## country-cases ## Source details **Canonical URL:** [country-cases](https://www.imf.org/-/media/files/publications/fandd/article/2021/december/country-cases.pdf) ## Other formats - [Markdown version](/-/media/files/publications/fandd/article/2021/december/country-cases.pdf.md) - [Structured JSON version](/-/media/files/publications/fandd/article/2021/december/country-cases.pdf.json) --- ### Overview - Denmark, Costa Rica and New Zealand highlighted as examples of countries “getting something right” on health and happiness. - Case studies emphasize: delivering services at the community level, cultivating social trust, and accounting for well-being in high-level policy. - Quotation: “Happiness does not mean pleasure, or emotional highs, but rather a life well lived.” — Jeffrey Sachs ### Denmark: It’s a matter of trust Findings - High social trust underpins Denmark’s consistent top rankings on measures of happiness and contentment. - Robust social welfare system provides generous unemployment, free health care and higher education, and heavily subsidized childcare. - Trust is linked to low perceived corruption, long tradition of consensus-building, and efficient government services. - Pandemic response demonstrated strong social cohesion: testing and vaccination framed as collective efforts. Key statistics and facts - “More than 75 percent of eligible citizens as of late October were fully vaccinated.” - “At the height of the pandemic, more than 60 percent of the adult population was being tested each week.” - “over 90 percent of Danes trust national health authorities.” Local policy example - Dragør municipal survey (2014) with the Happiness Research Institute led to actions: new indoor swimming center, improvements to sports facilities, more programming for senior citizens, and improvements to public space in the town’s historic center and harbor. Challenges - Difficulties integrating immigrants and refugees into the labor market and perceived strain on the social welfare system have fueled debate and eroded trust in some quarters. Selected quotes - “Essentially with all the social support from the government, you’re redistributing a lot of money to strangers, and we know people are not likely to vote for that kind of system if they don’t have at least some degree of trust in strangers.” — Christian Bjørnskov - “There is increasing evidence that there is a tight relationship between the functioning of political institutions and social trust.” — Michael Bang Petersen ### Costa Rica: The pure life Findings - “Pura vida” culture reflects laid-back lifestyle, strong social relationships, and a sense of community that contribute to well-being. - Long-standing investments in public health and social services produced dramatic health gains at relatively low ongoing cost. - Primary health care model (EBAIS) brings health services to communities and links household visits to electronic health records to set targets and focus resources. Key statistics and facts - “The 2021 World Happiness Report ranks Costa Rica the 16th happiest place on earth.” - Costa Rica is, aside from the Czech Republic, the only emerging market economy in the top 20. - Child mortality rates dropped “from about 74 deaths per 1,000 in 1970 to 17 by 1989.” - Life expectancy rose “from 75 in 1990 to 80 (well above the US).” - Costa Rica spends less on health care as a percentage of GDP than the world average: “7.3 percent versus 10 percent in 2017.” - Costa Rica is “the only country in Central America where 100 percent of the population has access to electricity and a source of drinking water.” Policy design and implementation - EBAIS teams assigned to local areas: health workers visit each household annually to assess needs; data are combined with electronic health records to inform targeting and resource allocation. - Public investments in preventive and community health began decades ago (noted heavy spending on health as a proportion of GDP in the 1970s). Governance and political economy - Long democratic history with cross-party continuity: “We have in Costa Rica what we call a social pact...the one that follows must put in one more brick.” - Environmental policy linked to economic and social well-being (shift from high deforestation to green policies due to hydropower concerns). Selected quotes - “People who are happy live longer. That’s why you need to spend less. It’s not only that health contributes to happiness. Happiness contributes to health.” — Mariano Rojas - “Before being born, a Costa Rican is guaranteed life, education, food, social security...” — Luis Alberto Vásquez Castro ### New Zealand: Changing the conversation on well-being Findings - Wellbeing Budget 2019 reoriented fiscal priorities toward mental health, child well-being, support for Māori and Pasifika aspirations, building a productive nation, and transforming the economy. - Holistic framing: recognition that health, education, community connection and cultural dimensions all matter