Out of the shadows – World Bank & World Health Organisation on Mental Health

Guest blog from our Chairman Dr Paul LitchfieldDr Paul Litchfield

I have just attended a joint meeting of the World Bank and the World Health Organisation in Washington – the topic was mental health and the pressing need to make it a global development priority. It was good to see that mental illness is now, at last, being seen as part of the non-communicable disease crisis that is afflicting every part of the planet.

Margaret Chan, WHO Director General, flagged up recent research showing the global cost of anxiety and depression as being $1 trillion per year and  Jim Yong Kim, World Bank President, framed the issue as one of development and not just public health.

WHO & World Bank

The meeting, titled Out of the Shadows, sought to shine a light on a subject still characterised in many parts of the world by fear, stigma and neglect. Even in the “developed” world the imbalance of resources devoted to mental health compared to physical health is stark. Innovative models of service delivery were showcased from around the world and ranged from individual placement and support in the most deprived communities to high tech psychological therapies.

Workplace interventions are of particular interest to me but progress in that area seems remarkably slow. There appears to be a widespread reluctance by many health professionals to engage with the private sector, even in relation to companies’ own employees. Perhaps that is a reflection of a lack of shared experience and language but some of it also appears to be driven by political dogma which has no place in responding to human distress and misery.

It is heartening to see the progress that has been made in addressing mental illness over the past 30 years. There remains much to do but the profile the issues now have and the range of key players that see the need for action gives cause for hope. The downside is that the positive aspects of good mental health and wellbeing are only mentioned briefly in any discussion before the focus shifts entirely to illness and healthcare systems. The medical model of health that has dominated the past 100 years is not sustainable. Spending 17.5% of GDP on healthcare (as the USA did in 2014) diverts resources from other essential areas and untold harm will be caused to emerging economies that try to emulate the model.

We need to not only accept and address the social determinants of disease but also to reframe political thinking to consider citizens’ wellbeing as the priority. Having a positive – wellbeing – as the end point aspired to is much more motivational than the simple avoidance of harm – illness. Promoting the elements that have been shown to improve wellbeing will reduce ill health while at the same time advancing human happiness and societal progress. That has to be a better framework than one based on the fear of pestilence – whether that is physical or mental.

Dr Paul Litchfield

World Economic ForumAlso launched at the conference is the World Economic Forum Global Agenda Council on Mental Health and their new guide for improving wellbeing at work.

Seven Steps Guide towards a Mentally Healthy Organisation

 

You may also like 

→ E-course on wellbeing in policy & practice

→ Case Studies wellbeing at work 

→ Wellbeing in the UK data

Wellbeing evidence around the globe – Nils Fietje WHO Regional Office for Europe

Nils-photoCulture and Health: how the study of cultural dynamics is finding its way into well-being discussions at WHO.

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 experL0058624 Wooden geomantic compass and perpetual calendar, Chinese. Plt 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.

Nils Fietje

Research Officer

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.

What Works Centre for Wellbeing announced today

Lord Gus OGus‘Donnell has announced that a new ‘What Works Centre for Wellbeing’ is being set up to bring together evidence about what works to improve wellbeing and to put that evidence into the hands of those that need it to make decisions.

The establishment of an independent What Works Centre for Wellbeing builds on the ONS Measuring National Wellbeing Programme and the Commission on Wellbeing and Policy. The Centre joins a network of independent What Works Centres that are responsible for distilling and sharing the evidence to support decision making.

The Centre is a collaboration and has initial funding of over £3.5million over three years, in-kind resourcing and the support of a broad group of founding partners.  Today’s announcement is in partnership with BT, Happy City and Bristol City Council.

Also published today are:

Why What Workswhat works network logo

The What Works Initiative is based on the principle that good decision-making should be informed by the best available evidence on what works and what does not. It aims to improve public services for people and communities by ensuring that resources are focused on those things which will have the greatest positive impact.

What Works Centres are fundamentally different from standard research centres. They aim to directly support policy makers, commissioners and local practitioners by providing reliable, accessible products which communicate the likely impact of real policy initiatives, and building professional capacity to use evidence effectively.

There are now nine Independent What Works Centres, including one in Scotland and one in Wales, supported by a combination of ESRC, Government, and charitable funding.

Why Wellbeing

Fundamentally, wellbeing is about quality of life and creating the conditions for people to live better lives. The Centre will bring together the best available evidence of the practical action that can be taken to increase wellbeing.

Locally

Wellbeing is an increasing part of policy and practice across a range of sectors and is important to the Scottish and Welsh Governments and Northern Ireland Executive, as well as major funders and commissioners such as the BIG Lottery Fund and local authorities including Health and Wellbeing boards. Employers are focusing on wellbeing in the workplace and its links to productivity and engagement. There is a growing interest in the social return on investment, with evaluation, innovation and collaboration fundamental to making the most of scare resources.

This rapidly developing field has many pioneering leaders and practitioners keen to connect up, share their work, learn from others, build the evidence base and bringing together the fragmented project and pilot evaluations into a meaningful, reliable, easy to navigate source. A strong credible evidence base can support those in the wellbeing field to be able to make their case for change, support bids and business cases and focus their efforts for the biggest impact.

Nationally

The UK is regarded as one of the leading countries on wellbeing. In November 2010, David Cameron launched the Measuring National Wellbeing Programme undertaken by the Office for National Statistics (ONS). Following a national debate asking people across the UK what matters most to them, ONS developed a measurement framework for wellbeing comprising 10 domains including personal wellbeing. Personal wellbeing data is now available for every local authority area across the UK.

Internationally

The OECD, WHO, the UN and the European Commission are all significantly engaged in wellbeing. A central focus of this international interest is on how societies, governments, communities and populations measure their progress, economic and social, recognising the limits of GDP as an indicator of economic performance and social progress.

About What Works Centres

What Works Centre is independent of government with a clear and relevant policy and delivery focus. The functions of a Centre are to:

  • Undertake systematic assessment of relevant evidence and produce a sound, accurate, clear and actionable synthesis of the global evidence base which:
    • Assesses and ranks interventions on the basis of effectiveness and cost effectiveness
    • Shows applicability
    • Shows the relative cost of interventions
    • Shows the strength of evidence on an agreed scale
  • Put the needs and interests of users and stakeholders at the heart of shaping a workplan
  • Advise those commissioning and undertaking innovative interventions and research projects to ensure that their work can be evaluated effectively
  • Publish and disseminate findings in a format that can be understood, interpreted and acted upon
  • To help produce a common currency for comparing the effectiveness of interventions
  • Identify research and capability gaps and work with partners to fill them

What next

The What Works Centre for Wellbeing is being set up by a development group of the founding partners, chaired by Lord Gus O’Donnell. The centre will be an independent body and a Chair, Board and staff for the centre will be recruited. The ESRC will commission the Centre’s evidence programmes and Public Health England are hosting the development team for the Centre until it is established.

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