Public Health

Reimagining public health as well-being

December 8, 2021 |8:55 min read

IN BRIEF: Today, I am writing about the importance of thinking about public health in terms of well-being, which includes physical, mental, spiritual health and the opportunity for every person to thrive. Focusing on well-being would enable us to consider how to build more effective and meaningful workplaces, including schools of public health. The inspiration for this post is a conversation between Vivek Murthy, MD, U.S. Surgeon General; Krista Tippett, host of On Being; and Richard Davidson, MD, the William James and Vilas Research Professor of Psychiatry and Psychology, and founder and director of the Center for Healthy Minds, at the University of Wisconsin–Madison.

Beyond burnout to well-being

I’ve been thinking a lot about the roles, functions and purposes of public health as we are about to embark on year three of life in the COVID-19 pandemic that has killed more than 800,000 people in the U.S. and more than 5.2 million people globally. As I and others have written, COVID-19 is one of three concurrent pandemics we are living through: there’s also the economic crisis and the pestilence of racial and other inequities in our society. This period has been difficult for people of all races, ages and income groups but, like most such tragedies, has affected vulnerable populations most seriously.

Burnout defined

We’ve heard a lot about the negative effects of these intersecting pandemics on employees. People routinely say they are burned out. Burnout — as an occupational phenomenon not a medical condition — is defined in the 11th Revision of the International Classification of Diseases (ICD-11) as follows:

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

Indeed, burnout was thought to be one of several reasons that record numbers of employees in the U.S. reportedly were quitting — or seriously considering quitting — their jobs last summer and are continuing to do so.

I don’t want to quibble over the language, but I believe the word burnout now is being used as shorthand to describe a range of emotions and feelings. During the pandemic, as millions of people were sent home to work remotely, the line between work and home was blurred; and so, the burnout concept also may be blurred by what has happened simultaneously across multiple dimensions of people’s lives. It is difficult to devise effective interventions and other solutions if we are imprecise in our language or if words are used to describe many different situations — some that may require immediate crisis intervention, and others that may be less serious.

Listening Sunday morning, Dec. 5, to one of the NPR shows I find most inspirational, On Being, I began to think that we should view public health through the lens of well-being. With attention to mental and physical health, well-being is a more comprehensive word. When people talk about burnout, what they really are telling us, in aggregate, is that their well-being has suffered. For some, it has suffered grievously. We can begin to build a healthier culture of well-being if we understand its meaning and then seek to recreate our organizations with well-being as a fundamental goal. What better place to create laboratories for well-being than schools of public health? 

Health in the broadest sense

The conversation on well-being that inspired me was between Vivek Murthy, MD, U.S. Surgeon General; Richard Davidson, MD, the William James and Vilas Research Professor of Psychiatry and Psychology at the University of Wisconsin–Madison, and founder and director of the Center for Healthy Minds there; and Krista Tippett, host of On Being.

Murthy said:
I think about well-being a lot, because I think we have an opportunity to really see health in its broadest sense; to redefine public health, not just as the absence of disease, but really as the endeavor that we all need to undertake to cultivate our ability to live at the top end of our scale, if you will, and through that, to not only enjoy life and contribute the most to the people around us, but to contribute, also, to society in the way that can move all of us forward and help us get through very difficult times, like this pandemic.

That definition of well-being should not apply only to those external to  our school but to us, as well. It is consistent with the focus of Professor Laura Linnan’s new Carolina Center for Total Worker Health® and Well-being.

Murthy continued:
But I think it’s also very important that it’s happening now, because the truth is that we can’t fully optimize our well-being, we can’t understand how to build a foundation for good health, if we don’t understand the interplay between our mental health, our physical health, our spiritual health.

