What would a wellbeing budget 2017 look like?

Over 50 years of research has told us how we can improve wellbeing through Government policy. Will these feature in the budget?

Work and the Economy

  • Think creatively about incentivising ‘good jobs’

This budget needs to prioritise reducing unemployment and creating high quality jobs.

Previous business rate proposals meant that rates for pubs, shops, GP surgeries hospitals could be set for increases as high as 400 per cent. This creates a short-term danger that a business’ biggest overhead could be cut: employees.  Unemployment is one of the most important things the Government should care about in a wellbeing budget.

Becoming unemployed has among the most damaging effects on wellbeing and mental health, alongside health and relationships. The wellbeing impacts of unemployment go beyond the impacts of income.  If someone is unemployed for more than a year, their wellbeing will  permanently be lower – it increases once back in employment, but doesn’t increase back to previous levels. Where a parent has been unemployed in the past, their adolescent children will have lower wellbeing and self confidence, years later and after their parents are back in employment.

Being in a job is good for wellbeing and being in a ‘high quality’ job is even better. We don’t mean a certain skill level, type or industry. It’s about what makes a job worthwhile for us. Things like how secure it is, the social connections we have, autonomy and purpose, among other things.  A people-centred Budget needs to address the fact that  fewer than 3 in 10 (28%) people in the UK reported high satisfaction with their job.

The Budget needs to encourage high quality jobs.   For example, business rates could be lower for organisations taking action to create high quality jobs, or ensuring higher wellbeing for employees at work. This would have benefits for the wider economy as well. Organisations that strive to improve employee wellbeing tend to have better productivity, higher levels of innovation and creativity and lower costs associated with absenteeism, presenteeism and staff retention(1).

  • Improve commuting

We know that a longer commute is negative for wellbeing.  Importantly, we never adapt to a poor commute. As anyone who has to catch the 7.41 from Hove to Farringdon can tell you, it affects us daily. Research shows that merely switching from commuting by car to walking improves our wellbeing. We need a budget that promotes job creation nearer to residential areas, and make sure those jobs are open to local people.

  • Encourage lifelong learning and improve training system

Evidence shows that continuing to learn throughout life is not only useful for developing skills and improving job prospects; it can improve and maintain our mental wellbeing.  Learning throughout life is associated with greater satisfaction and optimism, and improved ability to get the most from life. People who carry on learning after childhood report higher wellbeing and a greater ability to cope with stress. They also report more feelings of self-esteem, hope and purpose whilst setting targets and hitting them can create positive feelings of achievement. Learning often involves interacting with other people and this can also increase our wellbeing by helping us build and strengthen social relationships.

A shake-up of the current training system has the potential to provide young people with a quality learning route. Research shows this is important for personal wellbeing, as well as productivity gains. Typically, lower level and technical qualifications result in lower financial and wellbeing returns than higher education qualifications. It’s argued this stems from the perception of technical qualifications by employers as poorer quality and lower value . Creating a qualification that has value to both employers and employees could yield significant benefits for personal wellbeing as well as productivity.

  • Provide adequate support for those at the end of their careers

Those who are involuntarily forced into retirement, without a financial safety net, experience the greatest drop in wellbeing.  A wellbeing budget would provide incentives for firms to support employees in planning for their retirement – this might include the option of reduced hours or other forms of “bridging’’ employment.

Health and social care

  • Improve work for those in the sector

There are not two cultures in the workplace: how you treat staff is how patients will be treated. Social care is a key priority for many local areas, but care work can be viewed as low paid, precarious and undesirable, making recruitment difficult. The quality of care has often come under scrutiny and many working in care homes are unskilled and hold few formal qualifications.

We know what works to improve conditions, increasing wellbeing as well as productivity in the health social care sector. A forthcoming Centre review of the published evidence will show that training in the workplace, combined with changes in job design, can improve the quality of the job, improving conditions for staff as well as  improving performance, reducing absenteeism and conflict.

  • Think across departments – prevention matters

Acute responses to crises have high costs. Prevention has a long pay-back. Those with higher wellbeing are less susceptible to illness and are more likely to recover faster. Even the emotional support in the first 3 years of a child’s life can hugely influence later outcomes.

We know that physical activity can prevent and improve a range of mental health conditions and music and singing can improve wellbeing, especially for older people. There are clear health and wellbeing benefits from a connection with the natural world, including national parks, local pockets of green space, canals, rivers, or the coast.

The budget would recognise the valuable role which social connections play. Countries where everyone has someone to rely on have significantly higher wellbeing compared to countries where no-one has someone to rely on- around 10% higher, even when other factors like health and income are accounted for. Individuals with higher loneliness have significantly lower wellbeing. In countries where everyone feels that most people can be trusted, the country tends to have around 20% higher average wellbeing compared to those where no-one answers positively to their levels of trust.

And what can Government or local authorities do? What works for social relations? An upcoming Centre review will lay out the existing evidence. We already know that community and housing design play an important role – those living in walkable, mixed use neighbourhoods are more likely to know their neighbours and trust others.

