Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
In this month’s Health and Well-Being Matter blog, RDML Paul Reed addresses the recently released Overall Health and Well-Being Measure data for OHM-01 (Overall well-being). Following his commentary, RDML Reed also welcomes a perspective authored by Dr. Brian Moyer and his insights on NCHS’s important role in assessing this vital measure. Brian Moyer, Ph.D., M.A., is director of the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) which serves as statistical advisor to the Healthy People initiative. NCHS is the nation’s principal statistical agency for health, whose mission is to collect, analyze, and disseminate timely, relevant, and accurate data and statistics to inform and guide program and policy decisions to improve our nation’s health.
“So, how’s it going?” Or maybe I should ask, “How satisfied are you with your life?” or “Are you thriving or flourishing?” And, “What’s contributing to that sense of well-being?” Healthy People 2030 — and several other initiatives, as you’ll soon see — wants to understand the answers to these questions at the population level.
Questions about life satisfaction aren’t new. Deliberate consideration of the topic — mostly shaped by explorations of “happiness” or “contentment” — can be traced back to antiquity. You’ll find questions of this sort in the philosophies of Confucius, Buddha, and Aristotle, among others. However, defining limits for an accurate measure of specific types of happiness or satisfaction — or the qualities of individual and community well-being — and crafting an academically rigorous shared lexicon is only just beginning to reveal meaningful measures of how people assess the quality of their lives in ways that resonate with governments and civil society.
The fifth and current iteration of the Healthy People initiative, Healthy People 2030, tracks several Overall Health and Well-Being Measures (OHMs). There are 8 in total, and each represents a global outcome measure intended to assess the trajectory toward the Healthy People 2030 vision. The 8 OHMs are further organized into 3 tiers: well-being, healthy life expectancy, and summary mortality and health. OHM-01, the new well-being measure, is expressed as overall life satisfaction and reflects cumulative contributions of health and non-health factors.
The first set of data for OHM-01, collected in the 2021 National Health Interview Survey (NHIS), showed that 95.2 percent of the total adult population of the United States responded that they were “satisfied” or “very satisfied” with their life. Overall life satisfaction ranged from 90 to 97 percent across all population groups, except people with disabilities — only 79 percent of people with disabilities reported that they were satisfied or very satisfied with their life, a disturbing disparity that ought to give us all pause.
The topline number — over 95 percent of all adults being satisfied or very satisfied with their life — is significantly high and quite encouraging when considered alone. But this data point raises a number of questions given the era we’re living in, particularly in light of the COVID-19 pandemic, the current economic situation, and chronic inequities. Also, that number differs from comparable measures produced by other organizations during a similar time period.
In June of 2021, Gallup’s U.S. Life Evaluation Index showed that the percentage of Americans who consider themselves to be “thriving” reached an all-time high of 59.2 percent. The Human Flourishing Program at Harvard’s Institute for Quantitative Social Science examines human flourishing through 5 central domains: happiness and life satisfaction, mental and physical health, meaning and purpose, character and virtue, and close social relationships. Composites of the domains (as measured across different sectors) reflect varying degrees of whether or not individuals view themselves as “flourishing.” In 2022, flourishing in the United States, was about an average of 7 on a scale of 0-10, though it was lower on average for young people.
Even a cursory look at the results produced by these organizations, Healthy People 2030’s OHM-01, and other measures begs the question of why these numbers differ so dramatically. First, we should acknowledge that each is designed as a different measure using unique methodologies. And importantly, these measures seek to assess concepts that are not yet universally defined or even understood with any reasonable consensus. Healthy People looks at overall health and well-being as a measure of how people think, feel, and function at the personal and social level — and how they evaluate their lives as a whole, a gestalt of one’s life. The Gallup-Sharecare Well-Being Index is a daily tracking measure that reflects how Americans are viewing their lives — both now and in 5 years. In On the promotion of human flourishing, the paper that led to Harvard’s comprehensive look at human flourishing, Dr. Tyler J. VanderWeele reflects that, “Flourishing itself might be understood as a state in which all aspects of a person’s life are good. We might also refer to such a state as complete human well-being, which is again arguably a broader concept than psychological well-being.”
