good health and wellbeing research topics

82 Interesting Research Topics in Health and Wellness

Need some interesting and unique research topics in health and wellness? Find them here! Check out our list of the best health and wellness research topics for students. Here, we’ve gathered plenty of fresh and unique wellness research topics for a presentation, essay, or other academic paper.

🏆 Best Essay Topics on Wellness

🌶️ hot wellness essay topics, 🎓 most interesting research topics in health and wellness, 💡 simple wellness research topics for students.

• Quality Management in SPA and Wellness Industry
• Summary of Family Health Assessment and Nursing Wellness Diagnoses
• Police Officers’ Wellness and Mental Health
• “A Cure for Wellness” by Verbinski
• Ethical Issues in Health and Wellness Coaching
• Environmental Wellness and Problem of Air Pollution
• Program Planning: Health and Wellness for Senior Citizens
• “Sleep, Health, and Wellness at Work”: Article Analysis The source under analysis is a scholarly article that focuses on how sleep impacts individual health and wellness titled “Sleep, health, and wellness at work: A scoping review”.
• Personal Wellness: Deliberate Action Planning This paper describes the journey of recovery, and the author learned that many seemingly unsolvable problems could be solved through deliberate action planning.
• Alcohol and Wellness: How Alcohol Affects Human Wellness Wellness refers to deliberate actions to live healthy life by eating recommended foods and drinks respectively. This essay describes how alcohol affects human wellness.
• Wellness Assessment: Patient Case Study This article provides an overview of the patient’s health, including his illness after the study, as well as recommendations to help.
• A Health Coaching (Wellness) Program The paper discusses a health coaching program. Key components are consistent coaching relationships, customized goals, and client-centeredness.
• General Psychology: Mental Health and Wellness According to statistics, about 70% of the world population has been exposed to traumatic events, of which about 6% develop symptoms of posttraumatic stress disorder (PTSD).
• Wellness Program for Remote Workers The paper states that each employee receives a certificate for the gym they indicated in the survey. They will be able to attend classes not far from home.
• The Community-Based Mental Wellness Program To successfully develop and introduce a community-based mental wellness program, some relevant steps should be followed to build a sustainable plan of action.
• Influence of Dogs on Wellness During All Stages of Life The paper states that dogs can influence personal, academic, and work-life, supporting mental well-being and providing social interactions.
• The Gender Concept and Its Impact on Health and Wellness The concepts of gender and sexuality are critical phenomena, and the dissemination of awareness about which is necessary for society.
• Health & Wellness Profession: Me as a Health Coach This paper discusses aspects of the health field, factors that draw people into wellness coaching, the preparation of a coach, and concerns about working in the industry.
• The Wellness Plan Development The wellness plan appeared from community needs to provide access to healthcare and improve medical care standards for people who cannot pay.
• An Overall Wellness Improvement Plan for Officers A soldier’s job is demanding and stressful and is associated with higher mental and physical health risks than many other occupations.
• Physical Wellness to Prevent Obesity Heart Diseases Heart disease remains to be one of the most severe health concerns around the world. One of the leading causes of the condition is obesity.
• Obesity as a Wellness Concern in the Nursing Field A critical analysis of wellness can provide an understanding of why people make specific health-related choices.
• An Examination of College Student Wellness: A Research and Liberal Arts Perspective This project aims to evaluate my health conditions and the health behaviors to be adopted for healthy living. Questionnaires were used to capture the details needed.
• Physical and Mental Wellness of Young Children in the Early Childhood Classroom The paper research and summarizes the article “Affectionate touch and care” about ways to promote young children’s physical and mental wellness in the early childhood classroom.
• Mental Health Well-Being Notion: Its Effect on Education Addressing issues in wellness is crucial to understanding modern societies and personal and professional interactions within them.
• The Healthcare Reform: The Wellness Initiative The wellness initiative promotes the well-being of people by teaching medical students and nurses the basis of wellness and self-management.
• Wellness Programs for Colorectal Cancer In this plan, the researcher intends to give a clear intervention plan that can help address the problem of colorectal cancer that has affected so many elderly people in our society.
• COVID-19: Historical Lens and Wellness Looking at events using historical lenses can be beneficial for gaining an in-depth understanding of issues. Currently, one of the central wellness problems is the COVID-19 pandemic.
• District Growers and Metropolitan Wellness Center Situation Analysis This paper explores the case of Corey Barnette, namely the underperformance of District Growers and the Metropolitan Wellness Center.
• Wellness Education Program for African Americans A new wellness education program for African Americans will cover the educational needs of the latter concerning healthy prevention practices and management of diabetes.
• Wellness Policy Cocnept for Northern Tioga School Healthy nutrition is a decisive factor that affects students’ health and academic performance. This paper aims to create a School Wellness Policy for the Northern Tioga School District.
• “Wellness, Emotion Regulation, and Relapse during Substance Use Disorder Treatment” Article Critique The critical review of the given article shows that the convenience sampling method was used to recruit the participants of the study
• Spiritual Wellness: A Journey Toward Wholeness by Hrabe The topic is spirituality as a concept and its application in nursing. The article examined in this paper is “Spiritual Wellness: A Journey Toward Wholeness” by Hrabe.
• Y Health and Wellness Studio: Technology Plan, Management, and Social Responsibility Y Health and Wellness Studio business has integrated software and hardware technological devices to support its service delivery to its clients, who are young children.
• Family Genetic History and Planning for Future Wellness The patient has a family genetic history of cardiac arrhythmia, allergy, and obesity. These diseases might lead to heart attacks, destroy the cartilage and tissue around the joint.
• “Spiritual Wellness: A Journey Toward Wholeness” by Hrabe, Melnyk, and Neale “Spiritual Wellness: A Journey Toward Wholeness” discusses how to achieve the unity of the soul, mind, and body in order to comprehend harmony and enjoy well-being.
• Wellness Coach Health Practitioner Business Plan The Wellness Coach Health Practitioner (WCHP) project is a business plan that implies providing the combined services of a wellness coach and a health practitioner to customers.
• Population Health: Creating a Culture of Wellness The provision of vulnerable individuals with affordable healthcare came at the cost of budget expenses, which was met negatively by the conservative forces in the government.
• Wellness Program and Well-Being for the Elderly There is a need for a wellness model that will focus not on the diseases of older adult patients, but their future well-being.
• Wellness, Academics & You: Obesity Intervention One of the primary ethical issues arising in the course of the research is making sure that the chosen Community Nursing Intervention does not compromise children’s health.
• Stress and Wellness – Psychology Stress affects the emotional wellness of an individual. People who are under stress find it difficult to relate with other individuals in a normal manner.
• Dieting and Wellness Dimensions Dieting refers to the consumption of food in a really regulated manner. The goal for this is increasing, maintaining, or reducing body weight.
• Mental Health and Wellness Professionals
• Traditional Healing Ceremonies Promoting Wellness
• Obesity, Fitness, and Wellness Fitness
• Health and Wellness Programs in the Workplace
• Sexual Wellness Within the Alaskan Foster Care System
• Health, Wellness, and Determinants of Health
• The Role and Importance of Spa and Wellness Tourism in Hungary’s Tourism Industry
• Improving Health and Wellness in the Workplace
• Instituting Employee Wellness Program for Mobile County
• Caregiving Provides the Morale and Wellness of the Elderly
• Cultural History Background and How It Relates to the Wellness Wheel
• What Is Human Social Wellness?
• Wellness and Fitness Services Industry in India
• Later Life Healthcare and Wellness Services
• 5 Are the Basic Concepts of Wellness
• Occupational Wellness and Ways To Improve It
• Human Emotional Wellness Criteria
• Ecological Wellness: Goal and Means of Achievement
• Intellectual Wellness Is One of the Forms of Development of the Human Body
• What is the basis of moral Wellness?
• Music Therapy for Health and Wellness
• Implementing Wellness and Leisure in the Workplace
• How Menopause Wellness Program Can Help Women
• Maintaining Positive Health and Wellness Through Illness Reduction
• Health Care, Preventative Medicine, and Wellness Programs
• Enhancing Health and Wellness Relating to Health Psychology
• Why Is the Financial Wellness of Employees Important for the Prosperity of Companies?
• What Does Physical Wellness Include?
• Social Wellness as the Basis of Social Work
• Learning Wellness From the Islamic School of Spirituality
• Introducing Wellness Programs Into the Workplace
• Nutrition and Weight Loss: Wellness Nutrition Pyramid Diet
• Where Does Financial Wellness Begin?
• Health and Wellness Foods and Beverages
• Wellness, Disease, Health, and Changing Attitudes
• Spirituality and Its Affects on Wellness
• Wellness Components: Warm-Up and Cool Down
• Relationship Between Physical and Emotional Wellness
• Cardiovascular Wellness for Women Over 50
• What Factors Affect the Spiritual Wellness of a Person?

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These essay examples and topics on Wellness were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 9, 2024 .

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

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16 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

I have been racking my brain for a while on what topic will be suitable for my PhD in health informatics. I want a qualitative topic as this is my strong area.

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The Science of Well-Being

Melissa Hartman

Luke Kalb has spent over a decade focusing on the measurement, treatment, and epidemiology of mental health crises. It was only after earning his PhD and joining the faculty in  Mental Health and at  Kennedy Krieger Institute that he began exploring positive mental health and well-being—an experience that, he says, “stopped me in my tracks cold.”

“I was shocked to find a robust body of scientific research on well-being,” says Kalb, PhD ’17, MHS ’08, especially since he didn’t encounter the topic in any of his training. He became convinced by the evidence that there is a dimension of mental life beyond the absence of disease—and a role for public health beyond the mitigation of mental illness and crises. With funding from the Herbert Bearman Foundation, he designed the first course at the School that was solely focused on well-being:  Public Health and the Good Life .

The course was launched last year, in the heart of the pandemic. As Kalb met with students virtually and heard about their challenges in everyday life, it became clear there is a wide need for practices we can all use to protect our mental health during stressful, uncertain times.

Here, Kalb shares some important ideas that students take from the course, along with some evidence-based strategies and tools to try.

• Take advantage of the well-being toolkit. There are many evidence-based practices—including mindfulness and meditation—that can improve well-being and prevent the onset of psychological distress. The Calm app (which Johns Hopkins offers for free to all faculty and staff) is a great place to start.  
• Cultivate relationships. One of the most important influences on our well-being is our relationships with others. However, we are living in a world of deep isolation and discord. Staying in close contact with loved ones is critical, whether for a walk in the neighborhood or a phone or video call. Finding new social outlets, like joining clubs or attending socials (even if they’re virtual), can be especially helpful for students or others who are transitioning to a new location.
• Avoid the comparison trap. A number of biases are often baked into our thinking, and we need to be aware of them. For instance, we are prone to social comparisons. Historically, due to limited transportation, we could compare ourselves only to our neighbors. Now, social media allows us to compare ourselves to the most rich and famous people in the world. Those unrealistic comparisons and self-judgments can be distressing.  
• Don’t overlook the basics. Many techniques to improve our well-being are readily available to us but not often discussed, such as protecting your sleep and leveraging gratitude. These simple practices can have profound downstream effects.

Public Health and the Good Life will be offered again starting in January 2022. New for this year: a focus on mHealth technologies. Kalb will bring in mHealth expert Johannes Thrul, PhD, MS , an assistant professor in Mental Health; and Omar Jalazada, co-founder CEO of  Kin , to talk about how we can leverage digital peer supports to promote lasting behavior change.  

Melissa Hartman is the managing editor of Hopkins Bloomberg Public Health magazine and associate director of editorial at the Johns Hopkins Bloomberg School of Public Health.

• The Intersection of Mental Health and Chronic Disease
• Mental Wellness at Work
• SEE Change: Improving Health Through Self-Empowerment

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• Open access
• Published: 19 June 2020

Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries

• Kai Ruggeri 1 , 2 ,
• Eduardo Garcia-Garzon 3 ,
• Áine Maguire 4 ,
• Sandra Matz 5 &
• Felicia A. Huppert 6 , 7  

Health and Quality of Life Outcomes volume  18 , Article number:  192 ( 2020 ) Cite this article

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Metrics details

Recent trends on measurement of well-being have elevated the scientific standards and rigor associated with approaches for national and international comparisons of well-being. One major theme in this has been the shift toward multidimensional approaches over reliance on traditional metrics such as single measures (e.g. happiness, life satisfaction) or economic proxies (e.g. GDP).

To produce a cohesive, multidimensional measure of well-being useful for providing meaningful insights for policy, we use data from 2006 and 2012 from the European Social Survey (ESS) to analyze well-being for 21 countries, involving approximately 40,000 individuals for each year. We refer collectively to the items used in the survey as multidimensional psychological well-being (MPWB).

The ten dimensions assessed are used to compute a single value standardized to the population, which supports broad assessment and comparison. It also increases the possibility of exploring individual dimensions of well-being useful for targeting interventions. Insights demonstrate what may be masked when limiting to single dimensions, which can create a failure to identify levers for policy interventions.

Conclusions

We conclude that both the composite score and individual dimensions from this approach constitute valuable levels of analyses for exploring appropriate policies to protect and improve well-being.

What is well-being?

Well-being has been defined as the combination of feeling good and functioning well; the experience of positive emotions such as happiness and contentment as well as the development of one’s potential, having some control over one’s life, having a sense of purpose, and experiencing positive relationships [ 23 ]. It is a sustainable condition that allows the individual or population to develop and thrive. The term subjective well-being is synonymous with positive mental health. The World Health Organization [ 45 ] defines positive mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. This conceptualization of well-being goes beyond the absence of mental ill health, encompassing the perception that life is going well.

Well-being has been linked to success at professional, personal, and interpersonal levels, with those individuals high in well-being exhibiting greater productivity in the workplace, more effective learning, increased creativity, more prosocial behaviors, and positive relationships [ 10 , 27 , 37 ]. Further, longitudinal data indicates that well-being in childhood goes on to predict future well-being in adulthood [ 39 ]. Higher well-being is linked to a number of better outcomes regarding physical health and longevity [ 13 ] as well as better individual performance at work [ 30 ], and higher life satisfaction has been linked to better national economic performance [ 9 ].

Measurement of well-being

Governments and researchers have attempted to assess the well-being of populations for centuries [ 2 ]. Often in economic or political research, this has ended up being assessed using a single item about life satisfaction or happiness, or a limited set of items regarding quality of life [ 3 ]. Yet, well-being is a multidimensional construct, and cannot be adequately assessed in this manner [ 14 , 24 , 29 ]. Well-being goes beyond hedonism and the pursuit of happiness or pleasurable experience, and beyond a global evaluation (life satisfaction): it encompasses how well people are functioning, known as eudaimonic, or psychological well-being. Assessing well-being using a single subjective item approach fails to offer any insight into how people experience the aspects of their life that are fundamental to critical outcomes. An informative measure of well-being must encompass all the major components of well-being, both hedonic and eudaimonic aspects [ 2 ], and cannot be simplified to a unitary item of income, life satisfaction, or happiness.