The wellbeing budget would promote cross-departmental cooperation, working together to support social care of the elderly and creating an environment which is sociable. Continuing the positive steps already taken by the Department of Health, the wellbeing budget would continue to recognise the importance of wellbeing and the role of culture, sport and ‘green’ interventions for preventing and improving diagnosed conditions.

Taxes and stability

  • Tax increases, tax cuts, spending… and stability

The main insight from current wellbeing research into taxation is that poor individuals get more wellbeing from an additional pound than rich people. Once we reach a certain income, increases in our income only increase our wellbeing by a small amount – studies have estimated that doubling our household income would increase life satisfaction by a little over 1% (2).

Because we compare ourselves to others, our wellbeing won’t increase if the income of all those around us increases at the same rate. The level of national income has surprisingly little effect on wellbeing, as long as it does not go down. Measures of wellbeing are more than twice as sensitive to negative economic growth as compared to positive growth. Economic stability is important.

Why should the Government care about the wellbeing budget?

Where people have lower wellbeing, the leaders are more likely to be voted out.

The wellbeing budget – what next?

These are just examples of some of the evidence of what influences our individual and community wellbeing. Beyond this, our national wellbeing rests upon how this adds up as a whole – now and going forwards. Based on the evidence, a Government would prioritise investments to improve national wellbeing, current and future. However, there is still a lot to learn. We need to test which approaches work best, in what format, to understand how wellbeing can be improved. Especially for those with the worst lived experiences. We don’t need to roll out new approaches before testing – we need to try new things in a way which lets us understand what works – and what works for wellbeing.

You may also like: How a spending review would look if the government wants a happier Britain 

(1)  Prof. Alex Edmans, London Business School,2015, BITC/Ipsos MORI 2010, The Wellness Imperative: World Economic Forum 2010.

(2) The regression coefficient on log income in a BCS life-satisfaction regression (controlling for other adult outcomes, childhood outcomes and family background) is 0.20
Doubling household equivalent income is predicted to raise life satisfaction by oneseventh of a point.

Guest blog: How do Mental health non-profits use evidence ?

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Here, Caroline Fiennes from Giving Evidence shares findings from a new study into evidence use in non-profit services for mental health.

UK non-profits delivering mental health services are not great at producing or using scientific evidence. This is the main finding of a new study by Giving Evidence. We interviewed 12 such organisations to understand their ‘evidence system’, i.e., how evidence is:

  • Produced
  • Synthesized
  • Shared, both ‘outbound’ from them and ‘inbound’ to them – and stored.GivingE1

These nonprofits talked of their growing interest in being evidence-based and focusing on impact (and we don’t doubt them) but in practice it’s not happening consistently. Some charities said that they struggle to find and use external research about what is effective in treating or preventing mental health conditions when designing their programmes.

One reason given is the difficulty of accessing, interpreting and applying academic / independent research – for example, much academic research is behind paywalls, so charity staff sometimes resort to sneaking into their former universities to read it, and certainly much of it is pretty unintelligible to non-researchers. Another is the claim that there isn’t much research which is relevant, although that claim is disputed by some experts and researchers.

However, charities delivering mental health services seem laudably interested in the views of their service users. Three-quarters of the charities we interviewed regularly collect user feedback, and over half have done so on a large scale.

Evaluation research

About half of these organisations are producing (or funding production of) impact evaluations, i.e., investigations of the causal effects of their interventions, and many of these seem to be simple pre/post studies, which are open to considerable errors. It may be just as well that not all of them are producing such evaluations, because doing unbiased evaluation research is a specialism which most service delivery organisations don’t have. Instead, they should (we would argue) be using reliable research from elsewhere, which few are.

One charity said that:

Evidence for us is what our users say works…that is enough for us

This concerns us, because the human mind is often misled about what works and only rigorous research can reveal the reality. Happily some of the non-profits which are involved in producing evaluation research are doing so in partnership with reputable research institutions.

GivingE2Undervalued and underfunded?

Sadly some charities we spoke to seem to be being forced to produce low quality research. Several told us that funders and commissioners require ‘evaluations’ of services but only put towards them budgets too small to allow for reliable research (e.g., with adequate sample size). Most were only £5-10k, and a few were £20-30k.

For example, one charity said that is has dozens such budgets a year, which is very frustrating because individually, those budgets only allow for research that is essentially pointless, but collectively they could enable something insightful.

Adding to the knowledge pool?

About half of these charities are producing the kind of research or impact evaluations which could be useful to other organisations. Plus, reportedly, “every contract specifies different outcomes, which makes it a nightmare to aggregate”(charity interviewee) and also prevents comparisons. We didn’t have resource to look at the quality of that research, i.e., to see whether it is reliable and useful. However, dissemination of that is weak, and that’s not really the charities’ fault; there’s no incentive for them to do so, and few channels anyway.

One charity said that part of the reason they don’t publish much is that:

We don’t want competitors to pick this [our intervention] up.

GivingE3We have encountered this in other sectors and this is a major problem (not of the charities’ making).

On the upside, amongst the charities that do produce this kind of material, we found no evidence of selective publication: we had thought we might find that material which is flattering is more often published and unflattering material isn’t, which creates publication bias, but we did not find this.

