1. I
N the 1960s, wellbe-
ing was a rebel child,
adopted by tie dye
and ripped jeans-
wearing devotees of
the alternative health
and lifestyle move-
ment.
Fast forward to
today, wellbeing has
gone mainstream. Its
supporters are just as
likely to be wearing
a suit and tie. Some
even walk the cor-
ridors of power, such as Professor
Richard Layard from the London
School of Economics, who sits in
the ermine-clad confines of the
UK’s House of Lords.
It was in his landmark 2006
book, Happiness — Lessons from a
New Science, that Professor Layard
wrote pennies are not necessarily
from heaven: “There is a paradox
at the heart of our lives. All the
evidence shows that, on average,
people have grown no happier in
the last 50 years, even as average
incomes have more than doubled.”
This statement struck a chord
in the material world, eventually
becoming a crescendo following
the disastrous singular pursuit of
Mammon exposed by the global
financial crisis of 2008.
In its aftermath the UK Prime
Minister, David Cameron,
announced that there’s more to life
than money. “It’s time we focused
not just on GDP but on GWB —
general wellbeing,” he declared.
In the context of health and dis-
ease, the wellbeing movement has
become important. Population
studies have found a reduction in
all-cause mortality associated with
high wellbeing levels that is of the
same magnitude as not smoking.1,2
The US Centers for Disease Con-
trol and Prevention (CDC), for
instance, now states that “wellbe-
ing is a valid population outcome
measure, beyond morbidity, mor-
tality, and economic status”.
What is wellbeing?
So then, life is more than just about
money, it’s about wellbeing. But
what is well-being?
When the average person talks
about wellbeing, they often sim-
ply mean feeling happy, says Dr
Melissa Weinberg, honorary fellow
at Deakin University’s Australian
Centre for Quality of Life.
“However, the wealth of research
conducted on wellbeing has found
it’s more nuanced and complex.”
Wellbeing may be defined as a
holistic understanding of life — be
it for an individual or a population
group — that is made up of multi-
ple factors or domains.
Three years ago, the OECD set
out to measure something more
than the cash of economic growth
and came up with its Better Life
Index, which it said could be used
to rate countries on their wellbeing
performance.
The index set out a series of differ-
ent categories — the ‘material living
conditions’ category (which includes
income, housing and jobs) and a
‘quality of life’ category (which
includes objective factors like health
status and social connections, as
well as subjective wellbeing).
Importantly, all these factors
interconnect with each other in a
two-way flow, says Dr Weinberg.
“One of the key tasks of wellbe-
ing researchers is to identify and
translate the complexity that is a
www.australiandoctor.com.au 3 July 2015 | Australian Doctor | 31
The
pursuitof
happiness
Population studies have
found a reduction in all-cause
mortality associated with high
wellbeing levels that is of the same
magnitude as not smoking.
News Review
cont’d next page
John Kron charts the rise
of the wellbeing movement
and what it means for doctors.

2. result of the interconnections,” she
says.
“Money may improve health
status and overall wellbeing for a
person on a low income, but a rich
person can be unhappy due to poor
relationships.”
In another example, parents
can experience increased anxi-
ety, reduced sleep and less time
to do activities they enjoy. How-
ever, their overall wellbeing may
be counterbalanced by feeling a
greater sense of meaning and pur-
pose in life because of the role of
their children in their lives.
Of all these interconnecting fac-
tors, it’s subjective wellbeing that’s
a particular focus of attention for
many in the wellbeing movement.
Subjective wellbeing is the factor
that most closely relates to happi-
ness, says Dr Weinberg.
However “the research shows
that subjective wellbeing is a partic-
ular type of happiness. As opposed
to short-term happiness, such as
when you eat an ice-cream on a
hot day, subjective wellbeing is a
deeper, underlying long-term mood
of happiness and contentment”,
she says.
