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Well-being Concepts

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Well-being is a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well. Good living conditions (e.g., housing, employment) are fundamental to well-being. Tracking these conditions is important for public policy. However, many indicators that measure living conditions fail to measure what people think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life—i.e., their “well-being.”1, 2 Well-being generally includes global judgments of life satisfaction and feelings ranging from depression to joy.3, 4

Why is well-being useful for public health?

  • Well-being integrates mental health (mind) and physical health (body) resulting in more holistic approaches to disease prevention and health promotion.6
  • Well-being is a valid population outcome measure beyond morbidity, mortality, and economic status that tells us how people perceive their life is going from their own perspective.1, 2, 4, 5
  • Well-being is an outcome that is meaningful to the public.
  • Advances in psychology, neuroscience, and measurement theory suggest that well-being can be measured with some degree of accuracy.2, 7
  • Results from cross-sectional, longitudinal and experimental studies find that well-being is associated with:1, 8
    • Self-perceived health.
    • Longevity.
    • Healthy behaviors.
    • Mental and physical illness.
    • Social connectedness.
    • Productivity.
    • Factors in the physical and social environment.
  • Well-being can provide a common metric that can help policy makers shape and compare the effects of different policies (e.g., loss of greenspace might impact well-being more so than commercial development of an area).4, 5
  • Measuring, tracking and promoting well-being can be useful for multiple stakeholders involved in disease prevention and health promotion.

Well-being is associated with numerous health-, job-, family-, and economically-related benefits.8 For example, higher levels of well-being are associated with decreased risk of disease, illness, and injury; better immune functioning; speedier recovery; and increased longevity.9-13 Individuals with high levels of well-being are more productive at work and are more likely to contribute to their communities.4, 14

Previous research lends support to the view that the negative affect component of well-being is strongly associated with neuroticism and that positive affect component has a similar association with extraversion.15, 16 This research also supports the view that positive emotions—central components of well-being—are not merely the opposite of negative emotions, but are independent dimensions of mental health that can, and should be fostered.17, 25 Although a substantial proportion of the variance in well-being can be attributed to heritable factors,26, 27 environmental factors play an equally if not more important role.4, 5, 28

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How does well-being relate to health promotion?

Health is more than the absence of disease; it is a resource that allows people to realize their aspirations, satisfy their needs and to cope with the environment in order to live a long, productive, and fruitful life.25, 29-31 In this sense, health enables social, economic and personal development fundamental to well-being.25, 30, 31 Health promotion is the process of enabling people to increase control over, and to improve their health.25, 30, 32 Environmental and social resources for health can include: peace, economic security, a stable ecosystem, and safe housing.30 Individual resources for health can include: physical activity, healthful diet, social ties, resiliency, positive emotions, and autonomy. Health promotion activities aimed at strengthening such individual, environmental and social resources may ultimately improve well-being.24, 25

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How is well-being defined?

There is no consensus around a single definition of well-being, but there is general agreement that at minimum, well-being 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.4, 33-35 In simple terms, well-being can be described as judging life positively and feeling good.36, 37 For public health purposes, physical well-being (e.g., feeling very healthy and full of energy) is also viewed as critical to overall well-being. Researchers from different disciplines have examined different aspects of well-being that include the following:4, 34, 38, 39, 41-46

  • Physical well-being.
  • Economic well-being.
  • Social well-being.
  • Development and activity.
  • Emotional well-being.
  • Psychological well-being.
  • Life satisfaction.
  • Domain specific satisfaction.
  • Engaging activities and work.

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How is well-being measured?

