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The concept of flourishing has the potential to transform clinical care. By Tyler J. VanderWeele Ph.D. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. One of the central goals of the Human Flourishing Program at Harvard is to study and promote flourishing in human life. We aim to do this in life in general and also through the investigation of flourishing in specific contexts, including the workplace, families, schools, and within medicine. In May, we published a Viewpoint piece in the Journal of the American Medical Association on how the concept and measurement of flourishing are relevant for medical practice. Flourishing could be a transformative concept for clinicians and for medicine. Too often in medicine, and in public health, we focus on disease and its predisposing risk factors. This work is important, but its narrow focus often ignores the bigger picture of what leads to a truly whole and flourishing life. People certainly care a great deal about health, but they care about other things as well—about being happy, and having a sense of purpose, and trying to be a good person, and having good relationships. Our own conception of flourishing is a state in which all aspects of a person’s life are good. We have argued elsewhere that flourishing involves numerous domains of life, including happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, and close social relationships. This, of course, is a very broad conception, and a conception so broad is not always going to be relevant in every clinical encounter. However, when it comes to major treatment decisions that could have side effects that alter one’s capacity for work or affect aspects of one’s relationships, efforts to maximize physical health (or years of disease-free survival) may sometimes come into conflict with the goals of having a sense of purpose (e.g., through one’s work) or with satisfying relationships. In these cases, we believe that looking at clinical decisions through a lens of flourishing can be helpful. Examples we’ve given in our papers or presentations have included: 1. A man wrestling with treatment decisions over relatively advanced stage bladder cancer, thinking that a cystectomy will maximize life expectancy, but may severely hamper the quality of life and happiness 2. A young woman tests positive for a genetic variant that greatly increases the risk for breast and ovarian cancers; removal of ovaries would substantially protect her against these cancers but would also make her infertile, thereby potentially compromising her sense of social well-being, purpose, and happiness 3. A chef faces surgery options for his tongue cancer that might maximize his chances of survival, but would impede speech and effectively end his career. Many of these decisions relate not just to questions of quality of life, but specifically to questions of relationships and of meaning and purpose. Thinking about how various decisions affect different aspects of flourishing may help clinicians provide better care for patients and provide care that is more holistic. It may also be helpful in clarifying the right decision for each individual. It is easy to presume that physical health and longevity are the highest values in life. The concept of flourishing may challenge that presumption, or at least bring into consideration life’s other important aspects and enable more patient-centered care. A focus on flourishing might also be helpful in addressing issues of physician burnout. Physician burnout has been documented as an increasing problem over the past years, and one that threatens the practice of medicine. But research suggests that a focus on improving a sense of meaning, of control, and of optimism might help protect against such burnout. Our flourishing measure can be useful in assessing flourishing for both patients and clinicians alike. It can be useful for research purposes, or for a simple check-in with regard to how various aspects of life are going. It can be useful outside the clinical context for purposes of life reflection. But it can likewise be helpful in reflecting on the implications of important clinical decisions and how treatment success or side effects might alter these various aspects of flourishing. We’ve included the 12 questions from our flourishing index in the image below, and you are of course welcome to use it for your own reflection for these purposes, or in research. We have already started to partner with medical faculty at Johns Hopkins School of Medicine, the Medical College of Georgia, and Stony Brook University Medical School to collect data and carry out flourishing assessments on both patients and clinicians, and we have been in discussion with numerous other medical schools and centers as well. Recently, to explore the concept of flourishing further for a non-academic audience, the School of Public Health at Harvard worked with us to produce a podcast examining how the study of flourishing is relevant within public health and medicine. We believe a greater emphasis on flourishing would promote the well-being of patients, of society generally, and would also enhance the practice of medicine. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References VanderWeele, T.J., McNeely, E., and Koh, H.K. (2019). Reimagining health: flourishing. Journal of the American Medical Association, May 7; Volume 321(17):1667-1668.

