“Happiness: The True Measure of a Successful Society” | Talks at Google

“Happiness: The True Measure of a Successful Society” | Talks at Google


[MUSIC PLAYING] ANDREW RUBIN: Thanks,
everybody, for coming. My name’s Andrew Rubin. I work for NYU Langone Health. I’m the vice president of
clinical affairs for the health system. Basically, that means
I run their outpatient clinical operations. I also host a weekly
radio show on Sirius XM called “Healthcare Connect.” I’m really excited
to be here today. I was asked by a
good friend of mine from the Danish consulate
in New York to host, moderate a panel on
happiness, which I think is a topic that
everybody in this room wants to hear more about. And I think that the
team at the consulate put together probably one of
the best panels you could ever find, probably in the
world, to talk about it. So I’m going to
introduce people, and I’m going to
start with Jeff Sachs, who, personally, I’ve
never actually met. But it’s a privilege
to get to meet today, because he’s pretty much at
the forefront of many things– sustainable development,
economic policy. He’s the director for
sustainable development at the Earth Institute
at Columbia University. He is a university professor
at Columbia University, and for people who work
for academia, that’s pretty much the
highest rank you can have as a professor in the
world, certainly at Columbia as well. And he’s a special advisor
at the United Nations, and he’s known as a world leader
in economic and sustainable development. On my right here– this guy’s pretty cool. Not that you’re not, Jeff, but– JEFFREY SACHS: What can I do? ANDREW RUBIN: Meik Wiking– he has a very
interesting background. He’s the founder and CEO of the
Happiness Research Institute. So who gets to
spend all their day running a foundation
where you’re talking about being happy? This guy does. And to prove it, he is a
New York Times best selling author who wrote– I had to practice this. I actually did have to
practice this– wrote a book. It’s called “The
Little Book of Hygge.” And if you’re Danish,
you can make it sound much better than I just did. But hygge is essentially
a form of happiness. I’m going to let him
explain it to you. And I’m excited to tell you,
I’m getting an autographed copy on the way out. There are some books on
the table on the way out. So I encourage you
all to pick it up. It’s printed in 30
languages around the world, a million copies. It’s a pretty cool book. And I know this is Google,
but I still use note cards. I’m sorry. They offered me an iPad. They just don’t– they
don’t work in this form. Last is Catalina Cernica. She is a project director
for the health and happiness studies at the Leo
Innovation Lab. We have a lot of guests,
again, on my left, from the Leo Innovation Lab. It’s part of an
organization which is part of the Leo
Foundation, which is a very large philanthropic
organization based in Denmark. They fund a lot of
research in health care. They are independent of
Leo Pharmaceuticals, which is a huge dermatologic
pharmaceutical company in Denmark around the world. And their mission– I’m going to let Catalina talk
a little bit more about that. But let’s just get started. And I’m going to
start with you, Meik, because I think
this is a question– it’s not as obvious to
everybody as it sounds. But what is happiness? How do we define happiness? And who better than you to
answer that question for us? MEIK WIKING: So I think one
useful definition of happiness is the experience of joy,
contentment, and satisfaction with life, combined
with the sense that life is good,
worthwhile, and meaningful. Now, that is, of course, a very
wide definition, and complex. So usually what we do when
we work with happiness is we break it down and look
at the different components that happiness consists of. And it’s also what we do with
other complex phenomenons. If we talk about, how
is the US economy doing, we also break that down and
look at different components. We talk about GDP. We talk about growth. We talk about inflation,
unemployment rates. And that gives us a
language to talk about, how is the US economy doing? So that’s also what we
need to do with happiness. So when we look at
happiness, we look at overall life satisfaction–
taking a step back, looking at your life, considering the
worst possible life you could live, the best possible life you
could live, and where you feel you stand right now. Another dimension is
what kind of emotions do people experience
on a daily basis, both positive and negative ones? And thirdly, there
is a dimension that covers what Aristotle
believed the good life was, and he believed the good
life was the meaningful life. So that gives us the ability
to dissect happiness. And all of those things, of
course, are very subjective. And I think that’s
not a challenge. That’s a good thing. We study other phenomenons
that are subjective. We study depression. We study stress. We study loneliness–
all of those things about how we as individuals
experience the world. So the same with happiness. I don’t think it’s
more difficult to study positive emotions,
compared to negative emotions. And also, to me,
the only person here that can tell us whether
Catalina is happy or not is Catalina. So it is a metric that
is person-centric, or patient-centric. That allows Catalina’s
view on her life to be the core of what
we’re trying to understand. ANDREW RUBIN: So Jeff, why
are we talking about this now? I know the UN, which
you’re a co-author on, puts out a World Report on
Happiness for many years. Denmark was number
one on the list. I think you slipped
to number two this year– still a very
good ranking, considering the US continually falls
