When it comes to measures of physical health, such as exercise, smoking, and weight, people across the United States reported improvement in the 2017 Gallup-Sharecare Well-Being Index.

However, the survey found significant declines in well-being across the nation, marking a first in the nearly 10-year history of the index. Out of a possible score of 100, the national index score dropped from 62.1 in 2016 to 61.5 in 2017.

“This means that things that are happening around us in our environment or that are external to us have a greater impact on quality of life and well-being and the way we perceive our life more than we previously thought,” Dan Witters, research director for the index, told Healthline.

Researchers use the term “well-being” to refer to how satisfied people are with their lives and whether they view their emotional state positively or negatively, explains Laurie Santos, PhD, professor of psychology at Yale University.

“It’s by definition a subjective state, one that people report on themselves,” Santos told Healthline.

For the index, researchers surveyed more than 160,000 people 18 and older, living in all 50 states and the District of Columbia. Respondents answered 50 questions over the telephone that were based on five elements of well-being:

  • purpose: liking what you do each day and being motivated to achieve your goals
  • social: having supportive relationships and love in your life
  • financial: managing your economic life to reduce stress and increase security
  • community: liking where you live, feeling safe, and having pride in your community
  • physical: having good health and enough energy to get things done daily

When Gallup and Sharecare set out to measure well-being, Witters says they wanted to find all aspects of well-being that affect outcomes around healthcare utilization because of the skyrocketing costs in the United States.

They also were interested in business outcomes, such as unplanned absences from work and performance at work, as well as adaptability and resiliency.

“As far as community, things like violent crime, property crime, and high school graduation rates all relate to well-being,” Witters said. “We put a lot into using these five elements because each brings their own additive, not overlapping contribution to the model itself and its ability to predict the outcome of those things we care about.”

In addition to physical health improvements, community well-being was the only other element that improved for Americans between 2016 and 2017.

Purpose and social well-being metrics, as well as mental health aspects of physical well-being, are to blame for the sharp declines in overall well-being in 2017.

Many of the states showing declines in well-being scores worsened on the same set of metrics, including:

  • an increase in worry on any given day
  • a sharp uptick in reporting “little interest or pleasure in doing things”
  • an increase in clinical diagnoses of depression
  • elevated reports of daily physical pain
  • a decline in perceiving “positive energy” from friends and family members
  • a reduction in having “someone who encourages you to be healthy”
  • a drop in reports of liking “what you do each day”
  • a decrease in those who have a leader in their lives who makes them “enthusiastic about the future”
  • a decline in the percentage of respondents who report that they are reaching their goals
  • satisfaction with standard of living (compared to peers)

“Overall, these results fit with what a lot of the research is telling us — that even though we are generally richer and have more stuff (cars, cellphone, etc.) than in past decades, these changes haven’t affected our overall well-being that much. If anything, people are a lot less happy than we often think,” Santos said.

For those who ranked high in well-being in all five categories, Witters says, they have an advantage over others who didn’t.

“[They even] outperform those who are physically fit, but lack in the other four elements,” he said. “Holistic well-being is important. It influences how people perform at work, how they give back to the community, how they interact with those at home, as well as the way the economy works. The effects are wide-ranging and very real and significant.”

Which states topped the list?

South Dakota and Vermont took the No. 1 and 2 spots, both scoring 64 out of 100 possible points.

South Dakota had high scores in purpose and Vermont had high scores in social. Plus, both states have consistently ranked highly as “well-being elite” states since the inception of the Gallup-Sharecare Well-Being Index.

Hawaii ranked third, with a score of 63, making it one of only two states that have ranked in the top 10 every year since Sharecare and Gallup began measuring well-being in 2008.

Hawaii also placed among the top four states for purpose, social, and community well-being. It’s also the only state in the country that ranked in the top 10 across all elements of well-being.

But do these top-ranking states create a place of well-being for their residents or are well-being conscious people attracted to these states?

Michael Acker, general manager of Sharecare’s The Blue Zones Project, which implements strategies in local communities to improve well-being, believes it’s a bit of both.

“Places like Boulder, Colorado, attract people from across the country who also have well-being core values, but this can also be created in communities. For instance, places like Naples, Florida, or Fort Worth, Texas, are creating a culture of well-being and taking a comprehensive approach,” Acker told Healthline.

He says cities across the country use health and well-being as a competitive strategy to differentiate themselves from other communities. “Places that are healthy attract businesses that are vibrant. These places also see different opportunities economically compared to other communities as far as attracting philanthropy gifts and grants,” Acker said.

His work with The Blue Zones Project is based on the findings of Dan Buettner, a National Geographic fellow who discovered the five places in the world — dubbed Blue Zones — where people live the longest, healthiest lives.

Buettner coined the commonalities of these places as having what he called the Power 9, which are:

  1. Move Naturally
  2. Purpose
  3. Down Shift
  4. 80% Rule
  5. Plant Slant
  6. Wine @ 5
  7. Belong
  8. Loved Ones First
  9. Right Tribe

However, Acker says the most impactful of Buettner’s findings was that people in the Blue Zone didn’t try to be healthy.

“They didn’t live long because they got on a diet, or pursued health like we do in America,” he explains. “Rather they had a culture of health and their environments were set up in ways to make healthy choices really easily and abundantly.”

Acker’s team partnered with Buettner to use his Blue Zones findings as a blueprint for bettering health in the United States.

“We built the model together and we are now deploying that in 42 communities throughout the country,” Acker said.

The programs revolve around helping people to connect with one another and find their purpose by applying their strengths and passions toward work or their community. Acker also focuses on designing cities that allow people to easily walk or bike places with infrastructure that makes this possible.

Creating policies that foster a healthy lifestyle, such as those related to tobacco use or making healthy foods accessible to residents, is another focus.

Lastly, helping to create healthy environments in all places, such as restaurants, stores, work, schools, and places of worship, is a priority.

Acker believes that it’s no coincidence that states that ranked high on the index implement some of these approaches.

“A place like the state of Hawaii has some of the most progressive and forward-thinking tobacco legislation in the entire nation, and so it’s not coincidental that it has the lowest smoking rates,” Acker said. “When you look at the types of things that states are doing when it comes to people, places, and policy, we think it’s more than chance that they end up ranking higher.”

Since everyone can’t live in the top states on this index and even if your state falls near the bottom of the index rankings, Santos says there’s things individuals can do to improve their well-being, especially since research shows 40 percent of well-being is under our conscious control.

“There’s a lot we can do to improve our well-being through a set of intentional practices, so with some effort we can change these negative trends around,” says Santos. “Simple things like taking time for social connection, practicing gratitude and doing random acts of kindness can really bump up well-being. But there’s also a lot of room for healthy practices like getting enough sleep, meditating, and exercising, as well.”