What is Well-being?
Insights from Asian Health Behaviors and Lifestyles

- Profile -

Born in Tokyo in 1975, Kika Z. Hotta is a Senior Research Fellow at both the Asia Cancer Forum and the Applied Research Institute, as well as Executive Director of the Modern Haiku Association. Educated at Brown University and the University of Tokyo, Hotta is a Certified Social Researcher (JASR) and a trained data scientist. Hotta regularly leads social research, medical research, market research, and social impact projects, many of which are commissioned by government ministries, local municipalities, academic institutions, and publicly listed companies. Current research interests include organizational ergonomics, QoL and wellbeing, and medical humanities.

(1) Introduction to the lecture

KAWAHARA Norie, lecture series moderator, noted that in the previous week’s lecture, Prof. Shunya YOSHIMI had encouraged students to reflect deeply on the meaning of learning at university and to think about learning from the perspectives of both the humanities and sciences.

She noted that as the lecture series is being conducted in an omnibus style it would be of critical importance for students to not lose sight of the overall structure of learning, and remember the five key steps to deepening understanding that were introduced in the previous week’s lecture: 1) Critical framing, 2) Suffering as lens, 3) Comparative insight, 4) From theory to design, and 5) Global dialogue.

Students were encouraged to approach each weekly assignment not just as a task, but rather as an opportunity to internalize and reflect on the points raised each lecture. The accumulated assignments would also therefore become a valuable source of insight when students come to prepare the final report. 

Dr. Kawahara introduced the speaker for the second lecture, Kika Z. Hotta, a Senior Research Fellow at the Asia Cancer Forum and expert in social research. When engaging in interdisciplinary learning it is essential to develop a perspective that enables people to take a step back, observe patterns, and analyze across fields. Dr. Kawahara noted that in the lecture Prof. Hotta would address the question of “What is well-being?” drawing on work with the AsiaBarometer, an outstanding regional survey, which includes many years of data analysis. 

(2) Well-being and Asia - What is well-being? 

Kika Z. HOTTA began by explaining the latest concept of well-being, which has broadened from the former definition related exclusively to health or quality of life. Today well-being is considered as a multi-dimensional concept, encompassing physical, mental, and social health. Key related terms that link through to well-being are welfare, quality of life, wellness and happiness. The key question underlying the concept of well-being today is what is ultimately good for a person? 

Taking a look at the World Health Organization’s (WHO) definition of health, it can be seen that the WHO does not focus just on physical health: “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” 

This definition was introduced in 1948 and emphasizes the positive aspects of health, with a focus not simply on surviving, but thriving. This concept directly ties into the definition of what wellbeing is, which is based on encompassing physical, mental, and social health, and what is ultimately good for a person.

As referred to in the WHO definition of health, well-being is comprised of different components: 1) physical wellbeing, 2) mental, 3) social, and 4) “spiritual” (Fig. 1)

Fig.1  Components of Well-being

In the third of the above components, for the purposes of the lecture, “social capital” refers to sociological social capital, meaning how a person relates to their environment, including friendships, family, religion and local communities. Communities come in all shapes and sizes, from a community of university students, to an entire nation as a community, or a group of believers in a particular religion as a community. With regard to the fourth “spiritual” component of well-being, this is also related to mental and social aspects. 

In terms of the difference between well-being and welfare, it should be noted that welfare refers to the institutional support frameworks for well-being, including income support, healthcare and access to education. In other words, welfare is a means to well-being, but not an end in itself. 

As for Quality of Life (QoL), this has been a relatively common idea in academic circles in sociology and public health since the early 21st century. QoL basically refers to a broad measure of life satisfaction and functioning. It includes material conditions and subjective perceptions, and it is often used in policy and health evaluations. In terms of public health, there is another concept called health-related QoL, which is more focused on medical aspects of life quality. QoL is very close to well-being, but to date it has not been well defined.  

Another term that is often used is “wellness,” which is similar to well-being. Wellness is used more in relation to health itself, and the active pursuit of health in daily life. When referring to wellness there is a focus on personal choices, such as exercise, diet or stress management. It can be understood as being a very narrow field of well-being. 

A further term that is broad in its meaning is “happiness.” Happiness is usually something that is discussed in different fields of sociology. In the early 21st century the study of happiness was a popular subject, but in more recent years it has come to be subsumed into the broader concept of well-being. Happiness can basically be said to be subjective well-being, and its components are positive emotions and life satisfaction. Happiness is unique to each individual and different things will make different people happy, whether they be money or being able to get into a good university, or being raised in a democratic country, or if you are married, etc. Ultimately, however happiness cannot be perceived as the ultimate good, because it does not encompass objective aspects. 

