The Geneva Charter—Realising the potential of a well‐being society

Recently a group of global leaders came together to talk about The Geneva Charter for Well-being. The first of two resulting editorials highlights well-being concepts and ideas, relevant to policy-making. The second brief will present four case studies bridging the concepts with policy and political realities. The world faces significant and pressing threats to the environment, equity, health and well-being for people and the planet. Climate change and ecological loss; social and political threats including geopolitical conflict and displacement; job and household insecurity, and poverty limiting access to essential items such as food and heating are all complex and inter-related concerns. Health impacts include growing infectious and noncommunicable diseases and mental health concerns (see Figure 1).1 And the poorest in the world with the fewest resources suffer disproportionately.1 The COVID pandemic has further exacerbated the fractures in society, including health and social inequities.2, 3 These threats demand urgent, transformative, integrated and concerted actions. The Geneva Charter for Wellbeing4 charts a course forward towards ‘sustainable well-being societies’…to achieve ‘equitable health now and for future generations without breaching ecological limits.’ Human and animal health and well-being and planetary health are inextricably linked requiring multifaceted and holistic solutions by multiple actors. The Geneva Charter, developed as part of the 10th Global Conference on Health Promotion, sets out five action areas to create well-being societies (see Box 1) to address these wicked problems.4 The Charter rallies and aligns the health sector with the broader movement towards doughnut economics— a model framing the challenge of social and planetary boundaries, sustainable development and advancing a well-being economy.5, 6 It calls for ‘bold policies and transformative approaches’ underpinned by well-being foundations familiar to the health promotion community but reinvigorated by the new economics and Club of Rome7 thinking, including a broad view of health and concepts of equity and empowerment. The Charter is also consistent with the five key elements of the Sustainable Development Goals (SDGs) (UN, 2015): to promote societal well-being: human security (peace) and societal development—a core component of which is equity (people); economic development (prosperity); ecological sustainability (planet) and synergistic partnerships (partnerships).8 The core problem is the size of humanity's footprint, and the solution involves a major shift in how we are living on earth—meaning there are no easy solutions. Given that the current design of economies and economic policies are at the root of many of these challenges, the well-being economy approach offers some hope. Well-being economics considers all domains: ecological, social and population health and well-being and involves a redesign of the whole system by avoiding superficial approaches. A key concept of the well-being economy must be how it deals with social inequities. The well-being focus can be a unifying concept that resonates across sectors. But it is important to be alert to instances where a well-being approach is framed in terms of its benefits for economic development, rather than the economy being in the service of the well-being of people and planet. Further, it is often misunderstood, particularly in ‘health’ circles, to represent personal responsibility for adopting a ‘healthy lifestyle’.9 The policy actions required to create well-being societies are vast, pressing and complex and the risks of inaction are profound. There is every chance that changes will not be bold enough and extensive enough to make a difference. Progress requires action from many people, multiple sectors and governments, many of whom have little experience of working collaboratively. And this diverse responsibility carries with it the threat that it becomes nobody's responsibility.11 The health promotion field has evidence-based knowledge and experience that is useful in supporting change. Health promotion is about creating the conditions for good health, making healthy environments universal and advocating for investment in people and health to ‘build, protect and utilise human capital’12 aligning well with the actions required to support a well-being society. There is a wealth of knowledge about healthy public policy for the common good, use of good governance frameworks and health law instruments that are transferable to well-being policies. Allied to this is extensive experience in the use of financial instruments (e.g., subsidies and tax incentives) such as have been used in relation to tobacco control and could be used to stop other harmful practices. Environmental impact assessments are a useful tool and health promotion expertise in health impact assessments is convertible. Social mobilisation know-how will be valuable as will expertise in building health literacy in support of public health measures. Capability and experience in Health in All Policies will be especially important here since siloed thinking must end. Indigenous knowledge and leadership will also be significant. For example, evidence shows the importance of improving well-being for children and young people13 including addressing deprivation and poverty. Identifying overarching child and youth well-being objectives against which all policies can be assessed, efforts aligned and accountability enhanced would potentially support multiple well-being objectives both current and into the future. Building and investing in research and evaluation capacity to understand and measure the impact of these determinants on health and well-being as well as the effectiveness of interventions, is critically important. Good data underpins all decision making and the United Nations SDGs7 and OECD work on improving well-being measures, and monitoring a range of indicators, will inform progress.14 Prioritising the development of inclusive, high-quality, ‘green jobs’—jobs that contribute to preserving or restoring the environment—could improve health outcomes (less pollution and better housing) and contribute to positive planetary outcomes. Related to job transformations, building the rights of workers and the social protection floor for all, regardless of work ‘formality’ status and providing mechanisms for competency and skills development across the life course, is essential for realising gains in social equity and greater trust in government. These latter aspects are also imperative for dealing with inevitable pandemics and health security needs and well-being under these scenarios. The challenge is to understand what is entailed in the well-being approach, what role the health sector can play, and to integrate the approach across multiple sectors including, for example, environment, social security, housing and employment. WHO's Global Framework on Achieving Wellbeing is under development and should assist in transforming and translating the vision of the Geneva Charter into a roadmap for accelerating actions on the SDGs agenda and beyond. These actions should then be adapted to country and local levels' context and capacities along with rapid progress towards implementation of well-being economy frameworks. ‘Band aid’ solutions and superficial approaches based on rhetoric and good intentions need to be avoided. Meaningful change for the people and the planet should be based on good understanding of the urgency to act now for the benefit of current and future generations and for the sustainability of the natural ecosystem. We need a new social contract—mutual obligations among our family, community, place of work and fellow citizens and between countries that bind us together as a society—requiring us to share risks collectively and all contribute across the global community to better care for all of us and all of nature based on universal solidarity. Supporting a new generation of planetary and well-being health scientists will require changes to training, career pathways and funding to support work across disciplines, in partnership, to address real-world challenges and a ‘new class of solutions’.1 These skills are needed now.15 Health promotion practitioners need to bring these concepts and the urgency of action into their work. Their jobs need to expand to include the protection and regeneration of the world's natural systems, and engagement with the political economy, and the size of the threat means we must work across disciplines that have traditionally been siloed. We also have a responsibility as policy-makers to step up efforts to reinforce trust and encourage meaningful citizen participation in policy-making. As COVID-19 vaccination hesitancy has shown us, low trust can be associated with resistance. Communication, advocacy and working with communities are core health promotion competencies16 that will be crucial to the changes required. Health promotion actors need to be engaged in advocacy and action around climate change and environmental determinants for better well-being for all.17 Michele Herriot received funding as a consultant from the Centre for Health in All Policies Research Translation, SAHMRI to support the writing of this article.

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