By Jennifer Turgiss, Vice President, Behavior Science & Analytics, Johnson & Johnson Health and Wellness Solutions

Health and wellbeing are inextricably linked. Our health impacts our wellbeing, and our wellbeing impacts our health. While this link is understood and accepted, our current model of delivering health solutions, for employee or health plan member populations, may not be effectively addressing wellbeing. Employees and health plan members are best served when wellbeing solutions are made available to all individuals.
Wellbeing is a broad term with no current consensus on the definition. For the sake of clarity in this article, we will use an amalgamation of widely accepted constructs of subjective wellbeing. It is influenced by environmental, economic, social and psychological factors such as one’s perception of how life is going so far (life satisfaction) and how it has been going lately (positive/negative emotional experiences). Most importantly, wellbeing is measured against our own barometer; how we think or perceive it should be going. In other words, wellbeing is subjective.

Wellbeing is a state of being. It is always present and is highly dynamic. It fluctuates depending upon how we experience the many factors mentioned above. Wellbeing interacts with physical health, yet it is not dependent upon it. For example, an individual can be in excellent physical health and yet have low levels of wellbeing and vice versa; individuals with chronic health conditions can have high levels of wellbeing.

There is a substantial amount of high-quality, scientific evidence that helps us understand factors that influence wellbeing.[1],[2],[3] Some factors are not easy to modify by the individual such as personal safety at home and in one’s community, the economic consequences of being under- or non-employed, and being accepted by groups that matter to us. Other factors can be more easily modified: having a sense of purpose and meaning in life and living with alignment to that purpose, having vitality or the energy, having more positive than negative emotional experiences, experiencing new things, expressing creativity, having a sense of autonomy, developing mastery, having strong and meaningful personal relationships and having a sense of group belonging. We have learned from numerous studies that interventions designed to improve wellbeing can be highly effective, particularly if they improve factors that influence wellbeing. For example, in 2013 a meta-analysis of 39 randomized controlled studies (N=6,139) found that interventions that focus on building positive emotions increased subjective wellbeing.

Many population health initiatives that seek to improve health do not address wellbeing comprehensively. A common practice in population health management is to classify individuals into low, moderate and high-health risk buckets. The information for classification is commonly obtained from a health risk assessment or from past health insurance claim activity, which identifies health factors such as smoking, high blood pressure, physical inactivity or existing health conditions. The high-risk group typically receives interventions that are relatively more intensive, and thus more expensive to administer. The moderate-risk group is often eligible for interventions designed to decrease risk factors or limit the addition of new risk factors over time. The low-risk group is provided ‘wellness solutions’ that encourage and support individuals to keep up the good work and keep their health risks low. This approach has been relatively successful with regards to managing near-term health care costs. However, ignoring wellbeing as a component of health that always exists is leaving an opportunity to improve health on the table. In addition to improved health, higher states of wellbeing contribute to higher productivity, performance, and engagement at work.

Wellbeing is not on the far-left end (the healthy end) on a continuum of health, rather it is a critical element of our health, that always exists, and can be improved upon, despite existing physical or mental health conditions. States of wellbeing can thrive or suffer due to the absence or presence of factors that influence wellbeing such as social connectedness or purpose and meaning in life. Lastly, wellbeing interventions are complementary to and can augment, the medical management of physical and mental health therapies.

Employees and health plan members are served best when wellbeing solutions are made available to all individuals in the population and not just to the targeted already well. All individuals regardless of existing physical or mental health conditions can experience the benefits of improved wellbeing. When more individuals have higher levels of wellbeing, improvements in population health will be realized.
With thanks to Raphaela O’Day, Ph.D., Shawn Mason, Ph.D., and Matt Miller, Ph.D., for their contribution to this point of view.

Jennifer leads teams that work at the intersection of health behavior change and data science. She helps to build digital health behavior change interventions targeted toward the individual user (the patient or the consumer) and the health care provider.

As an applied scientist and practitioner in population health management, she spent a decade creating, measuring and optimizing wearable technologies and digital solutions to improve health and wellbeing in the employer market. I hold two patents in this domain.

As a business executive, she worked in several health-related start-ups across the US, the UK, South Africa and Italy, where she learned to scale operations while adapting products and programs to meet the needs of the local cultures.