In his introduction, Roy Romanow addresses a familiar theme: the need for a better means of measuring social progress than GDP alone, with a reference to the Canadian Index of Wellbeing. And Ryan Meili's first chapter introduces his own central organizing principle focusing on health (consisting of physical, mental and social well-being) - then informing what goes into that standard with a list of the factors which most heavily influence individual health:
In order of impact, the factors that make the biggest difference in people’s health are: 1. income status; 2. education; 3. social support networks; 4. employment and working conditions; 5. early childhood development; 6. physical environment; 7. personal health practices and coping skills; 8. biological and genetic factors; 9. health services; 10. gender; 11. culture; and 12. mass media technology (i.e., television viewing and physical inactivity).Now, the difference between a narrow focus on economic measures and the need to consider more broadly what we seek to achieve through public policy is one that I've discussed before. But let's compare Meili's list and order of factors to the closest we currently have to an index of overall well-being.
The lesson to be drawn from the list of determinants, and the one that is stressed to students, is that the most important factors that determine people’s health are social, and the most effective solutions are political.
Most of the factors listed by Meili map reasonably well onto the eight indicators contained within the CIW:
Income Status - Living StandardsOne CIW factor - that of democratic engagement - isn't reflected in Meili's list. But we might be able to explain that as reflecting societal rather than individual health - such that it makes sense to include it in the CIW even if it doesn't correlate directly with individual determinants.
Education - Education
Social Support Networks - Community Vitality
Employment and Working Conditions - Time Use
Early Childhood Development - Education
Physical Environment - Environment
Personal Health Practices and Coping Skills - Healthy Populations
Biological and Genetic Factors - n/a
Health Services - Healthy Populations
Gender - n/a
Culture - Leisure and Culture
Mass Media Technology - Healthy Populations / Time Use
That said, it's still noteworthy that the equal weight given to different categories within the CIW doesn't seem to fit with the variable importance of the social determinants as contributors toward individual health. And indeed, two high-ranking social determinants (education and early childhood development) are lumped together within a single CIW indicator.
So as my key takeaway from the opening to A Healthy Society, I'll pose a couple of questions for discussion. Can we reconcile the differences (in weight if not in kind) between the social determinants of health referenced by Meili and the measures of well-being within the CIW? And if not, do we need to develop a new metric of societal health to inform our discussion of what we can improve based on Meili's core premise?