towards the bottom. Why are we talking about this,
and how are we even measuring something like this? JEFFREY SACHS: Well, we’ve
been talking about happiness for at least 2,300
years, since Aristotle wrote “Nicomachean
Ethics,” where he said eudaimonia,
or happiness, is the highest goal
of individuals. And he wrote another
book, very good book, called “The Politics,”
where he said eudaimonia is the highest goal
of our community life also. That’s what politics
should be about. Let me ask you, is politics
making you happy these days? Or is it making you
incredibly depressed? It’s making me probably
crazy, at this point. And that was one of the
insights of Aristotle, that your well-being depends
on your social conditions– not only your personal income
and personal conditions, but whether your
president is a nut, or whether the government
is honest or corrupt, or other things like that. So talking about happiness
is a quite natural thing. But for 100 years,
especially in this country, we stopped talking
about happiness, and we talked instead about
gross domestic product. We talked about money. And the assumption
was, at various levels of sophistication,
from unbelievably crude to a little more sophisticated,
that your money was the measure of your happiness. And that has been
American culture as well. Then it was noted, around 1984,
by a very pioneering professor at Penn, Richard Easterlin,
that when people were asked about their happiness compared
to their per capita incomes, the US had been increasing
per capita income for decades, but it didn’t seem like
happiness was rising. And that basic idea is what
motivates the kinds of studies that are underway, that we
have to get beyond money as the measure of all things. And in the United
States, it’s pretty clear we have declining
happiness and rising income at the same time. So there’s a real puzzle and
challenge in this country. And more generally, it’s
pretty clear what the inventor of gross domestic
product said repeatedly– he was one of my teachers also,
Simon Kuznets, Nobel laureate– it’s not a measure
of well-being. Stop it. Stop using it. It’s a measure of
economic output. It’s not a measure
of well-being. But we’re obsessed
in our country. Will GDP rise 3.1% or 2.9%? And so we’ve gone a little
mad in the United States, way overboard on this, and we
haven’t asked about happiness. Well, it turns out, you
can ask about happiness. You ask, are you happy? And you do that with various
levels of sophistication, and you find out all sorts
of interesting things. So that’s why we’re doing it. ANDREW RUBIN: So when you
find out– and I’m sorry, I was going to– I have a question for you. But when you find out the answer
to that question, in this UN report, that Americans
are actually not happy and Danes are, relatively
speaking, much happier, what do you do about that? To me, the data is great. The report’s extremely useful. But what are we going
to do with that? It can’t be as simple as
getting a new president. JEFFREY SACHS: Well– [LAUGHTER] Now I’m happy! Now we’re talking! ANDREW RUBIN: That was
a softball question. JEFFREY SACHS: OK. Gallup has done a
really wonderful job over the last dozen years or
so of doing an annual survey. And they ask a very specific
question that Mike referred to. It’s called the Cantril ladder. So the question, which each of
you can now take in your minds, is, imagine that
life is a ladder, and the zero rung on
the ladder is the worst life you can imagine
for yourself, and the top rung, the 10th
rung, is the best life you can imagine for yourself. Where do you stand on
that ladder of life? So Gallup does that
question, asks that question to about 1,000 people, each
in 150 countries, so about 150,000 people. And we report that
once a year. and that’s where Denmark’s always
at or near the top. And the social democratic
countries of northern Europe are always at the top. The United States is by
no means that the bottom. We are 19th in the ranking out
of 150 countries this year. For the US these days,
hey, that’s pretty good. We’re still in the top 20. Maybe not for long, but
we’re still in the top 20. But we’ve been going down,
and clearly, the mood is bad. And we also found
this year, by the way, that tabulating mood, which
is, were you worried yesterday, were you anxious yesterday,
were you angry yesterday? That is soaring in
the world right now over the last 10 years. That’s really about the most
alarming finding of the report, in my view, of this year. So each year we do an analysis. What accounts for this ranking? Can we find the correlates? Can we find the
variables that seem to explain the differences? And that’s where
something can be done. John Helliwell, professor at
University of British Columbia, leads that analysis each year. He does a wonderful job. And speaking very
succinctly, I hope– the factors that count are
your per capita income. That definitely matters. Higher income– better,
but with what we call a declining marginal
utility of income. More and more doesn’t help that
much, after a certain point. Second is your health,
both mental and physical. Third is your social support. Do you have friends? By the way,
Aristotle, chapter 8, “Nicomachean Ethics,”
2,300 years ago, he said, have friends to be happy. Smart man. Good advice. That makes a big,
big difference. Fourth, do you feel you have
your life in your hands, that you have the freedom to
make important life decisions? Fifth, are you, and is
your society, generous? So various indicators
of generosity. Sixth, can you trust
your government? Is it corrupt or is it honest? One of the reasons why
Denmark rates so high is that Danish people