Following acknowledgement that well-being measurement is inconsistent across studies, with myriad conceptual approaches applied [ 12 ], Huppert and So [ 27 ] attempted to take a systematic approach to comprehensively measure well-being. They proposed that positive mental health or well-being can be viewed as the complete opposite to mental ill health, and therefore attempted to define mental well-being in terms of the opposite of the symptoms of common mental disorders. Using the DSM-IV and ICD-10 symptom criteria for both anxiety and depression, ten features of psychological well-being were identified from defining the opposite of common symptoms. The features encompassed both hedonic and eudaimonic aspects of well-being: competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self-esteem, and vitality. From these ten features an operational definition of flourishing, or high well-being, was developed using data from Round 3 of the European Social Survey (ESS), carried out in 2006. The items used in the Huppert and So [ 27 ] study were unique to that survey, which reflects a well-being framework based on 10 dimensions of good mental health. An extensive discussion on the development and validation of these measures for the framework is provided in this initial paper [ 27 ].

As this was part of a major, multinational social survey, each dimension was measured using a single item. As such, ‘multidimensional’ in this case refers to using available measures identified for well-being, but does not imply a fully robust measure of these individual dimensions, which would require substantially more items that may not be feasible for population-based work related to policy development. More detailed and nuanced approaches might help to better capture well-being as a multidimensional construct, and also may consider other dimensions. However, brief core measures such as the one implemented in the ESS are valuable as they provide a pragmatic way of generating pioneering empirical evidence on well-being across different populations, and help direct policies as well as the development of more nuanced instruments. While this naturally would benefit from complementary studies of robust measurement focused on a single topic, appropriate methods for using sprawling social surveys remain critical, particularly through better standardization [ 6 ]. While this paper will overview those findings, we strongly encourage more work to that end, particularly in more expansive measures to support policy considerations.

General approach and key questions

The aim of the present study was to develop a more robust measurement of well-being that allows researchers and policymakers to measure well-being both as a composite construct and at the level of its fundamental dimensions. Such a measure makes it possible to study overall well-being in a manner that goes beyond traditional single-item measures, which capture only a fraction of the dimensions of well-being, and because it allows analysts to unpack the measure into its core components to identify strengths and weaknesses. This would produce a similar approach as the most common reference for policy impacts: Gross Domestic Product (GDP), which is a composite measure of a large number of underlying dimensions.

The paper is structured as follows: in the first step, data from the ESS are used to develop a composite measure of well-being from the items suggested by Huppert & So [ 27 ] using factor analysis. In the second step, the value of the revised measure is demonstrated by generating insights into the well-being of 21 European countries, both at the level of overall well-being and at the level of individual dimensions.

The European social survey

The ESS is a biannual survey of European countries. Through comprehensive measurement and random sampling techniques, the ESS provides a representative sample of the European population for persons aged 15 and over [ 38 ]. Both Round 3 (2006–2007) and Round 6 (2012–2013) contained a supplementary well-being module. This module included over 50 items related to all aspects of well-being including psychological, social, and community well-being, as well as incorporating a brief measure of symptoms of psychological distress. As summarized by Huppert et al. [ 25 ], of the 50, only 30 items relate to personal well-being, of which only 22 are positive measures. Of those remaining, not all relate to the 10 constructs identified by Huppert and So [ 27 ], so only a single item could be used, or else the item that had the strongest face validity and distributional items were chosen.

Twenty-two countries participated in the well-being modules in both Round 3 and Round 6. As this it within a wider body of analyses, it was important to focus on those initially. Hungary did not have data for the vitality item in Round 3 and was excluded from the analysis, as appropriate models would not have been able to reliably resolve a missing item for an entire country. To be included in the analysis and remain consistent, participants therefore had to complete all 10 items used and have the age, gender, employment, and education variables completed. Employment was classified into four groups: students, employed, unemployed, retired; other groups were excluded. Education was classified into three groups: low (less than secondary school), middle (completed secondary school), and high (postsecondary study including any university and above). Using these criteria, the total sample for Round 6 was 41,825 people from 21 countries for analysis. The full sample was 52.6% female and ranged in age from 15 to 103 (M = 47.9; SD = 18.9). Other details about participation, response rates, and exclusion have been published elsewhere [ 38 ].

Huppert & So [ 27 ] defined well-being using 10 items extracted from the Round 3 items, which represent 10 dimensions of well-being. However, the items used in Round 3 to represent positive relationships and engagement exhibited ceiling effects and were removed from the questionnaire in Round 6. Four alternatives were available to replace each question. Based on their psychometric properties (i.e., absence of floor effects and wider response distributions), two new items were chosen for positive relationships and engagement (one item for each dimension). The new items and those they replaced can be seen in Table  1 (also see Supplement ).

Development of a composite measure of psychological well-being (MPWB)

A composite measure of well-being that yields an overall score for each individual was developed. From the ten indicators of well-being shown in Table 1 , a single factor score was calculated to represent MPWB. This overall MPWB score hence constitutes a summary of how an individual performs across the ten dimensions, which is akin to a summary score such as GDP, and will be of general value to policymakers. Statistical analysis was performed in R software, using lavaan [ 40 ] and lavaan.survey [ 35 ] packages. The former is a widely-used package for the R software designed for computing structural equation models and confirmatory factor analyses (CFA). The latter allows introducing complex survey design weights (combination of design and population size weights) when estimating confirmatory factor analysis models with lavaan, which ensures that MPWB scoring followed ESS guidelines regarding both country-level and survey specific weights [ 17 ]. Both packages have been previously tested and validated in various analyses using ESS data (as explained in detail in lavaan.survey documentation).

It should be noted that Round 6 was treated as the focal point of these efforts before repeating for Round 3, primarily due to the revised items that were problematic in Round 3, and considering that analyses of the 2006 data are already widely available.

Prior to analysis, all items were coded such that higher scores were more positive and lower scores more negative. Several confirmatory factor analysis models were performed in order to test several theoretical conceptualizations regarding MPWB. Finally, factor scores (expected a posteriori [ 15 ];) were calculated for the full European sample and used for descriptive purposes. The approach and final model are presented in supplemental material .

Factor scores are individual scores computed as weighted combinations of each person’s response on a given item and the factor scoring coefficients. This approach is to be preferred to using raw or sum scores: sum or raw scores fail to consider how well a given item serves as an indicator of the latent variable (i.e., all items are unrealistically assumed to be perfect and equivalent measures of MPWB). They also do not take into account that different items could present different variability, which is expected to occur if items present different scales (as in our case). Therefore, the use of such simple methods results in inaccurate individual rankings for MPWB. To resolve this, factor scores are both more informative and more accurate, as they avoid the propagation of measurement error in subsequent analyses [ 19 ].

Not without controversy (see Supplement ), factor scores are likely to be preferable to sum scores when ranking individuals on unobservable traits that are expected to be measured with noticeable measurement error (such as MPWB [ 32 ];). Similar approaches based on factor scoring have been successfully applied in large international assessment research [ 21 , 34 ]. With the aim of developing a composite well-being score, it was necessary to provide a meaningful representation of how the different well-being indicators are reflected in the single measure. A hierarchical model with one higher-order factor best approximated MPWB along with two first-order factors (see supplement Figure S 1 ). This model replicates the factor structure reported for Round 3 by Huppert & So [ 27 ]. The higher-order factor explained the relationship between two first-order factors (positive functioning and positive characteristics showed a correlation of ρ = .85). In addition, modelling standardized residuals showed that the items representing vitality and emotional stability and items representing optimism and self-esteem were highly correlated. The similarities in wording in both pairs of items (see Table 1 ) are suspected to be responsible for such high residual correlations. Thus, those correlations were included in the model. As presented in Table  2 , the hierarchical model was found to fit the data better than any other model but a bi-factor model including these correlated errors. The latter model resulted in collapsed factor structure with a weak, bi-polar positive functioning factor. However, this bi-factor model showed a problematic bi-polar group factor with weak loadings. Whether this group factor was removed (resulting in a S-1 bi-factor model, as in [ 16 ]), model fit deteriorated. Thus, neither bi-factor alternative was considered to be acceptable.

To calculate the single composite score representing MPWB, a factor scoring approach was used rather than a simplistic summing of raw scores on these items. Factor scores were computed and standardized for the sample population as a whole, which make them suitable for broad comparison [ 8 ]. This technique was selected for two reasons. First, it has the ability to take into account the different response scales used for measuring the items included in the multidimensional well-being model. The CFA model, from which MPWB scores were computed, was defined such that the metric of the MPWB was fixed, which results in a standardized scale. Alternative approaches, such as sum or raw scores, would result in ignoring the differential variability across items, and biased individual group scores. Our approach, using factor scoring, resolves this issue by means of standardization of the MPWB scores. The second reason for this technique is that it could take account of how strongly each item loaded onto the MPWB factor. It should be noted that by using only two sub-factors, the weight applied to the general factor is identical within the model for each round. This model was also checked to ensure it also was a good fit for different groups based on gender, age, education and employment.

Separate CFA analyses per each country indicate that the final model fit the data adequately in all countries (.971 < CFI < .995; .960 < TFI < .994; .020 < RMSEA < .05; 0,023 < SRMR < 0,042). All items presented substantive loadings on their respective factors, and structures consistently replicated across all tested countries. Largest variations were found when assessing the residual items’ correlations (e.g., for emotional stability and vitality correlation, values ranged from 0,076 to .394). However, for most cases, residuals correlations were of similar size and direction (for both cases, the standard deviation of estimated correlations was close of .10). Thus, strong evidence supporting our final model was systematically found across all analyzed countries. Full results are provided in the supplement (Tables S 2 -S 3 ).

Model invariance

In order to establish meaningful comparisons across groups within and between each country, a two-stage approach was followed, resulting in a structure that was successfully found to be similar across demographics. First, a descriptive comparison of the parameter estimates unveiled no major differences across groups. Second, factor scores were derived for the sample, employing univariate statistics to compare specific groups within country and round. In these analyses, neither traditional nor modern approaches to factor measurement invariance were appropriate given the large sample and number of comparisons at stake ([ 8 ]; further details in Supplement ).

From a descriptive standpoint, the hierarchical structure satisfactorily fit both Round 3 and Round 6 data. All indicators in both rounds had substantial factor loadings (i.e., λ > .35). A descriptive comparison of parameter estimates produced no major differences across the two rounds. The lack of meaningful differences in the parameter estimates confirms that this method for computing MPWB can be used in both rounds.

As MPWB scores from both rounds are obtained from different items that have different scales for responses, it is necessary to transform individual scores obtained from both rounds in order to be aligned. To do this between Round 3 and Round 6 items, a scaling approach was used. To produce common metrics, scores from Round 3 were rescaled using a mean and sigma transformation (Kolen & Brennan 2010) to align with Round 6 scales. This was used as Round 6 measures were deemed to have corrected some deficiencies found in Round 3 items. This does not change outcomes in either round but simply makes the scores match in terms of distributions relative to their scales, making them more suitable for comparison.

As extensive descriptive insights on the sample and general findings are already available (see [ 41 ]), we focus this section on the evidence derived directly from the proposed approach to MPWB scores. For the combined single score for MPWB, the overall mean (for all participants combined) is fixed to zero, and the scores represent deviation from the overall mean. In 2012 (Round 6), country scores on well-being ranged from − 0.41 in Bulgaria to 0.46 in Denmark (Fig.  1 ). There was a significant, positive relationship between national MPWB mean scores and national life satisfaction means ( r =  .56 (.55–.57), p  < .001). In addition, MPWB was negatively related with depression scores and positively associated with other well-being measurements (see Supplement ).

Distribution of national MPWB means and confidence intervals across Europe

Denmark having the highest well-being is consistent with many studies [ 4 , 18 ] and with previous work using ESS data [ 27 ]. While the pattern is typically that Nordic countries are doing the best and that eastern countries have the lowest well-being, exceptions exist. The most notable exception is Portugal, which has the third-lowest score and is not significantly higher than Ukraine, which is second lowest. Switzerland and Germany are second and third highest respectively, and show generally similar patterns to the Scandinavian countries (see Fig. 1 ). It should be noted that, for Figs.  1 , 2 , 3 , 4 , 5 , countries with the lowest well-being are at the top. This is done to highlight the greatest areas for potential impact, which are also the most of concern to policy.

Well-being by country and gender

Well-being by country and age

Well-being by country and employment

Well-being by country and education

General patterns across the key demographic variables – gender, age, education, employment – are visible across countries as seen in Figs.  1 , 2 , 3 , 4 , 5 (see also Supplement 2 ). These figures highlight patterns based on overall well-being as well as potential for inequalities. The visualizations presented here, though univariate, are for the purpose of understanding broad patterns while highlighting the need to disentangle groups and specific dimensions to generate effective policies.

For gender, women exhibited lower MPWB scores than men across Europe (β = −.09, t (36508) = − 10.37; p  < .001). However, these results must be interpreted with caution due to considerable overlap in confidence intervals for many of the countries, and greater exploration of related variables is required. This also applies for the five countries (Estonia, Finland, Ireland, Slovakia, Ukraine) where women have higher means than men. Only four countries have significant differences between genders, all of which involve men having higher scores than women: the Netherlands (β = −.12, t (1759) = − 3.24; p  < .001), Belgium (β = −.14, t (1783) = − 3.94; p  < .001), Cyprus (β = −.18, t (930) = − 2.87; p  < .001) and Portugal (β = −.19, t (1847) = − 2.50; p  < .001).

While older individuals typically exhibited lower MPWB scores compared to younger age groups across Europe (β 25–44  = −.05, t (36506) = − 3.686, p  < .001; β 45–65  = −.12, t (36506) = − 8.356, p  < .001; β 65–74  = −.16, t (36506) = − 8.807, p  < .001; β 75+  = −.28, t (36506) = − 13.568, p  < .001), the more compelling pattern shows more extreme differences within and between age groups for the six countries with the lowest well-being. This pattern is most pronounced in Bulgaria, which has the lowest overall well-being. For the three countries with the highest well-being (Denmark, Switzerland, Germany), even the mean of the oldest age group was well above the European average, while for the countries with the lowest well-being, it was only young people, particularly those under 25, who scored above the European average. With the exception of France and Denmark, countries with higher well-being typically had fewer age group differences and less variance within or between groups. Only countries with the lowest well-being showed age differences that were significant with those 75 and over showing the lowest well-being.

MPWB is consistently higher for employed individuals and students than for retired (β = −.31, t (36506) = − 21.785; p  < .00) or unemployed individuals (β = −.52, t (36556) = − 28.972; p  < .001). Unemployed groups were lowest in nearly all of the 21 countries, though the size of the distance from other groups did not consistently correlate with national MPWB mean. Unemployed individuals in the six countries with the lowest well-being were significantly below the mean, though there is little consistency across groups and countries by employment beyond that. In countries with high well-being, unemployed, and, in some cases, retired individuals, had means below the European average. In countries with the lowest well-being, it was almost exclusively students who scored above the European average. Means for retired groups appear to correlate most strongly with overall well-being. There is minimal variability for employed groups in MPWB means within and between countries.