And if I can just add to that, I think that the discoveries in modern medical science, neuroscience, biobehavioral science, have helped us to understand more of the details of how well-being is embodied. And so, when we think about well-being, it is not simply an ephemeral psychological state or condition, but it very much is intertwined, as you say, with our, all the organ systems in our body in ways that have demonstrable consequences for our physical health. And so, the opportunity to cultivate well-being is not simply an opportunity to cultivate these subjective qualities, but it can potentially have a profound effect on our physical health, as well. And this, I think, is one of the really exciting issues that is on the horizon now.

Look, if I — you know, one of the things I really want to do in this job is not only help us to get through this pandemic, but to really think more deeply about how we do better when it comes to mental health, about how we have a broader conversation as a country, about well-being and how we reflect that, not only in the decisions we make in our lives but how we design our schools, how we design our workplaces, and what we think of as success, when it comes to public policy — not just the dollars and cents of it, but whether or not policy contributes to a sense of well-being.

Tilting the world toward love

Murthy ended the conversation by saying,
The question I have found myself asking again and again is, what can we do in our lives, through the decisions we make, choices we make, about how to tip the scales in the world away from fear and toward love? How can we do that through how we treat other people, through what we say, through the issues we choose to speak up on in the public square, through the jobs we take and the purpose we seek to fulfill? How can we tilt the world toward love and away from fear? And that starts with what we teach our children, with what we choose to practice, like in our day-to-day life, and with fundamentally recognizing that public health is about more than policy and about structure. It’s about culture, values, and identity. And if we anchor that culture, our identity, our values in love, I think that will guide us to the place where we need to go, and truly be healthy and happy, which is, I believe, what we all want.

We’re not used to talking about organizations and love, but I believe it is a fundamental issue. We are not talking about sexual or romantic love, of course, but love as a deep connection to other people and the organizations and communities with which we are involved.

A few lessons and observations

Some lessons for us all from this conversation and my observations:

  1. We need other people. We and others benefit from connecting in a deep, authentic way, even if it is for 15 minutes a day. One of the gifts the pandemic has given me is Zoom time with my sisters in which we have asked and talked about some of the existential questions facing us as people aging in a youth-oriented society. It may be Zoom, but it feels like we’re in the same space. Try starting out Zoom meetings by asking how people are.
  2. Give the gift of presence. Be with people without checking devices and responding to other distractions. It’s something I try to do unless the world is impinging, and I then acknowledge the intrusion. As Murthy pointed out and many online studies have demonstrated, we tend to overestimate our effectiveness in multitasking. We’re not nearly as good at it as we might think. The perils of texting while driving have shown the tragedy of our overestimation.
  3. Let’s talk more about what people want from work, and what will make them feel more rewarded. What can be let go, and what must be retained? I have been impressed by faculty members who have jettisoned assignments because they recognized that students were overwhelmed. Can we begin to think more holistically about assignments across students’ programs? For ourselves, which tasks are essential, and which ones are we foisting upon ourselves? Before asking others to serve on committees, how about asking if we really need that committee and all the people we envision on it. There’s a constant tension between inclusion, representation and burden. Can we find ways to negotiate this more effectively so smaller teams can do the work and then involve others at the recommendation stage? I recognize that these are controversial suggestions that, if implemented poorly, could result in a less representative school. But I also see the impact of overcommitment, and it’s not healthy.
  4. Express gratitude every day for something, for some people. It’s good for our brains, our well-being and our relationships. When I first started doing this, it felt a bit artificial, but it has become natural.
  5. Maximize agency at work. We know, from many years of research, that workers who have a sense of agency — some autonomy over themselves, their work and their environment — are healthier, happier and more productive. At Gillings, we are part of a campus pilot that provides a fair amount of freedom for many employees to work remotely at least some of the time. We encourage folks to work with supervisors to tailor arrangements, where possible, to meet their own and the school’s needs. We want everyone to feel satisfied, be healthy and continue to care deeply about they do.

Well-being begins where we are. We can do better.

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The views expressed in this blog are Barbara Rimer’s alone and do not represent the views and policies of The University of North Carolina or the Gillings School.