Trends and geographic variation in population thriving, struggling, and suffering across the US, 2008-2017: A retrospective repeated cross-sectional study

Objectives: Wellbeing is a holistic, positively framed conception of
health, integrating physical, emotional, social, financial, community, and
spiritual aspects of life. High wellbeing is an intrinsically worthy goal
for individuals, communities, and nations. Multiple measures of wellbeing
exist, yet we lack information to identify benchmarks, geographical
disparities, and targets for intervention to improve population life
evaluation. Design: Using data from the Gallup National Health and
Well-Being Index, we conducted retrospective analyses of a series of
cross-sectional samples. Setting/Participants: We summarized select
wellbeing outcomes nationally for each year, and by county (N=599) over
two time periods, 2008-2012 and 2013-2017. Main Outcome Measures: We
report percentages of peopole thriving, struggling, and suffering using
the Cantril Self-Anchoring Scale, percentages reporting high or low
current life satisfaction, percentages reporting high or low future life
optimism, and changes in these percentages over time. Results: Nationally,
the percentage of people that report thriving increased from 48.9% in 2008
to 56.3% in 2017 (p<0.05). The percentage suffering was not
significantly different over time, ranging from 4.4% to 3.2%. In
2013-2017, counties with the highest life evaluation had a mean 63.6%
thriving and 2.3% suffering while counties with the lowest life evaluation
had a mean 49.5% thriving and 6.5% suffering, with counties experiencing
up to 10% suffering, three-fold the national average. Changes in
county-level life evaluation also varied. While counties with the greatest
improvements experienced 10-15% increase in the absolute percentage
thriving or 3-5% decrease in absolute percentage suffering, most counties
experienced no change and some experienced declines in life evaluation.
Conclusions: The percentage of the US population thriving increased from
2008 to 2017 while the percentage suffering remained unchanged. Marked
geographic variation exists indicating priority areas for intervention.