Inequality The Enemy of Wellness and Wellbeing


Inequality The Enemy of Wellness and Wellbeing

The Western Cape Department of Health recently renamed itself as the Western Cape Health and Wellness. What lies behind this renaming? We can only assume that the government department in the Western Cape who is responsible for the health of people recognises that wellness goes beyond the treating of disease. It seems they are trying to improve some underlying potentially complex to measure state of well-being.

Clearly wellness will mean different things to different people. It is also likely to be influenced by how it is experienced by someone at a given point in time. We call this a subjective measure. Though it is possible to create more objective ways of measuring it. If you are busy recovering from a cold, or coming out of a particularly busy period at work you may rate your wellness differently. It may also be different if their own wellness is measured relative to the wellness of other people.

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, thereby trying to show that health goes beyond just a focus on disease. The definition refers to well-being. We’ll get back to that word later.

Health systems tend to operate in silos. Think about clinics having a maternity unit, a separate TB unit and very strong guidelines and protocols focused on HIV, without necessarily touching on other diseases in HIV consults. To focus on wellness, a different approach to speaking with clients will need to be taken. Consults, whether with a nurse or GP, will need to go beyond the limits of talking about just one disease. Questions around other dimensions of wellness will need to be asked. And then the system will need to be able to support clients getting better in these dimensions. Think of a patient who has been unemployed for a long time, goes hungry regularly and suffers from depression. While medication can be prescribed for her depression, the other problems may contribute to her depression and will also need to be addressed.

Economists have spent a lot of energy on the measurement of happiness (more formally called subjective wellbeing). Now well-being is slightly different from wellness.

According to the Oxford Dictionary, ‘wellness’ is ‘the state of being healthy, especially when you actively try to achieve this. ‘ Well-being, in contrast, is a broader concept. It is defined as ‘general health and happiness, a state of emotional/physical/psychological well-being’ (emphasis added).

Economists derive their wellbeing data from surveys. In the United States, the Gallup Healthways Well-being Index survey, has surveyed randomly selected Americans every day since January 2008. The Gallup World Poll has asked similar questions in 160 countries since 2006. In South Africa, the National Income Dynamics Study tracked the wellbeing of the same group of South Africans from 2008 to 2017.

Studies that have been done in the past give a sense of direction on South Africans’ wellbeing, and the factors that affect it. One study by Dorrit Posel and Daniela Cassale, published in 2011 in Social Indicators Research, found that people’s rating of their own positions in society (relative to that of others) has a much larger effect on how they rate their own wellbeing. The effect is larger than the effect of more objective ways of measuring their position in society such as income. This means that in a highly unequal country like South Africa, even if people objectively have enough money to live from, if the distance they see between themselves and others’ positions in society is too large, they will rate their own wellbeing lower.

Wellness and wellbeing are strongly connected. These connections have been explored in many studies. Whether any of these factors really are within the control of the health systems is debatable. But the health system should turn its lens to look broader beyond a single condition and the prescription which may help with a cure or extending a life. It helps to understand the factors which allow people to live balanced, content lives. And the societies that help people achieve this. In a country like South Africa, we cannot ignore how inequality makes people experience their own wellbeing. In thinking about how we achieve wellness and ultimately wellbeing too, we therefore have to think about how we build a more equal country. A well-functioning health system is one of the puzzle pieces in achieving this.

This blog reflects the opinion of the writer.

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