Because well-being is subjective, it is typically measured with self-reports.40 The use of self-reported measures is fundamentally different from using objective measures (e.g., household income, unemployment levels, neighborhood crime) often used to assess well-being. The use of both objective and subjective measures, when available, are desirable for public policy purposes.5

There are many well-being instruments available that measure self-reported well-being in different ways, depending on whether one measures well-being as a clinical outcome, a population health outcome, for cost-effectiveness studies, or for other purposes. For example, well-being measures can be psychometrically-based or utility-based. Psychometrically-based measures are based on the relationship between, and strength among, multiple items that are intended to measure one or more domains of well-being. Utility-based measures are based on an individual or group’s preference for a particular state, and are typically anchored between 0 (death) to 1 (optimum health). Some studies support use of single items (e.g., global life satisfaction) to measure well-being parsimoniously. Peer reports, observational methods, physiological methods, experience sampling methods, ecological momentary assessment, and other methods are used by psychologists to measure different aspects of well-being.42

Over the years, for public health surveillance purposes, CDC has measured well-being with different instruments including some that are psychometrically-based, utility-based, or with single items:

SurveyQuestionnaires/questions

National Health and Nutrition Examination Survey (NHANES)

  • General Well-Being Schedule (1971–1975).43,44

National Health Interview Survey (NHIS)

  • Quality of Well-being Scale.45
  • Global life satisfaction.
  • Satisfaction with emotional and social support.
  • Feeling happy in the past 30 days.

Behavioral Risk Factor Surveillance System (BRFSS)

  • Global life satisfaction.
  • Satisfaction with emotional and social support.47, 48

Porter Novelli Healthstyles Survey

  • Satisfaction with Life Scale.49
  • Meaning in life.50
  • Autonomy, competence, and relatedness.51
  • Overall and domain specific life satisfaction.
  • Overall happiness.
  • Positive and Negative Affect Scale.52

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What are some findings from these studies?

  • Data from the NHANES I (1971–1975), found that employed women had a higher sense of well-being and used fewer professional services to cope with personal and mental health problems than their nonemployed counterparts.53
  • Data from the 2001 NHIS and Quality of Well-Being scale, a preference based scale which scores well-being between 0-1, found that males or females between the ages of 20–39 had significantly better well-being (scores ≥ 0.82) compared to males or females 40 years of age or older (scores >0.79).54
  • Data from the 2005 Behavioral Risk Factor Surveillance System found that 5.6% of U.S. adults (about 12 million) reported that they were dissatisfied/very dissatisfied with their lives.48
  • Data from the 2005 BRFSS found that about 8.6% of adults reported that they rarely/never received social and emotional support; ranging in value from 4.2% in Minnesota to 12.4% in the U.S. Virgin Islands.47
  • Based on 2008 Porter Novelli HealthStyles data.55
    • 11% of adults felt cheerful all of the time in the past 30 days.
    • 15% of adults felt calm and peaceful all of the time in the past 30 days.
    • 13% of adults felt full of life all of the time in the past 30 days.
    • 9.8% of adults strongly agree that their life is close to their ideal.
    • 19% of adults strongly agree that they are satisfied with their life.
    • 21% of adults strongly agree that their life has a clear sense of purpose.
    • 30% of adults strongly agree that on most days they feel a sense of accomplishment from what they do.

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What are some correlates and determinants of individual-level well-being?

There is no sole determinant of individual well-being, but in general, well-being is dependent upon good health, positive social relationships, and availability and access to basic resources (e.g., shelter, income).

Numerous studies have examined the associations between determinants of individual and national levels of well-being. Many of these studies have used different measures of well-being (e.g., life satisfaction, positive affect, psychological well-being), and different methodologies resulting in occasional inconsistent findings related to well-being and its predictors.37, 56 In general, life satisfaction is dependent more closely on the availability of basic needs being met (food, shelter, income) as well as access to modern conveniences (e.g., electricity). Pleasant emotions are more closely associated with having supportive relationships.5

Some general findings on associations between well-being and its associations with other factors are as follows:

Genes and Personality

At the individual level, genetic factors, personality, and demographic factors are related to well-being. For example, positive emotions are heritable to some degree (heritability estimates range from 0.36 to 0.81), suggesting that there may be a genetically determined set-point for emotions such as happiness and sadness.26,27,57,58,59 However, the expression of genetic effects are often influenced by factors in the environment implying that circumstances and social conditions do matter and are actionable from a public policy perspective. Longitudinal studies have found that well-being is sensitive to life events (e.g., unemployment, marriage).60, 61 Additionally, genetic factors alone cannot explain differences in well-being between nations or trends within nations.