There is a clear pattern of MPWB scores increasing with education level, though the differences were most pronounced between low and middle education groups (β = .12, t (36508) = 9.538; p  < .001). Individuals with high education were significantly higher on MPWB than those in the middle education group (β = .10, t (36508) =11.06; p  < .001). Differences between groups were noticeably larger for countries with lower overall well-being, and the difference was particularly striking in Bulgaria. In Portugal, medium and high education well-being means were above the European average (though 95% confidence intervals crossed 0), but educational attainment is significantly lower in the country, meaning the low education group represents a greater proportion of the population than the other 21 countries. In the six countries with the highest well-being, mean scores for all levels of education were above the European mean.

Utilizing ten dimensions for superior understanding of well-being

It is common to find rankings of national happiness and well-being in popular literature. Similarly, life satisfaction is routinely the only measure reported in many policy documents related to population well-being. To demonstrate why such limited descriptive approaches can be problematic, and better understood using multiple dimensions, all 21 countries were ranked individually on each of the 10 indicators of well-being and MPWB in Round 6 based on their means. Figure  6 demonstrates the variations in ranking across the 10 dimensions of well-being for each country.

Country rankings in 2012 on multidimensional psychological well-being and each of its 10 dimensions

The general pattern shows typically higher rankings for well-being dimensions in countries with higher overall well-being (and vice-versa). Yet countries can have very similar scores on the composite measure but very different underlying profiles in terms of individual dimensions. Figure  7 a presents this for two countries with similar life satisfaction and composite well-being, Belgium and the United Kingdom. Figure 7 b then demonstrates this even more vividly for two countries, Finland and Norway, which have similar composite well-being scores and identical mean life satisfaction scores (8.1), as well as have the highest two values for happiness of all 21 countries. In both pairings, the broad outcomes are similar, yet countries consistently have very different underlying profiles in individual dimensions. The results indicate that while overall scores can be useful for general assessment, specific dimensions may vary substantially, which is a relevant first step for developing interventions. Whereas the ten items are individual measures of 10 areas of well-being, had these been limited to a single domain only, the richness of the underlying patterns would have been lost, and the limitation of single item approaches amplified.

a Comparison of ranks for dimensions of well-being between two different countries with similar life satisfaction in 2012: Belgium and United Kingdom. b Comparison of ranks for dimensions of well-being between two similar countries with identical life satisfaction and composite well-being scores in 2012: Finland and Norway

The ten-item multidimensional measure provided clear patterns for well-being across 21 countries and various groups within. Whether used individually or combined into a composite score, this approach produces more insight into well-being and its components than a single item measure such as happiness or life satisfaction. Fundamentally, single items are impossible to unpack in reverse to gain insights, whereas the composite score can be used as a macro-indicator for more efficient overviews as well as deconstructed to look for strengths and weaknesses within a population, as depicted in Figs.  6 and 7 . Such deconstruction makes it possible to more appropriately target interventions. This brings measurement of well-being in policy contexts in line with approaches like GDP or national ageing indexes [ 7 ], which are composite indicators of many critical dimensions. The comparison with GDP is discussed at length in the following sections.

Patterns within and between populations

Overall, the patterns and profiles presented indicate a number of general and more nuanced insights. The most consistent among these is that the general trend in national well-being is usually matched within each of the primary indicators assessed, such as lower well-being within unemployed groups in countries with lower overall scores than in those with higher overall scores. While there are certainly exceptions, this general pattern is visible across most indicators.

The other general trend is that groups with lower MPWB scores consistently demonstrate greater variability and wider confidence intervals than groups with higher scores. This is a particularly relevant message for policymakers given that it is an indication of the complexity of inequalities: improvements for those doing well may be more similar in nature than for those doing poorly. This is particularly true for employment versus unemployment, yet reversed for educational attainment. Within each dimension, the most critical pattern is the lack of consistency for how each country ranks, as discussed further in other sections.

Examining individual dimensions of well-being makes it possible to develop a more nuanced understanding of how well-being is impacted by societal indicators, such as inequality or education. For example, it is possible that spending more money on education improves well-being on some dimensions but not others. Such an understanding is crucial for the implementation of targeted policy interventions that aim at weaker dimensions of well-being and may help avoid the development of ineffective policy programs. It is also important to note that the patterns across sociodemographic variables may differ when all groups are combined, compared to results within countries. Some effects may be larger when all are combined, whereas others may have cancelling effects.

Using these insights, one group that may be particularly important to consider is unemployed adults, who consistently have lower well-being than employed individuals. Previous research on unemployment and well-being has often focused on mental health problems among the unemployed [ 46 ] but there are also numerous studies of differences in positive aspects of well-being, mainly life satisfaction and happiness [ 22 ]. A large population-based study has demonstrated that unemployment is more strongly associated with the absence of positive well-being than with the presence of symptoms of psychological distress [ 28 ], suggesting that programs that aim to increase well-being among unemployed people may be more effective than programs that seek to reduce psychological distress.

Certainly, it is well known that higher income is related to higher subjective well-being and better health and life expectancy [ 1 , 42 ], so reduced income following unemployment is likely to lead to increased inequalities. Further work would be particularly insightful if it included links to specific dimensions of well-being, not only the comprehensive scores or overall life satisfaction for unemployed populations. As such, effective responses would involve implementation of interventions known to increase well-being in these groups in times of (or in spite of) low access to work, targeting dimensions most responsible for low overall well-being. Further work on this subject will be presented in forthcoming papers with extended use of these data.

This thinking also applies to older and retired populations in highly deprived regions where access to social services and pensions are limited. A key example of this is the absence in our data of a U-shaped curve for age, which is commonly found in studies using life satisfaction or happiness [ 5 ]. In our results, older individuals are typically lower than what would be expected in a U distribution, and in some cases, the oldest populations have the lowest MPWB scores. While previous studies have shown some decline in well-being beyond the age of 75 [ 20 ], our analysis demonstrates quite a severe fall in MPWB in most countries. What makes this insight useful – as opposed to merely unexpected – is the inclusion of the individual dimensions such as vitality and positive relationships. These dimensions are clearly much more likely to elicit lower scores than for younger age groups. For example, ageing beyond 75 is often associated with increased loneliness and isolation [ 33 , 43 ], and reduction in safe, independent mobility [ 31 ], which may therefore correspond with lower scores on positive relationships, engagement, and vitality, and ultimately lower scores on MPWB than younger populations. Unpacking the dimensions associated with the age-related decline in well-being should be the subject of future research. The moderate positive relationship of MPWB scores with life satisfaction is clear but also not absolute, indicating greater insights through multidimensional approaches without any obvious loss of information. Based on the findings presented here, it is clearly important to consider ensuring the well-being of such groups, the most vulnerable in society, during periods of major social spending limitations.

Policy implications

Critically, Fig.  6 represents the diversity of how countries reach an overall MPWB score. While countries with overall high well-being have typically higher ranks on individual items, there are clearly weak dimensions for individual countries. Conversely, even countries with overall low well-being have positive scores on some dimensions. As such, the lower items can be seen as potential policy levers in terms of targeting areas of concern through evidence-based interventions that should improve them. Similarly, stronger areas can be seen as learning opportunities to understand what may be driving results, and thus used to both sustain those levels as well as potentially to translate for individuals or groups not performing as well in that dimension. Collectively, we can view this insight as a message about specific areas to target for improvement, even in countries doing well, and that even countries doing poorly may offer strengths that can be enhanced or maintained, and could be further studied for potential applications to address deficits. We sound a note of caution however, in that these patterns are based on ranks rather than actual values, and that those ranks are based on single measures.

Figure 7 complements those insights more specifically by showing how Finland and Norway, with a number of social, demographic, and economic similarities, plus identical life satisfaction scores (8.1) arrive at similar single MPWB scores with very different profiles for individual dimensions. By understanding the levers that are specific to each country (i.e. dimensions with the lowest well-being scores), policymakers can respond with appropriate interventions, thereby maximizing the potential for impact on entire populations. Had we restricted well-being measurement to a single question about happiness, as is commonly done, we would have seen both countries had similar and extremely high means for happiness. This might have led to the conclusion that there was minimal need for interventions for improving well-being. Thus, in isolation, using happiness as the single indicator would have masked the considerable variability on several other dimensions, especially those dimensions where one or both had means among the lowest of the 21 countries. This would have resulted in similar policy recommendations, when in fact, Norway may have been best served by, for example, targeting lower dimensions such as Engagement and Self-Esteem, and Finland best served by targeting Vitality and Emotional Stability.

Targeting specific groups and relevant dimensions as opposed to comparing overall national outcomes between countries is perhaps best exemplified by Portugal, which has one of the lowest educational attainment rates in OECD countries, exceeded only by Mexico and Turkey [ 36 ]. This group thus skews the national MPWB score, which is above average for middle and high education groups, but much lower for those with low education. Though this pattern is not atypical for the 21 countries presented here, the size of the low education group proportional to Portugal’s population clearly reduces the national MPWB score. This implies that the greatest potential for improvement is likely to be through addressing the well-being of those with low education as a near-term strategy, and improving access to education as a longer-term strategy. It will be important to analyze this in the near future, given recent reports that educational attainment in Portugal has increased considerably in recent years (though remains one of the lowest in OECD countries) [ 36 ].

One topic that could not be addressed directly is whether these measures offer value as indicators of well-being beyond the 21 countries included here, or even beyond the countries included in ESS generally. In other words, are these measures relevant only to a European population or is our approach to well-being measurement translatable to other regions and purposes? Broadly speaking, the development of these measures being based on DSM and ICD criteria should make them relevant beyond just the 21 countries, as those systems are generally intended to be global. However, it can certainly be argued that these methods for designing measures are heavily influenced by North American and European medical frameworks, which may limit their appropriateness if applied in other regions. Further research on these measures should consider this by adding potential further measures deemed culturally appropriate and seeing if comparable models appear as a result.

A single well-being score

One potential weakness remains the inconsistency of scaling between ESS well-being items used for calculating MPWB. However, this also presents an opportunity to consider the relative weighting of each item within the current scales, and allow for the development of a more consistent and reliable measure. These scales could be modified to align in separate studies with new weights generated – either generically for all populations or stratified to account for various cultural or other influences. Using these insights, scales could alternatively be produced to allow for simple scoring for a more universally accessible structure (e.g. 1–100) but with appropriate values for each item that represents the dimensions, if this results in more effective communication with a general public than a standardized score with weights. Additionally, common scales would improve on attempts to use rankings for presenting national variability within and between dimensions. Researchers should be aware that factor scores are sample-dependent (as based on specific factor model parameters such as factor loadings). Nevertheless, future research focused on investigating specific item differential functioning (by means of multidimensional item response functioning or akin techniques) of these items across situations (i.e., rounds) and samples (i.e., rounds and countries) should be conducted in order to have a more nuanced understanding of this scale functioning.

What makes this discussion highly relevant is the value of a more informed measure to replace traditional indicators of well-being, predominantly life satisfaction. While life satisfaction may have an extensive history and present a useful metric for comparisons between major populations of interest, it is at best a corollary, or natural consequence, of other indicators. It is not in itself useful for informing interventions, in the same way limiting to a single item for any specific dimension of well-being should not alone inform interventions.

By contrast, a validated and standardized multidimensional measure is exceptionally useful in its suitability to identify those at risk, as well as its potential for identifying areas of strengths and weaknesses within the at-risk population. This can considerably improve the efficiency and appropriateness of interventions. It identifies well-understood dimensions (e.g. vitality, positive emotion) for direct application of evidence-based approaches that would improve areas of concern and thus overall well-being. Given these points, we strongly argue for the use of multidimensional approaches to measurement of well-being for setting local and national policy agenda.

There are other existing single-score approaches for well-being addressing its multidimensional nature. These include the Warwick-Edinburgh Mental Well-Being Scale [ 44 ] and the Flourishing Scale [ 11 ]. In these measures, although the single score is derived from items that clearly tap a number of dimensions, the dimensions have not been systematically derived and no attempt is made to measure the underlying dimensions individually. In contrast, the development approach used here – taking established dimensions from DSM and ICD – is based on years of international expertise in the field of mental illness. In other words, there have long been adequate measures for identifying and understanding illness, but there is room for improvement to better identify and understand health. With increasing support for the idea of these being a more central focus of primary outcomes within economic policies, such approaches are exceptionally useful [ 13 ].

Better measures, better insights

Naturally, it is not a compelling argument to simply state that more measures present greater information than fewer or single measures, and this is not the primary argument of this manuscript. In many instances, national measures of well-being are mandated to be restricted to a limited set of items. What is instead being argued is that well-being itself is a multidimensional construct, and if it is deemed a critical insight for establishing policy agenda or evaluating outcomes, measurements must follow suit and not treat happiness and life satisfaction values as universally indicative. The items included in ESS present a very useful step to that end, even in a context where the number of items is limited.

As has been argued by many, greater consistency in measurement of well-being is also needed [ 26 ]. This may come in the form of more consistency regarding dimensions included, the way items are scored, the number of items representing each dimension, and changes in items over time. While inconsistency may be prevalent in the literature to date for definitions and measurement, the significant number of converging findings indicates increasingly robust insights for well-being relevant to scientists and policymakers. Improvements to this end would support more systematic study of (and interventions for) population well-being, even in cases where data collection may be limited to a small number of items.

The added value of MPWB as a composite measure

While there are many published arguments (which we echo) that measures of well-being must go beyond objective features, particularly related to economic indicators such as GDP, this is not to say one replaces the other. More practically, subjective and objective approaches will covary to some degree but remain largely distinct. For example, GDP presents a useful composite of a substantial number of dimensions, such as consumption, imports, exports, specific market outcomes, and incomes. If measurement is restricted to a macro-level indicator such as GDP, we cannot be confident in selecting appropriate policies to implement. Policies are most effective when they target a specific component (of GDP, in this instance), and then are directly evaluated in terms of changes in that component. The composite can then be useful for comprehensive understanding of change over time and variation in circumstances. Specific dimensions are necessary for identifying strengths and weaknesses to guide policy, and examining direct impacts on those dimensions. In this way, a composite measure in the form of MPWB for aggregate well-being is also useful, so long as the individual dimensions are used in the development and evaluation of policies. Similar arguments for other multidimensional constructs have been made recently, such as national indexes of ageing [ 7 ].

In the specific instance of MPWB in relation to existing measures of well-being, there are several critical reasons to ensure a robust approach to measurement through systematic validation of psychometric properties. The first is that these measures are already part of the ESS, meaning they are being used to study a very large sample across a number of social challenges and not specifically a new measure for well-being. The ESS has a significant influence on policy discussions, which means the best approaches to utilizing the data are critical to present systematically, as we have attempted to do here. This approach goes beyond existing measures such as Gallup or the World Happiness Index to broadly cover psychological well-being, not individual features such as happiness or life satisfaction (though we reiterate: as we demonstrate in Fig.  7 a and b, these individual measures can and should still covary broadly with any multidimensional measure of well-being, even if not useful for predicting all dimensions). While often referred to as ‘comprehensive’ measurement, this merely describes a broad range of dimensions, though more items for each dimension – and potentially more dimensions – would certainly be preferable in an ideal scenario.

