Areas such as physical health showed improvement, but career and social well-being continue to weaken for Americans.
Americans’ sense of well-being edged lower again in 2018, according to a Gallup index that has tracked 5 health, financial, and social factors since 2008.
While the dip was not as large as it was in 2017, the 2-year decline suggests a trend that not all is well with people in the United States, according to Dan Witters, research director of the Gallup National Health and Well-Being Index.
The index surveyed 115,000 people throughout 2018 on how well they were doing in their career, financial, social, community, and physical well-being. The index, which rates well-being on a scale of 0 to 100, fell from 61.5 in 2017 to 61.2 in 2018; since 2016, the index has dropped 0.9 points.
“Improving and sustaining high well-being is vital to any population's overall health and to its economy,” the report states. “Prior research has shown that high well-being closely relates to key health outcomes such as lower rates of healthcare utilization, workplace absenteeism and workplace performance, reduction in obesity status, and the new occurrence of chronic diseases. Well-being is also a predictor of numerous business outcomes such as employee engagement, customer engagement, turnover, and workplace safety, which can affect a state's ability to reach its economic potential.”
A deeper dive into the numbers reveals both good news and bad news: In an interview with The American Journal of Managed Care®, Witters said that, after years of focus on rising obesity, it appears that in 2018, Americans’ sense of physical health is leveling off, and exercise may be on the upswing.
However, he said, “The big drop is driven by social well-being and career well-being.”
Witters said the measure for career well-being can include whether people feel they a working in a job that gives them a sense of purpose. “Do you like what you do? Is what you do a natural fit for you? Are you setting and reaching goals?” he said.
Social well-being, Witters said, includes the quality of relationships and whether a people feel they have someone who looks out for them.
States and Regions, Other Trends
Hawaii had the highest measure of well-being among the states for the seventh time since the index began, and West Virginia, a state hit hard by the opioid crisis, was the lowest for the 10th straight year. The regions of the country that fare poorly from year to year did so again in 2018: Deep South and Southwestern states and coal country made up the bottom 10, while the Mountain West, Northern Plains, Alaska, and Hawaii made up the top 10. Several states along the I-95 corridor—New York, New Jersey, Connecticut, Rhode Island, and Maryland—ranked poorly on the community rating, which asks if people like where they live.
Witters noted that Nevada, which had historically ranked low in well-being and been an outlier among the Western states, showed a big jump in 2018, coming in at 19th overall. By contrast, Arkansas, which has frequently ranked in the bottom 10, fell to 49th among states. It came in dead last in the financial and social rankings. In the past year, Arkansas has revised its Medicaid expansion policies to require that beneficiaries demonstrate proof of work, but the documentation requirements had forced more than 12,000 from the rolls as of November 2018.
Nevada expanded Medicaid in 2014 and a commentator last year pronounced it a “roaring success,” saying it brought the uninsured rate down to 6.4% in 2016.
Witters said the demographic trends that emerged in 2017 continued in 2018: well-being was strongest among the very wealthy and weakest as income declined. It was strongest among whites and Asians, weaker among African-Americans and Hispanics, and weakest of all among Spanish speakers.
By age, well-being was weakest among those under 30 and over age 65, he said. For men, well-being has stayed fairly stable, but for women it has dropped.
The Gallup report discusses the need for “holistic” well-being. “Research has shown that having high well-being across most or all elements results in a variety of better outcomes than for physical well-being alone,” the report states. “Hawaii's reascent to its number 1 ranking aptly reflects this, as Hawaii is the only state to rank in the top 5 across all 5 essential elements of well-being, demonstrating the usefulness of focusing on all of its aspects.”
The report encourages states to customize well-being programs for their constituencies, and without mentioning the political change that occurred in January 2017, it states that leadership matters.
“Specific interventions include working with schools, employers, grocery stores, and restaurants to foster healthier practices. Other initiatives can involve working with government and various agencies to enact changes that increase opportunities for healthier lifestyles and community life, like more walkable and bike-friendly environments, farmers markets and social activities. Regardless of specific programs or actions, potentially the most important aspect to a successful program is strong, uniform, sustained and visible support from governmental and organizational leadership, which can play a pivotal role in providing the foundation upon which a culture of well-being can be built.”