The U.S. needs to measure health in all of its dimensions: physical, social, and mental

WWhen decisions are based on data, it matters what the data is and, more importantly, what it measures. The metric can become the mission of an organization, influence the objectives and goals of a policy and guide the programs or projects of a government.

A correct measurement is incredibly powerful. Measuring what matters it is supposedly what built Google and the Bill and Melinda Gates Foundation. A bad measure can be catastrophic, such as the use of “body count” to track the progress of the Vietnam War, which many have argued gave a false impression of what was happening on the ground, misled leaders and prolonged the fighting.

Until now, data has been underused in responses to the Covid-19 pandemic. The most recent white house strategic public document, dated January 2021, includes seven goals, such as restoring confidence, protecting those most at risk, and mitigating the spread. However, it does not include numerical metrics (data) for decision making. The overall goal seems to be “zero covid” that many considered possible just a year ago.

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But times have changed. Covid-19 is likely to become endemic, like influenza. The US needs a data-driven off-ramp to transition from a pandemic to a new normal, with Covid here to stay for the foreseeable future at least.

Celine R. Gounder, Rick A. Bright, and Ezekiel Emanuel proposed a data approach in a recent study. test for STAT. building on a trio from JAMA viewpoint articles written with several colleagues, recommend that the health risk of everything Respiratory viruses, including Covid-19 and influenza, measured by hospitalizations and deaths, should drive health policy decisions. They argue that officials should use this metric to determine when to implement mask wearing, remote work or learning, and limit indoor public gatherings.

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While we applaud your data-driven approach, we believe the evaluation measure needs to be broader. If the US wants to use data in its health policy, then a better measure of health, in all its dimensions, is needed.

In 1946, the World Health Organization declared what has become the most famous definition of health as “…a state of complete physical, mental and social well-being and not simply the absence of disease or infirmity”. Today in the US, health policy and practice need data that encapsulates these three dimensions: physical, social, and mental.

The truth in this definition has become increasingly apparent during the two years of the Covid-19 pandemic. The physical health losses from hospitalizations and deaths and the long-term recovery have been enormous. Add in social losses, such as time lost with family, separation from friends and colleagues, and not celebrating life milestones in person, from birthdays and graduations to births and deaths. These have manifested themselves in rising rates of drug overdoses, mental health problems, social isolation, economic problems, and political instability, with some groups disproportionately bearing the burden of the pandemic. There could also be future losses, as an entire generation of students has been forced to “learn” remotely, the long-term impact of which on learning and critical socialization will not be known for years.

Data-driven health policy must include all of these factors, especially as the US seeks to overcome health disparities.

Consideration of social and psychological dimensions of health is not unusual in health metrics, as we identified in a recent study. White paper for the Lee Kum Sheung Center for Health and Happiness at the Harvard TH Chan School of Public Health. Many governments around the world have attempted broader health measures. Most of these examples focus on the WHO definition of well-being and measure it through surveys that ask a basic question: “How are you?”

These so-called life satisfaction or well-being questionnaires vary in length and detail. One of the most famous is the Gallup World Pollthat asks people from more than 100 countries to rate their lives from 0 to 10, an approach known as Cantril’s staircase. These data are the basis for the world happiness report, which aims to compare well-being, or what the report defines as happiness, between countries. Other approaches use dozens of questions, some even more. Numerous validated measures and resources they exist in the peer-reviewed literature for practitioners and policymakers to use in a variety of ways.

In policymaking, welfare data is often combined with other metrics, including educational, economic, and environmental data. Perhaps the most famous example is that of Bhutan. Gross National Happiness Index. It includes a measure of subjective well-being along with nearly three dozen other metrics, such as income, educational attainment, and life expectancy, to gauge that country’s national progress. The Bhutanese government evaluates new policies through the lens of this index and may reject policies that are expected to have a negative effect on it.

Well-being metrics are not limited to Bhutan, but have spread to France and the United Kingdom. Although the US federal government has lagged behind in using this approach, municipal governments in Santa MonicaCalifornia, and SomervilleMass., have attempted to measure happiness.

Measuring wellness can help the US and other countries move toward health equity. A report october 2021 by the National Commission to Transform Public Health Data Systems, sponsored by the Robert Wood Johnson Foundation, recommends taking a broader view of health as an approach to centering equity. The report argues that measuring well-being, or positive health, is necessary to reframe “deficits to strengths and oppressive to restorative” narratives as a way to overcome health inequity. This is particularly important in light of the devastating impact of Covid-19 on communities that have been historically and intentionally excluded locally, nationally, and globally.

Future decisions about introducing lockdowns or implementing remote work or learning should consider the risks to everything dimensions of health—physical, social, and mental—not just physical health. Decision makers must take into account the rise in depression and anxiety and other mental health issues, drug overdoses, social loss, and the like. A measure of welfare, combined with data from other sectors, provides the best estimate of the overall effects of new policies.

Getting there requires expanding the concept of health beyond illness and disease, to ensure that decisions positively affect what really matters: wellness in all its dimensions.

Eric Coles is the Tribal Public Health Officer for the Tule River Indian Tribe of California and Chairman of the DrPH Coalition. K. “Vish” Viswanath is a professor of health communication at the Harvard TH Chan School of Public Health.