore see wellness as circulating in a network of relations of support rather than a simple cared / care-for pairing.
Given this process-based approach, the focus of wellness measurement should surely move to considering the wider environment in which we live (based on what we know is important in terms of wellness). The emphasis could be more inclusive so that we do not rely quite so much on individual outcomes (‘how much wellness do we have’) but to an identification of the structures (or systems) that are key to delivery of wellness (such as family, work, housing) and assessing how well these are ‘performing’, able to facilitate care and associated characteristics needed to create an environment that supports us.
Systems level thinking and measurement is again needed as we see how some environments facilitate a much better wellness community than others. Adapting approaches is useful, such as Ruth Schmidt’s SPACE model which references the impact of ‘choice infrastructure’, but also tapping into wider narratives such as Doughnut Economics that emphasises the importance of holistic frameworks.
More on this important topic in future posts..
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