{
  "title": "A Life Well Lived",
  "sourceUrl": "https://www.imf.org/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery",
  "canonical": "https://www.imf.org/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery",
  "overlayPath": "/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery/index.md",
  "summary": "A Life Well Lived Analisa R. Bala, Adam Behsudi, and Anna Jaquiery Three countries provide lessons for improving health and promoting happiness",
  "sections": [
    {
      "heading": "Overview: three country case studies",
      "content": "- Focus: Denmark, Costa Rica, and New Zealand as examples of policies and institutions that promote health and happiness.\n- Key message: delivering services at the community level, cultivating social trust, and accounting for well-being at the highest policy level play important roles."
    },
    {
      "heading": "Denmark — social trust, collective action, and welfare institutions",
      "content": "- Core features:\n  - High social trust among citizens and in government institutions.\n  - Robust social welfare system: generous unemployment benefits, free health care and higher education, heavily subsidized childcare.\n  - Low perceived corruption and a tradition of consensus politics (no single party has held a majority since the early 1900s).\n- Pandemic outcomes and behaviors:\n  - More than 75 percent of eligible citizens as of late October were fully vaccinated.\n  - At the height of the pandemic, more than 60 percent of the adult population was being tested each week.\n  - Survey finding: over 90 percent of Danes trust national health authorities.\n- Local well-being example:\n  - Dragør (2014): municipal survey with the Happiness Research Institute led to investments in an indoor swimming center, sports facilities, senior programming, and improved public space to support work-life balance.\n- Challenges:\n  - Difficulties integrating immigrants and refugees into the labor market.\n  - Debates over perceived strain on the social welfare system have eroded trust in some corners.\n- Analytical perspectives:\n  - Christian Bjørnskov: happiness in Denmark arises from a combination of trust, tolerance, strong institutions, economic development, and resilient democracy—not solely extensive welfare.\n  - Michael Bang Petersen: tight relationship between functioning political institutions and social trust; citizens come to trust fellow citizens when institutions \"have your back.\""
    },
    {
      "heading": "Costa Rica — primary health care, social pacts, and \"pura vida\"",
      "content": "- Core features:\n  - Cultural framing: \"pura vida\" denotes health, work, and time with friends and family.\n  - Strong welfare provisions: free education, guaranteed state pension, universal access to electricity and drinking water (100 percent), and universal health coverage.\n- Health system design and outcomes:\n  - Investment profile: in the 1970s, Costa Rica spent more on health as a proportion of GDP than some advanced economies.\n  - Child mortality: dropped from about 74 deaths per 1,000 in 1970 to 17 by 1989.\n  - Life expectancy: rose from 75 in 1990 to 80 (well above the US).\n  - Health spending: the country spent 7.3 percent of GDP on health care versus 10 percent world average in 2017.\n- Primary care model (EBAIS):\n  - Every person is assigned to an equipo básico de atención integral en salud (EBAIS) — local primary health care teams including physicians, nurses, and community health workers.\n  - Annual household visits by health workers; data combined with electronic health records to set targets and focus resources on higher-risk areas.\n  - Implementation: EBAIS initially targeted underserved rural areas before expanding to urban centers, building robust data on social determinants of health.\n- Governance and continuity:\n  - Long-term \"social pact\": successive governments build incrementally (\"the one that follows must put in one more brick\") supporting long-term investments in welfare and health.\n  - Historical policies: free and compulsory primary education since 1869.\n- Additional factors:\n  - Environmental policy and green energy shift driven by self-interest in preserving hydropower resources; link between greener environment and jobs."
