Wellbeing: the challenge of "operationalising' an holistic concept within a reductionist public health programme

Wellbeing is a concept that, while contested, recognises individual and wider social, economic, political and environmental contextual influences - and is of growing interest and relevance locally and globally. In this article, we report on one aspect of an evaluative research study conducted on a public health programme in North West England. Aims: Within the context of a process evaluation that explored the delivery of a public health programme and sought to increase understanding of how and why different approaches worked well or not so well, this article focuses specifically on the concept of wellbeing, examining perceptions of multiple stakeholders. Methods: Interviews and focus groups were undertaken with 52 stakeholders involved in managing and facilitating the programme and its composite projects and with 90 community members involved as project participants. Data were subjected to thematic analysis, cross-check and refining. Results: Results highlight stakeholders' diverse understandings of wellbeing, the complex relationship between health and wellbeing, and the perceived dissonance between the holistic concept of wellbeing and the reductionist design of the programme. Conclusions: Wellbeing was understood to be more than health' and more than happiness', concerned with effective functioning, sense of purpose and flourishing. Essentially holistic, wellbeing offers opportunities to transcend clinical/pathogenic conceptions of health' and resonate with individuals, communities and local authorities. This raises concerns about how wellbeing can be meaningfully realised without compromising the concept, particularly when programmes are structured in reductionist ways requiring monitoring against discrete outcomes. Implications for practice include the following: utilising wellbeing as a driver for cross-cutting public health in challenging economic and organisational contexts, acknowledging that wellbeing is essentially social as well as individual, appreciating that wellbeing is experienced in relation to contexts and surroundings, and recognising that wellbeing defined in terms of individual happiness risks compromising the future wellbeing of societies and the planet.