for a “good life.” - Emphasis on process: giving communities more voice and resources to drive change; central government to play a listening and supporting role. Key statistics and facts - New Zealand population: “5 million people.” - Child poverty: “In 2020, up to 210,500 children lived in poverty (18.4 percent), according to New Zealand’s statistics agency.” - Budget investment: “$NZ 1.9 billion in mental health.” Policy actions and implementation issues - Budget 2019 allocated billions for mental health services and child poverty and record investment to tackle family violence. - Government introduced early support services for mental health at GP practices and community centers; a 10-year mental health strategy was unveiled. - Calls from experts for stronger outcome measurement and decision-making infrastructure: statistical ability exists but “we’re not making full use of it.” - COVID-19 reinforced and complicated priorities: “Since 2019, the government has been consistent in its goals in subsequent budgets, despite being hugely challenged by COVID-19.” Process and community role - Emphasis on devolving power and resources: “The types of issues we are dealing with cannot be sorted out from the center—the center needs to play a listening and supporting role.” - Child and Youth Wellbeing Strategy (launched August 2019) focuses on joined up responses and was accelerated by the pandemic. Selected quotes - “Well-being as a concept is the right one but you need measures and decision-making infrastructure to make it work.” — Emily Mason - “We’re thinking more holistically about how to deliver better outcomes for people. But we’re also continuing to build our understanding of well-being. This is hard.” — Dominick Stephens ### HEALTH AND WELL-BEING (Section 2) Decentralization and codesign - "Increasingly, there’s a move to devolve resources and decision-making, to codesign with families and community stakeholders, and to resource Māori and other providers to develop solutions that work for their communities.” - “It’s a work in progress but absolutely the right direction to be moving in.” Community-led provision - Emphasis on resourcing "Māori and other providers" to develop community-specific solutions. - Codesign with "families and community stakeholders" highlighted as a key approach. Reporting and context - Reported by ANALISA R. BALA, ADAM BEHSUDI, and ANNA JAQUIERY. - Playground in Wellington, New Zealand. PHOTO: JENNY TREVELYAN *Source: country-cases - Section 1 and Section 2 (PDF)* ### Section 1 ### country-cases - Section 1 ### Overview - Denmark, Costa Rica and New Zealand highlighted as examples of countries “getting something right” on health and happiness. - Case studies emphasize: delivering services at the community level, cultivating social trust, and accounting for well-being in high-level policy. - Quotation: “Happiness does not mean pleasure, or emotional highs, but rather a life well lived.” — Jeffrey Sachs ### Denmark: It’s a matter of trust Findings - High social trust underpins Denmark’s consistent top rankings on measures of happiness and contentment. - Robust social welfare system provides generous unemployment, free health care and higher education, and heavily subsidized childcare. - Trust is linked to low perceived corruption, long tradition of consensus-building, and efficient government services. - Pandemic response demonstrated strong social cohesion: testing and vaccination framed as collective efforts. Key statistics and facts (preserved exactly) - “More than 75 percent of eligible citizens as of late October were fully vaccinated.” - “At the height of the pandemic, more than 60 percent of the adult population was being tested each week.” - “over 90 percent of Danes trust national health authorities.” Local policy example - Dragør municipal survey (2014) with the Happiness Research Institute led to actions: new indoor swimming center, improvements to sports facilities, more programming for senior citizens, and improvements to public space in the town’s historic center and harbor. Challenges - Difficulties integrating immigrants and refugees into the labor market and perceived strain on the social welfare system have fueled debate and eroded trust in some quarters. Selected quotes - “Essentially with all the social support from the government, you’re redistributing a lot of money to strangers, and we know people are not likely to vote for that kind of system if they don’t have at least some degree of trust in strangers.” — Christian Bjørnskov - “There is increasing evidence that there is a tight relationship between the functioning of political institutions and social trust.” — Michael Bang Petersen ### Costa Rica: The pure life Findings - “Pura vida” culture reflects laid-back lifestyle, strong social relationships, and a sense of community that contribute to well-being. - Long-standing investments in public health and social services produced dramatic health gains at relatively low