Our response to the National Wellbeing Debate
Prepared by Dr Lynne Friedli
The Socialist Health Association welcomes the proposal to develop new measures of national wellbeing and the ONS launch of a public consultation on what influences the nation’s wellbeing. This is an important opportunity to build on the goals set out in the Stiglitz Report for measures of social progress that include non-market activities, sustainability and quality of life (Stiglitz et al 2008) and the OECD Global Project on Measuring the Progress of Societies.
We agree there is a need for measures that go beyond economic performance, that provide a more complete picture of ‘how society is doing’ and what improves or damages wellbeing, including social, cultural and environmental factors.
In particular, we believe it is important to have criteria for assessing the impact of Government policy and social trends on the wellbeing of everyone in society. To achieve this will mean ensuring that the debate about what wellbeing is and what influences wellbeing acknowledges the sharp inequalities in life chances, health, opportunities and everyday experience in Britain today (Sutton Trust 2010; Wilkinson & Pickett 2010; Institute for Fiscal Studies 2010). Measures that capture inequalities in wellbeing, for example by age, gender, ethnicity, class and disability will be of crucial importance, as will trends in wellbeing inequalities in the UK over time.
Wellbeing, poverty and inequality
Existing measures of wellbeing show that poor wellbeing is much more common among people living in deprived neighbourhoods or on very low incomes (Deacon et al 2009). Children in the lowest income households have three times more emotional and behavioural problems than those in the most well off homes (Department of Health 2010). Factors like poverty, racism, unemployment, insecure or poor quality work, insecure or sub-standard housing and poor quality school education all contribute to reduced wellbeing, as well as significantly increasing the risk of mental illness (McManus et al 2009).
There is also robust evidence that the stress of struggling with material hardship is considerably exacerbated by doing so in highly unequal societies ( Pickett KE and Wilkinson RG (2010) Inequality: an under acknowledged source of mental illness and distress The British Journal of Psychiatry 197: 426-428). Many studies suggest that a major impact of inequalities is psycho-social: how stark differences in income and wealth make people feel – about themselves and others and how they impact on social connections, social cohesion and the quality of civic society (Friedli 2009). People living in poverty, as well as other vulnerable or excluded groups, consistently describe the pain of being made to feel of no account, which is often experienced as more damaging than material hardship.
Public responses to inequality
In the aftermath of the banking crisis and the economic downturn, there has been considerable public debate about equity and fairness, notably in relation to income, wealth and taxation. What is evident is a growing unease about the scale of the gap between rich and poor in the UK, as well as calls for a closer relationship between what people earn and their contribution to society (UKuncut; new economics foundation 2009). As it stands, the ONS on-line questionnaire prompts people to assess whether income and wealth matter to wellbeing, but not whether the level of inequality in society influences wellbeing. Specifically highlighting the issue of the gap between rich and poor is important, because the damaging impact of income inequality is not always immediately obvious, perhaps especially to people who are not themselves struggling to make ends meet.
People who know what it’s like to be poor
The Socialist Health Association is also concerned that the debate on what influences wellbeing includes the views of people with direct experience of living in poverty, of managing on welfare benefits, of low paid employment, of homelessness and other experiences of what it is like to live on the margins. Without this input, ONS risks excluding what matters most to the wellbeing of those who are most vulnerable and excluded and who are particularly well placed to judge the relative importance of material and non material factors.
We believe that similar efforts should be made to involve and include the views of children and young people, building on the work of the Children’s Society and others (Rees et al 2010; Elsley and McMellon 2010).
Measures of collective wellbeing
As ONS points out, measures of national wellbeing are likely to include both how people feel about their lives (subjective wellbeing, happiness, life satisfaction) and the things that improve or detract from wellbeing (e.g. income/wealth, social networks, environment, participation, crime). What is missing is any reflection on more collective measures of wellbeing, for example solidarity, social justice and traditions of collective struggle. As Amartya Sen has observed, wellbeing depends on certain freedoms, as well as on economic assets. Feminism, civil rights, pensioners’ action, trades unions, gay liberation, ‘mad pride’ and disability rights are reminders that our own wellbeing can be enhanced by opportunities to act in solidarity with others: collective efficacy. Opportunities for solidarity and collective action may be overlooked determinants of mental wellbeing.
Concepts of collective wellbeing are also relevant to thinking about inequality, inviting debate about what difference it makes if difficulties, discomfort, deprivation and sacrifice are shared by everyone. Although social capital indicators (e.g. levels of trust, reciprocity, and participation) tell us something about the nature of social bonds, we need a wider debate about relative merits of individualist and collectivist traditions of thinking about wellbeing.
The public consultation on national wellbeing is an important opportunity to move beyond narrow economic measures of social progress. The view that wellbeing does not depend solely on economic assets already has some popular support and there has been widespread criticism of the environmental and social costs of ‘consumerism’ and ‘materialism’ (Layard R & Dunn J (2009) A Good Childhood: Searching for Values in a Competitive Age. London: Penguin Books). However, in presenting a critique of materialism, it is particularly important to distinguish between the impact on wellbeing of material factors – what we have -and the impact on wellbeing of inequalities – what we have relative to others. It’s not just that GDP fails to measure many things that matter, it also fails to measure how the products of growth are distributed.
The Socialist Health Association hopes that our response will stimulate greater debate on the relationship between wellbeing and equality, fairness, solidarity, collective action and the historical legacy of national and international struggles for social justice. Finally, just as GDP provides only a very limited measure of how society is doing, so the market should not have a monopoly on defining who makes a meaningful contribution. Every effort should be made to include the voices of all sections of society, and above all those who contribute out with the money economy.
About The Socialist Health Association
The Socialist Health Association (SHA) is a membership organisation, founded in 1930, which promotes health and well-being and the eradication of inequalities through the application of socialist principles to society and government. We have an extensive and varied membership which provides a wealth of information, knowledge and experience of the health system, both academic and practical. We have been concerned for many years at the economic inequalities in British society and their effects on the health of the population. We question the assumption that economic growth, which has for some time disproportionately benefitted those who are already wealthy, is of benefit to society as a whole.