 

Brutal under-funding of mental health

This is all in a context of brutal under-funding. Mental health accounts for 23% of the UK disease burden, but gets only 13% of the NHS budget and 5% of the UK health research budget. Moreover, charitable giving to mental health is very low: it’s only £714 for every adult with mental health problems whereas donkeys get £2,047 each.

Using evidence-based mental health research to find out what works

Giving Evidence has long said that most charities should not produce causal research, which requires expertise that they don’t have and don’t need, but rather should get good at hearing from their target users about what they want and think of what they’re getting, and then finding and using causal research about what works in addressing it. That seems to be the case for charities delivering mental health services. Some organisations help with this, such as the Centre for Mental Health, and the Mental Elf.

We recommend that mental health charities work towards (and are funded and incentivised to work towards) finding and applying the relevant rigorous research, and working with specialist researchers to produce research where none already exists. We expect to work with some mental health charities on this.

Discuss on our forum

What works in research use? from our Science of Using Science project.

Caroline Fiennes Biography

Caroline founded and directs Giving Evidence. She is one of the few people whose work has appeared in both OK! Magazine and The Lancet. She is on boards of the US Center for Effective Philanthropy, of the world’s largest charity rating agency Charity Navigator, The Cochrane Collaboration (specifically Evidence Aid). She is the Corporation of London’s City Philanthropy Coach, and writes a monthly column in Third Sector magazine. Caroline was named a Philanthropy Advisor of the Year by Spears Wealth Management. More information about Giving Evidence is at http://www.giving-evidence.com/about

Guest blog and report : World Mind Matters day

On World Mind Matters Day 2016, a global survey funded by the World Psychiatric Association (WPA), of laws and policies in 193 United Nations (UN) member states reveals the level of discrimination faced by people with mental illness in the areas of marriage, voting rights employment and right to contract. The results were published as the ‘Social Justice for People with Mental Illness’ report in  the International Review of Psychiatry in August 2016 and include these findings:

  • In 36 per cent of countries, people with mental health problems are not allowed to vote
  • In nearly a quarter of countries, there are no laws preventing discrimination in the recruitment of people with mental health problems.
  • In over half of countries, there is no explicit protection in laws against dismissal/termination/suspension of employment on grounds of health reasons including mental health problems
  • 38 per cent of countries deny right to contract to persons with mental health problems

The findings have led the WPA to create a Bill of Rights for Individuals with Mental Illness which urges ALL governments to ensure that persons with mental illness/mental disability/mental health problems are not discriminated against based on their mental health status, and are treated as full citizens enjoying all rights on an equal basis with others. 

“Those with mental illness/mental disability/mental health problems have the capacity to hold rights and exercise their rights and should, be treated on an equal basis with other citizens. The challenge for policy-makers, clinicians, and individuals with mental illness is to fight discrimination using strategies similar to civil liberties, gender equality, sexual minority (LGBT) communities, which in many parts of the world have proven to be useful.”

Here, Professor Dinesh Bhugra CBE President of the World Psychiatric Association  explains why this is important:

Mental health gives us the opportunity to Dinesh Bhugra-photofunction well, look after others and enjoy life. Often mental health and physical health are seen as completely different and in isolation from each other whereas the truth is that one affects the other. We know that if a person with diabetes gets depressed then both depression and diabetes are difficult to treat. Mental health has several aspects to it including mood, thoughts and behaviour. Different cultures add a further dimension of spirituality to mental health.

Why is mental health important? At a global level we know that mental ill health causes a tremendous amount of burden which is much greater than that caused by heart disease and cancers. Mental ill health often remains undiagnosed and affects individual functioning at work and at home creating further tensions. Cultures frame our view of the world and create our thinking processes and the way we express and deal with distress.

When an individual says: ‘I feel gutted’ they are expressing distress similar to what a Punjabi woman says: ‘my heart is sinking’.  Childhood experiences combined with experiences of bad parenting can cause problems in adulthood. Over half the mental illnesses in adulthood start below the age of 15 and three-quarters start below the age of 24. Thus preventive strategies have to focus on the vulnerable age groups.

‘Wellbeing’ is a difficult concept to define as it has different meanings at personal, cultural and global levels. Personal wellbeing has become ever more important as longevity, conflict, insecurity and environmental issues increase, and social and technological changes impact on our individual and collective lives.

Prejudice, stigma and discrimination against mental illness delay help-seeking. There is considerable research evidence to suggest that early recognition and early interventions will get people back to normal sooner. There are different types of mental ill-health or mental illness caused often by a mixture of biological vulnerability, social and psychological causative factors. Social determinants of health include poverty, overcrowding and unemployment.

Stigma against mental illness is caused by lack of knowledge and often improved knowledge may lead to changes in attitudes and behaviours making these more positive and accepting.  In small cohesive communities whether they are related to residential settings or work-place it may be easier to reduce stigma and deal with prejudice. Three years ago when 23 members of Parliament stood up in the House of Commons and talked about their personal experiences of mental ill health, that turning point really changed the nature of debate on mental health.

Mental health is everyone’s business and we all need to take responsibility for our own mental health and those in our immediate circle-whether these are professional or personal circles.