Parenting practices have a profound influence on the lives of children. By Tyler J. VanderWeele Ph.D. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. Over the past several years, the Human Flourishing Program at Harvard University has pursued research on parenting practices and how these practices affect the flourishing of children as they grow and develop into adulthood. A common division of parental styles classifies them along two axes: parental warmth, on the one hand, and parental discipline, on the other. Based on whether the parenting approach is high or low on each of these two dimensions, parenting styles are then divided into four types. The parenting approach with high warmth and high discipline is sometimes called the authoritative style. In contrast, the approach with low warmth and high discipline is referred to as the authoritarian style. The approach with high warmth but low discipline is referred to as the permissive style. And, finally, the approach with low warmth and low discipline is referred to as the neglectful style. Research has fairly consistently shown that the approach of high warmth and high discipline (the authoritative style) tends to be associated with the best childhood outcomes. However, much of the research on the topic of parenting styles has examined single outcomes, one at a time. When this is done with different samples, and in different settings, it can be difficult to get a broad picture of the relative strengths and weaknesses of the different approaches. Moreover, much of the existing research is also cross-sectional in nature, meaning that all of the data is collected at once, rather than collected repeatedly over time. This can make it difficult to infer causality. For example, if parental warmth is associated with better child outcomes, it is difficult to know whether parental warmth really causes those outcomes or whether, for example, those children who are going to have good outcomes anyway are simply easier to love. One needs data collected over time, ideally on numerous well-being outcomes, to resolve these questions. This year we published two empirical studies, one in January in Social Science and Medicine, and one just last month in Nature Human Behavior. Both studies used data collected over many years. We looked at the effects of different parenting styles on numerous health and well-being outcomes, and the results, using more rigorous methodology, were largely consistent with previous findings. Children who had parents with the authoritative approach to parenting (high warmth, high discipline) fared best later in life. One of the interesting results of our two studies was that parental warmth, or love, seemed to be the dominant factor. While those who had high warmth and high discipline (authoritative style) did the best, the next best category was high warmth, low discipline (the permissive style) and they did considerably better than the group that, in contrast, had low warmth and high discipline (authoritarian style). Not surprisingly, the group that had low warmth, low discipline (neglectful style) fared poorest. However, overall, parental warmth or love seemed the most important. When parental warmth was considered on its own, it was the most important aspect of parenting we were able to identify. This conclusion was especially manifest in our Nature Human Behavior study, in which we examined multiple aspects of positive parenting. In that study, parental warmth in childhood (measured by satisfaction with the parent-child relationship, generally concerning love and attachment) was associated, several years later, with a 46 percent reduction in depression, a 39 percent reduction in anxiety, a 68 percent reduction in eating disorders, as well as higher levels of emotional processing and expression, and lower levels of cigarette and marijuana smoking. Other parenting practices, like family dinners, were also important, but simply not as important as parental love and affection. Likewise, in our Social Science and Medicine study, parental warmth was associated with a wide range of positive flourishing outcomes later in life. The links to some of these (such as happiness/emotional well-being, positive relations later in life, and self-acceptance) were larger than the associations with others (such as social coherence), but they were positive for almost all outcomes. The research points to the important role of love in human flourishing. While the term “love” means different things to different people, in much theological writing, it is understood as a desire for and/or commitment to the good of the other. That seeking of the other’s good, in childhood (and arguably throughout life), is very powerful. In addition to the actions that promote the good of the beloved, that experience of love affirms the person’s intrinsic value and worth. It establishes a bond. It fulfills one of the deepest human yearnings for connection with others. It is no wonder, then, that the experience of love appears to affect so many health and well-being outcomes. Love is not often considered in our medical and public health discussions as to what shapes health. But perhaps that should change as more and more research points to its profound importance. Our study is not without its limitations. While the experience of parental warmth, or love, emerged as being of central importance, the measurement of constructs like love or discipline is challenging. Measures will always be imperfect. Our measures of parental discipline do not take into account what form that discipline takes. The range of outcomes we were able to examine with the data are also limited. They do not include assessments of character. Indeed, the measurement of character is still in its infancy, and difficult to study. But we might expect parenting practices oriented towards discipline to profoundly shape character, and to shape also the child’s subsequent contribution to the lives of others in adulthood. Nevertheless, despite these limitations, what the research does very clearly establish is the importance of a child’s experience of love. Love can be experienced in different ways. Our last posting pointed to the importance of forgiveness. Forgiveness—being understood as the replacing of ill-will with good-will towards the offender—is itself a form of love. Perhaps love thus ought to be given greater attention, in the empirical sciences, in life, and in our public discourse, as to what brings about true human flourishing. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Chen, Y. Kubzansky, L., and VanderWeele, T.J. (2019). Parental warmth and flourishing in mid-life. Social Science and Medicine, 220:65-72. Chen, Y., Haines, J. Charlton, B., and VanderWeele, T.J. (2019). Positive parenting improves multiple aspects of health and well-being in young adulthood. Nature Human Behavior, in press.