Some personality factors that are strongly associated with well-being include optimism, extroversion, and self-esteem.20, 62 Genetic factors and personality factors are closely related and can interact in influencing individual well-being.

While genetic factors and personality factors are important determinants of well-being, they are beyond the realm of public policy goals.

Age and Gender

Depending on which types of measures are used (e.g., life satisfaction vs. positive affect), age and gender also have been shown to be related to well-being. In general, men and women have similar levels of well-being, but this pattern changes with age,63 and has changed over time.64 There is a U-shaped distribution of well-being by age—younger and older adults tend to have more well-being compared to middle-aged adults.65

Income and Work

The relationship between income and well-being is complex.4, 39, 65 Depending on which types of measures are used and which comparisons are made, income correlates only modestly with well-being. In general, associations between income and well-being (usually measured in terms of life satisfaction) are stronger for those at lower economic levels, but studies also have found effects for those at higher income levels.66 Paid employment is critical to the well-being of individuals by conferring direct access to resources, as well as fostering satisfaction, meaning and purpose for some.67 Unemployment negatively affects well-being, both in the short- and long-term.61, 65, 67

Relationships

Having supportive relationships is one of the strongest predictors of well-being, having a notably positive effect.68, 69

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What are some correlates of well-being at the national level?

Picture of mother and daughterCountries differ substantially in their levels of well-being.4, 70 Societies with higher well-being are those that are more economically developed, have effective governments with low levels of corruption, have high levels of trust, and can meet citizens’ basic needs for food and health.4, 5 Cultural factors (e.g., individualsm vs. collectivism, social norms) also play a role in national estimates of well-being.70

What is the difference between health-related quality of life, well-being, flourishing, positive mental health, optimal health, happiness, subjective well-being, psychological well-being, life satisfaction, hedonic well-being, and other terms that exist in the literature?71

Some researchers suggest that many of the terms are synonymous, whereas others note that there are major differences based on which dimensions are independent and contribute most to well-being.37, 71 This is an evolving science, with contributions from multiple disciplines. Traditionally, health-related quality of life has been linked to patient outcomes, and has generally focused on deficits in functioning (e.g., pain, negative affect). In contrast, well-being focuses on assets in functioning, including positive emotions and psychological resources (e.g., positive affect, autonomy, mastery) as key components. Some researchers have drawn from both perspectives to measure physical and mental well-being for clinical and economic studies. Subjective well-being typically refers to self-reports contrasted with objective indicators of well-being. The term, “positive mental health” calls attention to the psychological components that comprise well-being from the perspective of individuals interested primarily in the mental health domain. From this perspective, positive mental health is a resource, broadly inclusive of psychological assets and skills essential for well-being.24, 25 But, the latter generally excludes the physical component of well-being. “Hedonic” well-being focuses on the “feeling” component of well-being (e.g., happiness) in contrast to “eudaimonic” well-being which focuses on the “thinking” component of well-being (e.g., fulfillment).35 People with high levels of positive emotions, and those who are functioning well psychologically and socially are described by some as having complete mental health, or as “flourishing.” 46

In summary, positive mental health, well-being and flourishing refer to the presence of high levels of positive functioning—primarily in the mental health domain (inclusive of social health). However, in its broadest sense, well-being encompasses physical, mental, and social domains.

The reasons why well-being and related constructs should be measured and evaluating how these domains can be changed should help inform which domains (e.g., life satisfaction, positive affect, autonomy, meaning, vitality, pain) should be measured, and which instruments and methods to use.71

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What is CDC doing to examine and promote well-being?