These dimensions were identified following extensive study for flourishing measures by Huppert & So [ 27 ], meaning they are not simply a mix of dimensions, but established systematically as the key features of well-being (the opposite of ill-being). Furthermore, the development of the items is in line with widely validated and practiced measures for the identification of illness. The primary adjustment has simply been the emphasis on health, but otherwise maintains the same principles of assessment. Therefore, the overall approach offers greater value than assessing only negative features and inferring absence equates to opposite (positives), or that individual measures such as happiness can sufficiently represent a multidimensional construct like well-being. Collectively, we feel the approach presented in this work is therefore a preferable method for assessing well-being, particularly on a population level, and similar approaches should replace single items used in isolation.

While the focus of this paper is on the utilization of a widely tested measure (in terms of geographic spread) that provides for assessing population well-being, it is important to provide a specific application for why this is relevant in a policy context. Additionally, because the ESS itself is a widely-recognized source of meaningful information for policymakers, providing a robust and comprehensive exploration of the data is necessary. As the well-being module was not collected in recent rounds, these insights provide clear reasoning and applications for bringing them back in the near future.

More specifically, it is critical that this approach be seen as advantageous both in using the composite measure for identifying major patterns within and between populations, and for systematically unpacking individual dimensions. Using those dimensions produces nuanced insights as well as the possibility of illuminating policy priorities for intervention.

In line with this, we argue that no composite measure can be useful for developing, implementing, or evaluating policy if individual dimensions are not disaggregated. We are not arguing that MPWB as a single composite score, nor the additional measures used in ESS, is better than other existing single composite scoring measures of well-being. Our primary argument is instead that MPWB is constructed and analyzed specifically for the purpose of having a robust measure suitable for disaggregating critical dimensions of well-being. Without such disaggregation, single composite measures are of limited use. In other words, construct a composite and target the components.

Well-being is perhaps the most critical outcome measure of policies. Each individual dimension of well-being as measured in this study represents a component linked to important areas of life, such as physical health, financial choice, and academic performance [ 26 ]. For such significant datasets as the European Social Survey, the use of the single score based on the ten dimensions included in multidimensional psychological well-being gives the ability to present national patterns and major demographic categories as well as to explore specific dimensions within specific groups. This offers a robust approach for policy purposes, on both macro and micro levels. This facilitates the implementation and evaluation of interventions aimed at directly improving outcomes in terms of population well-being.

Availability of data and materials

The datasets analysed during the current study are available in the European Social Survey repository, http://www.europeansocialsurvey.org/data/country_index.html

Abbreviations

Diagnostic and Statistical Manual of Mental Disorders

European Social Survey

Gross Domestic Product

International Classification of Disease

Multidimensional psychological well-being

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Acknowledgements

The authors would like to thank Ms. Sara Plakolm, Ms. Amel Benzerga, and Ms. Jill Hurson for assistance in proofing the final draft. We would also like to acknowledge the general involvement of the Centre for Comparative Social Surveys at City University, London, and the Centre for Wellbeing at the New Economics Foundation.

This work was supported by a grant from the UK Economic and Social Research Council (ES/LO14629/1). Additional support was also provided by the Isaac Newton Trust, Trinity College, University of Cambridge, and the UK Economic and Social Research Council (ES/P010962/1).

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KR is the lead author and researcher on the study, responsible for all materials start to finish. FH was responsible for the original grant award and the general theory involved in the measurement approaches. ÁM was responsible for broad analysis and writing. EGG was responsible for psychometric models and the original factor scoring approach, plus writing the supplementary explanations. SM provided input on later drafts of the manuscript as well as the auxiliary analyses. The authors read and approved the final manuscript.

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Additional file 1: figure s1.

. Hierarchical approach to modelling comprehensive psychological well-being. Table S1 . Confirmatory Factor Structure for Round 6 and 3. Figure S2 . Well-being by country and gender. Figure S3 . Well-being by country and age. Figure S4 . Well-being by country and employment. Figure S5 . Well-being by country and education. Table S2 . Item loadings for Belgium to Great Britain. Table S3 . Item loadings for Ireland to Ukraine.

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Ruggeri, K., Garcia-Garzon, E., Maguire, Á. et al. Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries. Health Qual Life Outcomes 18 , 192 (2020). https://doi.org/10.1186/s12955-020-01423-y

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When we published our research on workplace mental health in October 2019, we never could have predicted how much our lives would soon be upended by the Covid-19 pandemic. Then the murders of George Floyd and other Black Americans by the police; the rise in violence against Asian Americans and Pacific Islanders (AAPIs); wildfires; political unrest; and other major stressors unfolded in quick succession, compounding the damage to our collective mental health.

• Kelly Greenwood is the Founder and CEO of Mind Share Partners , a national nonprofit changing the culture of workplace mental health so both employees and organizations can thrive. Through movement building , custom training, and strategic advising, it normalizes mental health challenges and promotes sustainable ways of working to create a mentally healthy workforce. Follow her on LinkedIn and subscribe to her monthly newsletter.
• Julia Anas is the chief people officer at Qualtrics, the world’s #1 Experience Management (XM) provider and creator of the XM category. At Qualtrics, she is responsible for building a talented and diverse organization and driving employee development as well as organizational design, talent, and succession planning.

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Sustainable Development Goal 3

Ensure healthy lives and promote well-being for all at all ages.

Sustainable Development Goal 3 is to “ensure healthy lives and promote well-being for all at all ages”, according to the United Nations .

The visualizations and data below present the global perspective on where the world stands today and how it has changed over time.

The UN has defined 13 targets and 28 indicators for SDG 3. Targets specify the goals and indicators represent the metrics by which the world aims to track whether these targets are achieved. Below we quote the original text of all targets and show the data on the agreed indicators.

Target 3.1 Reduce maternal mortality

Sdg indicator 3.1.1 maternal mortality ratio.

Definition of the SDG indicator: Indicator 3.1.1 is the “maternal mortality ratio” in the UN SDG framework .

The maternal mortality ratio refers to the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births.

Data for this indicator is shown in the interactive visualization.

Target: By 2030 “reduce the global maternal mortality ratio to less than 70 per 100,000 live births” per year.

More research: The Our World in Data topic page on Maternal Mortality gives a long-run perspective over the last centuries and presents research on the causes and consequences of the deaths of mothers.

Additional charts

• Number of maternal deaths by region
• Number of maternal deaths by country

SDG Indicator 3.1.2 Skilled birth attendance

Definition of the SDG indicator: Indicator 3.1.2 is the “proportion of births attended by skilled health personnel” in the UN SDG framework .

This indicator is measured as the ratio of the births attended by skilled health personnel (generally doctors, nurses, or midwives) who are trained in providing quality obstetric care, to the number of live births in the same period.

More research: Research, discussed in the Our World in Data topic page on Maternal Mortality , shows that skilled staff can reduce maternal mortality.

Target 3.2 End all preventable deaths under 5 years of age

Sdg indicator 3.2.1 under-5 mortality rate.

Definition: Indicator 3.2.1 is the “under-5 mortality rate” in the UN SDG framework .

The under-5 mortality rate measures the probability per 1,000 that a newborn baby will die before reaching age five, if subject to age-specific mortality rates of the specified year.

Target: By 2030, “end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.”

More research: Child mortality is covered more broadly, and with a longer-term perspective in the Our World in Data topic page on Child Mortality .

• Number of under-five deaths
• Number of under-five deaths by region
• Child mortality rate by sex

SDG Indicator 3.2.2 Neonatal mortality rate

Definition of the SDG indicator: Indicator 3.2.2 is the “neonatal mortality rate” in the UN SDG framework .

The neonatal mortality rate is defined as the probability per 1,000 that a child born in a given year will die during the first 28 days of life, if subject to the age-specific mortality rates of that period.

Data on this indicator is shown in the interactive visualization.

More research: The Our World in Data topic page on Child Mortality includes a section on neonatal mortality.

• Number of neonatal deaths
• Number of neonate deaths by region

Target 3.3 Fight communicable diseases

Sdg indicator 3.3.1 hiv incidence.

Definition of the SDG indicator: Indicator 3.3.1 is the “number of new HIV infections per 1,000 uninfected population, by sex, age and key populations” in the UN SDG framework .

Data for this indicator is shown in the interactive visualization, by age group in the first chart and for the 15-49 age group in the second chart. You can change the country shown in the first chart by clicking the “Change country” button in the upper left hand corner.

Target: The target for 2030 is to “end the epidemic of AIDS” across all countries. 1

The targeted level of reduction is defined by UNAIDS as a 90% reduction in new HIV infections over 2010 levels. For all age groups combined, this would imply a target of around .03 per 1,000, or 3 new infections for every 100,000 uninfected people.

More research: HIV is covered in detail by the Our World in Data topic page on HIV/AIDS .

• Share of population infected with HIV
• HIV/AIDS death rates
• Number of HIV/AIDS deaths

SDG Indicator 3.3.2 Tuberculosis incidence

Definition of the SDG indicator: Indicator 3.3.2 is “tuberculosis incidence per 100,000 population” in the UN SDG framework .

Tuberculosis incidence is the number of new and relapse cases of tuberculosis (TB) per 100,000 people, including all forms of TB.

Target: The 2030 target is to “end the epidemic of tuberculosis” in all countries. 1

The World Health Organization's End TB Strategy defines this targeted level of reduction as a decrease in incidence of 80% over 2015 levels. This would imply a target of around 28 cases per 100,000 population globally.

• Tuberculosis death rates
• Number of tuberculosis deaths

SDG Indicator 3.3.3 Malaria incidence

Definition of the SDG indicator: Indicator 3.3.3 is “malaria incidence per 1,000 population” in the UN SDG framework .

Malaria incidence is the number of new cases of malaria in one year per 1,000 people at risk.

Target: By 2030 “end the epidemic of malaria” in all countries. 1

To achieve this target, the WHO Global Technical Strategy has set a target of reducing incidence by 90% by 2030 from 2015 levels. This would imply a target of 6 or fewer cases of malaria per 1,000 people globally in 2030.

More research: More information on global and national trends in malaria prevalence, deaths and interventions can be found at the Our World in Data topic page on Malaria .

• Malaria death rates
• Number of malaria deaths

SDG Indicator 3.3.4 Hepatitis B incidence

Definition of the SDG indicator: Indicator 3.3.4 is “Hepatitis B incidence per 100,000 population” in the UN SDG framework .

Hepatitis B incidence is the number of new cases of hepatitis B in one year per 100,000 people in a given population. This is measured indirectly as the share of children under 5 years of age with an active Hepatitis B infection, as measured by an Hepatitis B surface antigen test.

Target: By 2030 “combat hepatitis” in all countries with a focus on hepatitis B. 1 The targeted level of reduction, however, is not defined.

• Hepatitis death rates

SDG Indicator 3.3.5 Neglected tropical diseases

Definition of the SDG indicator: Indicator 3.3.5 is the “number of people requiring interventions against neglected tropical diseases” in the UN SDG framework .

This is defined as the number of people who require interventions (treatment and care) for any of the 20 neglected tropical diseases (NTDs) identified by the WHO NTD Roadmap and World Health Assembly resolutions. Treatment and care is broadly defined to allow for preventive, curative, surgical or rehabilitative treatment and care.

Target: By 2030 “end the epidemic of neglected tropical diseases (NTDs)” in all countries. 1

The associated WHO target is a 90% reduction in the number of people requiring interventions against NTDs from 2010 baseline levels. This implies a target of 219 million people needing interventions against NTDs in 2030.

• Number of people requiring interventions for NTDs by region

Target 3.4 Reduce mortality from non-communicable diseases and promote mental health

Sdg indicator 3.4.1 mortality rate from non-communicable diseases.

Definition of the SDG indicator: Indicator 3.4.1 is the “mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease” in the UN SDG framework .

This is defined as the percent of 30-year-old-people who would die before their 70th birthday from cardiovascular disease, cancer, diabetes, or chronic respiratory disease, assuming that they would experience current mortality rates at every age and would not die from any other cause of death (e.g. injuries or HIV/AIDS).

Target: By 2030 “reduce by one third premature mortality from non-communicable diseases through prevention and treatment” in all countries. 2

More research: Further data and research on non-communicable diseases can be found at the Our World in Data topic pages on Causes of Death , Burden of Disease , and Cancer .

• Cancer death rates
• Cardiovascular disease (CVD) death rates
• Stroke death rates

SDG Indicator 3.4.2 Suicide rate

Definition of the SDG indicator: Indicator 3.4.2 is the “suicide mortality rate” in the UN SDG framework .

The suicide mortality rate is the number of deaths from suicide measured per 100,000 people in a given population.

Target: By 2030 “promote mental health and wellbeing”. 2 There is no defined target level of reduction for this indicator.

More research: Further data and research on suicide, mental health and wellbeing can be found at the Our World in Data topic pages on Suicide , Mental Health and Happiness and Life Satisfaction .

• Number of suicide deaths
• Share of population with depression

Target 3.5 Prevent and treat substance abuse

Sdg indicator 3.5.1 coverage of treatment interventions for substance use disorders.

Definition of the SDG indicator: Indicator 3.5.1 is the “coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders” in the UN SDG framework .

This is the share of people with substance use disorders in a given year who receive treatment in the form of pharmacological, psychosocial, rehabilitation or aftercare services. Data coverage in household surveys of substance use disorders is limited in many countries, and efforts are currently in progress to better estimate this indicator.

Data for this indicator is shown in the interactive visualizations. The first chart shows the share of the population with an alcohol use disorder in each country, and the second chart shows coverage of treatment interventions for certain types of substance use disorder for the countries where this data is available.

Target: By 2030 “strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol” across all countries. However, there is no defined target level for this indicator.

More research: The Our World in Data topic page on Substance Use provides data on substance use disorder prevalence and as well as more limited data coverage of treatment interventions.

SDG Indicator 3.5.2 Alcohol consumption per capita

Definition of the SDG indicator: Indicator 3.5.2 is the “harmful use of alcohol, defined according to the national context as alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol” in the UN SDG framework .

More research: Further data and research on alcohol consumption and alcohol use disorders can be found at the Our World in Data topic page on Alcohol Consumption .

• Share of population with alcohol use disorders
• Share of population with drug use disorders
• Prevalence of substance use disorders by sex

Target 3.6 Reduce road injuries and deaths

Sdg indicator 3.6.1 halve the number of road traffic deaths.

Definition of the SDG indicator: Indicator 3.6.1 is the “death rate due to road traffic injuries” in the UN SDG framework .

Road traffic deaths include vehicle drivers, passengers, motorcyclists, cyclists and pedestrians.

Data for this indicator is shown in the first chart in the series of interactive visualizations. The second chart shows the absolute number of road traffic deaths for additional context.

