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April 1, 2019

Reimagining Health—Flourishing

Author Affiliations
  • 1Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 2Human Flourishing Program, Harvard University, Cambridge, Massachusetts
  • 3Harvard Kennedy School, Cambridge, Massachusetts
JAMA. 2019;321(17):1667-1668. doi:10.1001/jama.2019.3035

Clinicians spend substantial time monitoring patients for adverse outcomes. By assessing patients for high blood pressure, abnormal blood glucose levels, or cancer recurrence, clinicians may equate absence of disease with health. Public health officials, meanwhile, regularly track rates and leading causes of mortality, morbidity, or risk factors (eg, tobacco use, obesity, drug overdoses) that similarly apply a “deficits” framework to health. These approaches, while necessary and valuable, can fall short of capturing what is most important to people in their daily lives. A patient cares not only about physical health and test results “within normal limits” but also more broadly about being happy, having meaning and purpose, being “a good person,” and having fulfilling relationships.

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    2 Comments for this article
    Flourishing Could Add Value in the Global Efforts Towards Achieving UHC Target
    Eliudi Eliakimu, MD, MPH | Health Quality Assurance Unit, in the Ministry of Health, Community Development, Gender, Elderly and Children
    The authors have brought up a very useful concept in addressing the health of patients, clinicians, and the population in general. In particular, the indicated potential of "flourishing" in addressing clinicians' well-being is key, based on the fact that it will also help the physicians to provide better care to their patients. Apart from the high prevalence of burnout in physicians noted by the authors, Dugani, et al (2018) have documented the prevalence of burnout and associated factors among frontline primary health care (PHC) providers in low- and middle- income countries (LMICs) (1) Given the fact that the PHC system is a foundation for countries to achieve the Sustainable Development Goals (SDGs) 2030 - target 3.8 on "Universal Health Coverage (UHC)" (2), scaling up implementation of the concept of "flourishing" is an important endeavour. Also, having such research in LMICs especially in Sub-Saharan Africa will be a welcome idea and worthy for the "Harvard Team" to consider.

    1. https://doi.org/10.12688/gatesopenres.12779.3 
    2. https://www.r4d.org/events/measuring-matters-primary-health-care-foundation-uhc/ 
    Convergence with 100 Million Healthier Lives Well-Being Measurement
    Matt Stiefel, MPA, MS | 100 Million Healthier Lives Measurement Team
    100 Million Healthier Lives (100MLives), convened by the Institute for Healthcare Improvement, is an unprecedented collaboration of change agents across sectors who are pursuing an unprecedented goal: to fundamentally transform the way the world thinks and acts to improve health, well-being, and equity. To understand progress across a multitude of initiatives in a wide diversity of contexts across 30 countries, we promote the tracking of people-reported well-being as a leading outcome, a subjective outcome that can both be quantified and used to drive improvements in equity.

    On behalf of the 100MLives measurement team (1) we are pleased to
    see publication of this flourishing index from the Harvard Human Flourishing Program. This 10-12 item index is remarkably similar to the 7-item adult health and well-being assessment instrument we developed (2), covering the same domains of life satisfaction, physical and mental health, meaning and purpose, and social/financial well-being in a brief instrument, representing an important convergence around the conceptualization of health and well-being. The flourishing index adds and makes the case for the domain of character and virtue, which we are eager to explore. We are also actively working to add positive and negative dimensions of both affective well-being (e.g., happiness and worry) and social well-being (e.g., sense of belonging and social isolation) to our instrument. We also developed and tested a brief youth well-being assessment instrument, an 11-item questionnaire designed with items validated for use with adolescents (2).

    Our adult health and well-being instrument is currently in use in a large number of communities, systems, and organizations around the world. It has been adopted by hundreds of communities, health care organizations, the Veterans Administration, and the National Council on Aging to track their progress with accompanying evaluation. We have recently published results consistent with the point made in this article about the importance of financial circumstances and education to overall health and well-being in a large health system and community-based sample (3).

    The convergence of these activities coincides with the publication of an issue brief for Healthy People 2030 promoting and defining the term “health and well-being” (4). The importance of well-being as a unifying outcome measure for cross-sectoral collaboration is also described in a recent National Academy of Medicine perspective (5).

    We believe there is currently great possibility as well as need for convergence and harmonization of these efforts to measure well-being and welcome opportunities for collaboration.


    The 100 Million Healthier Lives Measurement Team

    Matt Stiefel, MPA, MS

    Brita Roy, MD, MPH, MHS

    Carley Riley, MD, MPP, MHS


    1. https://www.100mlives.org/
    2. https://www.100mlives.org/measure/
    3. http://www.thepermanentejournal.org/issues/2019/spring/7031-sociodemographics.html
    4. https://www.healthypeople.gov/sites/default/files/HP2030_Committee-Combined-Issue%20Briefs_2019-508c.pdf
    5. https://nam.edu/well-being-in-all-policies-promoting-cross-sectoral-collaboration-to-improve-peoples-lives/