Title:What it means to be well

The world is facing a silent but growing public health crisis—a decline in mental health and well-being.

People’s experiences of negative emotions, such as sadness, worry, stress, and anger, have reached a record high, according to Gallup’s 2023 Global Emotions Report. While COVID-19 played a significant role in the decrease in mental health and well-being, the trend long predates the pandemic. Today, multiple con – current forces, including war, climate disasters, economic uncertainty, xenophobia, and political upheaval, continue to directly undermine people’s sense of well-being.

This is not just about feelings, however—there is a well-established link between well-being and health, both physical and mental. Negative emotions are associated with an increased risk of heart disease, stroke, and dementia, among other serious physical conditions, in addition to mental health disorders such as depression and anxiety.

Two prime examples of negative emotions, loneliness and social isolation, have been closely linked to poor health outcomes. An oft-cited 2010 study found that chronic loneliness is as detrimental to one’s health as smoking up to 15 cigarettes a day. Other research has determined that loneliness and isolation can increase the risk of premature death by as much as 30 percent.

Though the warning light is flashing, the world’s public health infrastructure and attitudes are not oriented to contend with a crisis of well-being, experts say.

A signature focus

Georgetown’s new School of Health seeks to reshape the conversation around wellbeing and health by asking: “What does it mean to be well?” Launched in 2022, the school is explicitly and intentionally centering well-being as a signature focus for its research and academic missions.

School of Health Dean Christopher J. King says the focus is a natural fit.

“To improve the health of individuals, communities, and populations, we have to center well-being,” King says. “People do better for the world when we are doing well—when all our physical, mental, emotional, and spiritual needs are nurtured. But this broader picture has too often been missing from the conversation around health.”

For King, the focus reinforces the school’s commitment to approaching health through an interdisciplinary lens.

“We can’t focus on well-being and health without having different disciplines and sectors at the table,” King says. “For example, if we don’t engage the social sciences, history, linguistics, and other disciplines, we are missing an enormous opportunity.”

In this spirit, two School of Health faculty members, Shabab Wahid and Derek Griffith, along with other collaborators from across Georgetown, responded to a call for proposals from King to submit a “big idea” to the School of Health. Their idea, which was selected by the school’s leadership, is to create a Global Mental Health & Well-being Initiative that builds on work undertaken across the university.

This interdisciplinary initiative will pilot research, pedagogy, and advocacy around mental wellness and psychosocial issues, bringing together more than 40 Georgetown faculty, staff, and affiliates from the School of Health, School of Foreign Service, College of Arts & Sciences, School of Medicine, the Center for Global Health Science and Security, and the Law Center.

Wellbeing Project, a global partnership to help advance the well-being of those working in social change and education. Georgetown, the only higher education partner, is joined by Ashoka, Impact Hub, Porticus, the Skoll Foundation, and Synergos.

By leveraging the university’s existing strengths in this area, King says the School of Health is well-positioned to be a leader in establishing well-being as central to health.

“I see this as our opportunity to deepen and expand the conversation around wellbeing—among our students, in our communities, and around the globe—as a key driver of helping people live healthy and fulfilling lives,” King says.

An elusive definition

With no universally accepted definition, the term “well-being” can be challenging to pin down.

Well-being can be thought of as the fullest embodiment of mental, physical, psychological, and spiritual health, including healthy relationships, social ties, a sense of empowerment and belonging, and emotional resiliency, among other variables. But it can also be defined by the absence of social ills, such as loneliness, isolation, violence, racism and bigotry, political disenfranchisement, and exclusion.

“What is important to remember is that well-being is not solely objective. It is not only what somebody else observes, but also necessitates inclusion of a person’s own subjective assessment of their own state of health,” says Wahid, assistant professor in the department of global health at the School of Health, who studies the interrelationship between climate change and mental health and well-being.

According to Griffith, professor of health management and policy at the School of Health, well-being can be defined as that which gives your life meaning and purpose.

“I think of it as the founding principles of our country: life, liberty, and the pursuit of happiness,” he says. “It is about what we are trying to achieve in life and what things are important to us about being alive.”