trust their government. And, I would say, the
government delivers. And I was saying earlier
that, to my mind, the metric of this,
if you’ve watched the wonderful television
series “Borgen,” which was the “House of
Cards” version for Denmark of Danish politics– the worst thing that
happens in “Borgen” is that the prime minister
uses his office credit card for personal expense. He ends up losing office,
whereas, of course, in “House of Cards,”
the president, among many other things, pushes
the young reporter in front of a train. Which, as Donald
Trump already said, he could do in broad daylight,
shoot someone on Fifth Avenue, and his supporters, no
doubt, would love him for it. So that’s a difference
of politics. We don’t like our
government very much– it’s pretty clear
in the data– where the Danes like the government. And they’re happy about it. And I’m unhappy about it. So when you ask, what
can you do about it? Probably the main
message of this study is that social democracy
is really a good system. It provides security. It provides a
measure of decency. It keeps inequalities low. And America’s winner-take-all,
money-is-everything society is really going overboard. ANDREW RUBIN: Catalina, you
have done a lot of research on patients living with
chronic conditions. So based on what you’ve just
heard from Jeff and Meik, how do you think– how would you define happiness? How would the people you
study define their happiness, knowing that they’re facing
potentially huge obstacles in their life? And I think the data
that you’re going to talk about shows some
pretty interesting results. CATALINA CERNICA: I think there
are two layers to this answer. Because from a
individual perspective, health is a massive
driver of happiness. So if you have to live
with a chronic condition– and in our case, we started
with dermatology conditions, like psoriasis or eczema– your happiness is
defined by how you manage your condition
and the impact that condition has on
your everyday living. So we see that stress,
loneliness, are really impacted by living
with a skin condition. And it is definitely
having a big impact on your mental health. But I think what is
interesting in our work is that, like you said, I
worked for an Innovation Lab within a pharma company. And health care systems
don’t like subjective. They don’t care if
Catalina is unhappy. They will say, your
blood pressure is fine. Go away. So we like objective stuff. What we do– we want to
actually challenge that and say, get inspired by the work of
around happiness and say, what if we apply these
methodologies energies in health care? What are we going to learn? And to give you an
example, and think about how you would
answer this question, a clinically-driven driven
quality of life survey for people living
with a skin condition will ask the question,
has your skin impacted your leisure or
social activities in the last four weeks? Or, if you look at the overall
well-being methodologies, you will ask, have
you felt alone? Or, are you lacking
companionship? Which actually breaks
down this focus on, has your skin, or your diabetes,
or other chronic condition, has an impact on
your life, or just trying to understand
people’s lives. And then analyze the data
and see, what is income, and what is living with a
chronic condition, or the power of your community. And that way, we
actually challenge the way we look at classic
health-related measures, and we want to bring
happiness-related measures into health care. ANDREW RUBIN: Being
in a US audience, you can imagine a
lot of people might be confused why a pharmaceutical
company, as you described, would be– because it’s not. The Leo Innovation
Lab is actually separate from the
pharmaceutical company. But why is the foundation
doing this kind of work? What’s the goal of this group? And is this
something that you’re going to be trying to
apply to other conditions? US, a big problem,
mental health, addiction, areas where our population
here in the United States is struggling. Is there a role for this, and
what is the foundation actually trying to do? CATALINA CERNICA: I
think it would be great if we start looking at
health care policies the same way we’re
looking at other policies and actually bring these
well-being measures to influence our decisions. Our work– so it’s
like you said, I am part of Leo Innovation Lab. And because we are owned
by a pharma company, who is under Leo Foundation,
like you mentioned, we are quite lucky,
because we really have a patient-centric
approach, and we can look for the
long-term investment, not the immediate investment. So that’s one factor. The other factor is that– and my boss is here, so I have
to be careful with this answer. [LAUGHTER] It is that funnily
enough, our project started as a small
internal exercise. Because we focus in Leo
Innovation Lab in what you would call developing
digital therapeutics. So we were looking
for measures of how we can measure the impact of
our specific digital projects on the well-being of people
living with chronic conditions. And that’s how we ended up
developing this project. But as I said, because
we are very much focused on doing what’s right
for the patients, we saw the potential
of the project. And we just said, OK, let’s see
if we can publish our own World Happiness Report for people
living with psoriasis, and then start from there. And what we’re trying to
do now is actually set up an independent foundation that
is going to take this work further and really advocate for
looking at the health of people in a different way and
bringing well-being– this scary subjective stuff– into how we manage health. ANDREW RUBIN: What were
