Culture is making a comeback. After years of having remained at the margins of national and international policy discussions, the term is re-emerging as a powerful, affirmative concept. Particularly in relation to health, the importance of cultural values, behaviours, or assumptions is getting some much needed attention. Like, for inst ance, in this concept note, published by the United Nations Development Group as part of its report on the Post-2015 Development Agenda, which highlights the significant contribution cultural dynamics can make in improving people’s health. Or in this UCL/Lancet Commission Report which claims that the neglect of culture is the single biggest obstacle to developing equitable healthcare.
The comeback of culture hasn’t gone unnoticed by WHO, leading to the launch of a project at the WHO Regional Office for Europe that is trying to investigate the impact of culture on health in a more systematic way. Anchored in Health 2020, WHO’s European policy for health and well-being, the project’s first initiative is to tackle the issue of measuring and reporting on well-being. In 2012, the European Member States mandated the Regional Office to keep an eye on the well-being of its populations. As a result, five core objective well-being indicators and one core subjective indicator were selected for inclusion in the Health 2020 monitoring framework.
Of these, the subjective well-being indicator (life-satisfaction), is the most interesting, but also the most challenging. It’s at the heart of what WHO can say about well-being. And yet it doesn’t capture the soul of what well-being really means across a region that’s as culturally diverse as WHO’s Europe. From Iceland, across the central Asian republics, to the furthest reaches of the Russian Federation, the WHO European Region combines within one administrative entity an enormous variety of beliefs, values, and traditions
To help WHO think through the cultural determinants of well-being, the Regional Office convened an expert group meeting in January of this year. The group comprised 21 experts from a variety of disciplinary and professional backgrounds, including epidemiologists, statisticians, and public health experts, but also academics from cultural studies, history, philosophy, anthropology, geography, and cultural psychology.
From a measurement perspective, the well-known caveats about (for instance) cultural bias, language barriers, or contextual effects were mentioned in relation to subjective well-being. Although a lot of work has been done comparing collectivists versus individualist cultures, our experts agreed that more research was needed before the cross-cultural comparability of subjective well-being measures is firmly established. Particularly within the European Region, they pointed out, comparative research was almost totally lacking.
How then can WHO actually say something meaningful about “being well” in Europe?
One of the interesting recommendations the expert group made, was to encourage WHO to consider using other forms of evidence from a wider array of disciplinary perspectives in order to supplement its regional report on well-being. A lot of rich health information can be gathered about the well-being of groups, communities and even nations, by (for example) systematically analysing historical records, anthropological observations, or other forms of cultural outputs. However, one must first overcome the preconception that his kind of information is too “soft” for the public health sphere. Instead, the focus needs to be on validity – as it would be with more conventional forms of data.
Taking advantage of a more multidisciplinary approach when WHO communicates about well-being – one that benefits from the methodologies employed by historians, anthropologists and other cultural commentators – might have several advantages.
First, such an approach could allow for more compelling, and more textured well-being narratives, especially where developing and implementing costly, country specific well-being surveys is not an option. This is crucially important to the Regional Office, because European Member States have already expressed a concern about the current burden of reporting. It’s a burden that should not be unnecessarily increased by international agencies.
Second, the use of more culturally specific sources of evidence (gathered from, for instance, traditions and rituals) can help give a voice to marginalised communities (such as Roma), whose health experiences are often fundamentally underpinned by cultural attitudes and beliefs and whose well-being isn’t captured by national or global polls.
And finally, an integrated, multidisciplinary approach, one which is open to insights from the human and wider social sciences, can help to encourage a more balanced discussion about well-being. Working between disciplines exposes the system of values in which academics operate and encourages reflexivity. The kind of reflexivity that allows us to understand, for instance, how all our attention on well-being (and happiness) is producing its own cultural dynamics. Dynamics that might themselves have negative side-effects.
As a small post script, a culture centred approach to thinking and communicating about well-being isn’t exactly new. But the kind of work that exists tends to make very specific arguments about the well-being of very specific groups of people (like cancer patients in the NHS). And it isn’t really speaking to policy makers yet, either. What’s missing from these studies is scale and scope. The scale to construct larger narratives about well-being that transcend local or community boundaries; and the scope to make this research relevant within the public health policy arena. We believe that WHO and its Health 2020 policy can help to change this.
Division of Information, Evidence, Research and Innovation
WHO Regional Office for Europe
Nils Fietje is a staff member of the WHO Regional Office for Europe. The author alone is responsible for the content and writing of this piece, which does not necessarily represent the decisions, policy or views of WHO.