No country can be worse than Dystopia. Yet some, like lowest-ranking Afghanistan, come close to this worst-case scenario, while others, notably in the Nordics, rank far from it. But can surveys like this paint an accurate picture of what constitutes a healthy, happy population?
Can well-being be measured and could the data help engender happier societies? Health and well-being data collection happens all around us, mainly through the devices in our pockets. From health apps feeding insurance companies information about the fitness of individuals to determine their insurability, to businesses using data analysis to improve corporate health programs. While much of this data is gathered, bought and sold between private entities for commercial gain—the Googles, Amazons, and Facebooks—governments also see value in referencing well-being metrics in policy decisions. For example, in 2017, the Swedish government integrated their New Measures of Well-being statistics into their annual budgeting decisions. In the US, the Surgeon General and Health and Human Services Department recently released a framework to help corporations define and address employees’ well-being.
The recommendations signal a shift from an equality-centred (one-size-fits-all) approach to worksite wellness to a focus on equity-centred, individualised well-being. NGOs also use data and machine learning to predict human behaviour and social conditions. The Danish Refugee Council and IBM have developed a foresight model to provide predictions on displacement at a country level.
Over the last ten years, public interest in health and wellness has seen an upsurge, with the global wellness market now worth an estimated 1.5 trillion USD. In more recent years, the COVID-19 pandemic exacerbated a mental health crisis, with many suffering from isolation and loneliness. But it also created a post-pandemic wellness boom, with more people prioritising mental health practices in their daily lives.1 In line with this, a recent survey showed that 79% of respondents believe wellness is important, and 42% consider it a top priority.2
The paradigm for involving individuals (and their personal data) in their own healthcare has shifted from a closed-door, trained-professionals-only perspective to a culture of co-production with the patient. Trend experts predict that by 2030, healthcare will move away from the doctor's office and into the patient’s hands via personal monitoring devices, apps as personal trainers and a comprehensive offering of over-the-counter pharmaceutical products.3 This will empower people to control their health and lead to more accurate diagnoses based on a holistic perspective of life circumstances to which only the patient has the key.4
While some of these trends and developments are creating more well-rounded, personalised and discerning healthcare systems, the disparity of access to information, wealth and mobility continues to widen the well-being gap. In a recent study, the economist Raj Chetty, found that the neighbourhood you grow up in plays a significant role in upward mobility, and the longer you live in these neighbourhoods, the harder it is to break free.5 We also see a mass of evidence pointing to the urban poor being most at risk for exposure to pollution from underdeveloped traffic systems and cheap housing in the vicinity of heavy-polluting industries. This risks widening the economic gap both within and between countries. Furthermore, city development lacks representation, as the values and needs of those developing infrastructures are often reflected in the solutions created. This, coupled with poor diversity in data sets that amplify societal biases and stereotypes, paints a grim picture of a world where mobility solutions only work for the few.
A future scenario
It is 2040, and in Southern Sweden, the state has mandated that achieving good physiological and mental health is crucial for maintaining a vibrant and well-functioning society. This “ultimate health” system is built on nudging and incentivising behaviours that lead citizens to feel they are the masters of their own well-being. However, this is a highly-regulated nanny state in the guise of a system driven by personal choice. Sharing health data becomes the norm to access employment and other essential infrastructures, and there is high pressure to monitor, prevent and address health issues. This leads to greater stigmatisation and polarisation and, ultimately, counter-movements that encourage freedom of choice in health issues.
A system-wide approach
Health incentivisation starts early with “healthcare literacy” integrated into early-years education. Curriculums equip children with tools for emotional regulation and impart the importance of illness prevention. Healthcare becomes part of the workplace with health workers on-call and on-site in businesses and organisations, so it’s easy to access.
Healthcare has become increasingly de-medicalised and a joint venture, co-owned by the state, big business and trained health professionals. With health-focused behaviours at the centre of society, digital innovations are funded through state-regulated sharing of personal health data (including DNA). Digital and environmental tools, like wearables to monitor psychological safety or street benches that detect an irregular nervous system, nudge individuals towards choices that increase their health acumen.
With healthcare increasingly governed by state and business and less the sole domain of trained professionals, there is a concern amongst some healthcare professionals that their diminishing status is impacting their ability to provide ample care.
To be healthy is to be successful
There is significant societal pressure to address health issues, and generally, people are open to seeking care and accepting social support to improve their well-being. However, those who appear to neglect their physical or mental health are stigmatised as “unhealthy” and are typically less successful in education, employment and social scenarios and cannot climb the social ladder. For example, a clean bill of health is a basic requirement in most job descriptions.
Jumping on this climate of well-being anxiety, market opportunists develop new products and digital platforms to promote individual well-being. These so-called “socialisers'' infiltrate all areas of life, from diet, friendships, work and dating, with unique solutions to health issues. However, an oversaturation of options leads to a negative feedback loop where people experience feeling more pressure by being constantly exposed to health messages. Due to a higher level of health literacy, citizens begin to call out socialisers for “well-being washing”, and when scrutinised, their healthcare claims are deemed misleading, lacking evidence and not based on the agreed science of the day. Misinformation around health becomes prevalent, with self-diagnosis and pseudo-professional diagnosis exacerbating health fears and factitious disorders.
While people revere individual well-being as the epitome of a functioning society, community well-being is neglected and trivialised. The notion that each person should prioritise their own well-being creates an epidemic of individualism, narcissism and a false sense of self-sufficiency. This leads to increased loneliness and isolation with rising rates in single households and depression.
Those who can and those who can’t
Although healthcare is universally available through workplaces, educated, highly-literate and well-resourced individuals seek specialised care outside work to increase their health potential. As more private options to optimise “ultimate individual well-being” are made available outside the system, there becomes a widening gap between those who can source and afford better health and those who can’t.
Immigrants, marginalised groups and those outside the job market struggle to access and benefit from a work-embedded healthcare system. The most vulnerable enter a downward economic spiral with poor health credit and few resources. A lack of integration and belonging leads to conflict and polarisation between those who participate in the “ultimate health” system and those forcibly excluded. Black market care services and exploitative non-profits target under-resourced, “unhealthy” people, resulting in more health issues due to a lack of professionalism and knowledge.
Rage against the system
Several groups attempt an exposé of the nanny-state approach to healthcare and initiate a counter-trend that rejects the notion of “ultimate health.” Activists stage anti-health demonstrations and encourage people to stay purposefully unhealthy as a form of protest.
Increasing state surveillance of personal health in the digital and built environments leads to civic action to include marginalised groups and build grassroots solidarity. Many immigrant communities lose trust in and reject the state and workplace provision of healthcare and instead turn to their communities and elders for information and care. Non-Western, indigenous and traditional medicine and healthcare become predominant for those living at the fringes of society, helping them to thrive and find a sense of belonging again.
Assumptions
The assumptions that hold true for this future to exist are that people want to be responsible for their own health, there is a constant demand for specialist healthcare, we can avoid every health issue through “better” behaviour, that data will be used for tracking and not care itself, that corporations and the notion of individual income will still exist and that schools are only for children.
This narrative is based on a scenario collectively conceived and developed by core group participants in a Collaborative Foresight cycle. The group's voice was captured and creatively expanded by the writer.