you going to say, Meik? MEIK WIKING: One
of the reasons why I’m excited about
the studies, also, that we’re starting to use
happiness metrics within health care. And I think one of the issues
we have in a lot of countries is that we’ve been
using the wrong metrics. That leads to wrong decisions
and wrong priorities. And that’s why we see
in a lot of countries that we’ve gotten richer
without getting happier. And I think the core question
now, not just for the US, but also for countries
like Denmark, is, how do we convert
wealth into well-being? How do we invest
into quality of life? And I think we get
some answers where we start to map
inequalities in well-being. So the World Happiness
Report usually focuses on the average–
national averages. And usually Denmark and
the other Nordic countries come out on top when we
look at a national average. But the 2016 report, I
was really happy with, because for the
first time, there was a global ranking looking at
the distribution in well-being, the inequality in well-being. And I think that’s where we
need to address challenges in the coming years– to bridge the happiness gap
we see in a lot of countries. Because obviously, if
you have a disease, you are less happy than the
average citizen in that given country. But why do we see
so large variations in that happiness
gap, when we look at a specific, certain disease? I think that’s where the
study’s really exciting. ANDREW RUBIN: What would it look
like in this country to you? And I’m setting you up, because
I saw an interview that you had done where you said– someone asked you, what
would America look like if– as compared with Denmark,
some of these concepts. And you gave an
interesting answer. I’m going to see if you give– I’m going to tell you– MEIK WIKING: I’m not
sure which answer it was. But maybe I said
something like– ANDREW RUBIN: What you said
was, imagine Bernie Sanders as your president. That’s what some of the
concepts you’re describing would look like in
distribution of income, distribution of
health care services, and things of that nature. MEIK WIKING: So maybe
what I said was– JEFFREY SACHS: That’s a very
a good point, by the way. Could I jump in just
for one– oh, but go on. MEIK WIKING: Yeah,
because I think maybe what I said– and this might
have to be edited out– but I think I said Denmark
is Bernie Sanders wet dream. And in Denmark, it’s interesting
to see– because here, Bernie Sanders is progressive. He’s a socialist. And AOC’s a socialist. In Denmark, they’re
common sense. They’re not progressives. They are talking sense. And also, probably in the
same interview– at least, a lot of merit
American journalists will ask me, how can you be so
happy in the Nordic countries? You pay so high taxes. I say, maybe we are
happy because we’re paying a lot in tax. Because 9 out of
10 Danes will say we’re happy to pay our
taxes, because we see them as investments in
quality of life. We see them as investments
in health care, in mental health care, in great
infrastructure, in education. That brings happiness
to citizens. And I think it’s
interesting to look at the average
relationship there is, as Jeff described
before, between GDP per capita and happiness. There is those diminishing
marginal returns. But there is also countries that
are above the line, countries that are relatively
good at converting the wealth into well-being. Denmark has a lower GDP
per capita than the US, but higher happiness
levels, because there is investment in health
care, in mental health care, in infrastructure,
in education. So that– Bernie Sanders
is more than welcome. ANDREW RUBIN: Jeff, what
were you going to say? JEFFREY SACHS: It’s exactly
right, every word you said. Our discussion in
the United States is really messed up,
in part because we have really nasty people
leading it, like the president. I’ll leave him aside. But Rupert Murdoch and
the business press. So the Wall Street Journal is
a really deranged newspaper. And today, it ran
another story– Bernie Sanders
creates socialism. What does socialism mean? Venezuela. This is the meme of
this election cycle. It shows how we’re living
in a kindergarten world. By the way, these people are
idiots, I’m sorry to say. Their level of
knowledge is infantile. But Bernie Sanders
represents, basically, mainstream social
democratic ideas. So you put Bernie
Sanders in Denmark, like you said– it’s
completely the mainstream. Is it Venezuela? No, it’s not Venezuela. By the way, the United
States is trying to destroy Venezuela,
probably as a campaign prop. So it’s not just that
Venezuela is collapsing– the United States has put
every sanction possible, closing, grabbing
reserves, and so forth. I know I’m taking
us away from this– ANDREW RUBIN: Just a little bit. JEFFREY SACHS: But
the reason is we’re in a mind game in
this country where the richest, nastiest
people are trying to tell the American people,
you will not be happy. Do not be fooled. Having guaranteed health care–
that would make you unhappy. Do not be fooled. Having access to
quality education– that would not make you happy. Do not be fooled. That’s the route to disaster. And what Bernie Sanders
is, he’s our one politician in this country that just speaks
mainstream social democracy, which is the mainstream
of Scandinavia, which is the mainstream of why
Scandinavian countries are so happy. Because life is not
insecure every day. Because people aren’t at the
edge of falling off the cliff. Because if you’ve had
an experience like I did when I had an eyelash stuck. I had to go into a– duck into a clinic in Sweden
a couple of years ago, and they plucked out
whatever they had to do. And I said, where do