CDC’s Health-Related Quality of Life Program has led an effort since 2007 to examine how well-being can be integrated into health promotion and how it can be measured in public health surveillance systems. A number of studies are underway examining the feasibility of existing scales for surveillance, including application of item-response theory to identify brief, psychometrically sound short-form(s) that can be used in public health surveillance systems. CDC and three states (OR, WA, NH) are collecting data using the Satisfaction with Life Scale on the 2010 Behavioral Risk Factor Surveillance System. CDC also is leading the development of overarching goals related to quality of life and well-being for the Healthy People 2020 initiative.

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Resources

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1. Diener E, Seligman ME. Beyond money. Toward an economy of well-being. Psychological Science in the Public Interest 2004;5(1):1–31.

2. Diener E. Assessing well-being: the collected works of Ed Diener. New York: Springer; 2009.

3. Diener E, Scollon CN, Lucas RE. The evolving concept of subjective well-being: the multifaceted nature of happiness. In: E Diener (ed.) Assessing well-being: the collected works of Ed Diener. New York: Springer; 2009:67–100.

4. Frey BS, Stutzer A. Happiness and economics. Princeton, N.J.: Princeton University Press; 2002.

5. Diener E, Lucas R, Schimmack U, and Helliwell J. Well-Being for public policy. New York: Oxford University Press; 2009.

6. Dunn HL. High level wellness. R.W. Beatty, Ltd: Arlington; 1973.

7. Kahneman D. Objective happiness. In: D Kahneman, E Diener, and N Schwartz (eds.) Well-being: the foundations of hedonic psychology. New York: Russell Sage Foundation; 1999:3–25.

8. Lyubomirsky S, King L, Diener E. The benefits of frequent positive affect: does happiness lead to success? Psychol Bull 2005;131(6):803–855.

9. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull 2005;131:925–971.

10. Ostir GV, Markides KS, Black SA. et al. Emotional well-being predicts subsequent functional independence and survival. J Am Geriatr Soc 2000;48:473–478.

11. Ostir GV, Markides KS, Peek MK, et al. The association between emotional well-being and incidence of stroke in older adults. Psychosom Med 2001;63:210–215.

12. Diener E, Biswas-Diener R. Happiness: Unlocking the mysteries of psychological wealth. Malden, MA: Blackwell Publishing; 2008.

13. Frederickson BL, Levenson RW. Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cognition and Emotion 1998;12:191–220.

14. Tov W, Diener E. The well-being of nations: Linking together trust, cooperation, and democracy. In: BA Sullivan, M Snyder, JL Sullivan (Eds.) Cooperation: The psychology of effective human interaction. Malden, M.A.: Blackwell Publishing; 2008:323–342.

15. Diener E, Lucas RE. Personality and subjective well-being. In: D. Kahneman, E. Diener, and N. Schwartz (eds.). Well-being: the foundations of hedonic psychology. New York: Russell Sage Foundation; 2003:213–229.

16. Steel P, Schmidt J, Schultz, J. Refining the relationship between personality and subjective well-being. Psychological Bulletin2008;134(1):138–161.

17. Bradburn NM. The structure of psychologal well-being. Chicago: Aldine; 1969.

18. Diener E, Emmons RA. The independence of positive and negative affect. Journal of Personality and Social Psychology 1984;47:1105–1117.

19. Ryff CD, Love GD, Urry LH, et al. Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? Psychother Psychosom 2006;75:85–95.

20. Costa PT, McCrae RR. Influence of extraversion and neuroticism on subjective well-being: happy and unhappy people. Journal of Personality and Social Psychology 1980;38:668–678.

21. Schimmack U. The structure of subjective well-being. In: M Eid, RJ Larsen (eds). The science of subjective well-being. New York: Guilford Press; 2008.

22. Seligman ME. Authentic happiness. New York, NY: Free Press; 2002.

23. Frederickson, B.L. Positivity. New York: Crown Publishing; 2009.

24. Tellegen A, Lykken DT, Bouchard TJ, Wilcox KJ, Segal NL, Stephen R. Personality similarity in twins reared apart and together. J Pers Soc Psychol 1988;54(6):1031–1039.

