GOVERNMENT POLICIES ANDPOPULATION MENTAL WELL-BEINGDora Gudmundsdottir, Directorate of Health in IcelandHealth in allpolicies,
What you measure affects what youdo...…if you don´t measure the right thing,you don´t do the right thing.“ JosephStiglitz, 2009 Governments measure progress byeconomic indicators such as Gross DomesticProducts
GDP increases with Each sale of antidrepressant medication Each divorce pronounced Each prison built Air pollution Cigarette advertising But NOT„the health of our children, the quality of theireducation, or the joy of their play. It does not getthe beauty of our poetry or the strength of ourmarriages......it measures everything, in shortexcept that which makes life worthwile“ RobertKennedy, 1968
GDP and Happiness in USA 1945-1991GDP per capitaHappiness
The focus in public policy Economy growth Health How do we get health on the agenda: Health in allpolicies? Mental health How do we get mental health on the agenda? Happiness Economists are more interested than mental healthspecialist Well-being or Mental well-being Is it easier to get well-being on the agenda?
Shifting the Wellbeing Bell Curveof a Population
Too much focus on economicgrowth Led to the collapse of thewhole economic systemin Iceland in October2008 which led to the biggestfinancial crisis in thecountry since 1929
What happens in a society where: Unemployment increases Exchange rate of the currency falls Income decreases Purchasing power decreases debt increases All in a month?
At that time There was an opportunity to shift the focus Welfare, Mental Wellbeing, Equity and SocialIndicators
The Welfare Watch Watch out for the basic services providedby the state and local authorities Put special emphasis on assistance tovulnerable groups Developed social indicators Demographics Inequality Sustainability Health Cohesion
14. júní 2013“Young people in action” To avoid that young people become permanently stuckoutside the labour market All young people (16 – 25 years) who have beenunemployed for 3 months or longer get specialassistant. Now 90% of them is active (work, programs andschools) Each summer around 800 new jobs have been offeredto students and persons receiving unemploymentbenefits. Young students and some of the unemployed are nowactively working in a variety of jobs for the localauthorities and the state.
Iceland 2020 – a governmental policystatement focusing on: Knowledge, sustainability, welfare Mental wellbeing where the aim is: To improve wellbeing and sound mentalhealth so that the average measurements onthe mental wellbeing index rise from 26,6 in2009 to 28
Ensuring an impact on policy-makers and policy The decision to measure mental wellbeing at thenational level affected both health and whole-of-society policies. The mental wellbeing measures are usedas an indicator in Health 2020 for Iceland “Iceland 2020”, led by the Prime Minister
Impact of the crises on mental well-being Good social relationships – the qualityof relationships with family andfriends, along with the amount of timespent with family – predict happiness. Despite the crises there was an increase in happinessamong adolescents Difficulty making ends meet is the strongest predictor ofunhappiness. The population subgroups that find it difficult to make endsmeet are not the same as the unemployed or those in thelowest income group.Gudmundsdottir, D. (2013). The Impact of Economic Crisis on Happiness. Social IndicatorsResearch, 110(3), 1083-1101.
Planning for the futureIt is of importance to have good measures formental wellbeing on a population level indicators of mental wellbeing are now used tomonitor policies in Iceland, where several actionsaim to increase mental well-being. Even in times of austerity, there is an opportunityto strengthening mental wellbeing by publicpolicies
THANKSp.s.….if we measure the right thing,we might end up doing the right thing
5 ways to wellbeing (5 a day)- a public health message – popular publication In 2008, nef was commissioned by the UKGovernment’s Foresight Project on MentalCapital and Well-being to review the inter-disciplinary work of over 400 scientists fromacross the world. The aim was to identify a setof evidence-based actions to improve well-being, which individuals would be encouragedto build into their daily lives. Evidence suggests that a small improvementin wellbeing can help to decrease somemental health problems and also help peopleto flourish
What you focus on – gets more attention What you measure – gets more attention We´ve been measureing economic factors fora long time Gross domestic product (Gross nationalincome) Gross happiness
Wealth and well-beingUK - GDP and Life Satisfaction 1973 - 20020%20%40%60%80%100%120%140%160%180%200%1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001GDPLife SatisfactionSource: Eurobarometer
14. júní 2013Focus on Vulnerable Groups Sensitive families with young children: singleparents, the handicapped, the chronically ill, thedisabled, old people living in poverty, immigrants, theunemployed and those who depend on socialassistance from the local authorities for their survival. The populatin of Iceland is quite young: children are ap.25% of the nation. 7.800 children live in families that arebelow the poverty at risk rate, that is 10% of theicelandic children.
Main focus on economic growth Led to the collhas been one of the richest andhappiest countries in the world for decades
6 steps linking assessments andinterventions to improve well-being3. Ensuring the assessment responds tothe current context When its banking system collapsed inOctober 2008, Iceland’s public healthauthorities decided to conduct a newstudy to assess the impact of the economic crisison Icelanders’ well-being. The protocol included the single measure ofhappiness, WEMWBS and PSS.
6 steps linking assessments andinterventions to improve well-being2. Selecting methods and processes, including stakeholders, and gatheringinformation When the Public Health Institute of Iceland (which was incorporated into the Directorate of Health in 2011)decided to implement a national survey on health and well-being in 2007, a module on well-being therefore126 needed to be constructed. A group of experts was convened to decide what to include from measuresalready published: a single measure of happiness; the WHO-Five Well-being Index (WHO-5); Satisfaction With Life Scale (SWLS) created by Diener et al. a short version of the Perceived Stress Scale (PSS) created by Cohen et al. the short version of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) created by Stewart-Brown et al., which was translated specially for this purpose and has since been used as the mainmeasure on well-being within public policy. All these measures were included in the health and well-being study in 2007 which was repeated in 2009 and 2012. The second and third rounds added further scales, including the Meaning in Life Scale by Steger & Sammanand new well-being questions based on Huppert & So’s conceptual framework for defining well-being.
How did the crises impact well-being4. Presenting and communicating the results An analysis of the impact of the economic crisis in Iceland, usingdata from studies on both health and wellbeing and economicsand well-being, documented the findings (Gudmundsdottir). An open seminar presented the results, including a paneldiscussion with the Minister of Welfare and the studies’ projectleader. The panel discussed the kind of society that wouldincrease well-being in the population, and highlighted thefollowing points: Good social relationships – the quality of relationships withfamily and friends, along with the amount of time spent withfamily – predict happiness. Difficulty making ends meet is the strongest predictor ofunhappiness. The population subgroups that find it difficult to make endsmeet are not the same as the unemployed or those in thelowest income group. The results and the reaction from the Minister receivedextensive attention from the mass media (newspapers, radio
Aims for health and well-being by 2020 To improve wellbeing and sound mentalhealth so that the average measurements onthe mental wellbeing index rise from 26,6 in2009 to 28 To reduce the percentage of people (aged 18-66) withdisability from 7.3 % of the population to 5.7% To reduce the unemployment rate from 7% in 2010 to3% To achieve greater equality in Iceland, by lowering theGini coefficient for disposable income to around 23 To narrow the gender gap in order to bring the GlobalGender Gap Index close to 0.9
Social indicators weredeveloped Demographics Inequality Sustainability Health Cohesion