Policy approaches for well-being in the US

Every decade, the U.S. Department of Health and Human Services (DHHS) issues a set of recommendations and goals for improving the health of the U.S. population. The most recent of these recommendations are enshrined in Healthy People 2030. Healthy People 2030 “sets data-driven national objectives to improve health and well-being over the next decade.”¹ It includes 359 measurable objectives, but as Derrick Griffith notes, none of these objectives measure well-being. So, while well-being is mentioned as a DHHS goal, it remains undefined and unmeasured in the Healthy People 2030 recommendations. The absence of this definition presents an opportunity to shape how we approach well-being and policies that can promote well-being in the American context.

How do we define and measure well-being in the U.S.? The conceptualization and measurement of well-being has a long, international legacy. Well-being can be conceptualized as a subjective or objective measure. Achieving well-being is one of the UN’s Sustainable Development Goals (SDGs). Certainly, one potential way of thinking about well-being in the U.S. is to utilize one or some of the myriad existing definitions and measures.

Yet, the U.S. context has some interesting features that make the simple transfer of the existing definitions and measures of well-being a bit more complicated than one might think at first. Four years out from the devastating COVID-19 pandemic and from the intense racial reckoning that followed the May 2020 murder of George Floyd, experts and laypeople know that well-being can vary by race, place, gender, and socio-economic status. In a recent Brookings webinar on well-being, panelists cited the opportunity to embody the values and virtues of what it means to be a Black adult male in a community, the experience of equity and inequity, and the sense of belonging as examples of ways in which specific communities might define well-being.

As a further example, we know that Black women in the U.S. are more likely to die from childbirth than any other group in the U.S. While non-Black pregnant women might think of well-being in the context of childbirth as having regular check-ups and a successful delivery, Black women might think of simply surviving one of the most common human experiences as constituting well-being.

We also know that Black people are 2.6 times more likely to be killed by police than their white counterparts.² In Black communities that have lost a loved one to police violence, well-being might be defined in part by not having to experience that trauma and the devastating mental and physical health effects that follow. So, defining well-being in the American context requires sensitivity to the diverse experiences that characterize American life.

The U.S. context is therefore one that requires a more nuanced approach to defining and measuring well-being. One community’s definition of well-being might be different than that of another. Different communities will have varied assets upon which the experience of well-being could be accelerated. For some, the support throughout the community is the key asset; for others, those assets might be an entrepreneurial spirit, sovereignty over their land, the ability to interact with policymakers, or immigrant networks.

It is important then, as we think about defining well-being and the types of policies that might support well-being throughout different communities, to be sensitive to the community context. One approach to defining and measuring well-being is to enlist community organizations and their partners, members, and the communities they serve to define what it means to experience well-being in their communities. This approach has the advantage of having community members, who are intimately familiar with the assets and experiences in their communities, lead consideration of well-being in their communities. In so doing, community members drive the definition of well-being and the consideration of the types of policies and approaches that can support well-being in their communities.

When that approach is deployed over a range of diverse communities, it might be possible to understand what is common and unique across communities in the U.S. to experiencing well-being in the U.S. Commonalities can be incorporated into the subsequent Healthy People 2040 set of recommendations and goals. Where there are differences in the factors that can promote well-being, the DHHS can develop policies and health metrics for those factors and can associate those factors with other elements of social, economic, education, and community well-being.

Over the next year, the Brookings team will model this approach and partner with communities across the country to have communities themselves define what it means to experience well-being. Our goal is to have a robust set of community-generated definitions that allow us to depict the range of experiences, expectations, and assets that characterize communities across the U.S. and that allow policymakers to appreciate the depth and richness of the well-being experience across the country. When policymakers have these definitions, they can better define the goals associated with well-being in the U.S. context and can better measure their progress toward those goals.