Well-beingThe World Health Organization (WHO) defined health in its constitution in 1946 as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This understanding of health has become the epitome of a salutogenetic perspective, which only became explicit decades later. For the WHO, well-being is the ability to realize one's own personal, social and economic goals. Thus critical life events can be mastered, a common life path can be followed and the necessary living conditions can be cultivated for it. This addresses both subjective and objective parts of health, and at the same time establishes a holistic view of a bio-psychosocial health.
Definition and typifications
Well-being is an individual or collective state or process of experiencing oneself, others, and appropriate life circumstances as positive. However, depending on the scientific context of use ((z.B. in economics, politics, sociology or psychology) operationalized differently. In a narrower sense, well-being is characterized by the following typifications:
– current vs. habitual, – subjective vs. objective, – psychological vs. sociological vs. economic, – individual vs. environmental, – action-related vs. dispositional, – mental, physical-physical, emotional, functional, social, spiritual, community-oriented, – hedonic, respectively. eudaimonic and ontological well-being.
A certain fundamental and philosophical importance in all these distinctions have two types of well-being mentioned in the last indent. Hedonic forms of well-being are understood as the principle of avoiding unpleasure and approaching pleasurable states. Eudaemonic well-being means the realization of a good (meaningful, realizing human potential) life. From this arose a psychological construct that includes moments of self-acceptance, and the development of one's own personality. However, it also includes relationships with others and emphasizes the ability to be autonomous, to cope with everyday problems, and to shape one's own life in a goal-oriented way. The hedonic well-being describes more the side of the affective experience, the enjoyment. The notion of an ontological well-being is an attempt to link eudaimonic and hedonic well-being as a philosophical category.
Well-being is sometimes also equated with positive and negative affective parts, with happiness, life satisfaction, quality of life, "flourishing" (positively tinged experience in life accomplishment with a strong experience of one's strengths, creativity, goodness, growth possibilities and resilience), with wellness and also the negation of illness or anomie, respectively. health. Also these conceptual extensions of the well-being are additionally still differently defined in themselves and at the same time also to different illnesses and/or. has been adapted to age groups.
Subjective well-being is the result of comparisons between. These refer to judgments about the extent to which needs, values and attitudes have been adequately met. Involved are motives (z.B. hope, optimism, prosociality), which can be applied to the self or the collective resp. the environment are aligned. Together they are more or less domain specific (material, social, health etc.) and, in extreme cases, oriented to cross-life ies. What is important is how the internal or external possibilities for action, development, and coping are. Action related to well-being resp. its results or the corresponding external events are related to this judgment process.
Objective well-being describes the living conditions necessary for the subjective form. As a rule, the economic, ecological and human capital of a society is surveyed, d.h. its structural and security possibilities to create individually and collectively the conditions for subjective well-being (determinants of health). Individual well-being corresponds to subjective form. The collective feeling of well-being is brought close to the concept of human capital, i.e. the potential which is especially resident in the knowledge of society and which can also be used economically. This can be achieved through education. Social interaction are released.
In measuring well-being, quality of life, happiness, life satisfaction, and flourishing, almost all of the above determinants are reflected. In 2013, the OECD presented a guidance framework to help deal with the diversity of measurement instruments developed. This framework helps in the selection of measurement methods, especially when there is a need to focus more on the interests of the users. Epidemiological studies of well-being in national and transnational contexts indicate that well-being scores are in the middle range (generally with advantages for Europe and the U.S.). Similar information is also provided for life satisfaction. Quality of life made by children.
Well-being and health: models and conditions
Well-being is associated with a variety of characteristics. These include the quality of one's social life, one's state of mind, the success of one's life, and many conducive environmental conditions – v.a. also categories of health as a self-assessed category, as a correlate of longevity, health behaviors, and objective criteria of physical and mental health. The direct relationship between well-being. Health has a moderate correlative relationship. Longitudinal studies can hardly prove quasi-causal effects.
This result is likely to be related to the fact that there are much more complex interactions between well-being and health. Thus, a variety of psychophysiological, neurological, psychological processes, and behavior have been shown to be involved as mediating variables. In addition, a variety of person-bound. Contextual conditions play a role in these mediating processes. Thus u.a. the effect demonstrated of dopamine or endorphins, the responsiveness of the immune and autonomic nervous systems, the HPA axis, heart rate activity, neurological activity of the amygdala, and that of the reinforcer center (mesolimbic system; nucleus accumbens). They all influence the affective, motivational, and cognitive aspects of well-being and are able to reinforce appropriate behaviors. Thus, positive affect partially influences health-related knowledge and motivations (risk perceptions, action expectations, motives, etc).) from. Well-being also strengthens willingness to exercise and make healthy food choices to a considerable extent.