In formulating the mission and vision of the new school, Georgetown is leaning into existing international frameworks. The World Health Organization (WHO) explicitly links health with well-being, conceptualizing health as a human right requiring both physical and social resources to achieve and maintain. In its 1948 charter, the WHO defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.”

Griffith explains that despite a growing recognition of these linkages, most policies are framed around an overly narrow definition of health.

“We need to be looking beyond whether somebody is diagnosed with a disease or an illness,” Griffith says.

The School of Health aims to spark conversation around these disconnects, and to strengthen the evidence base to support policies that promote well-being.

“We are committed to evolving the science around social well-being and health: identifying what has been done, what is the next frontier, and where there are gaps and barriers to our understanding,” King says.

Drawing inspiration

The important recognition of the link between well-being and overall health is gaining traction—with a few prominent international leadership models making headlines.

In 2018, the United Kingdom established a new cabinet position, the Minister of Loneliness. The following year, New Zealand introduced its first “well-being budget,” which identified outcomes such as human health, safety, and flourishing to assess the success of policies, rather than sticking with conventional economic metrics such as gross domestic product.

In April 2023, U.S. Surgeon General Vivek Murthy declared an “epidemic of loneliness and isolation,” and set out a framework for a new and unprecedented National Strategy to Advance Social Connection.

“These are examples of true leadership,” says Wahid. “They reflect a world facing a variety of social ills and political polarization that make us feel like our society is ripping itself apart, and that contribute to us feeling disconnected from our fellow citizens.”

Building on these examples, the School of Health has an opportunity to train health policymakers and practitioners on how to improve measurement of well-being.

“In the U.S., we don’t have objective, measurable smart goals associated with well-being as we do for other metrics of health,” Griffith says. “So we are on par with other countries that are recognizing its importance, but not on par with those that are actually already doing a good job of measuring or addressing well-being.”

In a move to address this discrepancy, Griffith led the development of a model to ensure that a new strategic plan for addressing health disparities for the National Institute of Neurological Disorders and Stroke is anchored in both health and well-being.

Rise of ‘climate emotions’

Founded with an explicit emphasis on advancing equity, the School of Health’s driving force is to educate a new generation of health professionals who understand that equity is intrinsic to health. This focus, ranging from the local to the global, is a natural companion to the focus on well-being.

For example, Wahid’s research on the intersection between climate change and well-being is rooted in equity issues, as climate disasters tend to disproportionately impact those in lower-resource settings.

“Climate change has been described as the biggest global health threat of this century—there is no doubt it will impact every aspect of health,” he says.

In a national population survey in Bangladesh, Wahid and colleagues found that with every one degree Celsius increase in temperature, there are corresponding statistically significant higher odds of developing anxiety, or anxiety coupled with depression. Similarly, those populations that had experienced massive flooding had significantly higher levels of anxiety and depression.

Wahid is also collaborating with Emily Mendenhall, a medical anthropologist and professor at Georgetown’s School of Foreign Service, and Edna Bosire, at the Brain and Mind Institute at the Aga Khan University in Kenya, on a small project in Kilifi, Kenya, to look at the impact of severe drought on people’s well-being.

According to Wahid, drought—and the ensuing changes to the landscape—affects people’s sense of place and belonging, as well as their livelihoods. Wahid says it is not uncommon to see examples of “climate emotions”—or negative feelings associated with changes wrought by the rise in global temperature, along with ever-increasing and intensifying natural disasters.

He notes that seeing one’s way of life and sacred places suddenly transforming in negative ways can provoke an outpouring of ecological grief. This is true even if someone is not physically in the same place and is only seeing images of glaciers that have receded, or a river that is now dried out. It’s all part of “ecological grief,” according to Wahid.

“Maybe we don’t hear the birds in the spring anymore. The monarch butterflies are perhaps not as bountiful as they used to be. All of these things represent a deep sense of loss,” Wahid says.

Men’s health and well-being

Equity in health and well-being is also a central focus for Griffith’s research. Through Georgetown’s Racial Justice Institute, which he co-leads, Griffith established the Center for Men’s Health Equity to address health inequities. The goal is to comprehensively study the cultural and social factors that shape men’s health and well-being—such as African American and Latino men in DC, Atlanta, Baton Rouge, Miami, and Los Angeles—by collaborating with churches, social media influencers, and other community partners. Currently, Griffith’s center is piloting a tailored app that addresses men’s individual barriers to making healthy lifestyle changes, and shares motivational messages.

