How to create societies for human wellbeing

To create effective policies promoting psychological wellbeing for all, governments must not lose sight of the far-reaching impact of psychologically harmful environments, Dr Matt Fisher from the University of Adelaide writes.

Wellbeing is a popular topic with Australian governments, with several introducing frameworks to measure wellbeing, such as the Australian Treasury’s Measuring What Matters Framework, the Wellbeing Index for South Australia, the ACT Wellbeing Framework, and a new NSW Performance and Wellbeing Framework.

These steps by governments to move beyond gross domestic product (GDP) as the preferred proxy indicator of social progress are welcome. However, policy for psychological wellbeing is likely to fall far short if governments don’t address society’s broader social conditions.

Owning up to psychologically harmful environments

While Australians continue to grapple with physical health conditions such as diabetes, cancer and heart disease,  great challenges lie with the impacts of psychologically harmful environments on mental health and psychological wellbeing.

The multiple, intersecting factors now undermining wellbeing abilities and causing chronic stress include childhood adversity, socioeconomic inequality, discrimination, overwork, housing and financial stress, social isolation, online disinformation, and climate change anxiety.

ABS data shows the cumulative, harmful effects of such stressors on mental health – in any 12-month period, 1 in 5 adults and 2 in 5 young adults experience a mental health disorder. These conditions result in around $70 billion in annual costs to the Australian economy. Policy commitments to wellbeing which do not hold themselves accountable for these societal harms are at risk of being empty rhetoric.

Accepting the limitations of a biomedical response

Access to mental health services is important for people with serious illness. However, a dominant policy focus on remedial treatment of mental ill-health – as prevails in Australia – marginalises recognition of harmful social conditions and restricts policy attention on mental health promotion.

Evidence shows that, despite increased spending on mental (ill-)health services and escalating use of medications, the very high rates of illness shown in ABS data are not decreasing.

Getting clear on the conditions psychological wellbeing requires

If we are to live up to the aspiration of public wellbeing, the policy emphasis must shift from remedial, medical responses to ensuring equitable access to essential social conditions for psychological wellbeing.

This means reducing harmful stressors and creating better conditions such as caring family environments for children; secure, meaningful employment and work/life balance; positive social relationships; contact with and care for nature; comprehensive primary healthcare; lifelong education; and secure housing.

Thinking systemically about wellbeing policy

To promote conditions for wellbeing, Australian governments must go beyond social policy as merely an arms-length contracting of services. Investing in an ever-expanding array of remedial social service providers will never be enough to secure public wellbeing. Instead, policy-makers must think systemically about what a wellbeing society looks like in practice, require every policy sector to play their role, and engage with active communities. There are two broad strategies to achieve this.

First, governments should use fiscal and regulatory tools at their disposal to directly tackle systemic issues. Only then are they in a position to reduce socioeconomic inequality, regulate the online environment, take effective action on climate change, and ensure universal access to primary health care and education services.

Secondly, and more subtly, governments should use place-based approaches to engage with communities across the country; co-designing strategies to build collective and individual resources for wellbeing at a local scale.

Work in this vein might focus on conditions such as social connectedness, care for and contact with nature, parenting supports, and strengthening local economies. To optimise benefits for wellbeing, this should be a universal strategy with proportionately greater investment in communities subject to disadvantage.

Each of these changes presents a challenge to government business-as-usual. Each is anathema to short-termism. Public sector staff will benefit from understanding public health theory and evidence on stress, mental health and psychological wellbeing, and so they can argue for the sustained shifts in policy direction needed to deliver on wellbeing as a matter of fundamental public interest.

The issues raised in this article are examined in greater depth and detail in in Dr Matt Fisher’s forthcoming book: How to Create Societies for Human Wellbeing – Through public policy and social change, available now for preorder with Policy Press.