I sign, my insurance– No no, no. It’s free. Go. Go. Don’t worry. It’s a different kind of life. It’s not anxiety that
you’re just rubbish, or you’re disposable, or your
anxieties are your own problem. Don’t bother us. I’m Mr. Trump. Don’t bother us. Don’t bother me. I’m in it to make
money for my family. This is how our politics are so
terribly distorted right now, and why this is a very
relevant discussion. Because unhappiness is
coming from high inequality, from a lot of anxiety,
from poor people not being taken care of at all– in fact, told,
literally, go away. We don’t want you. There is no room. And of course, it’s
making everyone really very high anxiety. And we have many, many symptoms
of it– rising suicide rates, rising depressive disorder,
rising addiction rates. It’s actually not just
a footnote right now. It’s a serious matter. But what bothers me is how the
truth is so infantily distorted now by the uber-rich,
mega-rich, nasty right wing in this country. And that’s where we’re
really falling down, and where we really
have a big crisis. Anyway, Bernie is the only
one that gets it really right. But it’s completely
mainstream European politics. ANDREW RUBIN: So
I’m going to have– I will talk to the Google
team on the way out. we’ll debate Bernie’s health
care platform in a different– JEFFREY SACHS: Oh,
I’m ready to debate it right now, if you want. Medicare for all–
exactly right. Just in case anyone has
any questions about that. ANDREW RUBIN: And so am I. But
we’re not going to do that. Because it’ll take away
from the happiness. JEFFREY SACHS: I think
it would raise it. ANDREW RUBIN: No, certainly
we would both fully agree. And I know you’ve studied this,
having read a lot about you, that finding middle
ground is how– consensus-building and
finding a middle ground, Obamacare or other
things like that, are how you actually
move an agenda forward. CATALINA CERNICA: One
comment, because I think health inequality is
a very important subject, no matter the country. I live in London. We have NHS. It’s free for everybody. But we still see that
patients or people living with chronic conditions
are not necessarily happy. And we have to understand– from our data, living in
Denmark, if you have psoriasis, it’s not going to
make you happy. Actually– and we
have a modest start. We have 21 countries in
our own happiness report. And actually, Denmark
and Norway are mid-table. UK is next to the bottom. It’s really hard to leave
with a chronic condition like psoriasis or
eczema in the UK. And we have to ask
the question, why? Actually, people
living in Mexico– ANDREW RUBIN: Could you
substitute any illness, do you think, from
the data from that? Or do you think it’s
unique to psoriasis? CATALINA CERNICA: It has
to run specific research for specific chronic conditions. We do know that it creates
inequality, regardless of the chronic condition. And it’s the what we
call happiness gaps that are different. But it’s definitely
a very good question to ask, and actually
challenge the systems. Why is it that if you live with
a chronic condition in Denmark, a rather happy
country, otherwise, you will feel isolated? It’s almost like the long
tail, that it gets very long, and we lose people in the
society to their illnesses? ANDREW RUBIN: You
also see a difference between men and women within
those countries as well. CATALINA CERNICA:
Which is massive. Which is very interesting,
because we actually learn– and this is like going to
closer from the government to the health institutions– so like, what actually trying
to do to understand well-being? We talk a lot about preventative
medicine these days. And when we talk
about well-being, we’re all thinking of gym
and diet and that’s it. And cool gadgets. But we’re not thinking
about well-being as a holistic
definition of your life and what you do with your health
and with your social health and all the aspects. So it’s very
important to say, OK, so let’s start looking at
it and ask the questions in the same way the World
Happiness Report asks questions, and
say, why are women much less unhappy
than men when they leave with a chronic condition? Is it because the
classic pressures– you have to look pretty, you
have to look good all the time? Is it because we actually
react differently? We were talking at the beginning
about the positive and negative effects that you have in
research of well-being, and we see that
women are much more responsive to the negatives. But 99% of media talks about
how you should be positive and how you should
focus on the three steps to whatever– achieve happiness,
while the data actually shows that for women living
with a chronic condition, it would be probably more
effective to acknowledge that you will feel
down and stressed and your self-esteem is
going to be affected. This is how you can
manage it better. And by the way, it is
true, from all that I list, that men are most
affected by pain. That’s what [INAUDIBLE] [LAUGHTER] Yeah. Yeah. All the emotional stuff– if it’s pain, it’s really bad. ANDREW RUBIN: Go ahead. MEIK WIKING: I thought another
interesting pattern in the data was one explanation
for happiness gaps. So when patients
are severely less happy than the
average citizen, we could see if patients felt
their doctor didn’t fully understand the mental
impact psoriasis have on their well-being, there
was a happiness gap of 21%. If the doctor understands
the mental impact, then the happiness
gap was only 3%. And I think this is
one of the reasons why I really like happiness
metrics, is that it, I think, honors the definition of
health that the World Health Organization is using. So health is not just
the absence of disease, but health is good physical,