Models and theories of well-being have attempted to map such complex interrelationships. The factors involved in these processes are shown in Fig. 1 summarized.
Fig. 1: Model of the relationship between well-being and health
For processing information relevant to well-being, action goals and value orientations must be present. These comparative processes lead to certain sensations. Perceptions of different types of well-being. Through psychobiological or psychological processes, but also through perceptual action (including the processing of stressors), the necessary comparisons as prerequisites of well-being become possible in interaction with corresponding environmental conditions. Target variables of these processes are also collectively controlled (well-being as a sociological variable).
Individual and contextual conditions
Currently well-studied contextual conditions of well-being include:
– Genetic dispositions and personality traits; – Gender and age; – Information processing and behavior; – Life events; – Social position and life situation; – Social networks and social capital; – Work environment and social conditions.
In twin studies there are some isolated genetic respectively. dispositional partial effects. However, studies highlighting characteristics of personality, behavior, and social environment as more significant for well-being predominate. At Personality traits extraversion, neuroticism and agreeableness correlate most strongly with life satisfaction, happiness experience and negative affect. Subjective well-being is most significantly predicted by extraversion and neuroticism.
Low sex-related differences in well-being are associated among women with higher morbidity, more frequent widowhood, perceived lower attractiveness in old age, economic disadvantage, and their greater propensity to publish. On the well-being of various Age groups the following results are available: Depending on various underlying conditions (physical and mental health, personality traits, employment status, intrinsic values, goal orientation, self-efficacy, hope, social support, resp. family quality, parental parenting style, neighborhood quality of life, enculturation – less significant: gender group membership, ethnic affiliation, and socioeconomic status), children and adolescents show high life satisfaction and a predominantly pronounced sense of happiness. To the stability resp. There are no consistent results on changes in well-being during the aging process. However, the peak for feelings of happiness seems to decrease after 50 years of life, while life satisfaction increases again.
In many studies on Information processing has been shown that how well emotions or stress could be regulated is crucial for mental health, life satisfaction, quality of life, and positive affect. Clear interactive relationships between different forms of well-being have been demonstrated for hedonic well-being and affective states. Less clear is the relationship between eudaimonic well-being and sense of meaning. Positive affect helps to cope with stressors and activate internal and external resources (z.B. Sense of coherence, personal projects, social support). Prosocial, trusting Behavior and willingness to postpone rewards prove in many cases to make people "happy," life satisfaction and quality of life are increased. Risk behaviors and health-related quality of life, on the other hand, correlate negatively.
Life events, social networks, quality of jobs, various features of the environment, and even societal characteristics such as modernity take on a stable course in most cases contextual characteristics demonstrable influence on well-being. Marriage and birth experience prove to be the most significant predictors of positive cognitive and affective well-being in longitudinal studies. Divorce, widowhood, unemployment and retirement predict sometimes significant negative effects of well-being. However, these results are strongly influenced by other factors such as personality traits, coping skills, emotion regulation skills, and social network involvement.
Social position and living situationThe correlations between income and social status. Standard of living or even education and various types of well-being are largely in the medium effect range. Depending on many covariates (z.B. Connection a u-shaped. Thereby mostly also stable course. More significant, however, is the subjectively perceived injustice in the form of the perceived difference in concrete life situations.
Social networks and social capital have both a direct and indirect effect on well-being. The quality of social contacts in social networks, friendships, families and marital relationships is more significant for well-being than their quantity. If one examines the importance of social capital (defined as resource access, trust, social integration, etc.), positive references to quality of life, the experience of happiness and, in a broad sense, also to life satisfaction are also found here. The value of work is usually seen as a resource. Meaningful moment presented. Well-being has also been shown to depend on workplace characteristics. For example, the 2017 "World Happiness Report" shows significant differences between employed and unemployed people worldwide in their life satisfaction and quality of affect. But also in the case of employees it could be proven that conditions at the workplace (reward value, communication, leadership quality, job security and stability, etc) have a significant influence on the success of the company.) are clearly related to well-being. For countries in the OECD (2011), the associations between life satisfaction and income, social equity, housing, job security, support potential, and health are particularly high. In addition, the extent of liberality, stability of governments, social security, the extent of personal safety, and other quality-of-life characteristics (u. a. Access to clean water, air quality, sanitation, recreational opportunities) to be crucial for subjective well-being.