“This mood can be measured by
asking: ‘How satisfied are you with
your life?’ or more specific ques-
tions such as ‘How satisfied are you
with your relationships?’ or ‘your
community connections?’”
Not fluffy
The medical profession hasn’t
traditionally taken a great inter-
est in wellbeing, perhaps because
many doctors regard it as ‘nice, but
fluffy’.
“However, just because some-
thing is difficult and complex,
doesn’t make it fluffy,” says Profes-
sor Jill Gordon, a Sydney GP and
chair of the RACGP’s psychologi-
cal medicine special interest group.
“The connection between well-
being and health isn’t always obvi-
ous. A patient may experience low
wellbeing, which makes them do
less physical activity, contributing
to the development of a condition
such as osteoporosis years later,”
says Professor Gordon.
“Population studies are good
at identifying such associations
between mental wellbeing and
physical flourishing, and the body
of evidence they’ve produced is
impressive.”
“Enjoyment of life”, another
example of subjective wellbeing,
was the key measure question in a
longitudinal study of 50-plus-year-
olds in England.3
The study found that “enjoyment
of life” was associated with a 28%
reduction in mortality risk, even
after taking into account depres-
sion, as well as health behaviours
and socioeconomic factors.
The finding suggests that it
offered a protective benefit for both
unhealthy and healthy people.
Studies have also found evidence
to suggest that wellbeing is related
to positive health behaviours,
which may help to explain observed
reductions in mortality due to car-
diovascular disease and renal dis-
ease.4,5,6,7
It is also associated with
reduced infection risk such as the
common cold, improved wound
healing and speedier recovery from
illness, says Professor Gordon.7,8,9
It’s been the accumulation of
such research that led to the US
CDC now regarding wellbeing as
effective and beneficial for public
health.
Its key reasons are that wellbeing
“integrates mental health and phys-
ical health resulting in more holistic
approaches to disease prevention
and health promotion ... advances
in psychology, neuroscience and
measurement theory suggest that
wellbeing can be measured with
some degree of accuracy” and it is
“an outcome that is meaningful to
the public”.
Patchy action
Once wellbeing is identified as
important, the next step should
be to do something about it. But
while programs to measure wellbe-
ing have been established, such as
the Australian Unity Well-being
Index, conducted by the Austral-
ian Centre on Quality of Life,
much less is being done to actually
improve wellbeing.
For instance, the Victorian Gov-
ernment has a Community Indica-
tors program that collects wellbeing
data to “improve citizen engage-
ment, community planning and
policymaking”. However, there’s
no compulsion for local councils
or state departments to act on the
program’s findings.
“Australia is slower than nations
such as the UK,” says Dr Nicholas
Gruen, author of the Fairfax-Lat-
eral Economics Wellbeing Index,
published by the Age and Sydney
Morning Herald.
“Sadly we’re behind on this stuff,
and countries that have had better
leadership on both sides of the
political aisle, like the UK, are set-
ting the pace,” he says.
A stand-out example from the
UK is the Community Wellbeing
Practice, where GPs in 17 practices
in Halton, north-east England, are
able to refer patients for a ‘well-
being review’.
As a result, they can be recomm-
ended free services and support
networks, which can give these
patients access to hobby and inter-
est groups, life skills courses, and
social connections such as comm-
unity gardens.
The program delivers 4000 inter-
ventions per year, with an assess-
ment finding that 67% of patients
improve their subjective wellbe-
ing and 55% have a reduction in
depression symptoms.
There are some positive exam-
ples of wellbeing interventions in
Australia. The Family by Family
service — which runs in Marion,
Adelaide, and Mount Druitt, Syd-
ney — coaches and links up fami-
lies to develop each other’s goals
and connections, which helps
connect family members to new
opportunities, and offers positive
feedback and mutual support.
Going too far?
The flipside of needing to do more
with wellbeing, has in some cases
gone too far. First there is com-
mercial exploitation. Soft-drink
giant Coca-Cola, unsurprisingly,
has a happiness website that credi-
bly discusses the “modern science,”
but then concludes with the advice:
“Open an ice-cold Coca-Cola and
choose happiness!”
