Bhutan was the first country in the world to pursue happiness as a state policy. The Bhutanese concept of happiness is deeper than the common meaning of happiness in industrialized countries. The philosophy of gross national happiness has several dimensions: it is holistic, recognizing people's spiritual, material, physical or social needs; it emphasizes balanced progress; it views happiness as a collective phenomenon; it is both ecologically sustainable, pursuing well-being for both current and future generations, and equitable, achieving a fair and reasonable distribution of well-being among people.¹1 . Ura K, Alkire S, Zangmo T, Wangdi K. An extensive analysis of gross national happiness index. Thimphu: The Centre for Bhutan Studies; 2012. Available from: Available from: http://www.grossnationalhappiness.com/wp-content/uploads/2012/10/An%20Extensive%20Analysis%20of%20GNH%20Index.pdf [cited 2015 July 7].
http://www.grossnationalhappiness.com/wp... Since the early 1970s, Bhutan has promoted population well-being over material development. Happiness, health and well-being are closely related. ²2 . Graham C. Happiness and health: lessons-and questions-for public policy. Health Aff (Millwood). 2008 Jan-Feb;27(1):72-87. http://dx.doi.org/10.1377/hlthaff.27.1.72 PMID:18180481
http://dx.doi.org/10.1377/hlthaff.27.1.7... ³3 . Diener E, Chan MY. Happy people live longer: Subjective well‐being contributes to health and longevity. Appl Psychol Health Well‐Being. 2011;3(1):1-43. Good health is often considered the single most important determinant of well-being;¹1 . Ura K, Alkire S, Zangmo T, Wangdi K. An extensive analysis of gross national happiness index. Thimphu: The Centre for Bhutan Studies; 2012. Available from: Available from: http://www.grossnationalhappiness.com/wp-content/uploads/2012/10/An%20Extensive%20Analysis%20of%20GNH%20Index.pdf [cited 2015 July 7].
http://www.grossnationalhappiness.com/wp... ²1 . Ura K, Alkire S, Zangmo T, Wangdi K. An extensive analysis of gross national happiness index. Thimphu: The Centre for Bhutan Studies; 2012. Available from: Available from: http://www.grossnationalhappiness.com/wp-content/uploads/2012/10/An%20Extensive%20Analysis%20of%20GNH%20Index.pdf [cited 2015 July 7].
http://www.grossnationalhappiness.com/wp... conversely, adverse health changes have lasting and negative effects on well-being. ⁴4 . Easterlin RA. Explaining happiness. Proc Natl Acad Sci USA. 2003 Sep 16;100(19):11176-83. http://dx.doi.org/10.1073/pnas.1633144100 PMID:12958207
http://dx.doi.org/10.1073/pnas.163314410...

In industrialized countries, happiness is often linked with material consumption. A basic level of material wealth is necessary, but citizens of richer and more technologically advanced countries are not necessarily the happiest. ⁵5 . Easterlin RA. Will raising the incomes of all increase the happiness of all? J Econ Behav Organ. 1995;27(1):35-47. http://dx.doi.org/10.1016/0167-2681(95)00003-B
http://dx.doi.org/10.1016/0167-2681(95)0... Along with economic growth, there is a need to measure well-being and ecological sustainability to reflect the overall progress of nations and of humankind. ⁶6 . Helliwell J, Layard R, Sachs J, editors. World happiness report. New York: The Earth Institute Columbia University; 2012. Given increasing evidence that the current trajectory of human development is not sustainable, there is an urgent need for more inclusive measures of progress than traditional economic indicators such as gross domestic product.⁷7 . Stiglitz J, Sen A, Fitoussi J-P. The measurement of economic performance and social progress revisited. Paris: Commission on the Measurement of Economic Performance and Social Progress; 2009. Available from: Available from: http://www.stiglitz-sen-fitoussi.fr/documents/overview-eng.pdf [cited 2015 July 7].
http://www.stiglitz-sen-fitoussi.fr/docu...

