In 2008, at the peak of the global financial crisis, a group of scholars started a global conversation around the need to challenge the definition of health enshrined in the constitution of the World Health Organization (WHO) six decades before [2]. Such definition declared health, impossibly, to be "a state of complete physical, mental and social well-being, and not just the absence of disease or infirmity." [3]. This was perhaps the first time in history in which health and well-being were linked in a sentence, as part of a document designed to have global impact. Deceptively benign and seemingly aspirational, this definition, which has remained unchanged ever since, has a major problem: It condemns us all to be not healthy, as practically nobody could claim to have complete physical, mental and social well-being! [4,5]. In addition, those who proposed this definition neglected to pause and describe what they meant by "well-being". The WHO definition had another adverse effect: it gave well-being a subordinate role to health, a fact that has remained undisputed for more than 70 years, adding to the confusion as to what these words should mean [6,7].
Motivated by this confusion, and aware of the inadequacy of the WHO approach, the global conversation about the meaning of health, enabled by the British Medical Journal, led to a meeting in The Hague, during which leaders from around the world proposed a new conceptualization [8] (rather than a definition), which disentangled health from well-being by considering it to be the ability to adapt and self-manage in the face the inevitable social, physical, and emotional challenges we face through life [9].
Unfortunately, this work has been ignored by the WHO, which continues to conflate health, disease and well-being. This is reflected in the medicalization that characterizes the 100 indicators that this global body still uses to assess the health status of whole countries [10] and those seeking to guide efforts to achieve the third Sustainable Development Goal proposed by the United Nations, which aspires "to ensure healthy lives and promote wellbeing for all at all ages" [11].
In 2016, the opportunities created by the new conceptualization of health were seized by the National Federation of Coffee Growers, in Colombia. This entity - the largest rural non-profit organization in the world, as it supports two million low-income farmers - decided to become an incubator of new possibilities for healthy workplaces, and an epicentre for a pandemic of health. With support from an international group of members of the Maimonides Project, coordinated from Toronto, Canada [12,13], more than three thousand employees of the organization were invited to assess their own levels of health, by answering the following question: "In general, how would you rate your health today: excellent, very good, good, fair or poor?" Once the ratings were obtained, those reported as "good", "very good" or "excellent" were considered as reflecting positive health, while those regarded as "poor" or "fair" were deemed to represent negative health. By the end of September of 2019, more than 97.5% of them have been able to experience positive levels of health, with two clusters in which everyone is healthy, at a time when workplaces around the world are experiencing unprecedented levels of mental illnesses.
The events within the National Federation of Coffee Growers inspired another Colombian organization, Compensar, to engage in efforts to explore the relationship between health and well-being. This is a privately-run non-profit form of benefit society (or friendly society in British English) that receives and manages funds from more than four million people working at more than 96,000 companies and non-profit organizations in Bogota, offering them a wide menu of low cost well-being "benefits", which include among others, subsidized financial, sports, recreational, educational and housing services [14].
From the outset, choosing a way to assess well-being was difficult. Reviews of the literature and prominent reports [15-34] revealed how well-being (just as it had happened with health) had also been perceived as a state, or as something that can be evaluated from the outside. Since the 19th Century, driven by economic interests, it had been conceived as something that depends on the acquisition or provision of material goods. This motivated the decision to mirror the process followed with the concept of health, within the context of Compensar, and to explore ways in which it could also be viewed as an ability.
At that point, it was clear that the most influential link between well-being and ability had been made by Sen in 1979, when he proposed the concept of human capabilities. Later, he suggested that well-being be regarded as "the ability to do valuable acts" [35]. Nevertheless, it could be argued that this approach is also limited by the fact that it requires someone to judge what is "valuable", again running the risk of falling back into an economicist paradigm [36]. Consequently, we favoured a conceptualization proposed by Sumner, who views well-being as "the ability to judge that our life is going, or is well" [37, 38].
This conceptualization enables people to be the main protagonists of efforts that aim at optimizing their levels of well-being. Thus, analogously, well-being could be assessed in response to the question: "In general, how would you rate your well-being, understood as the ability to judge that your life is going well: poor, fair, good, very good or excellent?". In turn, the answers to this question would allow the levels of well-being to be considered as positive or negative.
In the first quarter of 2018, armed with these operationalizable conceptualizations, Compensar started to accelerate its efforts to become a new incubator of innovations to promote optimal levels of health and well-being, through four projects. The first of these projects focused on evaluating, enriching and describing the experience of its insurance company (known as Compensar EPS), which had developed a trust-based integrated network of healthcare services offered by 35 organizations. This project, which built on the best examples of integrated networks from around the world (e.g., Kaiser Permanente in the US, the Andalusian Healthcare System) revealed how this group was able to enable 88.6% and 93.1% of its 1.3 million affiliates to experience positive levels of self-reported health and well-being, respectively, while ranking first when compared with the performance of the health systems of the 36 countries that are members of the OECD. Trust among payers, service-providing institutions, professionals and users of health services was the key to achieving these results with only 25% of the average expenditure across the OECD (US$ 500 per person annually. This is equivalent to US$ 860 when adjusted for purchasing power parity) [39], [40].
The strength and consistency of these findings reinforced the commitment made by Compensar to explore the concept of well-being as deeply as possible, and its relation with health. By October of 2019, it had achieved positive levels of self-reported health and well-being in more than 95% of its close to 10,000 employees, embarking on similar efforts within low-income populations in Bogota, while working with children, youth and adult community organizers as partners in the creation of the conditions for positive health and well-being to occur.
The leaders of these two organizations, and their international collaborators, are now inviting anyone interested in the creation and spread of health and well-being to consider their experiences as invitations to muster the unprecedented levels of leadership, clear vision, conviction, and willingness to engage in the painstaking work that is needed to make it happen.
-------------------------------------------
INPUT REQUEST #2: Background
Please respond in the comments section