Target: By 2020 “halve the number of global deaths and injuries from road traffic accidents.”

While most SDG targets are set for 2030, this was set to be achieved for 2020.

Note that the SDG Indicator is the rate of road deaths while the target is set for the absolute number of road deaths. Because of this, the interactive visualization shows, in the first chart, the road traffic death rate, and in the second chart, the number of road traffic deaths.

• Road traffic deaths by user

Target 3.7 Universal access to sexual and reproductive care, family planning and education

Sdg indicator 3.7.1 family planning needs.

Definition of the SDG indicator: Indicator 3.7.1 is the “proportion of women of reproductive age (aged 15–49 years) who have their need for family planning satisfied with modern methods” in the UN SDG framework .

This indicator incorporates two components, the prevalence of modern methods of contraception, and the share of women of reproductive age who want to stop or delay childbearing but are not using any method of contraception.

It is measured as the percent of women of reproductive age (15-49 years) who are currently using at least one modern contraceptive method, out of the total population of women who have demand for contraceptive methods (defined as those using contraception of any form or who have unmet need for contraception).

Target: By 2030 “ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education.” 3

More research: Further data and research can be found at the Our World in Data topic page on Fertility Rate .

• Unmet need for contraception
• Contraception prevalence, any methods

SDG Indicator 3.7.2 Adolescent birth rate

Definition of the SDG indicator: Indicator 3.7.2 is the “adolescent birth rate (aged 10–14 years; aged 15–19 years) per 1,000 women in that age group” in the UN SDG framework .

Data for this indicator is shown in the interactive visualizations, which show, in the first chart, adolescent birth rates per 1,000 women aged 10-14 years old, and in the second chart, women aged 15-19 years old.

Target: By 2030 “ensure universal access to sexual and reproductive healthcare services, including for family planning.” 3

Target 3.8 Achieve universal health coverage

Sdg indicator 3.8.1 coverage of essential health services.

Definition of the SDG indicator: Indicator 3.8.1 is “coverage of essential health services” in the UN SDG framework .

Coverage of essential health services is defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population.

The Universal Health Coverage (UHC) Service Coverage Index is used to track progress on this indicator. The index is on a scale from 0 to 100, where 100 is the optimal value, and calculated from the geometric mean of 14 indicators measuring the coverage of essential services including reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access.

Target: By 2030 “achieve universal health coverage including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”

More research: Further data and research can be found at the Our World in Data topic page on Financing Healthcare .

SDG Indicator 3.8.2 Household expenditures on health

Definition of the SDG indicator: Indicator 3.8.2 is the “proportion of population with large household expenditures on health as a share of total household expenditure or income” in the UN SDG framework .

Two thresholds are used for defining large household expenditures: greater than 10% or 25% of total household expenditure or income.

The interactive visualizations show data for the 25 and 10 percent thresholds.

Target: By 2030 “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”

• Out-of-pocket expenditure on healthcare
• Risk of catastrophic expenditure for surgical care
• Risk of impoverishing expenditure for surgical care

Target 3.9 Reduce illnesses and deaths from hazardous chemicals and pollution

Sdg indicator 3.9.1 mortality rate from air pollution.

Definition of the SDG indicator: Indicator 3.9.1 is the “mortality rate attributed to household and ambient air pollution” in the UN SDG framework .

This is measured as the number of deaths attributed to indoor and outdoor air pollution per 100,000 people, accounting for differences in the age structure of different populations.

Data for this indicator is shown in the series of interactive visualizations, first for household and ambient air pollution combined, then for each separately, and then with a comparison of the two types of pollution in the final chart.

Target: By 2030 “substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.” There is, however, not a defined target level for this indicator.

More research: Further data and research can be found at the Our World in Data topic pages on Air Pollution and Indoor Air Pollution .

• Mortality rate from ambient particulate air pollution
• Number of deaths from outdoor air pollution
• Mortality rate from indoor air pollution
• Number of deaths from indoor air pollution

SDG Indicator 3.9.2 Mortality rate from unsafe water, sanitation, hygiene (WASH)

Definition of the SDG indicator: Indicator 3.9.2 is the “mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene” in the UN SDG framework .

This indicator is defined as the number of deaths per 100,000 people that are attributed to unsafe water, unsafe sanitation, and lack of hygiene (defined as exposure to unsafe Water, Sanitation, and Hygiene for All (WASH) services). This definition includes deaths from diarrhoea, intestinal nematode infections, malnutrition and acute respiratory infections.

Target: By 2030 “substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.” There is, however, not a defined quantified target level for this indicator.

More research: Further data and research can be found at the Our World in Data topic page on Water Access, Resources and Sanitation .

• Mortality rate attributable to unsafe water
• Mortality rate attributable to unsafe sanitation

SDG Indicator 3.9.3 Mortality rate from unintentional poisoning

Definition of the SDG indicator: Indicator 3.9.3 is the “mortality rate attributed to unintentional poisoning” in the UN SDG framework .

This measures the annual number of deaths per 100,000 people that are attributed to unintentional poisonings.

Target 3.a Implement the WHO framework convention on tobacco control

Sdg indicator 3.a.1 prevalence of tobacco use.

Definition of the SDG indicator: Indicator 3.a.1 is the “age-standardized prevalence of current tobacco use among persons aged 15 years and older” in the UN SDG framework .

This measures the share of people aged 15 and older who currently use any tobacco product, whether smoked or smokeless tobacco. This includes both people who use tobacco on a daily basis as well as those who use it on a non-daily basis but have used it at some point in the last 30 days before the survey. Age-standardization accounts for differences in age distributions between countries.

Target: By 2030 “strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.” There is no specified target level of tobacco use for this indicator.

More research: Further data and research can be found at the Our World in Data topic page on Smoking .

• Daily smoking in people aged 10 or older
• Share of men who smoke
• Share of women who smoke
• Death rate from tobacco smoking
• Deaths attributed to smoking and secondhand smoke

Target 3.b Support research, development and access to affordable vaccines and medicines

Sdg indicator 3.b.1 vaccine coverage.

Definition of the SDG indicator: Indicator 3.b.1 is the “proportion of the target population covered by all vaccines included in their national programme” in the UN SDG framework .

The UN currently includes the four following vaccines in this indicator: three-dose diphtheria, pertussis, and tetanus (DPT3); second-dose measles vaccine; recommended dose of pneumococcal conjugate vaccine (PCV3) and recommended dose of human papillomavirus vaccine.

Data on this indicator is shown across the four interactive visualizations.

Target: By 2030 “provide access to affordable essential medicines and vaccines.” 4

For this indicator, this means universal coverage of the vaccines noted above (if included in national vaccination programmes) must be achieved by 2030.

SDG Indicator 3.b.2 Development assistance to medical research & basic healthcare

Definition: Indicator 3.b.2 is the “total net official development assistance (ODA) to medical research and basic health sectors” in the UN SDG framework .

This indicator is measured as disbursements of official development assistance (ODA) and other official flows to the medical research and basic health sectors.

Official development assistance refers to flows to countries and territories on the Organization for Economic Co-operation and Development’s Development Assistance Committee (DAC) and to multilateral institutions which meet a set of criteria related to the source of the funding, the purpose of the transaction, and the concessional nature of the funding.

Data for this indicator is shown for recipient countries.

Target: By 2030 “support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, [and] provide access to affordable essential medicines and vaccines.” 4

SDG Indicator 3.b.3 Availability of essential medicines

Definition: Indicator 3.b.3 is the “proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis” in the UN SDG framework .

This indicator measures the share of surveyed healthcare facilities that had essential medicines available for purchase at prices, such that no extra daily wages would be needed for the lowest paid unskilled government sector worker to purchase a monthly dose treatment of this medicine after fulfilling their basic needs represented by the national poverty line.

The list of 32 essential medicines used in calculation is from the 2017 Model List of Essential Medicines from the WHO Expert Committee on Selection and Use of Essential Medicines, which updates its list of essential medicines every two years. Availability and affordability of specific medicines are weighted in the overall calculation based on the regional burden of disease.

Target: By 2030 “provide access to affordable essential medicines for all.” 4

Target 3.c Increase health financing and support health workforce in developing countries

Sdg indicator 3.c.1 health worker density.

Definition: Indicator 3.c.1 is “health worker density and distribution” in the UN SDG framework .

Health worker density is the size of the health workforce per 1,000 people. It is measured here based on the density of physicians, surgeons, nurses and midwives, dentistry and pharmaceutical personnel.

Target: By 2030 “substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries.”

• Nurses and midwives (per 1,000 people)
• Surgical workforce (per 100,000 people)
• Dentistry personnel (per 1,000 people)
• Pharmaceutical personnel (per 1,000 people)

Target 3.d Improve early warning systems for global health risks

Sdg indicator 3.d.1 health emergency preparedness.

Definition: Indicator 3.d.1 is the “International Health Regulations (IHR) capacity and health emergency preparedness” in the UN SDG framework .

The IHR Core capacity index is measured in terms of 15 capacities, where each capacity is measured as the average implementation score across a set of indicators. Countries self-report progress in the following 15 capacities: (1) Policy, legal and normative instruments to implement IHR; (2) IHR Coordination and National Focal Point Functions; (3) Financing; (4) Laboratory; (5) Surveillance; (6) Human resources; (7) Health emergency management (8) Health Service Provision; (9) Infection Prevention and Control; (10) Risk communication and community engagement; (11) Points of entry and border health; (12) Zoonotic diseases; (13) Food safety; (14) Chemical events; (15) Radiation emergencies.

Target: By 2030 “strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.”

SDG Indicator 3.d.2 Bloodstream infections due to antimicrobial-resistant organisms

Definition of the SDG indicator: Indicator 3.d.2 is the “percentage of bloodstream infections due to selected antimicrobial-resistant organisms” in the UN SDG framework .

This is measured as the share of people who are found to have a bloodstream infection due to certain antimicrobial-resistant organisms (methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to 3rd-generation cephalosporin), among those seeking care whose blood sample is collected and tested.

Data for this indicator is shown in the interactive visualizations.

Full text: “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.”

Full text: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.”

Full text:” By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.”

Full text: “Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all.”

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What humans need to flourish

By Jennie Dusheck

Illustration by Christopher Silas Neal

Plug “wellness” into a search engine and you’ll get 405 million hits — and a lot of advice. Everyone, from genuine experts to click-bait writers, has an opinion about what’s good for us.

We are told to strengthen our willpower, but indulge ourselves; exercise, but not too much; go vegetarian, but eat more meat; develop our social network, but indulge in more “me time”; have great sex, but not too much; safeguard our financial health, but spend our money on travel that leaves memories; keep our minds active, but empty our minds and meditate; volunteer; forgive; and be grateful.

Related reading

Thinking big: The Stanford Prevention Research Cente r

“There’s been a lot of ‘expert speak’ on the concept of what it means to be well,” says associate professor of psychology and of medicine Catherine Heaney, PhD, who is leading a team at Stanford that has been working to define and measure wellness. “What there has been less of,” ​Heaney​ says, “is going to ordinary people and trying to get a sense of what being well means to them.”

People long for a sense of well-being. For thousands of years, everyone — from philosophers such as Aristotle, Epictetus and Buddha to the smooth-talkingest snake-oil salesmen — have tugged at the problem of what makes for a good life.

Researchers at UC-Berkeley’s Greater Good Science Center, for example, report six major underpinnings of happiness, one component of wellness: compassion, friendship, gratitude, forgiveness, exercise and mindfulness. Private foundations, including the Charles Koch Foundation, have taken an interest in funding well-being research. Even governments have gotten into the act. In 2008, a commission of economists assembled by Nicolas Sarkozy, the president of France, called for the development of broader measures of national well-being. Two years later, the United Kingdom did the same.

But what does it mean to be well? If we want to promote wellness for everyone, we have to, first, be able to say exactly what it is and, second, devise rigorous ways of measuring whether it is increasing or decreasing. Once we can measure it, we can begin to discover which factors promote it or diminish it. In this way, an ambitious Stanford project aims to tackle anew an age-old question.

The path to wellness

In 2014, the Stanford Prevention Research Center launched the WELL program — its ultimate goal, to improve the health and wellness of whole populations. WELL, the Wellness Living Laboratory, emphasizes research on overall health rather than the absence of disease. Funded by an unrestricted $10 million gift from the Amway Nutrilite Health Institute Wellness Fund, WELL proposes to identify what factors help people maintain health and wellness and to develop techniques to help people to change their lifestyles.

The center’s WELL for Life program is both an observational study and an interventional study. WELL will observe more than 30,000 people over many years and also test behavioral modification and other interventions to help people make health improvements such as quitting smoking, eating better or exercising more. The center’s health promotion arm, the Health Improvement Program , will enable the techniques to reach the wider population.

“This is an effort to change the world of medicine and health,” says John Ioannidis , MD, DSc, professor of medicine and of health research and policy, who directs the center. “It may sound very ambitious, but I see this as a way to refocus the key priorities of biomedical research.

“The vast majority of biomedical research has focused on treating diseases,” he says. “A much smaller part has focused on maintaining health and maybe some prevention efforts. But there’s very, very little research that has tried to look at the big picture — what makes people happy, resilient, creative, fully exploring their potential and living not only healthy, but more-than-healthy lives.”

Among the things the WELL team wants to know: Is wellness the same for everyone, or do factors like gender or age influence how we perceive it? For example, among young adults, wellness might revolve around finances, career and athleticism. But as we age, social connectedness and resilience to stress may become more important drivers of our sense of how well we feel.

“We want to determine not only what makes people feel that they have a higher level of wellness, but also interventions that would help it,” says Ioannidis. “So we want to ask not only what is the profile of someone who feels good about their life, but how can we make that profile better?

“And how can we intervene with simple means — things that we do in everyday life — not with drugs or devices or complex procedures in the hospital?”

“We know that a person’s ability to move more, to sit less and to eat healthfully are influenced by their environment. This includes social relationships, neighborhoods and public policy,” says Abby King , PhD, professor of medicine and of health research and policy, who studies what’s needed for healthy behavior change.

“It’s about helping people make connections between their own pursuit of well-being and their health,” explains Heaney. Maybe for some people, making a better life for their children is more motivating than reducing their risk of a heart attack in the distant future, she says.

Once a doctor knows what motivates patients, it may be possible to harness that in the service of patients’ well-being and physical health.

During the first five years, the 30,000 participants — 10,000 each in China, Taiwan and the United States — will supply mountains of personal health information, ranging from general health and lifestyle information to genetic and other biological markers, says Sandra Winter , PhD, director of WELL. And it’s likely WELL will expand to other countries in the future.

Each of the thousands of participants will periodically answer scores of questions such as, “During the last two weeks, did your diet, physical activity and sleep habits influence your well-being?” or “How confident are you that you can bounce back quickly after hard times?”

Listening well

How do you ask people meaningful questions about a concept as fuzzy as wellness? To create an accurate vocabulary of wellness, trained interviewers sat down with more than 100 people from Santa Clara County and listened to their stories. Demographically representative of this diverse area, the 100 included men and women, young and old, and a variety of ethnic groups. Similar efforts took place in China and Taiwan.

