What does it take to create a healthy society with happy people? There is no direct answer to this question. However, according to a new Yale study, communities that offer racial diversity, preventive health care, and public transportation are more likely to have higher levels of well-being.
What Is Well-Being?
When talking about people and their well-being elements, such as education and income are always near the top of the list. However, that is only half the battle. Researchers have identified 12 attributes that are independently and strongly associated with well-being.
We came up with attributes that explained a large portion of the variation we see in well-being. Several factors were related to income and education, which is expected. But we also found that attributes related to the community environment and the way people commute and variables related to health care were linked to well-being.
Researchers noted that among these attributes was access to preventive health care and available heath centers was toward the top of the list. People reported feeling a sense of satisfaction when they took a bike or public transit to work, compared to those who drove to work.
Diversity also played a role in overall satisfaction. Living in a community with a higher percentage of black residents was associated with greater wellbeing.
PLOS defines wellbeing as “a person’s cognitive and effective evaluations of his or her life and includes emotional reactions to events as well as cognitive judgements of satisfaction and fulfillment.” This is a comprehensive, positively framed assessment of quality of life and health. It includes aspects of one’s mental, physical, and social health, beyond the presence of disease or the absence thereof, as well as the introspective evaluation of one’s life.
By definition, higher well-being has inherent positive value that was associated with a lower risk of cardiovascular events and greater longevity. The positive value of well-being, plus the recent focus on population health has created an interest in designing communities that support this construct. However, there needs to me more evidence about local elements associated with population well-being.
Varisables That Determine Well-Being
Where people live may be a strong determinant of one’s well-being and it varies by region. Community attributes, such as access to social services and basic healthcare, clean and safe streets, public transportation, healthy foods, green spaces, along with neighborhood cohesion and trust, influences one’s evaluation of their own well-being.
Many of the community attributes mentioned can be modified and have become a focus to improve population health and well-being. The Centers for Medicare and Medicaid Services have started to pilot accountable health community models. The new payment models recognize that the social and community factors influence health outcomes and compensation to support positive modification of these factors as necessary.
Determining which factors are the most strongly linked to health and well-being is a challenge because most of these attributes are correlated with one another. However, it is necessary to identify the community attributes that are independently and strongly linked to better health and well-being outcomes. If the strongest attributes are identified, it could provide evidence that will allow communities to prioritize targets that aim to promote well-being.
Studies of the Well-Being Variables
One study used a “systematic method to identify independent associations with well-being among highly interrelated county characteristics drawn from multiple community sectors emphasized by established theoretical frameworks.” Researchers performed a cross-sectional study with the data from the Gallup-Sharecare Well-Being Index (WBI). The WBI is a complete, multi-dimensional well-being assessment of more than 350,000 Americans annually.
Analysts showed an association among individual well-being scores and 77 county factors related to the following sectors: social and economic status, demographics, health behaviors, clinical care, and the physical environment. They also conducted an exploratory analysis of the relationship between these factors and life evaluation, a component of the WBI consisting of a subjective overall assessment of one’s current and five-year life outlook.
The study included 338,846 survey participants, representing 3,118 counties. Seventy-three variables were explored and found significantly associated with iWBS. Forty factors revealed a higher than 20 percent of the variation in well-being. They were retained for within-category multivariable analyses. Fourteen of the variables were not considered to be independently associated with iWBS after accounting for the effect of other variables in the same category. The greatest amount of variance was found in the social and economic category. The health category showed the least amount of variance.
After removing the non-significant variables within each category, 27 county factors remained. Of these, only 12 factors were significantly associated with health and well-being.
“We came up with attributes that explained a large portion of the variation we see in well-being. Several factors were related to income and education, which is expected. But we also found that attributes related to the community environment and the way people commute and variables to health care were linked to well-being,” according to Brita Roy, M.D., the first author of the study and assistant professor of medicine.
Toward the top of the list, were access to preventive health care and easily accessible health centers. People also reported satisfaction and fulfillment when they ride a bike to work or use public transportation, compared to those who drove to work.
Diversity had a key role in overall satisfaction. Living in a community with a higher percentage of black residents was associated with greater well-being for all.
The study only established a correlation between certain variables and well-being. It does not prove that these elements are the source of well-being, however, the correlation is very strong, as stated by researchers.
“The results of this study represent a step forward in our understanding of how we may efficiently and effective improve well-being through community-based action.” This was stated by Carley Riley, M.D., co-author and assistant professor at Cincinnati Children’s Hospital Medical Center.
Moving Forward
Researchers hope that lawmakers will take these finding into consideration and implement appropriate policies in communities.
To improve the well-being of a community, you need to work across multiple sectors and fields, to include the economy and health care and urban planning and transportation. Working across different groups, in coalitions, has the greatest potential to improve health and quality of life.
According to Business Insider, it has been reported that the cities that offer the best quality of life are in New Zealand and Australia. New Zealand has the first and 12th and Australia has the 7th and 8th best cities for quality of life. This was reported by Deutsche Bank Market Research.
The Deutsche Bank created the quality of life index for 50 cities with global economies by compiling a number of measures that included the overall quality of healthcare, housing affordability, and cost of consumer goods.
Prices for groceries, consumer goods, and rent were compared to determine the cost of living rank for each city. Housing affordability was measured by the ratio of price to income. Other variable included in the quality of life index included climate, safety, and traffic.
There are four U.S. cities on the list with Boston offering the highest quality of life in the country. New York received the lowest ranking, below San Francisco and Chicago. This study examined cities around the world.
Another report published in U.S. News & World Report, examined states for quality of life in America. The rankings were formed alongside McKinsey and Co. Two metrics were considered for each state: the natural environment, quality of drinking water, air quality, pollution and industrial toxins, the social environment, community engagement, voter participation and social support.
States in Order of Best for Well-Being
- North Dakot
- Minnesota
- Wisconsin
- New Hampshire
- South Dakota
- Mississippi
- Arkansas
- New Mexico
- Iowa
- Colorado
- Wyoming
- Maine
- Montana
- Nebraska
- Missouri
- Kansas
- Oklahoma
- Oregon
- Alaska
- Idaho
- Washington
- Utah
- Rhode Island
- Delaware
- Massachusetts
- Vermont
- Kentucky
- Tennessee
- Michigan
- South Carolina
- Maryland
- Georgia
- Florida
- North Carolina
- Alabama
- Hawaii
- New York
- Connecticut
- Arizona
- Ohio
- Virginia
- Louisiana
- Nevada
- Pennsylvania
- West Virginia
- Texas
- Illinois
- Indiana
- New Jersey
- California
By Jeanette Smith
Sources:
PLOS One: Identifying county characteristics associated with resident well-being: A population based study
ZME Science: What makes us feel well in society? Diversity, healthcare, and public transit
Business Insider: The states where Americans have the best quality of life, ranked
Images Courtesy of Karen Roe’s Flickr Page – Creative Commons License