    },
    {
      "heading": "New Zealand — institutionalizing well-being in budgetary policy",
      "content": "- Policy innovation:\n  - Wellbeing Budget 2019 prioritized five areas: mental health, child well-being, supporting aspirations of the Māori and Pasifika populations, building a productive nation, and transforming the economy.\n  - Investment: $NZ 1.9 billion in mental health included in Budget 2019.\n- Context and challenges:\n  - Population: 5 million people.\n  - Child poverty: in 2020 up to 210,500 children lived in poverty (18.4 percent), according to New Zealand’s statistics agency.\n  - Significant social problems: among the worst for family and sexual violence in OECD measures.\n- Institutional and process shifts:\n  - Emphasis on holistic measures of well-being beyond income; recognition that health and the economy are linked.\n  - Calls for better measurement and decision-making infrastructure to translate well-being concepts into outcomes.\n  - Movement toward devolving resources and co-designing solutions with communities, Māori and other providers.\n- Measurement and implementation gaps:\n  - Analysts note statistical capacity exists but is underutilized: need measures that follow individuals over lifetimes and link community wisdom to data.\n  - Treasury perspectives: continuing to build understanding of well-being; process matters—empowering communities and giving them resources is critical.\n- Pandemic effects:\n  - COVID-19 \"upped the ante\" on joined-up responses for children and young people; government consistency on goals across subsequent budgets despite pandemic challenges.\n- Mental health strategy:\n  - Introduction of early support services at GP practices and community centers; a recently unveiled 10-year mental health strategy acknowledged the need to give people tools to care for their own well-being."
    },
    {
      "heading": "Cross-cutting findings and policy implications",
      "content": "- Findings:\n  - Social trust is a key enabler for public-good provision and collective responses (Denmark).\n  - Community-based primary care models can deliver strong health outcomes at relatively low cost (Costa Rica: EBAIS; life expectancy and child mortality improvements).\n  - Institutionalizing well-being in budgeting and policy frameworks can reorient priorities toward health, child welfare, and mental health (New Zealand: Wellbeing Budget 2019).\n  - Long-term, incremental policy continuity and cross-party commitment support durable welfare outcomes (Costa Rica \"social pact\").\n- Policy recommendations and processes emphasized:\n  - Invest in community-level service delivery and data systems that link household-level visits to electronic health records (Costa Rica model).\n  - Foster and maintain social trust through transparent, efficient institutions and low corruption to sustain redistributive welfare policies (Denmark lessons).\n  - Institutionalize well-being metrics in budgeting and decision-making, while devolving resources and decision rights to communities and indigenous providers to co-design solutions (New Zealand experience).\n  - Prioritize measurement infrastructure that can follow individuals over their lifetimes and provide evidence for targeting resources and evaluating outcomes.\n  - Recognize multi-dimensionality of well-being: health, education, social connections, environment, and safety must be considered holistically.\n\nReported by ANALISA R. BALA, ADAM BEHSUDI, and ANNA JAQUIERY.\n\n---\n\n Content in this bundle\n\n- حياة رغيدة\n  - حياة رغيدة (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - حياة رغيدة (PDF){rel=\"external\" type=\"application/pdf\"}\n- A Life Well Lived\n  - A Life Well Lived (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - A Life Well Lived (PDF){rel=\"external\" type=\"application/pdf\"}\n- Una vida bien vivida ● Finanzas y Desarrollo ● Diciembre de 2021\n  - Una vida bien vivida ● Finanzas y Desarrollo ● Diciembre de 2021 (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - Una vida bien vivida ● Finanzas y Desarrollo ● Diciembre de 2021 (PDF){rel=\"external\" type=\"application/pdf\"}\n- Leçons de bien-vivre\n  - Leçons de bien-vivre (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - Leçons de bien-vivre (PDF){rel=\"external\" type=\"application/pdf\"}\n- bala\n  - bala (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - bala (PDF){rel=\"external\" type=\"application/pdf\"}\n- 美好生活 ● 《金融与发展》● 2021年12月号\n  - 美好生活 ● 《金融与发展》● 2021年12月号 (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - 美好生活 ● 《金融与发展》● 2021年12月号 (PDF){rel=\"external\" type=\"application/pdf\"}\n\n---\n\nSource: https://www.imf.org/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery"