So, what are the different kinds of well-being? One approach is to start from the philosophical views of what is good for a person. For centuries, human beings have done lots of thinking and research about what is good for human beings, and what is the purpose of living, etc. While there are probably no right or wrong answers, one example is hedonism, which focuses on pleasure and absence of pain, and the fulfillment of one’s desires. An extension of hedonism is objective list theory, where certain things are considered good regardless of desires, such as knowledge or friendship, etc. 

A further concept is social well-being as a core dimension. Social well-being is essential for a complete view of health. According to the WHO, you cannot be healthy without social well-being. Social well-being includes quality of relationships, sense of belonging, and community engagement. It involves both subjective and objective perspectives.  For both subjective and objective social well-being it is important to see whether a person is fully socially integrated, or in other words, a person is not fully well if that person is socially isolated or marginalized. This is where issues such as human rights, LGBTQIA+ need to be considered, because if a person is socially isolated, discriminated against or marginalized they are probably not in a good state of well-being.

Social determinants of well-being are comprised of different social factors that shape health outcomes and quality of life. There are many types of key determinants, including income and education, employment and job security, social inclusion and equity. Social support networks help to improve resilience and happiness, and this is where welfare frameworks come into play in a supporting role, including NPOs and NGOs, etc. Social equality is vital for well-being. 

(3) Deeper perspectives and policy implications of well-being

With regard to policy and well-being, good policies are critical to enable people to live better lives. As noted above, well-being is not just about mental or social health, and therefore most aspects of government policies can be said to relate to well-being for the people of that government’s country or region. The UN Sustainable Development Goals (SDGs) also relate to well-being.

The question of what makes people’s lives better is basically the study of well-being, and covers a vast range of issues, from healthcare, education, housing, jobs, income and taxation, to immigration, foreign policies, war, security, crime, and protecting the environment. The challenge of protecting the environment (natural, social, family, etc.) relates to well-being in that it supports long-term well-being. This underscores the point that it is essential to ensure well-being throughout a person’s entire life, without focusing unduly on a particular age group at the expense of a different group. It is important for governments to consider more than economic aspects of policy. While GDP is of course important in helping to improve well-being, another important aspect is to ensure equitable distribution of economic support for well-being. 

The WHO definition of health includes physical, mental and social aspects, and these have been enumerated in the WHO Social Determinants of Health Framework. This framework recognizes that health is shaped by life conditions, involve key factors such as money and jobs, education, safe homes and communities, and fair treatment for everyone. These are the factors that ultimately affect how healthy and happy people are. 

  Another concept that connects with long-term well-being is sustainable well-being, which in turn is connected to the SDGs and sustainable development. If a certain kind of well-being is not sustainable it will not benefit subsequent generations, therefore it is essential for well-being to be both long-term and sustainable, leading to intergenerational equity.

  In recent years employers have also started concentrating efforts on putting well-being into practice. There are also community health initiatives that seek to enhance well-being for members of that particular community. For example, the University of Tokyo has its own health and well-being-related initiatives tailored to students and faculty members. Another famous example of well-being in practice is the “Gross National Happiness” initiative of Bhutan, which is implemented on the national level. 

  When devising initiatives for well-being it is important to consider what are the things that are truly good for a person. As noted above, well-being means to thrive, not just survive, so it is important to consider what it is that will benefit people. A good life, or in other words a good state of well-being is multi-dimensional and context dependent.

Of course, there will be cultural variations in well-being, given that what gives people a sense of well-being will differ across cultures. In western countries there is a tendency to focus on individual happiness, freedom and achievement, whereas in eastern countries there tends to be a greater emphasis on family, harmony, and social roles. It is therefore imperative to understand well-being in its cultural context and social setting.

(4) Importance of studying well-being in Asia – AsiaBarometer

Asia is a vast and diverse continent, with many fast-changing societies, each with their own rich histories and cultures. There are also diverse ethnic groups, diverse races, diverse religions, and diverse governance systems.

The challenge when seeking to study well-being in the Asian context is that most well-being-related research to date has been conducted in western countries by western scholars. Inevitably, therefore such research and research subjects are western-centric, and have an inherent bias towards western cultures and values.

To study well-being in Asia it is essential to obtain and analyze local data, in order to make good policies and support people in living better lives. Asia faces unique challenges, including those of urbanization, aging and inequality and is an incredibly dynamic region. 

Given the lack of Asia-centric research there has, to date, been a failure to address the actual determinants of well-being in Asia, that is why the local data and insights of Asian researchers who are well-versed in the realities of Asia’s history, societies and cultures are urgently needed. 