The science of forgiveness points to its importance for well-being. By Tyler J. VanderWeele Ph.D. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. One of the projects of the Human Flourishing Program at Harvard University has been researching the topic of forgiveness and its importance for a flourishing life. Some of our empirical work has explored how forgiveness can powerfully shape health and well-being. For example, our research indicates that forgiveness reduces subsequent depression and anxiety by about 15-20%, when controlling for other variables, and suggests that forgiveness is a freeing and healing alternative to maladaptive responses like rumination and suppression. Forgiveness, understood as the replacing of ill-will with good-will towards the offender, does not imply condoning the action or not demanding justice. Forgiving simply means desiring the ultimate good of the offender, and this can be done without excusing the wrongful action and while still pursuing a just outcome. Our program’s work has explored how forgiveness might be conceived of as a public health issue. The experience of being wronged is common, and the effects of forgiveness on health are profound. Since there are now easy to use resources that can help people to forgive when they want to forgive, but are struggling to do so (see more below on forgiveness workbooks), we believe that more public attention should be given to this topic. Our work on forgiveness in fact recently captured the attention of Harvard Men’s Health Watch and they published a popular piece on forgiveness based on our work. An article, written by Professor VanderWeele, “Is Forgiveness a Public Health Issue?”, which also addresses some of the ethical issues around forgiveness, is publicly available at this link. New Templeton Funding for a Randomized Trial And our work on the importance of forgiveness continues on. We are happy to announce that we recently received funding from the Templeton World Charity Foundation to launch, in collaboration with Everett Worthington, a randomized trial of forgiveness workbook interventions in six countries around the world (Columbia, South Africa, Ghana, Ukraine, Indonesia, and China). The study will examine how this forgiveness approach might work globally since most of the research to date has been within the United States. The study will take place during 2020 and, if successful, it could potentially launch the beginning of a global forgiveness campaign. Stay tuned as our research in this area and others progresses. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References VanderWeele, T.J. (2018). Is forgiveness a public health issue? American Journal of Public Health, 108:189-190.