    }
  ],
  "bullets": [
    "[Markdown version](/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery/index.md)",
    "[Structured JSON version](/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery/index.json)",
    "[Bundle manifest](/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery/bundle-manifest.json)",
    "Authors: ANALISA R BALA, ADAM BEHSUDI, ANNA JAQUIERY",
    "Published: December 2, 2021",
    "Focus: Denmark, Costa Rica, and New Zealand as examples of policies and institutions that promote health and happiness.",
    "Key message: delivering services at the community level, cultivating social trust, and accounting for well-being at the highest policy level play important roles.",
    "Core features:",
    "Pandemic outcomes and behaviors:",
    "Local well-being example:",
    "Challenges:",
    "Analytical perspectives:",
    "Core features:",
    "Health system design and outcomes:",
    "Primary care model (EBAIS):",
    "Governance and continuity:",
    "Additional factors:",
    "Policy innovation:",
    "Context and challenges:",
    "Institutional and process shifts:",
    "Measurement and implementation gaps:",
    "Pandemic effects:",
    "Mental health strategy:",
    "Findings:",
    "Policy recommendations and processes emphasized:",
    "**حياة رغيدة**",
    "**A Life Well Lived**",
    "**Una vida bien vivida ● Finanzas y Desarrollo ● Diciembre de 2021**",
    "**Leçons de bien-vivre**",
    "**bala**",
    "**美好生活 ● 《金融与发展》● 2021年12月号**"
  ],
  "related": [
    {
      "title": "حياة رغيدة",
      "role": "document",
      "sourceUrl": "https://www.imf.org/-/media/files/publications/fandd/article/2021/december/ar/bala.pdf",
      "summary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/ar/bala.pdf.md",
        "mime": "text/markdown"
      },
      "binary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/ar/bala.pdf",
        "mime": "application/pdf"
      }
    },
    {
      "title": "A Life Well Lived",
      "role": "document",
      "sourceUrl": "https://www.imf.org/-/media/files/publications/fandd/article/2021/december/country-cases.pdf",
      "summary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/country-cases.pdf.md",
        "mime": "text/markdown"
      },
      "binary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/country-cases.pdf",
        "mime": "application/pdf"
      }
    },
    {
      "title": "Una vida bien vivida ● Finanzas y Desarrollo ● Diciembre de 2021",
      "role": "document",
      "sourceUrl": "https://www.imf.org/-/media/files/publications/fandd/article/2021/december/es/bala.pdf",
      "summary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/es/bala.pdf.md",
        "mime": "text/markdown"
      },
      "binary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/es/bala.pdf",
        "mime": "application/pdf"
      }
    },
    {
      "title": "Leçons de bien-vivre",
      "role": "document",
      "sourceUrl": "https://www.imf.org/-/media/files/publications/fandd/article/2021/december/fr/bala.pdf",
      "summary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/fr/bala.pdf.md",
        "mime": "text/markdown"
      },
      "binary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/fr/bala.pdf",
        "mime": "application/pdf"
      }
    },
    {
      "title": "bala",
      "role": "document",
      "sourceUrl": "https://www.imf.org/-/media/files/publications/fandd/article/2021/december/ru/bala.pdf",
      "summary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/ru/bala.pdf.md",
        "mime": "text/markdown"
      },
      "binary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/ru/bala.pdf",
        "mime": "application/pdf"
      }
    },
    {
      "title": "美好生活 ● 《金融与发展》● 2021年12月号",
      "role": "document",
      "sourceUrl": "https://www.imf.org/-/media/files/publications/fandd/article/2021/december/zh/bala.pdf",
      "summary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/zh/bala.pdf.md",
        "mime": "text/markdown"
      },
      "binary": {
        "path": "/-/media/files/publications/fandd/article/2021/december/zh/bala.pdf",
        "mime": "application/pdf"
      }
    }
  ],
  "alternates": {
    "markdown": "/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery/index.md",
    "json": "/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery/index.json",
    "bundleManifest": "/en/publications/fandd/issues/2021/12/countries-lessons-life-well-lived-bala-behsudi-jaquiery/bundle-manifest.json"
  },
  "generatedAtUtc": "2026-09-15T17:11:50.412Z"
}