The well‐being economy and health in all policies: Fostering action for change

This special issue, the ‘Well-being Economy and Health in All Policies: Fostering Action’, highlights the need for societal change in the way we think about health and well-being. It brings two separate but related concepts together—the well-being economy and Health in All Policies (HiAP). The first concept seeks changes to the way society values and measures progress; and the second requires decision-makers to work across departmental boundaries to use public policy to create the conditions for health and well-being. The papers included in the special issue explore these two concepts from different perspectives. They unpack the connections between the well-being economy and HiAP, share some examples of promising practice, and provide insights into the challenges and opportunities that need to be acted on if we are to move towards a flourishing well-being society; where decision-makers work collaboratively to care for people, planet and future generations. A well-being economy is both prosperous and distributes wealth equitably, creates health and well-being, while protecting the planet's resources for future generations and other species. It is designed to be equitable, restorative and regenerative.1 Well-being economies value indicators beyond gross domestic product, such as equity, happiness, human health and environmental outcomes. A broader set of indicators provide societies with a more holistic and balanced approach to development and sustainability.2 The importance of moving beyond measures of economic growth as a marker of progress has been stressed by the Organization for Economic Cooperation and Development OECD. It defines the Economy of Well-being as the ‘capacity to create a virtuous circle in which citizens ‘well-being drives economic prosperity, stability and resilience, and vice versa and that these good macroeconomic outcomes can sustain well-being investments over time’.3 It specifically highlights the need for people to be at the centre of policy and rejects the idea of ‘grow first, redistribute and clean up later’ towards a model that is equitable and sustainable from the outset. Several of the Sustainable Development Goals and targets also contribute to progress in this direction. A well-being economy differs from the type of economy that neo-liberal economics envisages with its focus on economic production and moves towards an economy that is concerned with three key elements: human capabilities; planetary boundaries; and equity in the distribution of planetary resources for both current and future generations. It starts with the idea that the economy should serve people and communities, first and foremost. Implementing these strategies will require policy actors to work across sectoral boundaries.6 Working across sectoral boundaries is required to shift the processes that underpin government decision-making, determine government priorities, and ultimately shape policy and budgets outcomes. Many of the problems facing society today require collective government and community action. These complex issues can be resolved effectively through healthy public policy and joined-up processes of government. HiAP is an approach to working across sectors to improve the outcomes of public policy and simultaneously improve population health, equity and well-being. It is an approach to ‘joined-up government’ that incorporates a focus on population health into policy development processes of sectors and agencies that sit outside of the health sector. It allows governments to address the environmental, socio-economic and commercial determinants of health in a systematic and integrated manner and draws on the concepts and actions outlined to reduce inequities by the WHO Commission on Social Determinants of Health.7 The World Health Organization (WHO) defined HiAP as an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity (pg. 2).8 It considers health impacts from all policy domains including food and agriculture, education, environment, fiscal, housing and transport. HiAP approaches seek to highlight the connections and interactions between positive health outcomes and policies within other sectors, and in so doing, identify the gains for the agendas of all sectors of having healthier populations. Despite substantial adoption of a HiAP approach regionally and in various countries globally, its implementation has not been easy as pursuing health goals can conflict with other sector goals and the needs of the private sector.9 Understanding and addressing the underlying determinants of health is difficult because how they influence health is complex, multi-faceted and dynamic. Government agencies are not structured to deal with multifaceted and complex issues. They operate within sectoral boundaries that are designed to implement policies and services focused on a narrow range of policy issues. Working across these boundaries requires dedicated and sustained efforts. Civil society can play an important role in calling for stronger whole of government collaborative approaches. The history of public health successes shows us that civil society actors are often the strongest advocates for HiAP. The papers in this special issue reflect the early stage of development of research on the well-being economy. Many of the papers have taken the well-being economy concept and explored how these ideas can be applied to an existing program of work and in a few cases drawn on practical HiAP examples. The papers in this special issue provide a valuable insight to the early emergence of the well-being economy field and the existing and future intersections with HiAP and other joined-up approaches to governance. The use of the well-being economy concepts to frame existing programs and issues is a useful first step, as it helps to challenge dominant economic models and thinking underpinning the context within which public health actions are being implemented. It also creates a narrative that can support a growing awareness about alternative economic models and so a more informed dialogue. It is time to build on these early foundations. There is still much to learn about what a well-being economy concept actually looks like in practice, how it is understood and valued by different actors. We need targeted research that asks practical policy-relevant questions that can support governments globally to understand the drivers and mechanisms for bringing about collaborative governance and integrated policies that account for a range of impacts on well-being. This latter element refers to the implementation of ‘how to’ questions that are so often absent from emerging evidence.10 The research–policy–implementation gaps need to be addressed—if we are to see the ambitious well-being economy agenda come to fruition. The health promotion and social determinants of health community has much to contribute to the move towards a well-being economy. Many of the concepts are compatible with the principles and suggested actions of the Ottawa Charter for Health Promotion,11 and the evidence of the 2008 Commission on Social Determinants of Health, which have set the foundations for health promotion action. It is timely for the health promotion and public health community to engage actively, by advocating, enabling and mediating the competing and diverse interests, building the capacity of stakeholders, and undertaking cutting-edge research—to answer the questions that matter most. For societies to flourish, governments must take holistic approaches to health and well-being, and health equity and to value, recognize and act within planetary boundaries. The health promotion community is perfectly positioned to hold governments to account and help create and advocate for the change that is urgently needed. As Associate Editor for the Special Issue, Carmel Williams is very grateful for the guidance and support provided by the Guest Editorial Team, who are also co-authors this editorial. Thanks, is also extended to the authors of all papers included in the Special Issue as they help to progress discussion on the important role of the wellbeing economy and HiAP in moving towards an inclusive and sustainable society.

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