New well-being assessment provides employers and their collaborators with a brief, validated tool to measure broader health and well-being impact

By IHI authors in collaboration with Karen Moseley and Jessica Grossmeier at HERO

Health and Well-being inforgraphicYears ago, employers and industry collaborators first approached HERO with a request to identify the core metrics and measurement approaches required to evaluate the impact of workplace health and well-being (HWB) initiatives. Initial efforts spanned several years and in collaboration with Population Health Alliance, HERO developed the HERO-PHA Program Measurement & Evaluation Guide: Core Metrics for Employee Health Management. The workplace health promotion field has evolved dramatically since the resource was published in 2015 and employers have asked HERO for measurement tools that better reflect the broadening of workplace HWB initiatives to address a more holistic view of well-being, including social, financial, career, and spiritual well-being.

In response, over the past several years, HERO has collaborated with the 100 Million Healthier Lives movement (100MLives) to identify intervention and measurement approaches that address a broader approach to well-being. One of the resources we’ve been following with great interest is a measurement tool that 100MLives developed to help communities in their coalition to measure the impact of their HWB initiatives. After many years of field implementation of an initial version as well as validation research, we are excited about the release of version two of the Well-being Assessment (Adult – 12 items) – 100 Million Healthier Lives tool for a number of reasons:

  • The tool is freely available for public use
  • The questionnaire is brief, only 12 items
  • All questionnaire items come from validated tools
  • Measurement topics include physical and mental health, as well as social, financial, and other aspects of well-being
  • Resources are available to support verbal or written assessment implementation

HERO’s vice president of research, Jessica Grossmeier, collaborated with the 100MLives measurement team that developed the assessment to identify ways to incorporate the tool into the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© and we are excited to announce that version 5 (coming in Q1 2021) will incorporate metrics from the Well-being Assessment (Adult – 12 items) – 100 Million Healthier Lives. This will support the development of benchmarks based on industry type, geographical region, and organization size.

Read on for more information from the developers of the Well-being Assessment (Adult) about the importance of measuring well-being and how you can utilize the assessment.

How do you define well-being?

Well-being is such a holistic concept that it’s difficult to define, and the field continues to evolve rapidly. The 100MLives definition of health and well-being aligns with the current general consensus, and includes two components of health (physical health and mental health) and three components of well-being (evaluative well-being, emotional well-being, and meaning and purpose). Within these three components of well-being fit items like relationships, community and social support, mood, and financial well-being. The 100MLives definition is also in agreement with Healthy People 2030, which defines health and well-being as how a person “thinks, feels, and functions.”[1]

Why is measuring well-being (in addition to traditional health metrics) important?

Well-being is a holistic, positively framed concept that integrates many aspects of life. Beyond physical and mental health, well-being is a worthy goal for individuals, workplaces, communities, and nations. Multiple studies support the understanding that higher well-being leads to longer, healthier lives. They have shown that well-being is associated with life longevity and other clinical outcomes, including diabetes and cardiovascular disease, and with health-related quality of life.[2]

Why is well-being especially important for employers to understand?

Higher employee well-being, including improved social relationships and work-life balance, is associated with increased productivity, profitability, and customer loyalty, as well as decreased staff turnover.[3]

Additionally important for employers who provide employee health insurance, higher well-being also is a predictor of lower health care spending and utilization. One study showed an association between well-being and risk for a hospital event.[4] Another study showed that higher community well-being was associated with lower rates of all-cause, cardiovascular, and respiratory hospital admissions.[5]

Which components of the Well-being Assessment (Adult – 12 items) are included in the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© version 5 (HERO Scorecard)?

The HERO Scorecard includes two measures of evaluative well-being from the 100MLives assessment.  These two items, known as Cantril’s Ladder, are measures of current and future life evaluation. The Cantril’s Ladder questions asks the respondent to indicate where on a ladder from the worst to best possible life for themselves they currently stand, and where they believe they’ll stand in 5 years.

What contributes most to a person’s well-being is something they define for themselves, so we use Cantril’s Ladder because it’s a subjective, person-reported measure. Individuals who self-report a 7 or higher on current life evaluation and an 8 or higher on future life evaluation can be categorized as “thriving”. Those who self-report a 4 or lower on both items can be described as “suffering”.  Individuals reporting any other combination of scores can be categorized as “struggling”. The HERO Scorecard focuses on the percent of respondents who are “thriving”, which is a positively focused, asset-based approach.

Life Evaluation table (Cantril's Ladder)

How sensitive are the measures to population-level and individual-level change over time? How often should it be re-administered?

We recommend assessing well-being quarterly, although this is not a strict guideline. If, for example, you’re in the midst of an active effort to improve workplace well-being, you may want to measure more frequently to track progress. If you’re instead just monitoring well-being, then less frequently may be appropriate.

With larger employee populations it will likely take longer to detect significant changes in well-being than in smaller populations.  For example, one 100MLives community testing a health improvement program that included 50 individuals was able to detect a 44% increase in individuals who were thriving after 6 months.[6]

Are there benchmarks for other employers?

Not yet!  As organizations share their well-being results with HERO, benchmarking at overall and industry sector specific levels may become available.  Gallup sometimes publishes national level data for Cantril’s ladder (here’s the most recent one!), but most of their data is unfortunately not publicly available .

Where may I find additional information about the Well-being Assessment (Adult – 12 items) – 100 Million Healthier Lives?

Additional information, including complete assessment questions and an accompanying approach measurement guide, is available at the Institute for Healthcare Improvement (IHI) website.


[1] Pronk N, Kottke T, Milstein B, et al. “Health and Well-Being.” In Issue Briefs to Inform Development and Implementation of Healthy People 2030. Secretary’s Advisory Committee for Healthy People 2030.

[2] Steptoe A, Deaton A, Stone AA. Subjective wellbeing, health, and ageing. Lancet. 2015;385(9968):640-648. doi:10.1016/S0140-6736(13)61489-0.

[3] Krekel, Christian, George Ward, Jan-Emmanuel De Neve, and Council Members: J. Harter, A. Blankson, A. Clark, C. Cooper, J. Lim, P. Litchfield, J. Moss, M. I. Norton, A.V. Whillans, and D. Cooperrider, and D. Mendelwicz. “Employee Well-being, Productivity, and Firm Performance: Evidence and Case Studies.” Chap. 5 in Global Happiness and Wellbeing Policy Report, by Global Council for Happiness and Wellbeing, 72–94. New York: Sustainable Development Solutions Network, 2019.

[4] Gandy WM, Coberley C, Pope JE, Rula EY. Well-being and employee health: how employees’ well-being scores interact with demographic factors to influence risk of hospitalization or an emergency room visit. Population Health Management. 2014;17(1):13-20. doi:10.1089/pop.2012.0120.

[5] Roy B, Riley C, Herrin J, et al. Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states. BMJ Open. 2019;9(11):e030017. doi: 10.1136/bmjopen-2019-030017.

[6] Callender S, Calleros M, Chen S, et al. Improving Health Outcomes for Women Experiencing Homelessness in the Skid Row Community of Los Angeles.; 2017. Accessed December 11, 2020.

©2024 Health Enhancement Research Organization ‘HERO’


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