Tia Rich, PhD, WELL senior research assistant, interviewed half of the Santa Clara County participants. She asked them to talk about a time of peak wellness, a time of low wellness and, finally, their current state. In each case, she also asked them to describe all aspects of their life that they wanted to share regarding each level of wellness.

And then Rich listened. The conversations lasted anywhere from 30 minutes to two hours. “The process of listening to 50 people share their life stories was extremely meaningful. It was really an honor to be trusted in that way,” she says.

The domains of wellness

After transcribing the Santa Clara County interviews and sorting the responses almost line by line into categories, Heaney’s team identified 10 domains of wellness that people most commonly mentioned:

• Social connectedness • Lifestyle behaviors • Stress and resilience • Emotional health • Physical health • Meaning and purpose • Sense of self • Finances • Spirituality or religiosity • Exploration and creativity

For these interviewees, having a social network was the single largest driver of wellness. Being integrated into a social network, having opportunities to receive support and companionship, feeling loved and feeling a sense of belonging, and also having others in your social network doing well is what most enhances wellness, said the interviewees. As one put it, “If my family is doing well, I will be doing well.”

But having a social network can be as much a burden as a comfort. “When people in your social networks are not doing well or when they act in ways that are socially undermining,” says Heaney, “that detracts from our sense of well-being.”

It’s important to manage our social connections so they contribute more than they detract. “It’s like the old saying,” she laughs, “When you’re a parent you can never be happier than your least-happy child.” So, ultimately, we need to find ways to support those we love while remaining somewhat stoic about their problems, so our own well-being doesn’t decline, too.

The second major domain was lifestyle behaviors such as eating well and getting plenty of sleep and exercise. People looked back on times when they were engaging in healthy behaviors as times of great well-​being, says Heaney.

As one interviewee reported, “I’d been outside all summer long just doing labor. I mean, sometimes you dig ditches, and sometimes you’re pruning Mrs. McGillicuddy’s pansies, whatever it is, you’re outside all day long, which really nourishes the animal, I’m here to say. And I remember my mother, for some reason we were driving along, and I said, ‘I’m at the peak of my physical health.’”

Wellness and resilience

The team also found that stress and resilience to stress were important factors in wellness. Major changes, such as a divorce or moving from another country, were especially likely to induce stress. But participants also spoke with pleasure about how well they had coped during a difficult time.

One interviewee said, “Even the worst of times, even the most difficult of times, there’s always been light and strength, and that is because I have a very rich inner life. And in the end, I have hope.”

Some people can adapt to the most dire of circumstances. In her book The Pursuit of Happiness , Carol Graham, PhD, an economist and a senior fellow at the Brookings Institution who studies happiness and well-being, reports that even though poor people around the world are less happy than the wealthy, some of the poorest often report high well-being.

Even those with serious illness may report a sense of well-being. “I was surprised by the extent to which people did not talk about illness,” Heaney says. People who had cancer might not even mention it in the context of their well-being. “Having an illness or not having illness was not what was important. What was more important was the experience of it and the extent to which a person felt like they were managing or coping.

“People would actually say, ‘Yeah, you know, a time of particularly high well-being for me was when I was diagnosed with heart disease,’ ” says Heaney. “And you’re like, ‘What?’ ” But they would then go on to say, ‘Yeah, because I learned how resilient I am. I learned how strong I am. I have come out of that a better person and I learned what matters to me.’ ”

The last five domains, which came up less often, included having a sense of meaning and purpose, which could encompass accomplishments or, alternatively, a sense of why we are here; a sense of self (a measure of confidence and self-esteem); financial comfort; spirituality; and, finally, exploring (or pioneering) and creativity.

Building the questionnaire

Using the 10 domains, Heaney and her team wrote 72 questions designed to probe people’s experiences of wellness. The questionnaire is already online for a small test group of WELL participants, and ultimately it will be available for all 10,000 U.S. participants.

Participants are asked, for example:

During the last two weeks, how often did you feel… …that you were very capable? …that you were interested in your daily activities?

To get at resilience, Heaney and her team included questions such as:

How confident are you that you can… . ..bounce back quickly after hard times? …adapt to change? …deal with whatever comes your way? …see the humorous side of problems?

The 72 questions have been translated for use in the China and Taiwan arms of the WELL study, field tested to make sure they have the same meaning in all three sites and modified to adjust for cultural or language differences. Additional modules may be added in each country to address determinants of wellness that are specific to that culture.  

While the questions themselves might vary a little from site to site, it remains to be seen how different the answers will be.

More broadly, each of the three WELL for Life sites will look a bit different, says Winter. “In the Bay Area, we’ve really been focusing on an online registry. In China, we are using a more traditional study approach in which people are going to come in in person, and we’ll gather physiological data such as BMI, height, weight, grip strength, plus blood samples and a battery of survey questions. And just as in Santa Clara, we’ll be following these people over time.” Meanwhile, the Taiwan arm of the study will add a biobank of tissue samples collected from all 10,000 participants.

Ioannidis says these tissues may reveal biological markers for wellness. “Just as we can monitor diabetes by looking at blood sugar levels,” he says, “is there some wellness biomarker that can tell us something about how one feels about one’s life? Are there biomarkers that indicate levels of wellness and that change as people’s levels of wellness increase or decrease?

“Of course, this is exploratory,” he says. “I cannot promise that we will have hundreds of biomarkers explaining everything about wellness, but it’s possible that some of them will be of interest.”

That would be a huge step forward.

How confident are you that you can… …overcome obstacles? …stay focused under pressure? …think of yourself as a strong and resilient person? …manage any unpleasant feelings that you might have? …not get disheartened by setbacks?

In a few years, the WELL project team may be able to help us answer questions like these with “very confident.”

Jennie Dusheck

Jennie Dusheck is a science writer for the medical school's Office of Communication & Public Affairs. Email her at [email protected] .

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The Importance of Research on Health and Well-Being

Director’s Page Helene M. Langevin, M.D.

February 7, 2019

As I’ve dived into my role as Director at NCCIH, one of the things that’s made me so energized about the position is the smart, pragmatic thinking embedded within the Strategic Plan NCCIH adopted in 2016. It’s a twofold cogent recognition of: 1) the very real challenges faced daily by patients and their health care providers, and 2) the opportunities the research community has to offer much-needed evidence to inform decisions about patient care. Especially important is our third strategic plan objective , which focuses on how we can explore the potential of complementary health approaches to foster health promotion and disease prevention across the lifespan.

Why is this part of NCCIH’s strategic plan so important? Since the beginning of the 20th century, modern medicine and biomedical research have overwhelmingly focused on the study and treatment of disease. In contrast, health—and especially the return to health after an illness—has received comparatively little attention.

This emphasis on treating diseases is largely a byproduct of a very good thing—the tremendous gains yielded by researchers in finding treatments for diseases and the effectiveness of pharmacologic approaches in both treating and managing diseases. These strides in advancing human health can be seen in antibiotics to treat bacterial infections or medications to manage chronic illnesses, such as diabetes, hypertension, and rheumatic diseases.

Yet these critical successes in treating and managing disease may also mean that the often-painstaking task of helping the patient recuperate during the “convalescent” period after an acute illness, or following an exacerbation of a chronic relapsing condition, has not yet been adequately studied.

Though the treatment-focused model is dominant in our research and health care ecosystem, there has been a longstanding awareness that many chronic diseases can be prevented or better managed by incorporating nonpharmacologic interventions such as nutrition, exercise, and stress management. When these methods are incorporated into care and patients are able to make lasting behavioral changes, the end result can be more durable improvements in health. Many complementary and integrative health practices follow this model, and there’s preliminary evidence indicating that some complementary approaches may be useful in encouraging improved self-care, a better personal sense of well-being, and a greater commitment to a healthy lifestyle.

In fact, one of the research strategies within NCCIH’s current strategic plan is to advance understanding of the mechanisms through which mind and body approaches affect health, resilience, and well-being. This includes a focus on methodologically rigorous evaluations that will lead to a greater understanding of whether, when, how, and for whom such practices can have substantial impact. For example, we support research designed to understand the ways in which an integrative approach to treating chronic back pain can lead to lasting healing and improved function and well-being. This research may provide critically important new therapeutic approaches for those patients who have not found relief with surgery or pain medicines.

I’m very much looking forward to the National Advisory Council for Complementary and Integrative Health (NACCIH) meeting on Friday, February 8th. It will be my first Council meeting as the director of NCCIH. The meeting will feature a symposium, “NIH Research on Well-Being,” and I invite you to listen to the conversation on this important research topic, as well as hear updates on the Center’s activities, policies, and funding priorities during the meeting’s open session. NCCIH will livestream the open session of Council on NIH Videocast from 10:00 a.m. to 3:20 p.m. ET, and it will be archived.

Past Messages From the Director

New Funding Opportunity To Advance the Field of Whole Person Research June 20, 2024

New Coalition Is Another Stepping Stone Toward Whole Person Health June 10, 2024

Disrupting the Disruptors: Convening a Research Discussion To Mitigate Endocrine-Disrupting Chemicals May 13, 2024

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Perspectives on health and well-being in social sciences

From a social scientific perspective, the field of health and well-being is differentiated with contributions of a wide range of topics, methodological approaches, and interdisciplinary research. This may challenge the understanding of health and well-being but can also make an important contribution to the development of the field. This thematic cluster presents new qualitative research on the importance of supportive structures addressing the societal and the organizational level in order to promote health and well-being in the individual. Social sciences have a double identity, being a science contributing with research on society and interacting processes between different levels in the society, and an identity taking on a critical assignment. The cluster addresses this double identity through research aiming to promote sustainable well-being. As guest editors of this thematic cluster in the International Journal of Qualitative Studies on Health and Well-being , we would like to present four studies describing different angles of individual experiences and views of the need of supportive structures. Highlighted areas are health promotion activities and shared decision-making processes in mental health care services for individuals suffering from mental ill-health. Furthermore, supportive structures in relation to experiences in professionals and health promotion interventions in work places are discussed. Contemporary societies meet different challenges concerning health and well-being. The overarching objective of this thematic cluster is to increase the knowledge that influencing factors for improved well-being in individuals often are to be found at societal and organizational level. To promote health and well-being in individuals, societal and organizational systems and actors need to interact with the individual as signified by the contribution of research in this thematic cluster. Moreover, the thematic cluster gives an understanding of the variety of approaches in qualitative studies on health and well-being within social sciences.

Living and working conditions are strong determinants of individuals’ physical, mental, and social health and well-being (Marmot, Allen, Bell, Bloomer, & Goldblatt, 2012 ). Applying a social science perspective on health and well-being means the recognition of the importance of influencing structures and pathways on a societal, organizational, and individual level. Moreover, supportive structures for individuals’ health and well-being are to a great extent shaped by the interactive process between these levels where social context, social position, and resources play an important role (Diderichsen, Evans, & Whitehead, 2001 ). Contemporary societies are complex and dynamic and require a reflexive understanding and methodology when aiming at increasing the knowledge of supportive structures for health and well-being. The social sciences have a double identity in the sense of being both a science contributing to research on society conducted with scientific methods based on an epistemological realism, and an identity taking on a critical assignment (Habermas, 1988 ). This critical assignment is a reflective approach in relation to various social phenomena in the society as well as towards the scientific activity in itself. The social sciences then are practiced based on a traditional methodology shared with other academic subjects, as well as a reflexive methodology based on a constructivist epistemology. The reflexive methodology comes from the very nature of the research object: the social aspects of human actions. When transferred to the field of health and well-being, this double identity can be understood as research on health and well-being and research about health and well-being. The research on health and well-being from a social scientific perspective would then level with other research traditions in the sense that the object of research constitutes different social aspects of health and well-being. The research about health and well-being from a social scientific perspective would focus on how the field is formed, what issues are at stake, and how this is done from a critical perspective applying a reflexive methodology (Alvesson & Sköldberg, 2009 ). In this thematic cluster, however, there is domination of traditional methodology in the contributions, with a common denominator of qualitative studies, but differing in approaches.

Studies have shown that mental ill-health problems are on the rise in both young people and among people in working age in Sweden (Danielsson & Berlin, 2012 ; Sandmark & Renstig, 2010 ). This raises an emerging need for health promotion initiatives where different actors on societal and organizational level work together with the individual in the development of supportive structures. In this thematic cluster, the included studies by Grim, Rosenberg, Svedberg, and Schön ( 2016 ) and by Jormfeldt and Hallén ( 2016 ) contribute to valuable understanding of the importance of supportive structures for individuals suffering from mental illnesses. In the work by Jormfeldt and Hallén, the discourse of mental illness is highlighted through written narratives by service users’ diagnosed with schizophrenia and their relatives’ concerning experiences of support in everyday life. Despite the knowledge that individuals diagnosed with schizophrenia often are at risk for an exacerbated well-being, the responsibility for everyday health promotion activities between authorities are not defined. The findings show a lack of support in everyday life, for example, in facilitating the practice of a healthy life style (Jormfeldt & Hallén, 2016 ). The findings may raise incitements for the societal level, that is, local authorities, to further develop health-promotive support structures and activities targeting the everyday needs of individuals with mental ill-health. Another example of a supportive structure within the field of mental health is shared decision-making which is investigated in the study by Grim et al. As in the study by Jormfeldt and Hallén, individuals with own experience of psychiatric illness and use of mental health care services are at focus. With an inductive and a deductive approach using focus group interviews, a thorough understanding is developed revealing the importance of informational as well as decisional needs among users of mental health services. This study makes a contribution to the understanding of what are the important constituents in shared decision-making among individuals with mental health problems. In addition, attitudinal, cognitive, and relation-based factors are discussed in order to reduce potential barriers for individuals to get involved in shared decision-making models and processes (Grim et al., 2016 ). Using different qualitative methods, these studies highlight the importance of participatory approaches where individuals’ experiences and views can form the knowledge base for health professionals and policy makers in the work for supportive structures. In an earlier study in International Journal of Qualitative Studies on Health and Well-being , another example of supportive structures as a response to a new welfare context was described among young people with intellectual disabilities (Tideman & Svensson, 2015 ).

Furthermore, Cuesta and Rämgård and Stenberg show that qualitative methodology is well suited for research on an organizational level in different work place settings. Cuesta and Rämgård aim at examining the use of an intersectional perspective as a way of increasing the knowledge on work place–based power structures. With focus group interviews, they focus at staff experiences and reflections from their work in an elderly care home for foreign-born persons with dementia. The need for an intersectional perspective that put a multifaceted focus on power relations is discussed as a tool for a “consciousness-rising” process which positively can affect well-being among professionals (Cuesta & Rämgård, 2016 ). The work by Stenberg ( 2016 ) gives another example of research where perspectives on health and well-being can be discussed from an individual and from an organizational and societal level. Narratives on fine artists staging artistic projects in different workplace settings are analysed and the meaning and importance of culture activities as a creative and health-promoting resource in modern working life is analysed. A two-folded result emerges showing that such artistic projects can be an important actor for supporting health and well-being at workplaces not at least by supporting social interaction. However, this study also indicates that this contribution can hamper the opportunity to actually perform and develop as an artist and thus entail adverse health developments and negatively affect the professional's own well-being (Stenberg, 2016 ). From different settings, the studies give an understanding of how the organizational level can be related to individuals’ construction of subjectivity in their professional roles, which in turn can affect their health and well-being. The study by Stenberg furthermore pinpoints a professional group whose working situation seldom is highlighted in occupational studies on health and well-being.