One pioneering research project that sought to address such issues was AsiaBarometer. AsiaBarometer was a series of social surveys that was initiated by the University of Tokyo. It was a pioneering prototype research on well-being in Asia and comprised a unique survey of Asian societies, with a focus on social, political, and well-being perspectives. It had a broader focus than some similarly named later projects. AsiaBarometer looked into the lives of ordinary Asian people living in different Asian countries. (Fig. 2) 

Fig. 2 AsiaBarometer – A pioneering study

The AsiaBarometer project recognized that Asia is home to over half of the world's population and it is a continent that is rapidly changing. It also recognized that Asia lacked locally relevant well-being data and accordingly there was a critical need to understand Asian values, lifestyles and challenges. 

The AsiaBarometer project was led by the late Prof. Takashi Inoguchi, starting from 2003 at the University of Tokyo. Prof. Hotta noted that he worked under Prof. Inoguchi on the AsiaBarometer project at the time. The project covered social capital, life satisfaction, governance, and daily life, surveying nationally representative samples across Asia, with a focus on ordinary people’s lives, not just the elite strata of society. The survey ultimately covered 29 different areas and regions of Asia. 

The first phase of the AsiaBarometer project in 203 surveyed 10 Asian countries. Topics included life satisfaction, social trust and support, political attitudes, and health and well-being. The ultimate aim was to map the quality of life in diverse Asian societies. The outcomes of the first phase of the project were published in 2005. ※1

From 2005 onwards the project was expanded to include more countries, with added questions on democracy and development, impact of globalization, and community involvement. There was a subsequent focus on regional comparisons and trends. ※2

The AsiaBarometer project was important in that it provided unique insights into Asian societies. It was the first survey to explore subjective well-being across Asia. Until AsiaBarometer different surveys had looked into objective aspects, such as the social care system, social welfare system, health insurance system, human rights and democracy, etc. AsiaBarometer was the first survey designed to help create better policies based on real-life data. It effectively showed that well-being is not the same everywhere. 

The key results of the AsiaBarometer survey included the following. Firstly, the survey showed that in Asia there is high social capital, characterized by strong family ties, and the importance of community support structures rather than formal institutions. There is also greater trust in personal networks that in governments. A second result was the relationship between well-being and development that became apparent. It could be perceived that economic growth improves well-being, but only up to a point, and that there are other non-material factors that are critical for life satisfaction. A third result of the survey was that it showed the diverse views on democracy that exist in Asia, with many Asian people associating democracy with stability, but with a preference for order and prosperity over pure political freedom. 

A further finding of the AsiaBarometer project was that it challenged the characterization set out by Samuel P. Huntington in Clash of Civilizations of Asia as a Confucian-Islamic bloc with authoritarian values. However, the AsiaBarometer survey found that there is immense variety within Asia, with no single, monolithic “Asian value,” nor does modernization in Asia always follow western paths. The survey made it clear that people in Asia balance tradition and modern life differently. It concluded that well-being in Asia is shaped by unique mixes of culture, economy, and politics. It was a groundbreaking survey that set the foundation for future analyses.

(5) Measuring well-being in the 2020s

While the AsiaBarometer  survey was a groundbreaking attempt to measure well-being, it is important to continue to monitor and measure well-being. This is because understanding well-being helps to guide public policy and social programs, and what constitutes well-being will evolve over the course of time. Measurement allows for comparison across countries, regions, and time, and well-being indicators highlight areas needing improvement. Measuring well-being also helps to shift from a GDP-only focus to more human-centered metrics. 

Organizations like the OECD and UNDP have also started to measure well-being using their own resources. 

There are various types of well-being indicators, including objective indicators such as GDP per capita, life expectancy and educational attainment. There are also subjective indicators such as life satisfaction surveys, happiness scales, and self-reported health, and there are composite indices that combine subjective and objective indicators for a fuller picture, including the UNDP Human Development Index (HDI) and the OECD Better Life Index (BLI). 

The HDI is an index developed by the United Nations Development Program and it measures health, education and the standard of living. The concept of well-being under the HDI is  more focused on objective well-being. The criticism levelled at HDI is that it does not directly measure inequality or well-being. So it has limitations, especially in terms of social indicators. There is now discussion about adjusting HDI for inequalities, but it continues to be a statistics-based index. 

Another index is OECD BLI which measures well-being across 11 dimensions relevant to people’s lives. It expands on the HDI, seeking to measure well-being across 11 dimensions relevant to people's lives, and go beyond GDP to capture quality of life (Fig. 1). It is also interactive, in that users can weigh dimensions based on personal values. 