ongoing cost. - Primary health care model (EBAIS) brings health services to communities and links household visits to electronic health records to set targets and focus resources. Key statistics and facts (preserved exactly) - “The 2021 World Happiness Report ranks Costa Rica the 16th happiest place on earth.” - Costa Rica is, aside from the Czech Republic, the only emerging market economy in the top 20. - Child mortality rates dropped “from about 74 deaths per 1,000 in 1970 to 17 by 1989.” - Life expectancy rose “from 75 in 1990 to 80 (well above the US).” - Costa Rica spends less on health care as a percentage of GDP than the world average: “7.3 percent versus 10 percent in 2017.” - Costa Rica is “the only country in Central America where 100 percent of the population has access to electricity and a source of drinking water.” Policy design and implementation - EBAIS teams assigned to local areas: health workers visit each household annually to assess needs; data are combined with electronic health records to inform targeting and resource allocation. - Public investments in preventive and community health began decades ago (noted heavy spending on health as a proportion of GDP in the 1970s). Governance and political economy - Long democratic history with cross-party continuity: “We have in Costa Rica what we call a social pact...the one that follows must put in one more brick.” - Environmental policy linked to economic and social well-being (shift from high deforestation to green policies due to hydropower concerns). Selected quotes - “People who are happy live longer. That’s why you need to spend less. It’s not only that health contributes to happiness. Happiness contributes to health.” — Mariano Rojas - “Before being born, a Costa Rican is guaranteed life, education, food, social security...” — Luis Alberto Vásquez Castro ### New Zealand: Changing the conversation on well-being Findings - Wellbeing Budget 2019 reoriented fiscal priorities toward mental health, child well-being, support for Māori and Pasifika aspirations, building a productive nation, and transforming the economy. - Holistic framing: recognition that health, education, community connection and cultural dimensions all matter for a “good life.” - Emphasis on process: giving communities more voice and resources to drive change; central government to play a listening and supporting role. Key statistics and facts (preserved exactly) - New Zealand population: “5 million people.” - Child poverty: “In 2020, up to 210,500 children lived in poverty (18.4 percent), according to New Zealand’s statistics agency.” - Budget investment: “$NZ 1.9 billion in mental health.” Policy actions and implementation issues - Budget 2019 allocated billions for mental health services and child poverty and record investment to tackle family violence. - Government introduced early support services for mental health at GP practices and community centers; a 10-year mental health strategy was unveiled. - Calls from experts for stronger outcome measurement and decision-making infrastructure: statistical ability exists but “we’re not making full use of it.” - COVID-19 reinforced and complicated priorities: “Since 2019, the government has been consistent in its goals in subsequent budgets, despite being hugely challenged by COVID-19.” Process and community role - Emphasis on devolving power and resources: “The types of issues we are dealing with cannot be sorted out from the center—the center needs to play a listening and supporting role.” - Child and Youth Wellbeing Strategy (launched August 2019) focuses on joined up responses and was accelerated by the pandemic. Selected quotes - “Well-being as a concept is the right one but you need measures and decision-making infrastructure to make it work.” — Emily Mason - “We’re thinking more holistically about how to deliver better outcomes for people. But we’re also continuing to build our understanding of well-being. This is hard.” — Dominick Stephens *Source: country-cases - Section 1 (PDF)* ### Section 2 ### HEALTH AND WELL-BEING ### Decentralization and codesign - "Increasingly, there’s a move to devolve resources and decision-making, to codesign with families and community stakeholders, and to resource Māori and other providers to develop solutions that work for their communities.” - “It’s a work in progress but absolutely the right direction to be moving in.” ### Community-led provision - Emphasis on resourcing "Māori and other providers" to develop community-specific solutions. - Codesign with "families and community stakeholders" highlighted as a key approach. ### Reporting and context - Reported by ANALISA R. BALA, ADAM BEHSUDI, and ANNA JAQUIERY. - Playground in Wellington, New Zealand. PHOTO: JENNY TREVELYAN *country-cases - Section 2 — https://www.imf.org/-/media/files/publications/fandd/article/2021/december/country-cases.pdf* --- _Source: https://www.imf.org/-/media/files/publications/fandd/article/2021/december/country-cases.pdf_