Health, Wellness, and Well-Being: The Need for a Common Terminology
Frederick M. Brown, Ph.D. (left) and Cynthia M. LaJambe, Ph.D. (right)
The Pennsylvania State University
Corresponding Author: Frederick Brown, Department of Psychology, The Pennsylvania State University, email: firstname.lastname@example.org
As our Positive Health and Wellness Division launches its first issue of Chronicle of Advances in Positive Health and Well-Being, there is an urgent need to clarify what is meant by “health,” “wellness,” and “well-being.” A large body of literature exists which provides numerous definitions of these three important concepts. Many current views of health originated with the simple 1948 WHO definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In contrast, definitions of wellness and well-being, the main focus of this commentary, have varied across applied/ practitioner fields and academic disciplines, from personal to sociocultural perspectives, as shown in the examples in the following table.
|Table of Sampled Definitions of Wellness and Well-being|
|Foster & Keller (2007)
Wellness: Dimensions of wellness include physical, emotional/psychological, social, intellectual, spiritual, occupational, environmental, cultural, economic, and climate.
|National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (US)
Wellness: Several dimensions, including emotional (coping effectively with life and creating satisfying relationships) and physical (recognizing the need for physical activity, healthy foods, and sleep).
|Centers for Disease Control and Prevention (US)
Well-being: A subjective state that at a minimum includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning; physical well-being includes, e.g., feeling healthy and energetic. Concepts of well-being are defined by multiple disciplines focusing on assessing health-related quality of life, positive emotions, psychological resources, and mental health, clinical, and economic states.
|Organization for Economic Co-operation and Development (OECD)
Well-being: Of people and households. Current well-being includes 1. Quality of Life: health status, work-life balance, education and skills, social connections, civic engagement and governance, environmental quality, personal security, subjective well-being, and 2. Material Conditions: Income and wealth, jobs and earnings, housing. Resources for future well-being (sustainability) include natural, economic, human, and social capital.
Well-being: (PERMA) A construct with five measurable elements: positive emotion (of which happiness and life satisfaction are all aspects), engagement, relationships, meaning and purpose, and accomplishment.
|Dodge, Daly, Huyton, & Sanders (2012)
Well-being: The balance point between an individual’s resource pool and the challenges faced. A stable state of well-being is where an individual has the required psychological, social, and physical resources to meet a particular psychological, social, and/or physical challenge.
Well-being: The eudaimonic perspective includes several dimensions: Autonomy (living in agreement with personal convictions), environmental mastery (managing life situations well), personal growth (making use of personal talents and potential), positive relations with others (deep ties with significant others), purpose in life (life has meaning, purpose and direction), and self-acceptance (knowledge and acceptance of self, including personal limitations).
|Schulte, Guerin, Schill, Bhattacharya, Cunningham, Pandalai, Eggerth, & Stephenson (2015)
Well-being: Workplace model that includes subjective well-being (experienced – hedonic, eudaimonic flourishing, evaluative), objective well-being (economic, health, basic survival, environmental, cultural, social, political) and composites (e.g., Work Ability Index).
The table clearly illustrates that current definitions of wellness, and well-being are varied, and depend upon the context in which they are used. In scientific literature, Miller and Foster (2010) found that these terms were being used inconsistently and often interchangeably. In particular, they noted that while well-being often is associated with conditions of positive psychological health, life satisfaction, and happiness, the term wellness “generally refers to the individual’s functioning and is viewed as the umbrella over-arching well-being.” Foster and Keller (2007) propose that models and definitions of wellness share certain core elements: (1) It goes beyond simple absence of illness (WHO definition); (2) it is multi-dimensional, with factors that interact in a dynamic and synergistic manner; (3) it requires “balance or dynamic equilibrium among dimensions”; (4) it requires individual motivation and responsibility for its success; and (5) it is measured on a continuum, rather than being viewed as simply an end state.
