© WHO/Andreas Beck
More than five decades ago, the Club of Rome warned the world that its natural systems would not be able to support the rates of economic and population growth forever and that indeed there are ’Limits to Growth’. Today, the planetary boundaries keep being pushed towards tipping points of no return, and societies are ever more characterised by social fractures with rising inequalities and declining trust across all institutions.
Could a Well-being Economy be the solution? Well-being economies are those that deliver in the interest of better lives, health, and prosperity for all, today and for the next generations. They have health, fairness, and social justice at the heart and pursue inclusive and sustainable development. The performance of societies that embrace the well-being economy is not measured by any economic indicator (such as the Gross Domestic Product, GDP), but by four essential well-being capitals: human, social, planetary, and economic well-being, which are further broken down into specific indicators.
But what do such economies look like? What can be learned from countries that are already using post-GDP indicators to measure progress? And what role can the health sector play in shifting towards well-being economies? These were some of the main questions being discussed at the WHO European Regional High-Level Forum on Health in the Well-being Economy, held in Copenhagen, Denmark, on 1-2 March 2023. The Forum brought together high-level representatives from ministries of health, finance and economy, public health policy-makers, and representatives from financial institutions, United Nations and European Union agencies, and civil society, including EPHA.
Leading the way
In his keynote speech, Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity, reminded the audience that while addressing the current crises – war in Ukraine, Covid-19, cost-of-living – we ought not to get distracted from issues in the future. A key message was that governments should rediscover public purpose, referring to ‘hollowing out’ of the public sector through the privatising of many of its tasks, which has led to great inequalities. Another point was intergenerational equity. He pointed out that in the better off countries in Europe, such as Denmark, it takes two generations to climb from the ‘low’ to the ‘middle’ social class, which is called social mobility, while in others, such as Poland and Italy, it takes five. He closed by saying that the knowledge and will to transition towards more equitable societies, or indeed well-being economies, are there, and rhetorically asked the audience whether the political will is as well.
That in some countries there is the political will, showed Katrín Jakobsdóttir, Prime Minister of Iceland. In her opening speech she shared her strong believe in the well-being economy and her vision for Iceland to make it a reality. She stressed the importance of measuring – ‘what is measured, gets done’ – but also to measure the right thing: when asked, people have indicated that it is not money that makes them happy, but strong relationships with others. She explained how after the financial crisis in 2011, Iceland’s GDP went down, but well-being went up. The explanation? People spent more time with friends and family. Iceland’s well-being economy strategy has 39 indicators, with ‘health’ being on top, and different priority areas, including mental health, work-life-balance, and better communication with the public. She emphasised the importance of collaboration between countries to share experiences, and that the transition is a process, of monitoring, prioritising, and executing.
The Forum showcased numerous examples from countries across the WHO European Region, which showed that the journey and the stage of transitioning towards more equitable societies is different for different countries, which depends on historical, cultural, economic, and political factors. While in Armenia peace is a vital and primary condition for investing in human capital, the example from Albania focussed on young people’s mental health, and the Minister of Labour and Social Protection from Moldova highlighted the importance of ‘agency’, so that people are empowered to take the ownership of the social contract with their country.
Wales brought various representatives who contributed to the Forum, including Sophie Howe, the country’s first – and now former – Future Generations Commissioner, whose role is to be the guardian of future generations. This means helping public bodies and those who make policy in Wales to think about the long-term impact their decisions have. Scotland presented its Wellbeing Economy Toolkit, which consisted of impact indicators and various features suitable at national and/or local levels.
Health in the well-being economy
Health and well-being are intrinsically linked, and hence policies for healthier societies and well-being economies are interconnected agendas. A key takeaway from the Forum was that health is both a beneficiary and a driver of well-being economies. It is a beneficiary as policies for a well-being economy, including e.g., job and income security, environmental and social protection, and work-life-balance promote healthier populations. It is a driver of well-being economies as healthier populations and health systems contribute to increased social cohesion and economic development; health and equity make key contributions to economic prosperity.
This is an important argument in the narrative that the transition towards well-being economies requires. But it also needs silos to be broken down, though dialogue, understanding each other’s languages, and shared action across the health, finance, and economic development sectors in pursuing these goals. In the fireside chat between Mario Monti, former Prime Minister of Italy and European Commissioner on ‘Health as an insurance Policy’, and Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, the point was made that medical students (and professionals) should read the Financial Times, and Mario Monti, who does not have a health background, mentioned he reads the medical journal The Lancet.
Last but not least, the well-being economy approach can heal social fractures only if it is co-created by and for the communities it is meant to serve. Milka Sokolović, EPHA’s Director General, stressed the importance of bottom-up, collaborative, and inclusive approaches.
Hans Kluge, WHO Regional Director for Europe, personally conveyed WHO Europe’s commitment for driving and taking leadership in the transition towards well-being economies. He emphasised the importance of social justice and to leave no-one behind. Chris Brown, Head of the WHO European Office for Investment for Health and Development which was the main organiser of the Forum, concluded the Forum by stating that she and her team will lead and advance the work on health in the well-being economy and will report on progress to the Regional Committee. The Regional Office will engage with partners to implement the actions in the outcome statement.