24. Herrman HS, Saxena S, Moodie R. Promoting Mental Health: Concepts, Emerging Evidence, Practice. A WHO Report in collaboration with the Victoria health Promotion Foundation and the University of Melbourne. Geneva: World Health Organization; 2005. http://www.who.int/mental_health/evidence/MH_Promotion_Book.pdf [PDF - 1.98MB]. Accessed Oct. 1, 2010

26. Barry MM, Jenkins R. Implementing Mental Health Promotion. Oxford: Churchill Livingstone, Elsevier. 2007

27. Lykken D, Tellegen A. Happiness is a stochastic phenomenon. Psychol Sci 1996;7:186–189.

28. Diener E, Lucas RE, Scollon CN. Beyond the hedonic treadmill: revising the adaptation theory of well-being. American Psychologist 2006;61(4):305–314.

29. World Health Organization. 1949. WHO Constitution. Retrieved February 12, 2008 from http://www.who.int/about/en/.

30. 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/

31. Breslow, L. Health measurement in the third era of public health. American Journal of Public Health 2006;96:17–19.

32. Green L., Kreuter M. "Health Promotion as a Public Health Strategy for 1990s". Annual Review of Public Health 1990;11:313–334).

33. Andrews FM, Withey SB. Social indicators of well-being. NewYork: Plenum Press; 1976:63–106.

34. Diener E. Subjective well being: the science of happiness and a proposal for a national index. American Psychologist 2000;55(1):34–43.

35. Ryff CD, Keyes CLM. The structure of psychological well-being revisited. Journal of Personality and Social Psychology 1995;69(4):719–727.

36. Diener E, Suh E, Oishi S. Recent findings on subjective well-being. Indian Journal of Clinical Psychology 1997;24:25–41.

37. Veenhoven R. Sociological theories of subjective well-being. In: M Eid , RJ Larsen (eds). The science of subjective well-being. New York: Guilford Press; 2008:44–61.

38. Csikszentmihalyi M. Flow: The Psychology of Optimal Experience. New York, NY: Harper Perennial; 1991.

39. Diener E, Suh EM, Lucas R, Smith H. Subjective well-being: Three decades of progress. Psychological Bulletin 1999;125:276–302.

40. Larsen RJ, Eid M. Ed Diener and The Science of Subjective Well-Being. In: RJ Larsen and M Eid, (Eds.) The Science of Subjective Well-Being. New York: Guildford Press, 2008:1–12.

41. Kahneman D, Krueger AB, Schkade DA, Schwarz N, Stone AA. A survey method for characterizing daily life: the day reconstruction method. Science 2004;306:1776–1780.

42. Eid M. Measuring the Immeasurable: Psychometric modeling of subjective well-being data. In: Eid M, Larsen RJ (eds.) The science of subjective well-being. New York: Guilford Press; 2008:141–167.

43. Dupuy HJ (1978). Self-representations of general psychological well-being of American adults. Paper presented at the American Public Health Association Meeting, Los Angeles, October, 1978.

44. Fazio, A.F. (1977). A concurrent validational study of the NCHS General Well-Being Schedule. Hyattsville, MD: U.S. Department of Health, Education and Welfare, national Center for Health Statistics, 1977. Vital and Health Statistics Series 2, No. 73. DHEW Publication No. (HRA) 78-1347.

45. Kaplan RM, Anderson JP. The quality of well-being scale: Rationale for a single quality of life index. In: SR Walker, R Rosser (Eds.) Quality of Life: Assessment and Application. London: MTP Press; 1988:51–77.

46. Keyes CLM. The mental health continuum: from languishing to flourishing in life. J Health Soc Res 2002;43(6):207-222.

47. Strine TW, Chapman DP, Balluz LS, Mokdad AH. Health-related quality of life and health behaviors by social and emotional support: Their relevance to psychiatry and medicine. Social Psychiatry and Psychiatric Epidemiology 2008;43(2):151–159.

48. Strine TW, Chapman DP, Balluz LS, Moriarty DG, Mokdad AH. The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U.S. community-dwelling adults. Journal of Community Health 2008;33(1):40–50.