More disturbing are cases of
wellbeing used as justifications for
getting rid of people you don’t like.
There have been examples of psy-
chologists demanding that employ-
ees unenthusiastic about wellbeing
interventions in the workplace
be sacked because their lack of
“engagement” is considered conta-
gious, according to a recent book,
The Happiness Industry: How the
Government and Big Business Sold
Us Well-Being.
Perhaps the greatest concern is
the push for everybody to be hap-
pier.
“Wellbeing is thrown around
in the same way as fad cures for
all sorts of diseases ... [however]
there’s no evidence a person who’s
already experiencing normal sub-
jective wellbeing levels can be
made chronically happier,” says Dr
Weinberg.
In fact, the research shows that
subjective wellbeing is governed by
homeostasis, in the same way as
core body temperature.
“Subjective wellbeing can vary as
a person deals with life events such
as a new medical diagnosis. But
over time there’s adaptation and
subjective wellbeing usually goes
back to a set point after we utilise
our resources such as social supp-
ort,” says Dr Weinberg. “But at
the same time, subjective wellbeing
homeostasis can break down when
a person is unable to adapt to nega-
tive life events.
“That’s when the risk of medical
conditions, such as depression and
anxiety, are increased.”
Twin studies have suggested that
up to 40% of subjective wellbeing
is genetic, determining features
such as whether a person tends to
be pessimistic.10
“A naturally pessimistic ... per-
son should not be made to feel that
they’re failing for not being hap-
pier more often,” says Professor
Gordon.
“Wellbeing and happiness also
shouldn’t be conflated. It‘s not
realistic to expect to feel happy all
the time ... we can, however, exper-
ience a sense of wellbeing if we
pay attention to the things that are
important to us as individuals.”
The message is that while the
‘Times are a-Changin’ with well-
being, it’s important to ensure it
doesn’t become an evangelistic
movement. l
References
1. Applied Psychology: Health and
Wellbeing 2011; 3:1-43.
2. Behavior Genetics 2015; 45:137-56.
3. Archives of Internal Medicine 2012;
172:273-75.
4. Lancet 2015; 385:640-48.
5. European Heart Journal 2010;
31:1065-70.
6. Psychosomatic Medicine 2008;
70:741-56.
7. Journal of Behavorial Medicine
2012; 35:538-47.
8. Psychosomatic Medicine 2003;
65:652-57.
9. UK Department of Health.
Wellbeing; Why it matters for health
policy. London, 2014.
10. Behavior Genetics 2009; 39:605-
15.
Happiness
Top
211. Switzerland
2. Iceland
3. Denmark
4. Norway
5. Canada
6. Finland
7. Netherlands
8. Sweden
9. New Zealand
10. Australia
11. Israel
12. Costa Rica
13. Austria
14. Mexico
15. US
16. Brazil
17. Luxembourg
18. Ireland
19. Belgium
20. UAE
21. UK
Source: UN Sustainable
Development Solutions Network
32 | Australian Doctor | 3 July 2015 www.australiandoctor.com.au
from previous page
‘A naturally
pessimistic ... person
should not be made
to feel that they’re
failing for not being
happier more often.’
— Professor Gordon
chair of the RACGP’s psychological
medicine special interest group
News Review
Australia ranks well
Australia ranks highly on wellbeing compared with the rest of
the world. We come in at 10th, according to the latest World
Happiness Report of 158 countries, produced this year by the
UN Sustainable Development Solutions Network. The lowest-
ranked countries were sub-Saharan African nations Togo, Benin
and Central African Republic. In the first World Happiness
Report (2010), Australia was ranked ninth.
Source: UN Sustainable Development Solutions Network.