The work of creating a season of peace and goodwill for all. By Tyler J. VanderWeele Ph.D. Key points Caring for others is critical for a flourishing society. A caring character is part of what it means for us to flourish as individuals. Embedding caring into our character means loving even those with whom we disagree and even when it is difficult. As the holidays approach, many are preparing to spend more time with friends, family, and loved ones. A feeling of generosity and kindness often permeates the holiday season, along with a sense of hope and expectation for the new year. Through this, we can come to care for one another more deeply; and this sense of caring, of generosity, of kindness, is arguably a much-needed balm for our society in the midst of conflicts and tensions, both at home and abroad. Much has been, and continues to be, done to promote caring for one another. Harvard has a Center on Making Caring Common. Our collaborators at SHINE have published on the beneficial effects of a caring climate in the workplace. We’ve written previously on the importance of love in parenting and in society and of caring for others through volunteering. Acts of kindness are one of several evidence-based activities to promote flourishing. Reporting on the caring actions of others can help prompt further caring actions to propagate throughout society. We all need to continue this work of promoting a caring, kind, and generous society. Caring and Character To create a flourishing society, however, it is also important that this promotion of caring not be restricted to one-off actions when we are in a cheerful or festive mood. That sense of caring, of kindness, of generosity, of love of neighbor, really needs to be present throughout our lives if we, and if our society, are to flourish. We need to seek to be loving and caring not only when times are good, but also when life circumstances are difficult, or when we are not feeling particularly cheerful or inclined to assist others. Said another way, caring needs to become a part of our character. Character itself might be thought of as someone’s habits of thought, emotion, and behavior that relate to a person’s ability to achieve goals or to attain what is good. When one’s goals and purposes are themselves good, and one’s actions, thought, and emotions reasonable, it arguably becomes proper to speak of virtuous character. Such good virtuous character, almost by definition, contributes to the flourishing of oneself and others. As examples, the virtue of justice is sometimes defined as “a steady and enduring will to render to each his or her due or right;” the virtue of generosity as the habit of “giving good things to others freely and abundantly”; the virtue of mercy or compassion as the habit of “heartfelt sympathy for another's distress, impelling us to help him or her if we can.” Each of these virtues concerns bringing about what is good for others. Good character contributes to the good of others. Good character enables the flourishing of others. However, good character enables the flourishing of oneself, also. We have written previously on how one’s self-reported evaluation of a character statement, “I always act to promote good in all circumstances, even in difficult and challenging situations” predicts, a year later, a number of health and well-being outcomes, even after controlling for these same outcomes at baseline, along with a host of other factors. In our most recent study on the topic, we extended this work to also examine more objective (not just self-reported) outcomes, obtained from medical claims insurance data. This work likewise found beneficial effects of various aspects of character on subsequent depression diagnoses, and possibly also with some evidence for effects on subsequent anxiety disorder diagnoses and on cardiovascular disease diagnoses, once again controlling for these same outcomes from claims data in prior years. The empirical evidence thus continues to mount that good character contributes not only to the well-being of others, but also to one’s own well-being. Flourishing and Caring Character Of course, these effects of character on well-being are just averages. Good