Fig.3  OECD BLI – 11 Dimensions

It is thanks to the above 11 dimensions that the OECD BLI index is more suited to assessing well-being. It combines objective data (e.g. income and education) with subjective data (e.g. life satisfaction), and also recognizes individual preferences. It can also be used to highlight disparities across countries and within populations. 

  When comparing the UNDP HDI and the OECD BLI, it can be said that HDI is simple, focused on basic human capabilities, whereas BLI is broader, more nuanced, including subjective elements. Whereas HDI is used primarily for global development comparisons, BLI is employed in work to gain policy insights in developed countries. However, neither index is perfect, which leads to questions of where to go in the future.

(6) Looking to the formulation of an Asia Well-being Barometer (AWB)

Looking to the future, a number of professors and researchers at the University of Tokyo are now considering implementing a new survey that would help to formulate an “Asia Well-being Barometer (AWB)”. This new survey would build on the foundation of AsiaBarometer as started by Prof. Inoguchi, and be dedicated to understanding life satisfaction, health, social trust, and local values. It seeks to respond to Asia’s diversity and fast-changing societies. 

AWB would be a bottom-up survey, listening to ordinary people about what makes life good. It would not only record numbers, but would aim to also capture feelings, hopes, and social context. AWB would be tailored for Asian realities, including in emerging economies (Fig. 4).

Fig.4  Asia Well-being Barometer – Distinct from HDI or OECD BLI 

The purpose of the AWB would be to: 1) help policymakers improve people’s real lives, not just economic statistics, 2) reflect Asian values, blending tradition and modern modernity, and 3) track social change and well-being over time.

The scope of AWB aims cover a wide range of Asian countries from South Asia to East and Southeast Asia. Topics covered will extend to health and mental well-being, social connections and trust, work-life balance, environment, safety, and personal meaning and happiness. Hopefully it will prove be a tool for researchers, governments, and NGOs to understand what matters most to people in Asia.

Discussion

Dr. Kawahara noted that she and Prof. Hotta are working on a project in Malaysia, known for its rich cultural diversity. She asked how the Asia Well-being Barometer (AWB) approach could help gain deeper insights in a complex and diverse environment such as Malaysia.

Prof. Hotta noted that the important aspect of AWB is to look into Asia and address the realities that Asia is currently facing. In the original AsiaBarometer study, Prof. Inoguchi proved that Asian countries are very diverse and that existing templates relating to well-being are predominantly western-centric and therefore not necessarily relevant or useful in the Asian context. The proposed AWB will incorporate more questions relating to the social determinants of health and well-being, covering more than the 11 dimensions addressed in the OECD BLI.  

A student asked Prof. Hotta to share some specific examples of how Japan and Malaysia differed in their approach to well-being in the original AsiaBarometer study. Prof. Hotta responded that Malaysia is a very multi-ethnic country, and the different ethnic communities lead very different lifestyles, in contrast to the case of Japan, where the population is less diverse in terms of ethnicity. There was also a wide range of happiness among the survey respondents, depending on their ethnicity, religion and environment. In terms of religion in particular, Malaysian people were much more likely to state that they place their belief in god for support, or seek support from the religious community. It is also known from various studies that when facing cancer, people tend to make different responses depending on their ethnic group or religion. 

A student asked about metrics for objective well-being. Prof. Hotta responded that these include such indices as income level, water supply, healthcare systems, human rights, and gender equality (female representation in the workplace, etc.), etc.

A student asked about the AsiaBarometer survey and how it was structured in order to gain an accurate snapshot of diversity in each country that was sampled. Prof. Hotta responded that the survey was based on previous surveys and various academic papers, seeking to gain a holistic picture of the status of well-being in Asia and the various differences among countries and regions. It was noted that the compilation of the survey took a year or more, because experts from various fields needed to be consulted. Looking ahead to the next AWB survey, a similar amount of time will be required to compile the survey as experts from multiple fields will be required to provide their input. The aim is to initially create a prototype and implement it initially among a small sample group. 

Dr. Kawahara noted that in the next lecture information would be provided about what is required for the final report to be submitted at the end of the lecture series, which will be in the form of a policy proposal for the NCDs Summit taking place ahead of the ASEAN Summit in Malaysia in September 2025. 

Notes:

※1: Inoguchi, Basanez, Tanaka, Dadabaev, eds., Values and Life Styles in Urban Asia: A Cross-Cultural Analysis and Sourcebook Based on the AsiaBarometer Survey of 2003, Institute of Oriental Culture, University of Tokyo, 2005.

※2: Inoguchi, Tanaka, Sonoda, Dadabaev, eds. Human Beliefs and Values in Striding Asia: Country Profiles, Thematic Analysis and Sourcebook Based on the Asia Barometer Survey of 2004, Institute of Oriental Culture, University of Tokyo, 2006.