In recent years, the Gross National Happiness (GNH) has emerged as a contender to the Gross Domestic Product (GDP), the latter being a traditional measure of the country’s overall economic output. The issue with GDP is that it does not give a reflection of the standards of living. And it ignores the generation of diseconomies or negative externalities, otherwise known as negative environmental impacts such as air or noise pollution. Hence, the suggestion of Gross National Happiness as an alternative indicator, because it measures quality of life in holistic and psychological terms.
Originally coined in 1972 by Bhutan’s former King Jigme Singye Wangchuck, GNH comprises four pillars – economic self-reliance, environmental conservation, cultural preservation and good governance. Years later in 2006, Med Jones, President of International Institute of Management proposed the measurement of GNH as the average of the following measurements – economic wellness, environmental wellness, physical wellness, mental wellness, workplace wellness, social wellness and political wellness.
Arguably, serious weight should be accorded to GNH by policy planners; it is not goal of this essay to argue the superiority of GNH over GDP, but rather to advocate consideration be given to the former besides other economic indicators. This essay will utilize the biopsychosocial-envionmental-cultural model of health as a recurring theme, which incorporates all four pillars of GNH and their interplay in the shaping of human health. The latter model also establishes crucial links between the various wellnesses (physical, economic, mental etc) as proposed by Jones in an earlier point.
What exactly is the biopsychosocial-environmental-cultural model of health? It is basically a model which posits that biological, psychological, social, environmental and cultural factors affect human functioning in the context of human health. This possibly establishes GNH as a predictor of the general health of the population, and by its extension the economic costs associated with the loss of health.
The first in the list is economic wellness, and one of the four pillars – economic self-reliance. The question is how the latter is related to human health? Economic well-being directly affects the nutritional well-being of the individual. Thus, we are interested to know if the individual is able to afford a nutritious diet with all the food groups fulfilling the required daily intake. The ability to afford nutritious food groups and consume a healthy diet is especially crucial to pregnant mothers and that of both mother and child after the latter is born. It is known that early life nutrition affects the risk of the child to cancers, asthma, lung disease and osteoporosis.
Access to affordable medical treatment is also determined by socio-economic status but it is also to a certain degree determined by good governance, the fourth pillar of GNH. A policy research working paper authored by Maureen Lewis and Gunilla Petterson and published by the World Bank described good governance as the” traditions and institutions by which authority in a country is exercised for the common good, which includes the process of selecting those in authority, capacity of the government to manage, and respect for the state.”
Good governance in health systems ensures smooth delivery of health services and includes essential elements such as appropriate standards, incentives, information, and accountabilities. Poor governance results in inefficiency of healthcare service provision or in some cases, no service at all. The dearth of standards, information, incentives, and accountability not only leads to poor healthcare provision, but also eventually to corruption – the use of public office for personal gains.
Elaborating on the next wellness index, environmental; it is not difficult to see why environmental issues can have an impact on human health. Air pollution causes respiratory diseases whilst noise pollution takes a “toll on human health and happiness” through interruption of sleep, slight suppression of our immune system and increases the chances of a heart attack, screams a headline in the Washington Post reporting on the studies done to analyze the health impacts of noise pollution.
According to an analysis of health costs as a result of road traffic-related air pollution in three European countries – France, Austria and Switzerland published by the World Health Organization (WHO), Austria incurred the highest per capita (per head) cost which ranges from 425 to 1,250 EUROs. The Swiss incurred 297 to 892 EUROs whilst the French spent 344 to 1,004 EUROs. Hence, this hammers home the importance of the second pillar of GNH – environmental conservation.
Mental wellness is considered an important determinant of human health, and impacts on one’s ability to function in the workplace which is related to income and current socio-economic status. And again, mental wellness is dependent on workplace wellness and social wellness. The mental wellness model developed by Myers, Sweeney and Witmer included 5 life tasks – essence/spirituality, work, leisure, friendship, love and self-direction. Those who are diagnosed with anxiety disorders are not able to function as other normal persons do in their workplace or school, and they are likely to suffer from heart disease later on in life. Mental disorders exert a significant burden on society.
To put things into perspective, depression rose from number 4 in terms of Disability Adjusted Life Years (DALYs) during the 1990s to 2 in our current era, according to WHO estimates. In simple terms, DALY is the measure of disease burden which is the impact of health problems expressed in terms of financial costs, death, ill-health, disability and other indicators. The economic cost of depression is staggering; in US, companies are losing up to $44 billion a year due to loss of productivity directly related to depression.
Mental wellness and social wellness are factors which determine the individual’s propensity to turn to substance abuse. Tobacco use results in the largest burden in Europe and South-East Asia while alcohol poses the largest burden in Africa, the Americas, and Western Pacific. The issue with tobacco use is that it affects not only the health of the smoker, but also those around him whom are passive smokers, all of whom are at risk of suffering from respiratory and cardiovascular diseases and cancer. The problems with regards to alcohol abuse are well-documented. Issues include absenteeism from work which constitutes a loss of productivity.
The economic cost of alcohol consumption in Thailand comprises 1.99% of its GDP in 2006. In Australia, absenteeism attributed to alcohol use resulted in an estimated 7,402,341 work days lost at a cost of AUD 1.2 billion. More alarmingly, road traffic accidents has now leapfrogged from number 9 in the DALY charts during the 1990s to 3 in the current era, which means that it exerts a sizable global burden, and it is worrying that alcohol consumption is a major contributing factor to road accidents.
Cultural wellness has important ramifications on human health due to its interplay with social and mental well-being, the combination of which ultimately determines human health. Culture is what defines a community – its language, customs or rituals, dress codes and other forms of practice. The threat to indigenous or/and local culture has always been displacement or erosion by outside forces. Due to settlements from Europe, the indigenous people of Australia have faced erosion of their culture. As a result, there is a breakup of the indigenous community, there is loss of kin, language and eventual social isolation, which have an adverse impact on mental, physical and emotional health. Such individuals are at risk of suicide, substance abuse and depression, and as a result may develop cardiovascular diseases and other chronic illnesses later on in life.
Much of the preceding elaboration is on how economic, social, mental, environmental and cultural forces shape health and their impact on the society. The factors that GDP ignores are the very ones that result in future costs to the community both socially and economically. The biopsychosocial-environmental-cultural model of health should be considered as an extension to the GNH, albeit in the health context– the components that makeup GNH are also variables of the model and are in interplay with each other to produce outcomes in human health.
In recent years, increasing focus has been accorded to environmental issues, the latter being a constituent of GNH. Last year’s United Nations Climate Change Summit (COP15) saw carbon dioxide emission reductions as the main agenda. Before the COP15 summit, Obama announced new emissions rules which demand greater efficiency of fuel usage and reduce the number of barrels of oil needed, and ultimately vehicle emissions.
To conclude, it may be very tempting for a policy planner to be fixated on the health of the economy in terms of GDP numbers. Yet, we cannot ignore the health of the nation’s populace in social, physical, psychological, cultural and environmental terms. Granted that GNH may not tell us much about how well the economy is doing, yet if we apply its variables to the biopsychosocial-environmental-cultural model of human health, we can determine the likely impact it has on the health of the populace.
Put simply, a very, very unhappy populace as indicated by poor GNH indicators tells us one thing – declining quality of human health, escalating costs of healthcare and economic losses of productivity as a result. Thus, an apt advice to a policy planner obsessed with GDP at the expense of the country’s Gross National Happiness – Is it worth it to accumulate wealth today, only to spend it on declining health and sustain losses in productivity tomorrow?