49. Diener E, Emmons R, Larsen J, Griffin S. The Satisfaction with Life Scale. J Personality Assessment 1985;49:71–75.

50. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. J of Counseling Psychology 2006;53(1):80–93.

51. Deci EL, Ryan RM. The “what” and “why” of goal pursuit: Human needs and self-determination of behavior. Psychological Inquiry 2000;11:227–268.

52. Watson D, Clark LA, Tellegen A. Development and validation of brief measure of positive and negative affect: the PANAS scales. J of Personality and Social Psychology 1988;54(6):1063–70.

53. Wheeler et al, Employment, sense of well-being and use of professional services among women. Am J Public Health 1983;73:908–911.

54. Hanmer, et al. Report of nationally representative values for the noninstitutionalized US adult population for 7 health-related quality of life scores. Med Decisi Making 2006;26:391–400.

55. Kobau R, Sniezek J, Zack MM, Lucas RE, Burns A. Well-being assessment: an evaluation of well-being scales for public health and population estimates of well-being among U.S. adults. Applied Psychology: Health and Well-Being 2010;

56. Kahneman D, Deaton A. High income improves evaluation of life but not emotional well-being. Proceedings of the National Academy of Sciences, doi/10.1073/pnas.1011492107.

57. King LA. Interventions for enhancing subjective well-being: can we make people happier and should we? In: M Eid, RJ Larsen, (eds.) The Science of Subjective Well-Being. New York, NY: Guilford Press; 2008:431–448.

58. Nes RB, Roysamb E, Tambs K, Harris JR, Reichborn-Kjennerud T. Subjective well-being: genetic and environmental contributions to stability and change. Psychol Med 2006;36:1033–1042.

59. Schnittker J. Happiness and success: genes, families, and the psychological effects of socioeconomic position and social support. Am J Sociol 2008;114:S233–S259.

60. Lucas RE, Clark AE, Georgellis Y, Diener E. Unemployment alters the set point for life satisfaction. Psychological Science 2004;15:8–13.

61. Lucas RE, Clark AE, Georgellis Y, Diener E. Reexamining adaptation and the set-point model of happiness: Reactions to changes in marital status. Journal of Personality and Social Psychology 2003;84:527–539.

62. Diener E, Oishi S,and Lucas RE. Personality, culture, and subjective well-being: emotional and cognitive evaluations of life. Annual Review of Psychology 2003;54:403–425.

63. Inglehart R. Gender, aging, and subjective well-being. Intl J Comp Sociol 2002;43(3-5):391–408.

64. Stevenson B, and Wolfers J. The paradox of declining female happiness. National Bureau of Economic Research. Working paper 14969; 2009. (http://www.nber.org/papers/w14969

65. Argyle, M. Causes and correlates of happiness. In: D Kahneman, E Diener, N Schwarz (Eds.) Well-being: the foundations of hedonic psychology. New York: Russell Sage Foundation; 1999:307–322:353–373.

66. Biswas-Diener RM. Material wealth and subjective well-being. In: M Eid, RJ Larsen (eds). The science of subjective well-being. New York: Guilford Press; 2008:307–322.

67. Warr P. Well-being in the workplace. In: D Kahneman , E Diener, N Schwarz (eds.) Well-Being: The foundations of hedonic psychology. New York: Russell Sage Foundation Publications; 2003:392–412.

68. Myers DG. Close relationships and quality of life. In: D Kahneman, E Diener, N Schwarz. (eds.) Well-Being: The foundations of hedonic psychology. New York: Russell Sage Foundation Publications; 2003:374–391.

69. Diener E, Suh EM. National differences in subjective well-being. In: D Kahneman, E Diener, N Schwarz. (eds.) Well-Being: The foundations of hedonic psychology. New York: Russell Sage Foundation Publications; 2003:434–450.

70. Helliwell JF, Huang H. How’s your government? International evidence linking good government and well-being. British Journal of Political Science 2008;38:595–619.

71. Hird S. What is well-being? A brief review of current literature and concepts. NHS Scotland; 2003.

 

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