mental, and social well-being. And I think we address
that and we capture that with happiness metrics. And also coming back to
what you said earlier, across different diseases. I think that’s the real
strength of happiness metrics like the Cantril ladder, that we
can use it as a common currency to look across
different diseases and see, how do we address
the different happiness gaps that we see? JEFFREY SACHS: One of the things
we know, also, from the data, is that people with
mental illness problems do not get treatment, period. Maybe only a quarter or a
third in the US actually will find their way to
professional treatment. And worldwide, it’s absolutely
a dismally low proportion. And the way that health
care is delivered here is it’s delivered for
specific symptoms, for specific diseases,
for specific events, not a holistic approach to life. So if you’re in a poor
community and in this city, you may have many,
many social challenges that will never be attended to. You may find your way
to an emergency room fairly frequently and have
an acute episode addressed, but the underlying human
needs are not addressed. And we don’t have a health care
system that actually builds out something more
holistically by design. It’s very much an
intervention-based, specific, acute response system. CATALINA CERNICA: Yeah. That’s my favorite
insight from the report. And you’re absolutely right. Even in England,
they’ll tell you– you feel like to be sad? Go have a tea. Come back in two weeks. That’s the pretty much
treatment you get there. And I’ve presented the insights
from our health and happiness studies for a
couple of years now. And every time I
talk about if people think that their
doctor understands the impact a chronic condition
has on their mental health, they’re going to be happier, the
reaction I get from the doctor is like, but it’s not my
job to make them happy. My job is to treat them. So it is, as I said, a very
big challenge to the system. If we are serious about
getting more holistic and more well-being-led not
just disease-led, that will require
a massive change. It’s not only
about the hospital, but it’s also your
community, social services, what we have in Europe now. ANDREW RUBIN: Here
in the United States, we had to take a pause
for the past two years. The previous government,
previous administration– probably not the most
articulate way– did launch– attempt to launch– a massive
transformation of our health care system in
the United States. And it was starting
to take hold, with all of the inherent
inefficiencies of something so massive. In the United States,
our health care system’s 20% of the– close to
20% of the economy. So $0.20 of every dollar is
not spent on fuel or food. It’s spent on health care. That’s a lot. So Obamacare, electronic
record transformation– there’s a lot of new things
happening in this country. And candidly, we’ve lost the
past two years of momentum. And we have two more years
to get through, hopefully, until there’ll be an opportunity
to start this back up. But everything Jeff
has said, and you’re saying, about what are doctors
are actually able to do? We put so much pressure on
them to see as many patients as they can through the day
that we don’t give them time– we don’t give– I’m
the administrator. I’m the bad guy. I don’t give them time to ask
that question, are you happy? What can I do for you
today other than treat this underlying diagnosis,
then send you on your way? Because the next patient’s in
the room, and I’ve got to go see them. The promise of health care
reform in this country was to change some of that. And it stopped. All these pilot innovation
projects, the government sponsors, New York state– some of the largest innovation
projects in the country are in New York
state and California, and they’re going–
they’re literally going nowhere, unfortunately. So again, health care is–
we’ve lost the momentum. And we’re going to have to see
how this plays out over time. We certainly have the
infrastructure in place. And I know many,
many Danes and people from London who still view
our health care– we certainly have some of the best
technology in the world. Many European physicians
come to the United States to do their research. More health care research
has done in the United States than any other place
in the world combined. So there are a lot of good
things about our health care system. But we’ve certainly
lost our way. JEFFREY SACHS: I think you
raise a very good point that’s also worth discussing,
which is we’ve talked about happiness
in the context of a doctor and a patient. There’s happiness,
generally, in work. And some places are
happy places to work– I hope that’s true
where we are– and some places are quite
miserable places to work. And since we spent a lot
of time in work per day, that’s a big deal. So all of these metrics
and this evidence is actually something for
work organization as well. My wife’s a physician, and at
one point, several years ago in the university
practice she was in, they put a time and motion
person to follow her around– ANDREW RUBIN: I don’t
do that, by the way. JEFF SACHS: To determine that
it was eight minutes per patient and how many times to the
restroom and to go to the lab. And so she quit. It was so unpleasant,
so de-professionalizing. They were told, these
are not patients, they’re your clients now. It was really bizarre. But it was, as a
more general point, that when we look
at happiness, it’s not only a direct indicator
to a minister of finance or something, but it is how
health care is organized, it’s how our kids are in
school, what they learn, what the classroom is like. It’s actually specific