Societies today face emerging challenges concerning health and well-being. Especially the increase in mental ill-health among young people and people in working age is worrying. This call for attention and action and a need for interdisciplinary approaches have been advocated. The results from the included studies show that research from a social scientific perspective can make an important contribution to the knowledge development by including influential processes also originating from a societal and an organizational level. Finally, this thematic cluster will give an understanding of the variety of approaches within the social sciences and by this make an inspiring contribution for future submissions to the International Journal of Qualitative Studies on Health and Well-being of social science research.

• Alvesson M, Sköldberg K. Reflexive metodology—new vistas for qualitative research. London: Sage; 2009. [ Google Scholar ]
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• Tideman M, Svensson O. Young people with intellectual disability—The role of self-advocacy in a transformed Swedish welfare system. International Journal of Qualitative Studies on Health and Well-being. 2015; 10 :25100. doi: http://dx.doi.org/10.3402/qhw.v10.25100 . [ PMC free article ] [ PubMed ] [ Google Scholar ]

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Campus-wide media campaigns and print materials alert students to the potential dangers of alcohol and other drug use, address illegal and disrespectful behavior, and promote sobriety.

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Alcohol or Other Drug-facilitated Sexual Assault

Alcohol or other drug-facilitated sexual assault (DFSA) can occur when alcohol or other drugs are used to compromise or incapacitate an individual. This may result in lowered inhibitions, reduced ability to resist, and inability to remember details of an assault.

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Healthy People 2030

Building a healthier future for all

Healthy People 2030 sets data-driven national objectives to improve health and well-being over the next decade.

Healthy People 2030 includes 358 core — or measurable — objectives as well as developmental and research objectives.

Learn more about the types of objectives .

Social Determinants of Health

Social determinants of health have a major impact on people's health and well-being — and they're a key focus of Healthy People 2030.

Leading Health Indicators

Leading Health Indicators (LHIs) are a small subset of high-priority objectives selected to drive action toward improving health and well-being.

Health Disparities Data Feature

Healthy People 2030’s disparities data feature allows you to track changes in disparities to see where we’re improving as a nation — and where we need to increase our efforts.

Evidence-Based Resources

Healthy People 2030 provides hundreds of evidence-based resources to help you address public health priorities.

Healthy People in Action Spotlight

Southern nevada health district: setting targets to drive improvements in disease prevention and health promotion.

This blog post is part of our quarterly series highlighting the work of Healthy People 2030 Champion organizations . Healthy People 2030 Champions are organizations recognized for their work to improve the health and well-being of people in their communities and to help achieve Healthy People 2030’s goals. 

The Office of Disease Prevention and Health Promotion (ODPHP) cannot attest to the accuracy of a non-federal website.

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

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Promoting Health and Well-being in Healthy People 2030

Pronk, Nico PhD, MA, FASCM, FAWHP; Kleinman, Dushanka V. DDS, MScD; Goekler, Susan F. PhD, MCHES; Ochiai, Emmeline MPH; Blakey, Carter BS; Brewer, Karen H. MPH

Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Drs Pronk, Kleinman, and Goekler); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai and Ms Blakey); and Health ConTexts, LLC, Silver Spring, MD (Ms Brewer).

Correspondence: Emmeline Ochiai, MPH, Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, US Department of Health and Human Services, 1101 Wootton Pkwy, Ste 420, Rockville, MD 20852 ( [email protected] ).

This article is based on 2 briefs that were prepared by the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 and are available online at HealthyPeople.gov . The authors acknowledge and thank the following contributors to these original briefs: Tom Kottke, MD, MSPH; Bobby Milstein, PhD, MPH; Rebecca Rossom, MD, MSCR; Matt Stiefel, MPA, MS; and Elaine Auld, MPH, MCHES.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site ( http://www.JPHMP.com ).

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Healthy People 2030 describes a vision and offers benchmarks that can be used to track progress toward the goal of all people in the United States achieving their full potential for health and well-being across the life span. This vision can be realized through evidence-based interventions and policies that address the economic, physical, and social environments in which people live, learn, work, and play. Securing health and well-being for all will benefit society as a whole. Gaining such benefits requires eliminating health disparities, achieving health equity, attaining health literacy, and strengthening the physical, social, and economic environments. Implementation of Healthy People 2030 will by strengthened by engaging users from many sectors and ensuring the effective use and alignment of resources. Promoting the nation's health and well-being is a shared responsibility—at the national, state, territorial, tribal, and community levels. It requires involving the public, private, and not-for-profit sectors.

Healthy People provides science-based national objectives with 10-year targets for improving the health of the nation. Healthy People 2030—the fifth edition of the Healthy People initiative—describes a vision and offers benchmarks that can be used to track progress toward the goal of helping all people in the United States achieve their full potential for health and well-being across the life span. Healthy People 2030 expresses an expanded focus on health and well-being and an understanding that health and well-being for all people is a shared responsibility. This vision can be achieved through evidence-based interventions and policies that address the economic, physical, and social environments in which people are born, live, learn, work, play, worship, and age. High-quality data that are accurate, timely, and accessible are required to record and report on progress 1 over the course of the decade and to direct interventions to populations that are most likely to benefit from them.

Healthy People sets the federal agenda for the nation's health, guides its direction and allocation of resources, informs federal data collection and programmatic activities, and provides a model for promoting health and well-being at the state and local levels. The initiative's emphasis on promoting health and well-being signals to the nation that it is time to work across sectors to achieve health equity. This decade Healthy People 2030 is a resource for all sectors.

As part of the development of Healthy People 2030, the US Department of Health and Human Services (HHS) sought guidance from the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee), a federal advisory committee composed of nonfederal, independent subject matter experts. The Secretary's Advisory Committee presented recommendations to the HHS Secretary for developing and implementing the objectives for 2030. The Secretary's Advisory Committee convened regularly between December 2016 and September 2019, with meetings open to the public.

Health promotion has been a cornerstone of the Healthy People initiative since its inception in 1979. The Secretary's Advisory Committee recommended that the focus of Healthy People 2030 expand beyond health promotion to the broader purpose of promoting “health and well-being.” The process that has been called health promotion no longer focuses on health alone, but now leads to health and well-being for individuals in addition to society as a whole. This offers a chance to balance the needs of individuals and society. Society is defined as “a voluntary association of individuals for common ends.” 2 Health and well-being are elements among the common ends that motivate us, as individuals, to act for the good of all. In return for participating in society, individuals expect fair and just opportunities to be as healthy and well as possible. This article provides insights into defining health and well-being, promoting health and well-being, fostering user collaboration to improve health and well-being, and measuring health and well-being, in addition to implications for policy and practice.

The Secretary's Advisory Committee produced 2 detailed briefs that offered guidance for promoting health and well-being. Secretary's Advisory Committee members, joined by additional subject matter experts, developed these 2 briefs. The original documents are available on the HealthyPeople.gov Web site. 3 , 4

Defining Health and Well-being

Healthy People 2030 refers to health and well-being in every aspect of the framework, including the vision, mission, foundational principles, plan of action, and overarching goals. 5 The expanded role for health and well-being in Healthy People 2030 was supported by the Secretary's Advisory Committee's recommendations and its definition of health and well-being as how people think, feel, and function—at a personal and social level—and how they evaluate their lives as a whole. 6 How people think, feel, and function affects their beliefs about whether their lives have meaning and purpose 7 , 8 ( Table 1 ). This definition recognizes the multilevel nature of health and well-being. It acknowledges that social structures, such as families, neighborhoods, communities, organizations, institutions, policies, economies, societies, cultures, and physical environments, strongly influence health and well-being. Such influence is reciprocal between individual, social, and societal health and well-being. *

The terms “health” and “well-being” describe separate but related states; health influences well-being and, conversely, well-being affects health. 9 Health incorporates both physical and mental conditions; it implies fitness under changing circumstances, such as degradation of the physical, social, or economic environments, and must be safeguarded against threats from illness, injury, or death. Safety, as a result, is an important determinant of health. Well-being is both a determinant and an outcome of health. 10 It encompasses objective and subjective elements and reflects many aspects of life and states of being. These include physical and mental, as well as emotional, social, financial, occupational, intellectual, and spiritual, elements. 11 The terms apply to individuals as well as to groups of people (eg, families, communities) and environments (eg, physical, social, economic).

The World Health Organization defines health promotion as:

The process of enabling people to increase control over, and to improve, their health. 12 Health promotion ... covers a wide range of social and environmental interventions that are designed to benefit and protect individual people's health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure. 12

The World Health Organization identifies 3 key elements for health promotion: good governance for health; health literacy; and healthy cities. Adding the concept of well-being to this definition emphasizes that promotion of health and well-being takes place across different environments and users.

Promoting Health and Well-being

The concept of promoting health and well-being at both personal and systems levels has evolved over history, starting with ancient and classical civilizations. 13 Policy strategies for promoting health have been proposed since the 1970s. 14 More than 3 decades ago, the Ottawa Charter for Health Promotion described health as a “resource for everyday life, not the objective of living.” It noted that prerequisites for health include “peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.” 15 This guidance remains relevant today. Promoting well-being requires engaging an expanded and diverse array of users, disciplines, and sectors that extend beyond public health, such as mental health, housing, childcare/education, business, and aging.

Interventions to promote health and well-being occur at the individual, site-specific community, and societal levels. They address economic, social, and physical environmental and political factors (“determinants of health”) that influence health and well-being. Promoting health and well-being is critical because determinants of health—the physical, social, and economic circumstances in which people are born, live, learn, work, play, worship, and age—have disparate effects on vulnerable populations. These factors interact to affect people disproportionately based on race and class. All sectors are needed to remedy such disparities and achieve health equity.

At the individual level, interventions to promote health and well-being might focus on health behaviors, employment, housing, food security, or childcare. These interventions also would apply to the community level since they target settings where people spend their time, including home, school, work, or places where they socialize such as community centers and parks. These interventions can address designs of the built environment for ease of access and to ensure safety. The Robert Wood Johnson Foundation's Culture of Health initiative is one such national model. The Foundation defines a culture of health as one in which “good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities guides public and private decision making; and everyone has the opportunity to make choices that lead to healthy lifestyles.” 16

The concept of promoting health and well-being has evolved over the decades ( Figure ). Health and well-being operate on more than 1 level. Broader conditions shape individual experiences of health and well-being, and organized efforts can influence those conditions. Social structures, such as families, neighborhoods and communities, and policies, economies, and cultures also play important roles. 17–21

Engaging users from many sectors and ensuring the effective use and alignment of resources will strengthen implementation of Healthy People 2030. To promote health and well-being for all people and foster equity and social justice, socioecological factors and determinants of health must be addressed at all levels. A dynamic mix of resources will be needed for long-term improvements to livability (eg, stable housing, healthy food, clean air, education, living wage jobs) and for urgent needs (eg, acute care for illness or injury, food assistance, shelter, addiction treatment, disaster relief). Such resources will need to address a more diverse range of factors than in the past.

All too often, communities and institutions function in a reactive and responsive mode, deferring or delaying long-term investments. This way of functioning generates persistent needs for urgent services, along with pressure to maintain them. Collaborative decision-making across sectors can optimize the positive impact of resources and reduce the number of crises that happen in the first place. Identifying evidence-based programs to promote health and well-being among users can serve common interests, help users expand their thinking about solutions, and set priorities for limited time, money, and other scarce resources.

Multisectoral Collaborations to Improve Health and Well-being

Achieving population-level improvements in the coming decade will require users working at all levels to function across sectors and establish or participate in multisectoral collaborations. Such efforts can improve outcomes—not only in the health sector but also in nonpublic health or health care sectors, such as education, economics, the environment, and social cohesion. Collaboration among various users groups can benefit all partners by creating win-win solutions that recognize the interrelatedness of population health status with factors that lie outside the health care and public health systems.

Achieving optimal health and well-being requires efforts that include partners from different sectors, who operate at multiple levels (eg, state, local, community) and address the circumstances of people's lives. † Such efforts could span the behavioral, psychosocial, socioeconomic, cultural, and political circumstances of the population. No single actor has sole ownership of, accountability for, or capacity to sustain the health and well-being of an entire population. 22–24 The 10 “causes of the causes” of poor health comprise psychological influences (eg, social gradient, stress, and social exclusion), as well as elements of community infrastructure, such as food and transportation. 25 Thus, success depends on strengthening the capacity of communities to cocreate their own futures. 26

The COVID-19 pandemic is a case study of the reciprocal, complex relationships between the health of individuals and the health of society as a whole, as well as the resulting unintended consequences. An individual's decision not to wear a mask at a grocery store or other indoor gathering place can result in the virus' spread to other people who are present. Defining some workers as essential and required to work, such as those who work in grocery stores, transportation, health care, and in other occupations that require interaction with the public, increases the risk of infection for many low-wage earners. When essential workers are compensated with low wages, lack of financial viability creates challenges to their overall health and well-being. When health insurance is tied to employment and unemployment is soaring, unemployed people often delay seeking care. When older adults stay in isolation to avoid the possibility of infection, they can experience loneliness, depression, and mental health issues. When schools are closed and children stay at home, those who lack Internet connectivity are at risk of falling behind in their schoolwork. Those who receive free school lunches may go hungry.

To help local health departments identify strategies for promoting population health and well-being and addressing determinants of health, the National Association of County and City Health Officials (NACCHO) identified 9 domains of determinants, 27 as well as data sources for each ( Table 2 ). Healthy People users at the state and tribal levels may find NACCHO's domains and data sources useful for identifying and acting upon opportunities to improve and monitor measures of health and well-being. These include indicators that are important to the success of other sectors, such as high school graduation, crime reduction, and economic prosperity.

Measuring Health and Well-being

Monitoring and documenting changes to the population's health and well-being will require the use of new data sources and types of measures. The way people evaluate their own lives as a whole is one indicator of health and well-being. Yet, systems that are outside of an individual's control shape the exposures, choices, and services that people experience. An important distinction exists between individuals' subjective ratings of their own health and well-being and the objective conditions that surround and support people as they strive to improve their health and well-being.