1
21
9
10
15
16
12
14
13
20
11
18
7
3
1917
2
4
8
6
5
Dr Melissa Weinberg, of the Australian Centre for
Quality of Life, says subjective wellbeing is the
factor that most closely relates to happiness.

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News Review
Happiness and care on the cancer ward
I
had been mulling over
the meaning of happi-
ness a whole month as I
cared for a patient near-
ing the end of her life. She had
young children, a supportive
husband and, most of all, an
abiding faith that allowed her
to imagine heaven as a better
place now that treatment was
no longer possible for her
advanced cancer.
It struck me as extraor-
dinary that she could mus-
ter such unflappable peace
in the face of something as
momentous as death. But I
also thought that if everyone
shared a drop of her equa-
nimity, the inevitability of
dying would be so much eas-
ier on all of us, the deceased
and the ones left behind.
Some days on the ward,
happiness is avoiding the fate
of many of my patients. Eve-
ryone who works in oncol-
ogy is only too aware of the
flick of the wheel of fortune
that transforms happiness
into its opposite.
But if being an oncologist
is sobering stuff, it’s also a
job where happiness steals
into your life in unexpected
ways. My working week is
filled with diverse roles ...
but my favourite moments in
medicine are those spent in
direct patient care.
Lately, I have been hearing
a lot about disillusionment
in medicine. How doctors
would not recommend the
profession to their children.
How doctors are burning out
amid skyrocketing rates of
drug and alcohol abuse, and
mental illness.
Medicine is just another
form of consumerism.
Bureaucrats breathe down
our necks, tired of our inabil-
ity to distinguish cost-effec-
tive measures from plainly
wasteful ones. Patients no
longer regard us with the
level of respect, or even affec-
tion, that they once did.
Here is what I have real-
ised. More beds, shiny
wards and more scanners
don’t make anyone happy.
More beds without more
staff means more patients
per overworked doctor and
nurse. More scanners mean
more scans but not necessar-
ily better care.
I have rarely met a patient
who felt better for being on
a new ward that was staffed
by jaded doctors and nurses.
So while pouring money
into medicine is usually well-
intentioned, it’s a stretch to
say it makes doctors happy.
What does make doctors
happy is happy patients. In a
profession where established
beliefs are routinely turned
on their heads, this seems to
be a fairly irrefutable one.
In fact, the capacity to make
a palpable difference to the
human condition is what sets
medicine apart from other
prestigious jobs. But how can
the modern doctor make the
modern patient happy?
In this age of unrelenting
dissatisfaction with every
aspect of our life, is it even
possible to aim for a happy
patient, or should doctors
just accept that customer ser-
vice delivered with civility,
efficiency and accuracy ought
to be enough?
This would be a shame
because the wonder of medi-
cine lies in its human touch.
The rest Google keeps getting
better at. Take the example
of a skin rash that a patient
took to Google for a diagno-
sis. Google reassured her that
the rash should get better by
itself. It took the triage nurse’s
radar to sense that although
Google was right about the
rash, it couldn’t possibly
diagnose the patient’s distress
at remembering that a similar
rash had heralded the death
of her mother from leukae-
mia when the patient was
merely seven years old.
I have met some wonderful
doctors in my career, loved by
patients and their colleagues.
They all have something in
common — they have honed
the art of communication.
These doctors look at their
computer screen less and their
patients more. They smile,
wince, celebrate and commis-
erate with their patients and
they look them in the eye.
I asked a very busy GP
once how he managed to
keep so many patients happy.
“I behave as if for those 10
minutes the patient before
me is my only concern in the
world,” he said. l
Dr Srivastava is an oncologist
and author based in Melbourne
at Monash Health. This is an
edited extract of an article
published by the Conversation
for their collection ‘On
Happiness: New Ideas for the
Twenty-First Century’.
See: bit.ly/1SIMD1t
Oncologist Dr Ranjana
Srivastava says happiness
can be the heart of medicine.
Dr Srivastava
says happy
patients make
doctors happy.