mind training– meditation, or mindfulness, or
compassion training, and so forth that can
make a big difference. How a workplace is organized,
how a city, by the way, is designed, so that
people can be together. I know in New York, we’re
just the luckiest in the world to be able to be in a
wonderful city where you walk, you see outdoor cafes,
you have Central Park. This is a fantastic part of
our well-being in this city. And some cities are so
polluted, dangerous to walk, no sidewalks, no green. Of course people are going
to be incredibly unhappy. And when you’re in
Copenhagen, it’s incredible how the city
has reclaimed itself from the automobile. So now it’s walking everywhere. And by the way, the density
of coffee shops in Copenhagen is like I’ve never seen
before, because every block is at least three or four coffee
shops, which, to my mind, is a definition of happiness,
almost tautologically. But it does mean we
should be thinking about this in all of
these different aspects of our social organization. MEIK WIKING: We spend 20%
of our GDP on coffee, so– [LAUGHTER] –a lot of things. We’ve only been talking about
the one way of the relationship between health and
happiness, because you say, why should the doctors care
whether they’re happy or not? They should because we can
see it also impacts longevity. When we look at
longitudinal studies where we follow
people over time, and there’s a lot
of studies on this, we can see that people
that are happier also have a lower mortality
rate even when we control for health status and
a lot of other factors from the beginning of the study. And I completely
agree with what Jeff is saying in terms of,
for example, urban design. I mean, happiness metrics– when we know what we know
from happiness research, the questions are, how do
we design our health care systems differently, how
do we design our policies differently, how do we
design workplaces differently and our cities differently? I have a very similar
experience to what you do in terms of how urban
planning impacts happiness. One of the cities that invests
a lot in infrastructure but forget to invest in
infrastructure for people, but only for cars,
in my experience, was Kuala Lumpur in Malaysia. I was there a
couple of years ago. And I was staying 200 meters
from the botanical garden, and I wanted to go over there. JEFF SACHS: You couldn’t. MEIK WIKING: And gave up halfway
because there was no pavement. JEFF SACHS: Yeah. MEIK WIKING: So you
invest to create cities for cars and not people. And what you’re essentially
telling your citizens is that if you do not own a car,
you are a second-rate citizen. Now, what I like
about Copenhagen, where the majority of
people cycle to work, the majority of students
cycle to university, the majority of– also the cost of [INAUDIBLE] but
also the real-life politicians cycle to Parliament. The reason they do that is there
is investment in infrastructure for pedestrians,
for cyclists, that makes you feel like you are
king and queen of the road. That’s what needs to get
done in terms to create a city with high mobility. ANDREW RUBIN: I’d be remiss if
I didn’t throw this question out to all three of you,
with the few minutes that I have left. Technology. We’re at Google,
right, the center of the technology universe. I believe it was
a UN World Health Report, happiness report. But certainly the
materials I’ve read have said that
technology has had a negative impact on the
happiness of children in this country. Thoughts on that? JEFF SACHS: We have a chapter
in this year’s report, which is putting forward that as
an important hypothesis. I would say it’s unsettled. I received a lot of
responses to that. It’s not my article
but in the volume. This was looking at adolescence. What we know in the
United States is from around 2009 onward,
there is a real epidemic of depression. And nobody knows exactly
what this is coming from, but one hypothesis is that
that’s when the iPhone came. And what is clear in
the data is, of course, our lives have been
changed unbelievably in how we spend our day. And the data from this
sample of young people was something like
eight hours a day of screen time on
digital devices. Sleep collapsing. Time with friends collapsing. And so having friends
is doing this. Basically, you’re
online with your friends perhaps, but not
really interacting with them face to face. I don’t know. It’s a very big deal because
the digital revolution is the biggest
change on our planet. I don’t think any of us has ever
experienced anything like this. You walk down the
street, you realize it is a completely
fundamental change to how we live our lives. Every single person’s
carrying their phone, or with headphones,
or somehow plugged in. Within 10 years. So is this good? Is it really working? Are we creating addictions? Is this serving our
humanity or not? I don’t know. You guys are in the
forefront of it. You need to really study this. It’s no good just to
get faces on the screen to sell advertising. This is a disaster. We have to know whether
this is really good. Potentially, it ought to open
up lots of things for us, but is it really the
way we’re doing it? I don’t think we know. ANDREW RUBIN: Meik? Hygge, happiness, technology? MEIK WIKING: We’re
actually working right now on a report on digital
well-being, which will come out in the fall. And also because we’ve been
interested and concerned. And I think what we’ll
find is probably also that how we use technology
has different impacts. If we use technology to become
addicted, to lose sleep, if we use technology to become
jealous of the wonderful lives that all my friends
are living on Facebook, then, obviously, that will
