Goal

In this unprecedented time of global disease and distress, it is more important than ever to proactively understand, measure, and promote well-being for people and communities worldwide. The ability of humans to flourish despite such challenges provides an essential foundation for health, stability, resiliency, and progress.
For the past five years, the Stanford WELL for Life Study (WELL) has been focused on accelerating the science of well-being. Our multidisciplinary team of experts has been studying >30,000 participants from the U.S., China, Taiwan, Singapore, and Thailand to understand and measure well-being – the synthesis of each person's biological, psychological, and spiritual experiences.
Moving forward, we believe that the best way to create durable interventions to improve well-being is to investigate the context in which people live, work, play, and learn. We propose a new global initiative that leverages and expands WELL to study an individual's intersection with social, built, and natural environments; and how communities and environments might be best structured to promote population well-being. Our goal is to help people and communities around the world restore hope and build a foundation for future generations to flourish.

Opportunity

We propose a Global Human Flourishing Initiative (GHFI) to study how the interplay between individuals, community, and the environment impacts human flourishing, and how this differs across cultures. The WELL Study has collected and analyzed survey data on individual well-being, and clinical and biometrics data to examine physical manifestations of well-being. We can leverage the infrastructure of the WELL longitudinal cohorts of >30,000 individuals with over 300,000 specimens for this initiative. Our objective is to expand the multi-dimensional data collection to 100,000 individuals and incorporate the embedded contextual data in people's social, physical, and cultural environments to attain real-world insights.

Roadblocks

One key challenge is to ensure that our conceptualizations of well-being capture unique racial/ethnic and culture-specific attributes in each country. In our data, although many well-being constructs are universal, about 20% are culture specific. Second, one must collect representative samples of participants with a high response rate, and high retention in prospective follow-up. Third, standardization and harmonization of the clinical data and bio-specimen collections, processing and assays (genetic and -omics) across nations is pivotal. Finally, these individual-level data will need to be integrated with the higher-level environmental and contextual data that will be a major focus of this new initiative.

Breakthroughs Needed

Regarding capturing unique racial/ethnic and culture specific attributes, we are poised to build on the initial strides we have already made in this area. In WELL, we have conducted semi-structured qualitative interviews in each of the five counties to identify potential culturally-specific domains to build culturally-appropriate measures. We have also carried out rigorous statistical modeling to refine the measurement model for each country. We will use this approach for each newly added country. Regarding response/retention rates, we will draw the skills of behavioral experts on our team to promote continuing and expanded involvement of our registry of "citizen scientists" to optimize engagement. As for data/specimen standardization and harmonization, standardized protocols and training are critical; within WELL, we have carried out studies in five countries successfully. For this global initiative, we will establish a Data Coordinating Center, a Data Analytic Core, and a Laboratory Core at Stanford for coordination, quality control, data harmonization, and -omics assays. All of the procedures will be tested in a pilot phase of the study. We have over 30 years of experience in international collaborations and will be able to overcome these potential roadblocks with careful planning and implementation.

Key Indicators of Success

We will develop milestones and use a number of metrics to measure the success of the global initiative, including metric in the following areas: recruitment and retention, assay results, data quality, novel discoveries, key publications, breadth and depth of global scientific collaborations, community outreach and engagement, mapping of intervention-derived impacts and ripple effects, scientific summits for dissemination of key findings, and, importantly, changes in relevant policies and establishment of programs to improve human flourishing in individuals and communities globally over time.

Additional Information

The Stanford WELL for Life Study (https://med.stanford.edu/wellforlife.html)
The WELL Study has developed country-specific and universal well-being measurement models to quantify an individual's well-being (WELL score). Each person's WELL score is derived based on their survey responses to 76 questions in 10 domains: social connectedness, stress and resilience, emotions and mental health, physical health, purpose and meaning, sense of self, financial security, spirituality, creativity, and lifestyles. We have collected over 300,000 specimens (blood, DNA, saliva, urine, stool, nail, hair) and stored in WELL Biobank for molecular studies. Currently, we are using them to assess an array of biomarkers, gut microbiome, and metabolomics profiles (in a subset) and quantification of telomere length to aid our understanding of the complex biology of well-being.

We also have a unique assessment of the Traditional Chinese Medicine (TCM) body types. Our publications can be found here (https://med.stanford.edu/wellforlife/updates1.html).

Proposed Templeton Global Human Flourishing Initiative
This new initiative will build upon our WELL Study, expanding to 100,000 individuals from 8-10 countries, with data that can connect biological and behavioral factors to societal and environmental impacts on human flourishing. Our multi-level framework will examine: 1) biological factors (molecular and biomarker data); 2) behavioral/psychosocial factors; and 3) social and physical contexts.
We will link the multidimensional well-being data with the contextual data to examine the intersection of individual well-being with society. We will procure large-scale contextual data through methods like GIS-supported contextual mapping, social network analysis, and technology-enabled citizen science in which community members capture aspects of their physical and social environments that impact well-being. We will also collect on the built environment (building quality, accessibility, green space), social networks, social relationships (social support, religious participation, civic engagement), social contexts (collective efficacy, social capital, racial/ethnic integration), institutional contexts (health care, economic, and political systems), social conditions and policies (poverty, economic index, norms, racial injustice), and environmental factors. We will integrate individual data with the system data to gain insights on the interplay of individuals, community, and the environment on well-being across different cultures. We will additionally use our insights to test and refine interventions that promote well-being in our WELL community.

The Global Initiative Team (partial list)
Professor Ann Hsing of Medicine, a molecular epidemiologist and population scientist, and PI of the Stanford WELL for Life, will lead and oversee all aspects of this global initiative.
Professor Catherine Heaney of Psychology/Medicine, who designed the WELL survey will refine country-specific surveys and develop cross-culture comparison methods.
Professor Michael Snyder, Chair of the Genetics Department, will oversee the Core Laboratory and all omics-related efforts.
Professor Christopher Gardner of Medicine, a nutritionist with mirobiome expertise, will lead the microbiome project.
Professor Abby King of Epidemiology, a behavior scientist and interventionist, will oversee the design of intervention studies.
Professor Michael Lepech of Engineering with expertise in big data and physical environment will lead integration/harmonization of the contextual, GIS and biometrics data.
Professor Ying Lu of Biomedical Data Science Department, principal biostatistician of WELL, will oversee all analytic efforts in the Analytic Core.