Mental ill health and major psychiatric disorders are eminently treatable and many conditions have cure rates of 90-98%.  It is important that we understand the concepts of wellbeing. We must support family members and friends as well as colleagues who may be stressed and developing mental illness so that they are able to lead fulfilling and functioning lives and can contribute fully to their community and society.


Professor Dinesh Bhugra CBE is President of the World Psychiatric Association (2014-2017) and President of the Mental Health Foundation in the UK. He is the recipient of over 10 honorary degrees. His research interests are in cultural psychiatry, sexual dysfunction and service development. He has authored/co-authored over 350 scientific papers, chapters and 30 books and is the Editor of the International Journal of Social Psychiatry, International Review of Psychiatry and International Journal of Culture and Mental Health.  Previously he was the Dean (2003-2008) and President (2008-2011) of the Royal College of Psychiatrists where he led on major policy initiatives on psychiatry’s contract with society and the role of the psychiatrist.

 

Guest blog: What Makes a Good Childhood?

Rachel2Rachel Beardsmore,Senior Research Officer, Wellbeing; Children and Young People at  Office for National Statistics shares insights from the 5th annual Good Childhood report:

 

 

Today sees the publication of The Children’s Society’s 5th annual Good Childhood Report. The report highlights some of the key differences in well-being between boys and girls, including for overall life satisfaction, how happy they are with their appearance and mental health.

The Office for National Statistics publishes 31 measures of children’s wellbeing across 7 areas of life and our analysis of these measures supports the findings published in the Good Childhood Report. Using data from the Understanding Society survey, we found that in 2013-14, girls aged between 10 and 15 were more than twice as likely to be unhappy with their appearance as boys of the same age. Girls in their early teens are more likely than younger girls to say they are unhappy with their appearance; over 1 in 4 (26%) girls aged 13-15 said they were unhappy with their appearance, compared with 1 in 10 (11%) girls aged 10-12. The Good Childhood Report shows that between 2009 and 2013-14 things have been getting worse for girls, while for boys there has been no change. We found that teenage boys are much less likely to say they are unhappy with their appearance with just 1 in 14 (7%) reporting being unhappy.

Social media is an ever-present feature WBWKY1FQ2Iof social life, especially for the young. Our
research using the Understanding Society survey
shows that there is a clear association between longer time on social websites and symptoms of mental ill-health. This is concerning, as we have found that the proportion of children using social networking websites for over 3 hours on a school night has increased from 6% in 2009-10 to 9% in 2013-14. Further analysis shows that 1 in 5 (20%) teenage girls spent over 3 hours a night on social networking sites in 2013-14, compared with less than 1 in 10 (9%) teenage boys and 1 in 20 (5%) pre-teen girls. Less than 3% of pre-teen boys reported using social networking sites for over three hours a night. We are currently looking at further research into social media use and wellbeing as part of our programme of research.

The Good Childhood Report illustrates how children’s direct experiences, such as their perceptions of the quality of local facilities and how safe they feel, are more important for their wellbeing than factors that may be more removed from them, such as local area deprivation. Similarly, our research using the Understanding Society survey shows that a child’s relationship with their parents is one of the most important factors associated with their well-being. Around 1 in 10 (10%) children who quarreled frequently with their mother, and 1 in 12 (8%) who quarreled frequently with their father, reported being relatively dissatisfied with life overall. This compares with less than 1 in 40 children who quarreled less frequently with their mother or with their father.

Overall, the majority of children in the UK report good wellbeing. However, there are some aspects of life that are experienced differently by boys and girls and by children of different ages. Our research, and that of The Children’s Society, provides insight to policy-makers to ensure all children have the best childhood possible.

The  Children’s Society and ONS would be very interested in your views →discuss on our forum

 

 

 

 

 

 

 

Guest blog and report: The Implications of Wellbeing Research on Government Policy

 

kim_engel (no 10 downing street)The Hertford Business & Economics Society, an undergraduate group at the University of Oxford, recently completed a research project looking at wellbeing and government policy. The final report was presented to the Cabinet Office in December 2015. Here, Kim Engel, one of the co-authors of the report introduces its three main proposals.

 

  1. Guidelines for civil servants

Ideally governments would carry out controlled experiments to assess the wellbeing impact of every plausible policy. The most cost-effective policies would be implemented. Then further experimentation would be used to refine those policies.

But in reality experiments require scarce resources like money, time and expertise. And there are still large methodological controversies surrounding the quantitative measurement of wellbeing. This leaves room for organisations such as the Civil Service to adopt other approaches to improving wellbeing.

We proposed the use of a brief, one-page “wellbeing table” for making speedy estimates of wellbeing impact. The table would provide space to describe the probable effects of a policy on key determinants of wellbeing such as employment and mental health. It would come attached to a one-page “information table” highlighting the main conclusions of existing academic research into factors affecting wellbeing.

  1. School and university incentivesHBESoc

A study involving more than 17,000 Britons found that “the most powerful childhood predictor of adult life-satisfaction is [a] child’s emotional health” (Layard et al., 2013). Yet schools currently have limited incentive to prioritise wellbeing. OFSTED assessments cram “Welfare, personal development and behaviour” into one section out of a total of four.