character and caring actions will not always beneficially affect all aspects of one’s well-being. Caring actions can sometimes involve sacrifice. There may be some loss. However, this very point, perhaps itself, gestures towards how character may, in fact, constitute, and not just be causally related to, well-being. To have good character and to care for others is part of what it means to flourish. We are social beings, and as such, our own well-being is intimately tied to that of those around us. The flourishing of others is, in some sense, a part of our flourishing. Helping others to flourish, being of caring character, is part of what it means for us to flourish as the type of social creatures that we are. It can sometimes seem as if our own well-being and that of others occasionally comes into conflict. However, a deeper insight is that by caring for others and by embedding such caring into our character, we are flourishing ourselves, even if there are accompanying losses and sacrifices. Plato and Aristotle, and many others who have thought about these matters, thus conceived of character as central to well-being. Having and exercising virtuous character is principally what flourishing looks like for a human person. It is constitutive of our own flourishing and contributes to the flourishing of others. Celebrating the Season Such insights are relevant to us as individuals. They are relevant to our communities. They are relevant for our leaders. They are relevant in our professional lives. They are relevant in business. They are relevant in psychiatric care. They are relevant in the news media. They are relevant for shaping our society into one that is more just, more generous, and more compassionate. We need to work on caring for one another, not only when it comes easily, but especially when it is difficult. We need to embed caring in our character. We need to work towards loving our neighbors and even our enemies. This is by no means an easy task. It is one that requires continual work and refinement. It is one that requires that we encourage one another in this difficult work. This time of year can be one of kindness and generosity to others, and towards those with whom we are close. But it can also be a time of reflection, in which we extend that sense of goodwill to all others, even towards those with whom we might disagree. Indeed, as the new year approaches, one possible resolution might be to work towards having that goodwill for at least one person towards whom we currently feel animosity, ill will, or even hatred; to seek forgiveness and a replacement of ill will with goodwill. This is hard work, but it is work that more firmly helps us embed caring into our character. It forms the habit of caring. This holiday season, Christians all over the world remember and celebrate the birth of one who declared his mission to be “not… to be served, but to serve, and to give his life as a ransom for many” and who taught others to follow in his footsteps. The Christian community has not always lived up to this lofty ideal. However, if the Christian message surrounding Jesus’ birth of “peace on earth and goodwill towards all people” is to be realized, we must all work towards devoting our lives towards better serving and loving others. Different people will, of course, celebrate this holiday season in different ways. However, we can all also celebrate together by being generous towards and caring for others, certainly towards our loved ones, but also towards those from whom we feel estranged. These are the small and sometimes difficult steps towards embedding caring into our character, and thereby towards bringing about greater peace and justice, towards bringing about a more flourishing society. References VanderWeele, T.J. (2022). Virtues, mental health, and human flourishing. In: J.R. Peteet (ed.). Virtues in Psychiatric Practice. Oxford University Press. Weziak-Bialowolska, D., Lee, M.T., Bialowolski, P., Chen, Y., VanderWeele, T.J., and McNeely, E. (2022) Prospective associations between strengths of moral character and health. Longitudinal evidence from survey and insurance claims data. Social Psychiatry and Psychiatric Epidemiology, in press.