The Interplay of person-environment relationships as conditions of well-being is probably best predicted by the interaction of certain personality traits and self-selected situation. A concept strongly associated with this notion is the idea of the Realization opportunities/capabilities. Originally, this concept was used to measure the well-being of societies, i.e., the extent of liberal, economic resources and opportunities, or the quality of life. Collateral. In the end, these are only significant for well-being if certain skills are available to be able to use the corresponding offers. Well-being is equated with realization opportunities to create stable living conditions and ensure access to education, attachment, autonomy, success and enjoyment.
Interventions to enhance well-being
Numerous interventions to promote well-being have been developed not only on the basis of findings on the relationship between well-being and health, but also through a positive orientation of health goals as given by the WHO, positive psychology, and other social conceptions of a successful life. The focus is on curative and preventive programs that have an educational or self-help orientation and improve well-being v.a. of ill persons wanted to improve. Studies from positive psychology, which seeks to prevent and treat mental health problems, predominate.
(a) Interventions for physical illnesses: Studies on this topic usually examine whether classic medical interventions for physical illnesses not only lead to symptomatic improvement, but also improve quality of life. Results are more mixed when the effects of psychotropic drugs have been studied for pain, relapse prevention of psychosis, or dementia patients. Bariatric surgery (reduction of the size of the stomach) produces barely traceable effects on patients' quality of life. Even when the effect of psychosocial interventions has been studied, the results tend to be mixed: for example, in arthritis, asthma, heart disease, COPD, cancer, cardiovascular disease, and hemodialysis patients. High values could be demonstrated in the change of quality of life in patients with osteoporosis or multiple sclerosis. Overall, the ways in which the aids have affected types and components of well-being still remain obscure. (b) Interventions for the mentally ill: There is limited evidence that psychotherapeutic treatment of mental disorders also helps improve characteristics of well-being (mostly quality of life), Many results show predominantly effects on symptoms and less on characteristics of well-being (demonstrated for psychotic disorders, eating and anxiety disorders). (c) Many interventions will include in the preventive field offered with sometimes more pronounced effects. Specific studies on the effectiveness of methods to increase positive activities, mindfulness, and gratitude report weak to moderate effects. Classical preventive approaches, such as physical fitness training, have proven to be only marginally successful in raising the level of positive affect among older people. Among young people, some positive effects can be demonstrated, but these may have more to do with membership in associations or clubs. Setting-oriented measures to strengthen well-being are mainly limited to interventions at the workplace (health promotion and company). Workplace physical training, positive psychological interventions, or web-based psychosocial supports do little to improve psychological well-being, absenteeism rates, and productivity.
Conclusion and outlook
Examining and promoting well-being in the context of health raised a lot of hope. However, the interrelationships between conditions. Consequences of well-being are complex. Only rarely are studies designed that comprehensively examine all the components involved. This applies equally to individual, collective and societal measures to cultivate well-being. Even if results can be improved through more complex studies, there also remain dangers in the end of committing unilaterally to the category of well-being. The dangers are great of not seeing well-being predominantly in terms of interaction with the pathogen, of reducing it only to individuals and not also understanding it as an environmental feature.
Recent health policy strategies to promote "health and well-being" attempt to be oriented toward population health that focuses more on social determinants and sustainable development goals, thus also preventing the dangers of an individualizing reductionism of well-being. They use the multifaceted potential of the concept of well-being to link it to different policy areas in order to serve the overarching goal of social and health equity. The global ideas on sustainable development also refer to it in the 2030 Agenda and the "Sustainable Development Goals (SDG)" (Health Promotion International 3, Global Health/Global Health). Worldwide, corresponding efforts are becoming apparent, especially in countries such as the USA, Canada, Australia, but also in countries of the European Union. The European Health Report (2012) seeks to significantly revitalize the concept of well-being. Despite the so far weak connections between health, illness and well-being, one wants to advocate that living conditions and also the health care system become a guarantor of societal well-being precisely by means of the concept's diversity of meaning. This view influenced u.a. also European public health action programs, such as that of the Statistical Office of the European Union (Eurostat) and those of networks such as EuroHealthNet. The desired paradigm shift has not been achieved in some European countries, such as z.B. In England or Holland already clearly arrived. They all link the goal of health equity with the promotion of well-being (health promotion and the European Union). In Germany, well-being is addressed primarily in the German government's Quality of Life Report (2016). However, it also emerges as a topic in the field of promoting child development, child health, and child well-being; here also as "growing up in 'well-being'" (prevention chains/integrated community health strategies) and in connection with promoting resilience. Thus, overall, there is a paradigm shift away from a narrow and one-dimensional view of (physical) "health" to a multidimensional concept involving a variety of biopsychosocial processes at the individual level and also a complex set of societal living conditions, institutions, and social networks. Hopefully, this more differentiated revitalization of well-being will also lead to a sustainable societal shift, where health and well-being become important pillars of a dignified life.