We suggested that a new section on “Pupil Wellbeing” could be introduced to OFSTED reports to give schools credit for adopting proven methods of improving wellbeing such as social and learning (SEL) programmes, healthy eating measures, and the provision of good counselling services.

Universities can also make a big difference to wellbeing in the UK. Above all they must address massive increases in the number of students with mental health problems. HEFCE statistics published in 2015 show a 125% increase in the number of students with mental health problems in the four years to 2012-13, while many universities are reporting double-digit annual growth in demand for counselling services.

We therefore proposed that the National Student Survey (NSS), taken by more than 300,000 students annually, should include a question about satisfaction with university mental health services. This would generate valuable information for prospective students, and give universities strong incentives to up their game.

We also mention the further possibility of adding the “ONS4” wellbeing questions to the NSS. By providing a snapshot of wellbeing at every UK university, this would help researchers and universities figure out “what works” for wellbeing.

  1. Wellbeing reporting

 Businesses can take a variety of evidence-based actions to improve employee wellbeing. These include improving work-life balance, promoting good health, helping employees take greater control over their work, and developing employee’s sense of the social value of their work (New Economics Foundation, 2014). Companies that succeed are likely to enjoy a boost in profits as productivity rises and absenteeism and employee turnover decline, raising economic growth and making everyone better off.

We proposed that the government should mandate large firms to produce an annual report on employee wellbeing. The reports might explain how wellbeing policies are adding value to the firm and disclose expenditure on non-financial wellbeing (e.g. social activities, counselling, physical health programmes). They would alert shareholders, employees and the media to underspending or under-performance on employee wellbeing. Firms would therefore have additional incentive to invest in employee wellbeing.

 Full report: The Implications of Wellbeing Research on Government Policy

→ Response to the report by Ewen McKinnon, a member of the Analysis and Insights Team at the Cabinet Office

Discuss on our forum

References

Jeffrey, K., Abdallah, S., Michaelson, J. (2014). Wellbeing at work. New Economics Foundation.
Layard, R., Clark, A. E., Cornaglia, F., Powdthavee, N., Vernoit, F. (2013). What Predicts A Successful Life? A Life-Course Model of Well-Being. Discussion Paper No 1245. Centre for Economic Performance, LSE.

 

 

 

 

Guest Blog: Bank of England’s Andy Haldane, A Recovery for the Few, Not the Many

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Andrew G Haldane, Chief Economist, Bank of England takes a deeper look at the UK’s economic recovery up to the EU referendum.

 

At least up until the referendum, macro-economists like me would wax lyrical about the UK’s economic recovery.  The numbers spoke for themselves.  GDP was 7% higher than its pre-crisis peak.  More than 2 ½ million extra jobs had been created since 2010.  Almost £3 trillion of extra wealth had been amassed.  The UK was riding high at the top of the G7 growth league table.

Yet for those of us who have toured the country, speaking not just to businesses but to public sector companies, charities and communities, the picture often painted was a far from rosy one.  For many of them, there had been no discernible improvement in their incomes and wellbeing.  The language of “recovery” simply did not fit their facts.

This posed something of a conundrum for me in my day-job as Chief Economist at the Bank of England.  Was this a healthy and wealthy recovery, as the headline numbers suggested?  Or was it an insipid, or perhaps even non-existent, one as anecdote implied?  Digging into the headline numbers began to provide some reconciliation of this puzzle.

If we look not at headline GDP but at households’ disposable income, a somewhat different picture emerges.  Not one of a relentless rise over the past three years, but of disposable incomes flat-lining for the better part of 10 years.  Perhaps as many as half of UK households have experienced a “lost decade” of income growth.

Dividing-up this income pie – regionally, socio-economically, inter-generationally – paints an even more nuanced, and uneven, picture of recovery.  For example, at present there are only two regions across the UK – London and the South-East – where GDP per head currently exceeds it pre-crisis peak.  In others words, in all bar two UK regions, there has been no real recovery even in GDP terms.

The distribution of this income across rich and poor is no less striking.  Although the distribution of incomes across the UK may well have narrowed since 2008, patterns of wealth have diverged remarkably.   While the lowest 20% of earners have been their wealth fall by around 20% since 2008, the highest-earning 20% have seen wealth rise by over 15%.

Age may have been a key driver of these patterns.  All of the £3 trillion rise in net wealth since 2008 has been harvested by those over the age of 50 and two-thirds by those over the age of 65.  While pensioner incomes comfortably exceed their pre-crisis levels, the same cannot be said for working families.  These are huge inter-generational transfers, from young to old.

So when it comes to asking “Whose recovery?”, the answer is reasonably clear:  those living in London and the South-East, those earning higher incomes, those aged over 50 and those owning their own home.  This has been a recovery for the few, rather than the many.

This pattern of gains and losses across the economy is relevant for making sense of the past and for fashioning the future.  For example, these distributional patterns may help explain why global and UK growth has remained fairly anaemic over recent years, despite large amounts of monetary policy stimulus.  Large chunks of society are feeling no better off, and hence are no more willing to spend, than a decade ago.

