Clinicians, public health experts should focus on helping people flourish, article says

Clinicians and public health practitioners should start considering the concept of flourishing when examining patients and assessing population-level health trends, according to a new Viewpoint article in JAMA, authored by Tyler VanderWeele, Ph.D. (Human Flourishing Program — Harvard), Eileen McNeely, Ph.D. (SHINE — Harvard), and Howard K. Koh, M.D., M.P.H. (Culture of Health — Harvard). It explores how even more holistic measures of “well-being” from medicine, psychology, economics, sociology, and government, while coming closer to capturing an individual’s complete well-being, still often fall short.

The article, published on April 1, contends that doctors tend to focus on the absence of disease as a defining trait of health, while public health experts tend to home in on quantifiable measures of societal health, such as leading causes of mortality. But these measures don’t fully account for factors such as happiness and life satisfaction, character and virtue, and social relationships, all of which can affect health. These factors, which are not easily measured, fit within the broad notion of human flourishing, which “has the potential to capture health more broadly than existing wellness measures for both patients and populations.”

There is evidence that the medical and public health fields are paying closer attention to human flourishing. Researchers have recently developed a “flourishing index” consisting of six domains that account for qualities such as happiness, financial stability, and mental and physical health, among other factors. According to the JAMA article, the index has potentially wide applications at the patient level and population level — and across society at large. Already researchers are examining how employers might use measurements of flourishing to help assess and improve employee well-being.

The authors also conclude that the concept of flourishing has the potential to capture health more broadly than existing wellness measures for both patients and populations. Asking questions related to flourishing can inform and refine many complex trade-offs for patients facing treatment decisions. The concept can potentially guide clinicians in assessing their own personal well-being as well as delivering better patient-centered care. At the population level, too, attention to flourishing may represent a more useful way to address policy and societal goals than current options. Such an approach could open a national conversation that reframes and reimagines traditional concepts of health.