Column

Leave well being alone

‘Oh dear. I don’t like the look of this.’

‘What is it doctor? Tell me!’

‘Well, it’s the results of the test. They are… er… rather unfavourable I’m sorry to say.’

‘What test? What does it mean? What have I got?’

‘It’s the Well-being Test I’m afraid. You know, the assessment we took from you last week? I’ve just got the print out back from the lab. It says your level of well-being is -27.3865. In lay terms your well-being is about mid-way between ‘moderately’ and ‘severely’ deficient.’

‘But I feel fine, doc!’

‘Oh no. I’m afraid you can’t possibly feel fine. I suspect you feel really rather awful. You do, don’t you?’

‘No. I don’t as a matter of fact. I’m just great at the moment. I’ve landed this new part. I’ve moved in with Brian. Things are going well.’

‘You will forgive me, but I beg to differ. Look at your WB profile. You never exercise. You’re almost always up until the early hours. You drink. You smoke. You read philosophy. Frankly, you’re riddled with angst... Look at you. You’re 29 and you’ve never had a steady job. There’s no sign of marriage. You move from flat to flat. All you’ve got is a few books, some scruffy clothes, and a guitar. And you’re trying to tell me that you’ve got well-being?’

‘Doc. I’m an actor. It’s what I want.’

‘Need I say more? There is hope, but it’ll be touch and go. What you have to do is…’

v

Fantasy? Science-fiction? Out of the question? Not these days. Forget health promotion. Well-being is what reallymatters.

There are, admittedly, a few technical hitches to be overcome. There are certain prerequisites for the credible promotion of well-being: a workable theory, an understanding of the causal links between ‘lifestyles’ and ‘well-being outcomes’ and an objective means of assessment. None of which are currently available.

But not to worry. An influential group of health promoters claims to know what ‘well-being’ is. They say they can distinguish between ‘subjective’ and ‘objective’ well-being (apparently you can be mistaken about your ‘subjective’ well-being whereas ‘objective’ well-being is a matter of fact). And that the way to ensure ‘objective’ well-being is to put in place the means for ‘balanced’ living.

Anyone who claims to know the components of ‘objective’ well-being is bound to offer a selective account of ‘the good life’. The present trend is to say that (true) well-being is possible only for those who live in particular sorts of ways (for instance, for those who ‘live moderately’, who plan ‘sensibly’ for the future, and who uphold ‘family values’).

Such ways of life may well be widely commended, but they are very clearly not the only ways in which people can choose to live.

The argument that health professionals should seek to bring about well-being must be concerned with the ends of human activity. The trouble with this is that any specific account of well-being will inevitably be prescriptive about all human thoughts and actions (since all thoughts and actions must, in one way or another, have a bearing on an individual’s goals).

It is immensely important to be clear about the implications of adopting well-being as the ultimate purpose of health care. It may well be that some people’s lives are a waste. It may be that some people just get it wrong, and drift through life without ever finding a fulfilling path. Preventable ‘cases’ perhaps.

But ‘bad life’ prevention comes at too high a price. At a stroke the adoption of a theory of well-being legitimises social judgements: you’re a smoker, you’re unfit, you take too many risks. For liberty’s sake, health workers should leave the well-being of others alone.