These endeavors take aim at men’s aspirations for a better quality of life overall—such as having more energy or more availability to be with their loved ones—rather than encouraging them to get healthy for health’s sake.

Despite a common assumption that men don’t need this type of outreach, Griffith says that, in fact, men tend to become more socially isolated as they age.

“So we lose the time and energy to really connect, to share and express both happiness and sadness and a whole range of other emotions,” he says. “Often, as the stereotype goes, the reason that men don’t ask for help or advice or even directions, is that they’re thinking they are alone in what they are experiencing and that they are the only ones struggling with their kids, jobs, partner, etc.”

Once in small group settings, the men Griffith works with begin to open to the idea that they are all struggling with similar issues and that they can learn from one another.

Griffith and his colleagues are working to translate their learning into stronger national policies to foster men’s well-being. For example, they are currently assessing what a national men’s health policy would look like and how that could incorporate well-being. Earlier this year, Griffith became the chair of Global Action on Men’s Health—a global organization whose mission is to make the case for national and global policies that create and promote conditions “… where all men and boys have the opportunity to achieve the best possible health and well-being wherever they live and whatever their backgrounds.”

A sense of belonging

A core facet of well-being is that of belonging— feelings of exclusion, alienation, marginalization, inequity, or discrimination can directly undermine a person’s well-being. With this in mind, the School of Health is taking concrete steps to strengthen community and belonging among students, faculty, and staff.

In October, the school launched a year of programming, supported by Georgetown’s Learning, Equity, Access, and Pedagogy Initiative, that is focused on making the learning experience more inclusive for all students.

“In order to build a future where a sense of well-being is essential to health, we have to start with ourselves,” says Jessica Kritz, assistant professor in the global health department at the School of Health, who leads the year-long initiative and holds the position of Champion of Diversity, Equity, Inclusion, and Anti-Racism Initiatives at the school. The support empowers and funds student, staff, and faculty cohorts to design and implement activities that they envision will build a sense of belonging within and across cohorts. For example, as part of this initiative a group of students is working with a mentor—Georgetown alumnus Timothy Casey (C’07), who runs a communications firm in Los Angeles— to develop multimedia content that represents their identity and voice.

These types of initiatives are particularly important due to the school’s high number of students who come from low-income and immigrant backgrounds.

“We have the ability and the responsibility to reach into populations that our students represent—to tap into and uplift their cultural competence and unique capacities—and to incorporate that diversity into our own teaching and learning,” Kritz says.

School administration is also conducting audits of course syllabi to ensure coursework reflects the school’s commitment to equity, diversity, inclusion, and antiracism, according to King. In addition, the school will monitor end-of-course evaluations to assess students’ sense of belonging at the school.

“When students, staff, or faculty don’t have a sense of belonging, they’re not able to be their authentic selves and do their best work,” King says. “We must foster an academic environment where, undoubtedly, every person knows that their unique identity and lived experience is critical for a world-class education. It is incumbent on us to deliver on that promise.”

The concept of well-being underpins Georgetown’s foundational credo of cura personalis, or care of the whole person. It’s not just a person’s diabetes or depression that matters, but also their own overall sense of how they are navigating through this world.

It also feeds into Georgetown’s value of “people for others”—the idea of prioritizing the needs of the most vulnerable. A core part of this means placing the individual we are trying to help at the center, Wahid says.

“Instead of saying ‘we know what’s good for you,’ it entails actually asking them and then using that as a way to guide how we shape policy, how we deliver health care, and how we approach and interact with communities.”

For King, this all ties back to the School of Health’s approach to solving the world’s most daunting health challenges.

“As educators and learners in this space, our mission is grounded by a sense of concern for the world, and recognition that a well-lived, fulfilled life goes beyond physical health,” King says. “Innovation is needed to support systems, processes, and practices that take us closer to the North Star. This is the work we are called to do.”