Relieving loneliness and social isolation. By Tyler J. VanderWeele Ph.D. Key points Social isolation and loneliness have important independent effects on mental and physical health. Various aspects of social connectedness have been in decline in the United States. We need multiple approaches to improve social connection and build more connected communities. Humans, Aristotle observed, are political animals. We do not typically live alone, but in a community. We receive many of the conditions for our survival as a gift from others: no one chooses his or her mother tongue, or the caregivers who provide nurture and support in infancy and childhood. One result of this profoundly communal way of being is that we long for connection and belonging. We need others. We desire to be loved. Our social connections are part of who we are—they are a part of our flourishing. There are both objective and subjective aspects to social connectedness. On the one hand, there is the set of relationships and communities that we have, the time we spend with and in them, and the objective support that they offer. On the other hand, there is also a subjective sense of connection and belonging, of being loved, cared for, and understood. Both the objective and the subjective sides of social connectedness are important. Both are a part of, and shape, our health and well-being. Prior research and meta-analyses of longitudinal studies have indicated that both the objective and the subjective sides of social connectedness are important for health: those with higher levels of social isolation or with higher levels of loneliness are at greater risk of early death. In our most recent empirical work, we have further examined these objective and subjective sides of social connectedness not only as they relate to mortality risk but also to a host of other health and well-being outcomes. Understanding this is important in its own right, but it is also important in motivating efforts to build more connected communities. The Effects of Social Isolation and Loneliness In our recent paper, published in Social Science and Medicine–Population Health, we used data from 13,752 older adults in the Health and Retirement Study and employed our outcome-wide methodologies to examine longitudinal associations of both social isolation and loneliness with 32 different health and well-being indicators four years later. We employed various methodological approaches to try to provide evidence for causal inference that we have described elsewhere. Similar to much prior research, we found evidence for important effects of both loneliness and social isolation on numerous health and well-being outcomes, including mortality risk, physical functioning limitations, happiness and life satisfaction, optimism, purpose in life, depression, and hope. One of the additional interesting insights in this study, however, was that by using the same sample and the same design and analysis, we could more directly compare the respective effects of loneliness on the one hand and those of social isolation on the other. What we found was that the objective side of connectedness, e.g. whether a person was socially isolated (living alone, not spending time with friends and family, etc.), had larger effects on physical health, such as mortality risk and physical functioning limitations, than did loneliness. Conversely, however, loneliness had larger effects over time on a number of mental health and well-being outcomes than did social isolation (e.g., on happiness, optimism, purpose in life, sense of mastery, depression, and hope). So, both loneliness and social isolation matter for these outcomes, but they matter to different degrees for different outcomes. Interestingly, however, even when we made simultaneous control for both loneliness and social isolation, each had separate important effects, independent of the other, on numerous outcomes, again including mortality risk, physical functioning limitations, happiness, purpose in life, and hope. Both the objective and the subjective side of social connection matter. Both contribute above and beyond the other. Both should be addressed. Building Connected Communities Social connection is, of course, important not only because of its effects on physical and mental health but also in its own right. Close social connectedness, as we’ve noted elsewhere, is an end sought for its own sake. We all want to be close to others; we all want to be loved. There is, however, unfortunately now considerable evidence that various aspects of social connectedness have been in decline in the United States in recent years. A recent advisory report released by the U.S. Surgeon General notes that from 2003 to 2020, the average American’s self-reported time spent with friends and in social engagement with others decreased by two-thirds and one-third, respectively, while time spent in social isolation increased by 17 percent; about 50 percent now report being lonely; marriage- and birth-rates are at all-time lows; religious affiliation is down; and other forms of civic participation are in long-term decline as well. This is cause for concern in its own right, and a cause for concern with regard to health and well-being also. We need to work towards addressing these declines and building more connected communities. To that end, in collaboration with the Foundation for Social Connection and Healthy Places by Design, and with generous support from Einhorn Collaborative, we will be hosting a conference next month, October 12-14, at Harvard University and in the wider Boston community, to bring together various community, civic, and corporate leaders, along with academics and the general public, to discuss the topic. The conference is open to everyone, and registration details can be found here. The problem is, of course, complex, and numerous societal and technological trends have contributed. The Surgeon General’s advisory offers not only a diagnosis of the problem and some analysis of its causes but also offers helpful suggestions as to ways forward, focusing on six “pillars” to structure public health responses. These are to strengthen social infrastructure in local communities; enact pro-connection public policies; mobilize the health sector; reform digital environments; deepen our knowledge; and build a culture of connection. We believe each of these is important in its own right, and, all together, could go a long way in fostering greater social connectedness and reducing loneliness and social isolation. However, our hope with the conference is also to broaden the set of considerations yet further. To that end, we have recently released a draft version of a “Supplement” to the Surgeon General’s advisory, going into greater detail on various facets of the decline in social connectedness and on various additional approaches to try to address it. These include greater emphasis on improving economic conditions of the working class; addressing the decline of free play and independence among American children; the growing isolation of America’s elderly as households shrink; and the critical role that the decline of religious participation and marriage rates play in the United States; along with what might be done about these various trends. As always, comment and critique are most welcome, especially since the document is still in an early draft form, and one we hope will be shaped further by responses from our readers. We very much hope that the various discussions and additional research on these questions, and further communal and policy efforts, will help us together to build more connected communities. References Hong, J.H., Berkman, L.F., Chen, F.S., Shiba, K., Chen, Y., Kim, E.S., and VanderWeele, T.J. (2023). Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach. Social Science and Medicine - Population Health, 23:101459. Case, B., Corbin, I.M., Teubner, J., Cowden, R., Bachiochi, E., Cratty, F., and VanderWeele, T.J. A Supplement to the Surgeon General’s Advisory “Our Epidemic of Loneliness and Isolation”. Working Paper. Available at: osf.io/preprints/socarxiv/y4pqx.