Looking ahead, these distributional fault-lines – regional, inter-generational, socio-economic – are not ones which can be ignored.  For growth to be sustainable and strong it needs to be inclusive and comprehensive.  There is a role for public policy, over time, to seek to close these fault-lines to achieve inclusive and sustainable rises in societal well-being.

→ Whose Recovery? speech in Port Talbot, Wales on 30 June 2016

→Discuss on our forum

 

Guest blog: NPC’s Dan Corry on Wellbeing over the life-course

 

Dan Corry, Chief Executive of NPC and What Works Wellbeing board member, reports from the Wellbeing over the Life Course one day conference run by our Cross Cutting Team led by Lord Layard at London School of Economics (LSE).

DanThe Wellbeing juggernaut is well and truly ploughing on in the academic world as evidenced by a full day conference held recently at the LSE. Here, some of the best academics around presented draft chapters of a book due to come out soon, looking at wellbeing in many different ways. These included Richard Layard, Andrew Clark and Andrew Steptoe. Equally powerful academics, like Alan Manning, Jane Waldfogel and Tim Besley, discussed them and the audience – of which I and several of my What Works Centre for Wellbeing colleagues were part – chipped in.

The book, and the day, looked at wellbeing issues as they affect young people and are influenced by the early years; at those of working age; and at the wellbeing of older people too. They used a number of different data sets and were all focused around the causes and correlates with subjective wellbeing, a controversial issue in its own right but one that conference organiser Richard Layard still thinks is the best measure for us to use however imperfect it inevitably is.

There was a lot to take in, but here are some of the particular things that struck me. None are ground breaking, but all are of interest.

  • This area is growing fast. The fact that questions about wellbeing (along the lines of the four ONS questions) are being added to many surveys makes this analysis much more possible. We are seeing economists and other disciplines getting into the area using cross section and panel data.
  • Expectations matter. Subjective wellbeing is all about how you feel and so is bound to include how you feel you are faring relative to how you expected or want to feel. One finding for instance (from a recent DCLG survey) that shows that wellbeing is not diminished by living in a damp, over-occupied property seems to suggest that people living in such conditions are comparing themselves to those who have nothing, not those in fancy houses. The media also becomes important in this space, helping set norms – often very unrepresentative and misleading ones.
  • Peer effects matter too. One of the bits of research suggested that while being unemployed is detrimental for wellbeing (indeed one of the worst things that can happen to you), being in an area where there are a lot of other people unemployed means it is less bad. On the other hand it makes those in employment feel a bit worse. One needs to be careful on policy prescriptions therefore – the fact that one could improve short term wellbeing by making all the unemployed live in the same area, would do nothing for longer term wellbeing.
  • Some impacts of bad things are temporary – some go on and on. Research presented suggested that while a separation in a relationship is pretty bad for wellbeing, after a few years wellbeing moves back to the level it was before. The same happens with losing a spouse. Even the boost from deciding to have a child and becoming a parent appears not to last! But other things do have a lasting impact – being in a relationship or partnership is a good example.
  • People adapt – sometimes with strange affects. Women used to do poorly paid, low status work. Many now have better jobs. But the wellbeing associated with the job appears to be no better – or sometimes worse. If we had been making decisions based on wellbeing we might have said this change is of no value and should be resisted – which feels completely wrong.
  • There are externalities at play with profound implications for policy making based on wellbeing. The analysis suggests for instance that my income going up is good for my wellbeing, but may make you feel worse. Same if I get a job. So maximising society wellbeing is not at all the same as pushing up individual wellbeing.
  • The wellbeing lens is putting a new emphasis on some issues – like mental health and early action, something emphasised by former Cabinet Secretary and wellbeing enthusiast Gus O’Donnell. There is a danger that we get into a tautology in some of this – naturally those who are depressed or have anxiety related conditions are likely to say they have low wellbeing; we surely did not need wellbeing data to tell us this! But nevertheless the focus this agenda has given to mental health has been very valuable and  the same sort of thing applies to relationships, something I have written about elsewhere .
  • A focus on the most unhappy is sometimes useful. Looking at the bottom 10% in terms of wellbeing for instance really helps us see who we should perhaps be looking to help most. Looking at the average can obscure the things we really want to get at and we want to also explore changes in wellbeing inequality alongside changes in average wellbeing.
  • How you are considered matters to your wellbeing. Alan Manning alluded to the Brexit vote and the fact that while a job in a service industry might be as well paid as a job in the mines it is unlikely to carry the same sense of worth or status.
  • Psycho-social factors in childhood matter more to wellbeing than academic ones. This raises issues about schools policy and parental behaviour, as well as putting a big focus on the mother’s mental health. We also need to get some data on genetics into the analysis to see how much, if any, this is driving.
  • There are inevitably lots of interactions that will bedevil the search for key drivers of wellbeing. For instance separation is associated with lower wellbeing, but at least some of this is due to income dropping not separation per se.
  • We need to dig harder on gender. The research presented to us rarely distinguished between men and women. That seemed to most a big gap – as there is no real reason to think the drivers of wellbeing will always be the same across genders.
  • The old are not less happy than the young. As Andrew Steptoe noted, given all the things that happen to you health and relationship-wise as you get older, this is perhaps surprising. In addition physical health seemed to be less important for older people than emotional health and ‘social’ issues.
  • We can’t use this version of wellbeing for deciding on things like climate change. Perhaps obviously, subjective wellbeing is not a good way to make decisions on things that are about the future and – implicitly – about assessments of future risks and discount rates.