have a negative impact on how I evaluate my life. If we use technology to
connect, if we use technology to connect across geography,
across generations, then there might be hope for
technology and well-being. Also, further down the line, at
one point, we’ll get to a level where artificial intelligence
and emotional intelligence maybe will help us produce
early detection when it comes to suicide. If my phone can pick
up when I’m depressed or if FaceTime can pick up
certain muscles in my face that show signs of sadness
or suicidal thoughts combined with me googling “suicide
methods” and so on, I think that area is super
interested in mental health technology to maybe
not improve happiness, but to reduce misery for those
that are struggling with life. ANDREW RUBIN:
Interesting debate ahead. So we’re going to open
this up to the audience if there are any questions. AUDIENCE: So I actually have a– first of all, great stuff. And to be clear, I’m a believer. I think what you guys
are doing is great. But I have a bit of a
challenge for you, which is I feel a little bit unsettled
being here in the audience, that this feels mildly
self-congratulatory in as much as most of the people in
this audience, certainly the Googlers, you’ve got
really good health insurance. There’s free food right
out there that any of us could go and eat. I wonder if you
guys have thoughts of how to make this
conversation more inclusive in the sense
of people who actually work in the cafeteria and who
are working at the security desk. They’re not in this room. And how to bring
everybody into it and let everyone
benefit from it? CATALINA CERNICA:
Actually, because I’m an optimist of
technology, I think technology will
help bring everybody into this conversation
to start with. And I know it’s
a system problem, but I think it’s also becoming
aware of the differences we’re having– income, or health
status, or the biases that we can get from
technology usage, and actually make sure that
everybody’s voice is heard. For me, technology
actually helps us talk to people who suffer
from different illnesses that normally wouldn’t engage. And actually, social
media is helping us reach people who wouldn’t
otherwise share their stories. And we get to really learn and
really, again, kind of, like, challenge the status quo of what
we think is healthy, or happy, or what are your problems when
you live with a condition, by trying to bring everybody’s
voices to the table. JEFF SACHS: I think it is the
essence of one approach to life that society should be
inclusive for everybody. That’s not the libertarian idea. That’s not the American
idea right now. But in Denmark or
many other countries, everybody has the
guarantees that allow the inclusion, at
least in a material sense– everybody has decent pay,
everybody has vacation time. We don’t have one day
of guaranteed vacation time in the United States
other than federal holidays. But paid vacation is
normal in northern Europe and in the United States
nonexistent as a right. And so I think this
question that you’re asking is really a very basic and
important one, which is, what does it mean to be inclusive? In the United States,
in theory, “inclusive” means you’re on your
own, so good luck. And if you make
it, that’s great. And if not, that’s tough
but don’t bother me. I think what we are all saying
is it’s not really a way to make anybody happy
to have such an unequal, high-stress society that
would have you ask a question, a very valid question like that. But that is our society. It’s not an inclusive society. AUDIENCE: Thank you so much
for coming here and speaking with us today. A lot of the themes you
guys talked about today around happiness have to deal
with public policy, politics, urban planning, health care. As individuals, what’s
one thing that we can do to increase
happiness for ourselves? And then what’s
one thing that we can do to increase
happiness for others besides moving to Denmark? [LAUGHTER] ANDREW RUBIN: Meik, this is
definitely your question. MEIK WIKING: I think Aristotle
or Jeff said it earlier. Friends. I mean, I think one of the
clearest, most consistent patterns we see in the
data is the importance of our relationships. Loved ones, friends, family. And that’s also what
you can do for others– be a good friend,
connect with people. I think the World
Happiness Report, one of the questions
collected by Gallup is, do you have somebody
in your life you can rely on
in times of need? Yes or no? That’s a very simple question. You can also use the
UCLA Loneliness Scale. 20 different
questions that tries to capture what loneliness is. But I think connecting
with other people, creating strong communities,
creating social fabric, caring about the ones that are
at the low end of the Cantril Ladder, understanding
that perhaps we should focus our
efforts on where well-being is most scarce. Being somebody
else’s person they can rely on in times of need. I think that would be my
best universal advice. JEFF SACHS: What
to do for yourself and what to do for the
others is the same. Be nice. Give something. Giving something
is actually proven to be enormously effective
at raising your own feelings of well-being. And it doesn’t hurt
the receiver either. So I think that it’s
really a powerful antidote to the kind of aggressive
and individualistic social and cultural
attitudes that are pernicious and that have
gotten out of hand. ANDREW RUBIN: So we’re
going to have to stop here. I’m sure we could talk
for hours and answer hundreds of questions. But Jeff, Catalina,
Meik, thank you. Really good discussion. I’m Andrew Rubin. Thanks for joining us. [APPLAUSE]

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