Measures of progress that go beyond those specific to public health and health care settings will require tapping into existing data sources across other domains and sectors. For example, data used by agricultural extension offices, planning departments at all levels, schools, businesses, parks and recreation agencies, transportation systems, the Bureau of the Census, aging services, and the financial sector, among others, can inform health and well-being. Data partnerships between public health, health care settings, and other sectors can often benefit collaborators by providing a much richer source of information for each partner as well as for the entire partnership. 28

Healthy People 2020 used functional measures, including Healthy Life Expectancy, ‡ Summary Mortality and Population Health, § and Disparities, as global health measures for assessing progress. Earlier iterations of Healthy People used life expectancy and other measures. ∥ Holistic evaluations of health and well-being status of individuals, communities, and systems require broad measures, such as life satisfaction or social cohesion. 29–33 Assessing progress toward improved health and well-being must consider health disparities, health literacy, multisectoral policies, and determinants of health and well-being.

Realizing the potential of Healthy People 2030 will require accurate data from credible sources at all levels, with a renewed emphasis on local action. There are barriers to generating high-quality data (eg, funding, staffing, technology). Healthy People supports local action by providing guidance for consistent data collection methods and measures, as well as examples of best practices and innovations. A data partnership infrastructure and network focused on Healthy People objectives could address and respond to new developments in data sources and data analytics. For example, a data partnership could expand the availability of locally relevant data, stimulate access to new data sources to measure determinants of health and health equity, and enable linkage of geographic and demographic data in presentation formats for Healthy People users.

Partners would be able to share data, methods, and analyses and access guidance on data developments relevant to all 3 Healthy People objective types—core, developmental, and research. A data partnership infrastructure and network that links national, tribal, state, territorial, and local data through partnerships and collaborations could enhance the nation's capacity to identify and record the achievement of Healthy People objectives and overarching goals.

Healthy People 2030 continues the Healthy People initiative's tradition of serving as a catalyst for action by expanding the focus of health promotion to promoting health and well-being (see Supplemental Digital Content file, available at https://links.lww.com/JPHMP/A716 ). This emphasizes the need to shift from a disease-specific orientation to more upstream policy efforts. Healthy People 2030 offers data, objectives, and tools for creating well-being and a healthier nation. Realizing the potential of Healthy People 2030 will require the active involvement of a variety of public and private institutions and organizations, including national, tribal, state, territorial, and local health departments. Health departments at all levels can contribute to this work by engaging multiple sectors in the implementation and monitoring of objectives.

Discussions within the public health community, and between public health and other sectors, around defining health and well-being offer opportunities to engage partners that historically have not been involved in Healthy People. Engaging new partners in the Healthy People initiative will require those who traditionally have led the initiative to understand what those partners need to succeed, communicate how new partners' goals complement those of Healthy People, and convey how engaging with Healthy People can benefit the new partners. For example, partnering to improve high school graduation rates benefits the education and public health sectors, as well as the financial sector and potentially the criminal justice system. Accomplishing that goal might involve engaging with the telecommunications sector to support students' access to affordable Internet service. By engaging in such partnerships, everyone would become more familiar with the goals of other sectors and discover more win-win opportunities.

In their health improvement plans, public health departments at all levels should think broadly about which partners from other sectors could help them advance health and well-being goals, while considering what public health can offer those sectors in achieving their own goals. For example, in Maryland, each county has been charged with having a local health improvement coalition that brings together key users to achieve locally identified needs for health and well-being and to eliminate health disparities. Organizations and individuals often need to see value for investing their time and resources before they agree to participate. Involving partners early allows them to be part of identifying issues and finding solutions.

Open access data portals at the state level are proliferating and can inform decision makers as well as the public. These data portals and related data dashboards provide community leaders and residents with current geographically tracked data and tools that support assessments and linkages to evidence-based interventions. These data initiatives offer yet another opportunity for partners to convene and develop collaborative programs for their respective populations.

One of Healthy People 2030's foundational principles is that “the health and well-being of all people and communities are essential to a thriving, equitable society.” Achieving health and well-being for all will benefit society as a whole. Achieving such benefits requires eliminating health disparities, achieving health equity, attaining health literacy, and strengthening the physical, social, and economic environments. Promoting the nation's health and well-being is a shared responsibility—at the national, state, territorial, tribal, and community levels. By enlisting the involvement of the public, private, and not-for-profit sectors in efforts to promote the health and well-being of our populations, we will improve the health of the nation and the achievement of Healthy People 2030's targets.

Implications for Policy & Practice

• Across the field of public health, the focus on health promotion should be expanded to include health and well-being.
• No one sector has the ability, responsibility, or needed expertise to promote health and well-being for all. Multisectoral approaches are needed to address the social, economic, and physical determinants of health and well-being.
• It will be critical to identify common data sources and indicators that can be used to measure and evaluate trends in health and well-being.
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* Other definitions exist of the terms “health” and “well-being,” respectively. This is the definition proposed for Healthy People 2030, and it considers “health and well-being” as a single term.

† In the coming decade, Healthy People 2030 will highlight innovative and successful state- and local-level efforts through HealthyPeople.gov, webinars, and other channels.

‡ Healthy Life Expectancy (HLE) includes the following: HLE free from activity limitations at birth/age 65 years; HLE free from disability at birth/age 65 years; HLE in good or better health at birth/age 65 years.

§ Summary Mortality and Population Health includes the following: life expectancy at birth/age 65 years; any activity limitation at birth/age 65 years; any disability at birth/age 65 years; percentage in fair or poor health at birth/age 65 years.

∥ Healthy People 2010 used Life Expectancy, Healthy Life Expectancy, and Disparities. Healthy People 2000 used Years of Healthy Life; Disparities; and Clinical Preventive Services.

health promotion; Healthy People 2030; well-being

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• Top universities pursuing sustainable development goals in 2024

Top universities for advancing global health in 2024

University impact rankings for un sdg 3: good health and well-being.

Times Higher Education has meticulously assessed and ranked 1,498 universities from 115 countries/regions for their exceptional contributions to the United Nations’ Sustainable Development Goal 3: good health and well-being. These institutions are at the forefront of advancing universal health coverage, reducing preventable deaths, and enhancing public health through innovative research, comprehensive health services and community outreach programmes. They excel in addressing key health challenges such as mental health support, access to essential medicines and reproductive health services.

By prioritising critical areas such as vaccine distribution, tackling soil pollution and combating various forms of abuse, these universities not only foster healthier communities but create resilient systems that support sustained well-being and health equity. Their efforts contribute significantly to global health improvements, making a substantial difference to the lives of people across diverse populations.

Summary of findings

The ranking for SDG 3: good health and well-being is led by JSS Academy of Higher Education and Research in India. The second and third spots are taken by the Australian Catholic University and Mahidol University in Thailand respectively.

The highest-ranked newcomer is Datta Meghe Institute of Medical Sciences, also in India, in joint 15th place.

Three of the top ten universities are in Australia, two are in Taiwan and two are in India.

Methodology

Our methodology for SDG 3: good health and well-being encompasses a broad spectrum of indicators that evaluate universities’ effectiveness in promoting health and preventing disease across the global community:

Research on health and well-being (27%)

• Number of studies on universal health coverage and preventive healthcare
• Proportion of health-related papers that are viewed or downloaded
• Proportion of health-related research cited in clinical guidance

Graduates in health professions (34.6%)

• Proportion of graduates who receive a degree associated with a health profession, which reflects the university’s contribution to the global health workforce

Collaborations and health services (38.4%)

• Partnerships with health institutions for improved health outcomes locally and globally
• Health outreach and community service programmes that enhance public health
• Initiatives for better access to health services, including sexual and reproductive health care

The Impact Rankings are inherently dynamic: they are growing rapidly each year as many more universities seek to demonstrate their commitment to delivering the SDGs by joining our database; and they allow institutions to demonstrate rapid improvement year-on-year, by introducing clear new policies, for example, or by providing clearer and more open evidence of their progress. Therefore, we expect and welcome regular change in the ranked order of institutions (and we discourage year-on-year comparisons) as universities continue to drive this urgent agenda.

View the overall Impact Rankings 2024

Read our analysis of the Impact Rankings 2024 results

Download a free copy of the Impact Rankings 2024 digital report

Register to participate in next year’s Impact Rankings

To raise your university’s global profile with  Times Higher Education , contact  [email protected]

To unlock the data behind  THE ’s Impact Rankings and access a range of analytical and benchmarking tools,  click here  

Explore Impact Rankings for individual SDGs

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Rankings table information *

Read more about the Top universities for advancing global health in 2024

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Garden empowers cancer patients/survivors to live a healthier lifestyle

Cancer patients and their loved ones report there’s little they can control along their cancer journey. Lifestyle changes like eating healthier and exercising  are factors patients can change, but that’s not easy.

There are many barriers to adopting healthy eating. A lack of access to healthy food and resources, conflicting health messages and time constraints make it difficult to consume a cancer-fighting dietary pattern. An unhealthy diet over time can contribute to many chronic diseases, from cancers to diabetes and cardiovascular diseases. But improving diet quality can prevent some diet-related diseases from occurring in the first place and may improve the quality of life for those with disease.

The Garden of Hope better enables adoption of a healthy, plant-focused diet for people who are beyond their cancer treatment and those who are currently receiving treatment (at the OSUCCC – James, patients are often called “survivors” from the moment of their diagnosis). Caregivers for these groups are able to benefit, too. They all receive education and readily available, free, healthy food. Instead of handing an overwhelmed cancer patient a few worksheets with diet and recipe tips, they’re immersed in a new culture of health from farm to table.

“The garden started over 10 years ago as a collaboration at Ohio State among the OSUCCC – James, the Ohio State Wexner Medical Center and the Waterman Agricultural and Natural Resources Laboratory,” says Julie DeBord, the program manager of James Care for Life . “Dr. Colleen Spees joined within the first year and has been an ongoing advocate for the garden, which is currently at 1.5 acres and over 100 varieties of veggies and herbs.”

“There are many fad diets, especially those that target cancer patients with false promises of cures. The premise of the Garden of Hope is simple: Provide patients with evidence-based nutritional information to support a plant-based lifestyle.” Colleen Spees, PhD, RD

The astonishing results speak to the broader potential for this “food is medicine” model.

How food can be medicine

Dr. Spees’s research on lifestyle modifications to help prevent or reduce nutrition-related disease risks is both personal and professional. Three of her six siblings were diagnosed with cancer and found to be carriers of a gene mutation known as Li-Fraumeni syndrome, making them more susceptible to cancer.

“I don't recall a time when cancer wasn’t a part of my life.” Colleen Spees, PhD, RD, director of The Ohio State University Hope Laboratory

Dr. Spees started her career as a registered dietitian, then got her doctorate studying her family’s particular mutation. Clinician scientists work from “bench to bedside and beyond” to bring research findings from the lab to the individuals most in need.

For Dr. Spees, her living laboratory is in the garden.

Unlike cancers in Dr. Spees’s family, most cancers are not caused by genetic mutations but are linked to the environment and modifiable lifestyle behaviors. Many of the most common cancers are linked to obesity . Meanwhile, most U.S. adults fail to meet the dietary recommendations for cancer prevention and survivorship, such as adopting a plant-based diet and engaging in regular physical activity.

When someone is diagnosed with cancer, they are often overwhelmed and anxious. Research interventions that combine healthy food provisions with tailored nutrition counseling provide support during the chaos of cancer.

Despite evidence supporting the benefits of adequate nutrition, standard nutrition guidance and physical activity programs aren’t routinely integrated into cancer care. This is why helping people adopt a “food is medicine” lifestyle is essential, says Dr. Spees.

Hands-on gardening experience improves well-being in addition to health

At the Garden of Hope, registered participants can harvest vegetables  to bring home and join food demonstrations to learn how to prepare them. They also have access to dietitians who provide nutrition counseling, healthy recipes, cooking tips and safe food-handling practices. Demos occur onsite at the garden and are available online.

“It’s an educational garden at its core,” DeBord says. “We pair harvesting herbs and vegetables with education from two James dietitians, who focus on recommendations from the American Institute for Cancer Research about healthy eating for cancer survivorship and prevention, including a plant-based lifestyle.”

The focus is on making small, realistic changes over time, based on evidence and not on nutrition trends.

Learn about volunteer opportunities

Besides supporting a healthier diet, the garden also nourishes the soul. “It’s free from wifi and some of the stressors of life, so they find it a peaceful haven where they can harvest and enjoy being outside,” Dr. Spees says.

There’s also a sense of camaraderie in the garden.

“We also see that participants have a chance to meet other survivors or caregivers while they are in the garden,” DeBord says. “And we know that feeling connected has a positive impact in many ways. I consider it is a success anytime someone can walk away from our programs feeling a sense of community.”

Research shows the benefits of the garden

When Dr. Spees began helping in the Garden of Hope soon after it launched in 2012, it wasn’t long before she realized she needed to study its benefits. “They’re telling me it’s their urban oasis, helping their stress levels and navigating the chaos of cancer, but no one was studying it. So I thought, why not me?” she says.

She launched the Hope Lab — a “crop to clinic” model — to study how lifestyle modifications can improve health. What started as hands-on education to help people adhere to evidence-based diet recommendations became a way to measure clinically meaningful biological results.

Dr. Spees found improvements in participants’ inflammatory and metabolic markers, blood lipids, body composition, functional status, quality of life and the microbiome. “My research shows we can modify lifestyle behaviors to improve the nutritional status of individuals. This can decrease the prevalence of cancer, and if diagnosed, it can improve our response to treatment and possibly slow disease progression,” she says.

For example, in an early Hope Lab study , participants showed significant increases in how much produce they ate and significant decreases in how often drank sugary beverages or ate red and processed meat. This corresponded with signs of improved health, such as decreases in blood cholesterol and blood glucose and increases in skin carotenoids (correlated with increased fruit and vegetable intake).

In two different Hope Lab studies of lifestyle modifications for cancer survivors, participants significantly improved their adherence to dietary recommendations. One of the studies focused on survivors of cancer affected by obesity and showed significant improvements in body weight (-3.9 kg on average), BMI (-1.5), waist circumference (-5.5 cm), cholesterol (total cholesterol -6%) and blood pressure (-9.5 mmHg).

In addition to the physical health improvements, says Dr. Spees, they’ve found significant improvements in quality of life for both the caregivers and patients in her Hope Lab clinical trials.

Expanding upon her garden interventions, Dr. Spees is now leading a national initiative to provide home-delivered food to patients affected by lung cancer . The Hope Lab team and their research partners have delivered over 30,000 meals and provided 1,500 nutrition counseling sessions to participants across the country. Preliminary data is promising and shows participants have improved diet and quality of life as well as reduced depression and food insecurity. Her team is currently analyzing treatment toxicities, hospitalizations, malnutrition and the microbiome.

How cancer behaves in the human body is as complex and individualized as the patients themselves. But the simple truth is that healthy lifestyle modifications  give everyone a better chance for optimal health.

“We’re supporting people on their cancer journey while exposing them to an enriched environment where they thrive. We want families to develop a positive relationship with food and learn how to prepare delicious and convenient meals to support health and their families,” Dr. Spees says.

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Building on the Millennium Development Goals, the UN Sustainable Development Goals are the cornerstone of the 2030 Agenda for Sustainable Development, billed by the UN as “An Agenda of unprecedented scope and significance.” The seventeen ambitious goals, which are intended to be reached by 2030, are conceived ...

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