Here's how employers can and should enhance flourishing. By Tyler J. VanderWeele Ph.D. Key points Work can contribute to wellbeing in numerous ways Organizations that promote wellbeing are more likely to have flourishing employees AND better work outcomes There are many practices, interventions, and wellbeing resources that companies can use to enhance wellbeing Work and Flourishing When work is carried out well, it provides goods and services that help meet the needs, desires, and aspirations of human society. Work promotes our well-being. As has been noted by various thinkers throughout history, the very process of working can also be conducive to our flourishing: In addition to providing for our material needs, work can help us to use and develop our capacities and strengths; it can be a forum for relationships; and it can give us a sense of purpose. Because work has the potential to contribute so much to our lives, it is important that it is structured well, so that it allows for opportunities to flourish. Individuals bear responsibility for this, but so do managers and organizations. The workplace can be structured in ways that are conducive to well-being or in ways that impede it. A Business Case for Promoting Well-Being Companies often have programs to promote health and wellness and are concerned about the physical health of their employees. This is important. But people care about more than that; they also want to be happy, to have a sense of meaning, to try to be a good person, and to have good relationships. People care about these things, and so should businesses. Some of our prior analyses have indicated that while physical health does contribute to important work outcomes like job satisfaction, worker performance, and work engagement, so do other aspects of well-being. Our research in fact indicated that happiness and character strengths contribute to job satisfaction as much as does physical health. Happiness contributes about as much to work performance as does physical health, and social relationships contributes even more. A similar story pertains to the longitudinal associations between character strengths and subsequent work engagement, on which it has as large or larger effects than physical health, and character strengths are more important than physical health for preventing work injury. Our ongoing research with the Aetna employees, currently under review, has indicated similar effects of well-being on work outcomes. While these longitudinal associations provide some evidence for causal effects, they are not necessarily definitive. However, our colleagues at the University of Oxford have provided even more compelling evidence for some of these effects in a study, using data from a clever natural experiment, which once again indicated effects of employee happiness on labor productivity and also on sales success. Meta-analyses have also suggested that employee well-being is related to lower turnover, though more rigorous longitudinal designs are still needed to definitively confirm. Employee well-being is also longitudinally related to subsequently lower healthcare costs and considerably lower costs due to distraction. Employee well-being matters for work outcomes. Employee well-being should be advanced as a moral imperative in its own right, but enhancing employee well-being may also help businesses with their bottom line as well. Promoting Well-Being in the Workplace So how might well-being be promoted in the workplace? There are a variety of possible approaches, from top-down to bottom-up. First, organizations could start measuring and tracking well-being to understand what is going well and what is not; who needs help and in what ways; and how things are changing over time. We’ve carried out such assessments with a number of different organizations including Aetna, Levi, Kohler, Owens Corning, Eileen Fisher, Delta Airlines, and the World Bank as well as in numerous schools, universities, and clinical institutions. In addition to providing helpful information on what needs the most attention, the simple act of measurement within organizations can often alter the conversation and change priorities so that well-being becomes more central. Second, organizations can work towards providing structures and schedules that are more conducive to work-family balance and to flourishing in all of life. Studies have indicated that programs to promote family-supportive supervisory behaviors and employee control over work location and schedule have important effects on employee wellbeing, including on adequacy of sleep, control over schedule, and better and more family time, and this is accomplished without reducing total work hours or increasing job demands. Similarly, one of our own studies at the Human Flourishing Program at Harvard has indicated that creating a caring organizational climate, including respect and trust, leads both to better employee well-being but also better work outcomes, including lower distraction at work and increased productivity, engagement, and job satisfaction. Third, individuals can carry out practices like job-crafting which aim at helping people to intentionally enhance their own efficiency at work, to enhance relationships, and to connect their own jobs with the purpose of the organization in order to find greater meaning. Such activities again contribute both to an individual’s sense of well-being and to work engagement. Fourth, workplaces might broadly disseminate more general well-being activities that we know, from randomized trials, enhance flourishing. Such activities include, for example, gratitude exercises, or acts of kindness, or imagining one’s best possible self, or the use of character strengths, or forgiveness. We’ve summarized some of these activities in an evidence-based guide. These are activities that can be freely distributed and will enhance both well-being and, because well-being in life affects well-being at work and vice-versa, will likely also enhance work outcomes. Relatedly, and finally, workplaces might provide opportunities for greater social connection at work, or for volunteering, or for alleviating financial struggles by helping restructure debt and by providing a living wage. All of these are ways in which workplaces might enhance the well-being of their employees and thereby also contribute to the well-being and productivity of their organizations as well. References Weziak-Bialowolska, D., Lee, M.T., Cowden, R.G., Bialowolski, P., Chen, Y., VanderWeele, T.J., and McNeely, E. (2023). Psychological caring climate at work, mental health, well-being, and work-related outcomes: Evidence from a longitudinal study and health insurance data. Social Science & Medicine, 323:115841. VanderWeele, T.J., Węziak-Białowolska, D., Białowolski, P., and McNeely, E. (2019). Re: A comprehensive approach to problems of performance measurement. Journal of the Royal Statistical Society, Series A, 182:797-798.