Since the global recession of 2008-2009, the importance of well-being has gained political momentum - driven, in part, by a perception that the poorest and most vulnerable members of society are paying the price for excessive greed and risk-taking in the financial sector. In Europe, a shift in emphasis from measuring economic production to measuring people's well-being has been recommended.⁷7 . Stiglitz J, Sen A, Fitoussi J-P. The measurement of economic performance and social progress revisited. Paris: Commission on the Measurement of Economic Performance and Social Progress; 2009. Available from: Available from: http://www.stiglitz-sen-fitoussi.fr/documents/overview-eng.pdf [cited 2015 July 7].
http://www.stiglitz-sen-fitoussi.fr/docu... ⁸8 . Bache I. Measuring quality of life for public policy: an idea whose time has come? Agenda-setting dynamics in the European Union. J Eur Public Policy. 2013;20(1):21-38. http://dx.doi.org/10.1080/13501763.2012.699658
http://dx.doi.org/10.1080/13501763.2012.... Following a resolution proposed by Bhutan, the United Nations convened a high level meeting at which the Secretary-General Ban Ki-moon called for development outcomes that value and measure happiness and well-being.⁹9 . The report of the high-level meeting on wellbeing and happiness: defining a new economic paradigm. New York: The permanent mission of the Kingdom of Bhutan to the United Nations; 2012. Available from: Available from: https://sustainabledevelopment.un.org/content/documents/617BhutanReport_WEB_F.pdf [cited 2015 July 7].
https://sustainabledevelopment.un.org/co...

The recent political momentum and the close links between health and well-being present an opportunity for health objectives to be included in other policy domains. Gross national happiness has greatly influenced the health system in Bhutan, as reflected in the constitution which states that "the state shall provide free access to basic public health services in both modern and traditional medicines." Health is recognized as a prerequisite for economic and spiritual development and as a means to achieving gross national happiness.¹⁰10 . The constitution of the Kingdom of Bhutan. Article 9, section 22. Thimphu: Royal Government of Bhutan; 2008. Available from: Available from: http://www.bhutanaudit.gov.bt/About%20Us/Mandates/Constitution%20of%20Bhutan%202008.pdf [cited 2015 July 7]
http://www.bhutanaudit.gov.bt/About%20Us...

In Bhutan, 7.4-11.4% of total government spending is in the health sector.¹¹11 . Health policy. Thimphu: Bhutan Ministry of Health; 2011. Available from: Available from: http://www.gnhc.gov.bt/wp-content/uploads/2012/04/nationalHpolicy.pdf [cited 2015 July 7].
http://www.gnhc.gov.bt/wp-content/upload... Primary health care is emphasized; privatization of health services is prohibited. A health trust fund was established in 1998 to ensure uninterrupted supply of essential drugs and vaccines. These policies are based on the philosophy of gross national happiness and provide an indication of the population-health benefits of prioritizing well-being in national policy-making. Bhutan screens all sectoral plans and policies to ensure that they are consistent with gross national happiness.

At the global level, translating gross national happiness into policy has the potential to promote health as defined in World Health Organization (WHO) charter, acknowledging the role of the environment, ecological sustainability, good governance and social determinants. WHO can play a more active role in strengthening consultation between sectors, improving access to relevant data and disseminating evidence on health and well-being. As a leader in the happiness movement, Bhutan has hosted several international conferences on gross national happiness; a further conference will be held in November 2015.

The conference will be an opportunity to collate and disseminate the latest evidence from Bhutan and other countries linking health and well-being. Participants will discuss tools needed to pursue research and policy initiatives that contribute to sustainable development goals. First, the philosophy of gross national happiness needs to be understood more widely in the corporate boardroom. Second, the required indicators should be incorporated into current databases in the health sector. Third, the health sector has a responsibility to communicate the fact that health, human happiness and ecologically sustainable development are interdependent.

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