Noteworthy is the fact that the opposite is true in the business sector. There, wellness often is viewed as primarily relating to physical health; in contrast, well-being is seen as conceptually broader and involves a variety of factors (including physical health) that relate to the quality of workers’ lives (Schulte et al., 2015). Schulte et al. propose a workplace well-being model that includes subjective well-being, objective well-being, and composite elements (see table). In their model, wellness as physical health is one factor under objective well-being. McLellan (2017) also states, “Beyond good health, employee well-being incorporates quality-of-life attributes such as happiness, financial security, job and retirement security, a sense of purpose, justice, and equity.” Because of these adopted definitions, businesses have been replacing employee “wellness programs” with what they view as more comprehensive “well-being programs.”
The varied and sometimes contradictory perspectives on states of health, wellness, and well-being have important implications for both research and applied/practitioner settings. As for well-being, a recent review by Diener et al. (2017) noted that over 140,000 articles have been written on the topic, despite confusion over its use as “a broad umbrella term that refers to all different forms of evaluating one’s life or emotional experience.” They suggest that the dimensions of subjective well-being are separable and should be measured individually using well-established measurement instruments. It is not clear whether more dynamic and synergistic definitions of wellness and well-being would be amenable to this type of dissection.
In addition, the construct of well-being may be defined in narrow or broad terms, depending upon how it is being used, i.e., as an outcome, a predictor, or a moderating protective factor (Ryff, 2014). This latter issue is particularly important since research findings indicate that well-being is related to health behaviors (Ryff, 2014). Moreover, higher levels of subjective well-being are associated with better health and increased longevity (Diener et al., 2017). Since these relationships align closely with the Statement of Purpose for our Positive Health and Wellness division, it is imperative that we find some common terminology for well-being.
In conclusion, our intent for this article is to open further discussion among division members regarding the knowledgeable use of the concepts ‘health’, ‘wellness’, and ‘well-being.’ Given our division’s diversity, we may be able to offer unique perspectives on further development of these constructs, as related to methods of measurement, theoretical models, and applied/practitioner uses in teaching, coaching, and advising, the development of educational, intervention, and employee programs, for more effective patient treatments, and for enhanced public policy.
Centers for Disease Control and Prevention. Health-Related Quality of Life (HRQOL): Well- being Concepts. Available at https://www.cdc.gov/hrqol/wellbeing.htm. [Accessed January 2018].
Diener, E., Heintzelman, S. J., Kushlev, K., Tay, L., Wirtz, D., Lutes, L. D., & Oishi, S. (2017). Findings all psychologists should know from the new science on subjective well-being. Canadian Psychology, 58 (2), 87–104.
Dodge, R., Daly, A., Huyton, J., & Sanders, L. (2012). The challenge of defining wellbeing. International Journal of Wellbeing, 2 (3), 222-235.
Foster, L. T., & Keller, C. P. (2007). Defining Wellness and Its Determinants. In L. T. Foster & C. P. Keller (Eds.), The British Columbia atlas of wellness (pp. 9-19). Victoria, Canada: Western Geographical Press.
McLellan (2017). Work, health, and worker well-being: Roles and opportunities for employers. Health Affairs, 36 (2), 206–213.
Miller G & Foster L. (2010). Critical Synthesis of wellness literature. University of Victoria, Faculty of Human and Social Development & Department of Geography. Available at www.geog.uvic.ca/wellness/Critical_Synthesis%20of%20Wellness%20Update (accessed January 2018).
National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health. Wellness and Well-Being. https://nccih.nih.gov/health/wellness (accessed January 2018).
Organisation for Economic Co-operation and Development (OECD). Measuring Well-being and Progress: Well-being Research. Available at http://www.oecd.org/statistics/measuring- well-being-and-progress.htm [Accessed January 2018].
Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and Psychosomatics, 83 (1), 10–28.
Schulte, P. A., Guerin, R. J., Schill, A. L., Bhattacharya, A., Cunningham, T. R., Pandalai, S. P., Eggerth, D., & Stephenson, C. M. (2015). Considerations for Incorporating “Well-Being” in Public Policy for Workers and Workplaces. American Journal of Public Health, 105 (8),e31–e44.
Seligman, M. (2011). Authentic Happiness. Available at https://www.authentichappiness.sas.upenn.edu/learn/wellbeing
World Health Organization Ottawa Charter for Health Promotion, First International Conference on Health Promotion, Ottawa, 21 November 1986 – WHO/HPR/HEP/95.1. Available at http://www.who.int/healthpromotion/conferences/previous/ottawa/en/