Second, the perspectives we hold as individuals, regarding what contributes to our personal life satisfaction, are derived from widely different experiences and expectations of what qualifies as a satisfying and/or healthy life. There’s even less consensus when it comes to defining and quantifying what’s colloquially referred to as “living well” or “living our best life” or simply “a good life” among the public than there is among those who study such concepts. The context of one’s life greatly influences any examination of one’s personal views, including our understanding of what it means to be healthy or well.
Lastly, as scientists, clinicians, and public health professionals, one of our first instincts is to compare, contrast, and dissect numbers — and with good reason. After all, guidance that we provide is only as good as the data underpinning it. Finding “the meaning” within data or looking for ways to make that data more accurate and relevant comes naturally to those in our fields. This is why objective, quality data sources and analyses — such as those provided to Healthy People by NCHS and detailed by Dr. Brian Moyer below — are so important. They provide reliable references we can use to formulate insights and identify new areas for exploration. Given the relative newness of the data and the differing methodologies briefly outlined above, I caution that it is important we contextualize each measure and take a very critical eye to comparing these measures. This is especially important in these early stages of evaluation of well-being, thriving, flourishing, and resilience.
Though it is profoundly important and long overdue, we’re all exploring relatively new ground — and it’s too early to make definitive assumptions of any measure’s meaning. I encourage constructive criticisms and ongoing dialogue of these data and methods so that we can eventually find the best way of understanding what it means to be well, thrive, flourish, and be resilient.
These numbers are just the beginning of the story. The baseline for Healthy People 2030’s OHM-01 measure, Overall well-being, is established. And as more data comes in over time and we evolve our understanding of all these related measures, we’ll be able to appreciate their implications more fully.
Yours in health,
Paul
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis — In the Service of Health
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To measure overall health, you can’t just look at lab tests or medical charts. You should also look at other measures, like how people think and feel about their lives. To better understand this concept, the National Center for Health Statistics (NCHS) is working with other groups to identify and evaluate items related to life satisfaction and well-being.
This type of work helps inform the Healthy People Initiative, a collaborative health promotion and disease prevention effort with a vision toward a healthier nation. A key collaborator, NCHS advises Healthy People on statistical issues, including measuring global or overarching concepts like population health, disabilities, disparities, and recently, the concept of well-being.
To get better information about life satisfaction and well-being, NCHS conducted research to learn how people interpret related survey questions, if certain aspects of wellness are measurable, and if these data can be compared across demographic groups.
Results from this study led to a new survey question on the National Health Interview Survey (NHIS):
In general, how satisfied are you with life? Would you say, “very satisfied,” “satisfied,” “dissatisfied,” or “very dissatisfied”?
This question was also included in CDC’s BRFSS (Behavioral Risk Factor Surveillance System) as part of its Social Determinants of Health Module. It was implemented by 42 states in 2022.
The inclusion of a life satisfaction measure on both NHIS and BRFSS means that for the first time ever, comparable, reliable, nationally representative data collected by NHIS can be harmonized with state data collected by BRFSS. This will help NCHS and others measure important aspects of well-being, including progress toward Healthy People 2030.
A new indicator on well-being, as measured by life satisfaction, was included in Healthy People 2030. The indicator (OHM-01) is based on the NHIS life satisfaction question and will complement Healthy People’s other Overarching Health Measures, including life expectancy and healthy life expectancy. Overarching measures of health have been part of Healthy People since its inception and are designed to reflect population health in the broadest sense, as well as summarize the impact of actions and interventions to achieve Healthy People objectives and goals.
Brian C. Moyer, Ph.D
Director
National Center for Health Statistics
Related Healthy People 2030 objectives:
