Population Well-Being Linked to Life Expectancy

Nicola M. Parry, DVM

November 09, 2016

Well-being is an important measure of a population's health and longevity and represents a promising focus for intervention, according to a recent study published online November 9 in Health Affairs.

"When it comes to life expectancy, we think a lot about disease," lead author Anita Arora, MD, MBA, from Yale School of Medicine, New Haven, Connecticut, told Medscape Medical News. However, "well-being, which captures how our physical, mental and social health come together, may also be important to how long people live," she said.

According to the authors, life expectancy varies substantially across US counties, and although factors such as race, poverty, and education partly explain these differences, it remains important to identify other contributing factors. As such, the concept of population well-being is a comprehensive measure of both individual- and neighborhood-level factors that may affect the health and life expectancy of an entire community.

"We had a hypothesis that well-being was linked to life expectancy, independent of the effects of race, poverty, and education," said Dr Arora.

With this in mind, they obtained data from the Global Health Data Exchange, analyzing findings from the 2010 to 2012 Gallup-Healthways Well-being Index among 3092 US counties. This nationally representative telephone survey assessed six major components of well-being: physical health, emotional health, healthy behaviors, life evaluation, basic access, and work environment.

Overall, well-being scores for males and females ranged from 35.6 to 87.1 (mean, 66.4; standard deviation [SD], 4.2), and county life expectancies ranged from 72.6 years to 85.0 years for women and 63.9 years to 81.7 years for men. Counties with lower life expectancies were located in the South and had a higher percentage of blacks, lower education levels, and higher poverty rates than counties with higher life expectancies.

However, the researchers found that counties with higher well-being scores had greater life expectancy: every 1 SD increase in well-being score was associated with a life expectancy increase of 1.9 years for women and 2.6 years for men.

This positive association persisted even after the researchers controlled for race, poverty, and education, and well-being partially mediated the relationships of these factors with life expectancy (P < .001).

The authors also found that all six components of well-being that were assessed were significantly associated with life expectancy. In particular, the physical health index was most strongly associated: for every 1 SD increase in physical health, life expectancy was 2.0 years higher for women and 2.5 years higher for men. Similarly, for every 1 SD increase in healthy behaviors, life expectancy was 1.8 years higher for women and 2.2 years higher for men. And for every 1 SD increase in the basic access index, life expectancy was 1.6 years higher for women and 2.2 years higher for men.

According to Dr Arora, these findings have important implications for clinical practice. "As physicians, we should strive to understand and improve the overall well-being of our patients, not only because it might help them live longer, but also because well-being itself is an important health outcome," she said.

Physicians therefore need to learn more about their patients and the communities where their patients live, she added. "We need to ask patients if they feel safe in their neighborhoods, if they like where they work, if they feel happy or stressed, and if they have access to healthy foods and a place to exercise."

She also stressed the need for physicians to advocate for community-based investments that could support and improve population well-being. For example, physicians can encourage the construction of fresh food outlets and recreation centers and support local efforts to reduce neighborhood violence, she said.

"As many components of well-being are not determined by the health system, but by social and economic policies, we need to collaborate with civic leaders and policy makers to enhance the well-being of our patients," Dr Arora concluded.

Dr Arora has received funding from the Robert Wood Johnson Foundation and the National Center for Advancing Translational Science, a component of the National Institutes of Health. Several coauthors have received funding from various organizations: the Agency for Healthcare Research and Quality Patient Centered Outcomes Research Institutional Mentored Career Development Program; the Centers for Medicare and Medicaid Services; the Robert Wood Johnson Foundation; and the US Food and Drug Administration. Several authors have also reported various financial relationships with various companies: Healthways, Hugo, Johnson & Johnson (Janssen), Medtronic, and UnitedHealth.

Health Aff. Published online November 9, 2016. Abstract

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