As I hope this summary shows, this whole agenda is raising many fascinating issue. Many are familiar, a few are surprising, but all are making us think harder about the world and how to make it a better place.  And that cannot be bad for the wellbeing of all of us.

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What can we learn from £40M invested into wellbeing?

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Here, the Centre’s Ewan Davison takes a look at the Big Lottery Fund’s Wellbeing 2 programme and evaluation.

Following the recent publication of the Wellbeing 2 final evaluation we’ve gathered an overview of the programme, links to evaluations and a series of case studies together as a learning resource 

Wellbeing 2 followed the £160m Wellbeing funding, continuing to support communities to create healthier lifestyles and improve their wellbeing. It funded interventions to improve levels of healthy eating, activity and mental health. But wellbeing is much wider than one particular aspect or determinant, it means a lot of different things to different people – as we’ve learnt from talking to people across the UK about what matters to them. At a high level it’s their quality of life. So, improving quality of our lives and our wellbeing should be the ultimate aim of policy.

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A really encouraging part of this study was the use of personal wellbeing as a measure; simply put it was asking individuals how they feel using the ONS 4 wellbeing questions. Across the Wellbeing 2 portfolios adults reported an increase in their levels of life satisfaction from 6.2 (on a scale of 0-10) at the start of the interventions to 6.5 at the end to 7.0 at three months post intervention. Life satisfaction is a key measure for wellbeing. There were also positive change reported in feelings of being worthwhile, happiness and anxiety levels. For example: 54% of young people reported a positive change in their mental wellbeing.

For those of us interested in policy, the wellbeing 2 evaluation report is important. We need to look beyond the numbers to try and identify what works, and what doesn’t in delivery and measurement. The report shares a real wealth of qualitative data, insights from projects on what worked across delivery, promoting behavior change, achieving systems change and sustainability.

The key points to take away from it are:

  • The importance of ensuring engagement in design and delivery (such as using peer educators).
  • Taking asset-based approaches which work with local settings.
  • Developing the skills of staff and partners along with volunteers.
  • For some portfolios, working with local systems to enable sustainability and change to those systems, such as basing staff in local authorities and working with authorities (and communities) to meet outcomes identified in their Joint Strategic Needs Assessments.

The importance of time when evaluating

Another key finding from this report and the follow up round table was that time is a very important factor (perhaps a luxury which this funding has allowed). It enables a test, learn, and adapt approach in delivery and in terms of measuring impact. Policy makers need to make time to engage people in the design of delivery and evaluation to keep activities relevant and effective.

There is some great work going on out there (as shown by this report) and as a nation we’re spending a lot of money and effort on activity so we need to learn from it collectively and in a systematic way. We need to measure with enough consistency to enable a meaningful comparison across interventions which looks at impact and cost, and reflects the strength of evidence. We can also use existing activities and management data to make running trials easier and cheaper, which in turn make the research findings more useful to practice and decision making.

We all need to get better at capturing learning on wellbeing impacts and growing the evidence base. This is the start.

What are your issues with evaluating wellbeing? With wellbeing impact often being a secondary outcome- or not the primary focus of funding a project – how can we create a measurement instrument sensitive enough to capture changes without becoming overwhelming  or a burden to providers/participants? → Join our forum to discuss

overview of the Wellbeing 2 programme, links to evaluations case studies 

Full evaluation on Wellbeing 2 along with  Big Blog

 

 

Guest blog: The benefits of healthy advice?

Here, James Sandbach, Research Manager for the Low Commission reflects on the impact advice services can have on our wellbeing and health.

IMG_0388(3) (1)The VCSE (Voluntary, Community, Social Enterprise) review on partnerships for health and wellbeing has been the latest in a number of strategic studies looking at how bringing in a wider range of community based services into the health system can contribute to improving health, wellbeing and care outcomes.

The recent Kings Fund report on “Supporting integration through new roles and working across boundaries” is also an important piece of work highlighting some of the issues about the interface between non-clinical support workers and health professionals within the health system. As new care models emerge outlining different strategies to provide the right services by the right teams at the right time targeting individual needs and delivering place-based population health systems, searching questions are being asked about what sort of partners should commissioners and provider bodies be working with to deliver social value and reduce health inequalities.

An important sector that tends to get overlooked in this debate is the contribution of the advice sector, ie organisations providing free welfare, money/debt and legal advice, information and assistance. Evidence for example of the value of placing a local Citizens Advice service outreach within GP surgeries has long been amassing for several decades.[1] However it is only in the past couple of years, especially as ideas around social prescribing have taken root, that there has been any discernable interest in looking more systematically about how advice services can add value or support improved health and wellbeing outcomes in health settings and contexts. Last year the Low Commissionimage001 (2) – an independent Commission on the future of the advice sector – undertook an extensive evidence review on the relationship between advice and health outcomes, and models of good practice in collaboration and service delivery. It found that:

The effects of welfare advice on patient health are significant and include: lower stress and anxiety, better sleeping patterns, more effective use of medication, smoking cessation, and improved diet and physical activity.”

The review looked at provision of welfare advice provision in primary health settings, mental health services and also in secondary and tertiary care settings for example in supporting the discharge planning process and rehabilitation. Evidence of the value of advice based interventions were particularly strong in the mental health context, perhaps unsurprisingly given the amount of empirical data collected in recent years focussing on the relationship between indebtedness and poor mental health, and also in areas like homelessness prevention, income maximisation, community support and reduced in-stays and repeat appointments. Of course as you might expect the evidence base is somewhat varied, with much of it in the “grey literature” territory, but also some more robust data emerging from advice services capturing specifically capturing health outcomes generally gathered from before and after follow up assessments with clients, most commonly using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS).

Critically from a policy perspective the research found considerable variation across commissioners in their approach to engaging the advice sector or requirements when commissioning services; at one end of the spectrum there are examples of commissioning partners making considerable investments in advice services to address deprivation and health inequalities and at the other end of the spectrum advice service providers are struggling to engage key commissioners, and services are being decommissioned due to financial pressures. I’ll leave it to readers to study the report and decide for themselves about whether welfare advice in health settings is a good example of “what works in wellbeing,” but it is worth repeating Michael Marmot’s clarion call from the report’s foreword “to broaden our thinking in the future if we are really to put patients and their whole experience and needs at the heart of everything we do.”

James Sandbach was Research Manager for the Low Commission which ran from 2013-2016 

[1] Veitch T. & Terry A. (1993) Citizens’ advice in general practice. Patients benefit from advice. British Medical Journal 307, 262.

→Review: the VCSE’s role in improving wellbeing

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Guest blog: Alcohol, wellbeing, and subtle policy -does drinking make us happy?

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Ben Baumberg Geiger, Senior Lecturer in Sociology and Social Policy at the School of Social Policy, Sociology and Social Research (SSPSSR) at the University of Kent  poses some questions about drinking and our wellbeing….

 

There has been an increasing interest in wellbeing among alcohol policy researchers. Recent studies have estimated wellbeing-related impacts such as ‘harms to others’, while the world-leading Sheffield Alcohol Policy Model estimates a 50p minimum price would lead to wellbeing benefits worth more than £2bn over 10 years.

Yet strangely these studies have ignored the main reason that people drink – the pleasure of drinking. Conversely, those few studies that have estimated the value of the pleasure of drinking have made wildly optimistic assumptions about its wellbeing-enhancing effects, which ignore the impaired rationality of people when drinking – something that most of us drinkers can vouch for – or its addictive nature.

To try to spur a more careful consideration of alcohol and wellbeing, George MacKerron and I recently published a paper in Social Science and Medicine that looks empirically at how people’s wellbeing changes as their drinking changes over time. We used two different datasets:

  • The more conventional analysis was to use the British Cohort Study 1970, looking at how people’s life satisfaction changes between the ages of 30, 34 and 42, and how this is associated with changes in their drinking.
  • The more unusual analysis was to use George’s ‘Mappiness’ data – over two million observations from over 30,000 people, collected by buzzing them twice a day on their iPhones. We were able to look at whether people report being happier at moments that they are drinking.

We found that drinking does seem to make you happier. People report being happier at moments that they’re drinking compared to other moments (controlling for what else they’re doing, who they’re with, and what time of day it is). And while it’s impossible to completely rule out reverse causality – that people drink more when they’re happier – we did control for people’s happiness earlier that day, and still found that people were happier when they’re drinking.restaurant-alcohol-bar-drinks.jpg

Yet at the same time, this happiness doesn’t spill over much to other moments (in Mappiness), nor do people say they are more satisfied with life in years that they drink more (in BCS70). Indeed, if people develop alcohol problems then they become (unsurprisingly) less satisfied with life.

What does all this mean for wellbeing-focused policymakers and researchers?

The first point is that this is an area that could desperately use more research. We would assume that different patterns of drinking are associated with different wellbeing impacts for different people – but sadly the only alcohol-related information that Mappiness includes is whether or not people were drinking (and this only for the relatively advantaged groups with iPhones in 2010-2013). A more alcohol-focussed app-based project would undoubtedly uncover more complex patterns of practical significance.

Still, our research already suggests that the wellbeing impacts of alcohol are subtle – they are not simply positive or negative, but rather depend on the time frame and wellbeing measures that you are interested in. And if they also depend on other factors (such as patterns of drinking or cultural associations), then this opens up the possibility of subtle policymaking that particularly reduces the drinks that are least beneficial (or even harmful) to wellbeing. For example, policies could ‘nudge’ intoxicated people into better decisions through smaller serving sizes or regulations on the pub/bar environment.1MZGVQHJT0

Rather than being the final word, we hope our study prompts other researchers and policymakers to think further about alcohol policy and wellbeing, rather than falling back to the two untenable positions that we set out at the outset.

→Discuss on our forum

Ben is also Co-Director of the University of Kent’s Q-Step centre, and member of the editorial board of the Journal of Poverty and Social Justice