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Asian Development Outlook Update, September 2020

Wellness in Worrying Times

Physical and mental health is vital to post-pandemic recovery. The theme chapter in this report explores wellness, or the deliberate pursuit of activities that bring holistic health.

Summary

  • Wellness is vital for post-pandemic recovery in developing Asia.

    COVID-19 underlines the importance of wellness, or the deliberate pursuit of activities that bring holistic health, happiness, and well-being. Public health, both physical and mental, has taken a beating during this pandemic. In Asia, as elsewhere, wellness can revive the human body, mind, and spirit, which are the first steps toward rebuilding the economy and society.

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  • Wellness is a large and growing part of the Asian economy.

    Even before COVID-19, Asians demanded more wellness as their incomes rose, chronic lifestyle diseases became more prevalent, and the population aged. A result has been a rapidly growing wellness economy, comprising industries that enable consumers to incorporate wellness activities into their daily lives. The wellness economy provides 11% of output in Asian countries, having grown annually by 10% in recent years. COVID-19 is likely to further boost demand in the coming years and support a strong recovery.

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  • Asian wellness traditions can serve both well-being and the economy.

    Although modern wellness industries originated in Western countries, Asia has a wealth of wellness traditions. Those traditions are productive assets for the wellness economy. At the same time, tapping these traditions can promote mental and physical health in the lives of Asians. As such, the present is the opportune time for Asia to rediscover its wellness roots.

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  • Wellness polices should be comprehensive and target all Asians.

    Government efforts to boost physical and mental well-being fall into four policy domains: create a healthy urban environment, enable and support physical activity, encourage healthy diets, and enhance wellness in the workplace. Because healthy aging begins in childhood, a lifelong wellness policy framework such as Japan’s 100-Year Life Program should complement the four policy domains. And, because the poor have fewer opportunities for wellness activities, governments must invest in wellness infrastructure that benefits them.

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COVID-19 brings wellness to the fore

Wellness is conceptually distinct from happiness and well-being.

It is the active pursuit of activities, choices, and lifestyles that lead to a state of holistic health.

Whereas happiness and well-being are subjective conditions when one feels happy or in a state of well-being, wellness arises from the process of actively choosing options that enable optimal health and well-being. Wellness is related to but distinct from medical health. The two overlap in preventive health care, but medical care focuses primarily on treating and curing illness, while wellness aims to improve on neutral health to achieve optimal health by, most notably, exercising, eating healthy food, and meditating. Wellness is thus multidimensional and holistic in that it has physical, mental, emotional, and social dimensions.

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The pandemic spotlights both physical and mental wellness.

Medical evidence indicates much higher risk from COVID-19 for individuals with underlying physical health conditions such as obesity, asthma, or diabetes, as well as for the elderly.

Meanwhile, pandemic-induced isolation, fear, uncertainty, and economic hardship are causing a lot of stress and anxiety around the world. A recent United Nations report warns of a global mental health crisis, with current rates of mental distress at 35% in the PRC and 45% in the US. The crisis thus strengthens the case for individuals to take action to strengthen their own physical and mental health.

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Demand for wellness reflects three broad, long-term trends.

These trends are higher incomes, the rising prevalence of chronic lifestyle diseases, and aging populations.

Decades of rapid economic growth have left many Asians much richer than their forebears. Consequently, they are more aware of the benefits of healthier lifestyles as, most starkly, hunger for more calories gives way to a quest for better nutrition. The rise of conditions such as heart disease, stroke, diabetes, and cancer—as well as maladies caused by worsening pollution in the region— encourages Asians to exercise more, eat better, and make healthier life choices. In addition, Asia’s population is aging, and older populations are vulnerable to chronic diseases, loneliness, and mental health issues.

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Wellness is pro-poor and contributes to sustainable development.

Wellness, or the active pursuit of well-being, aligns with the United Nations Sustainable Development Goals, in particular the third goal: Ensure healthy lives and promote well-being for all at all ages.

A focus on wellness promises to bring a more balanced and holistic view of development than does measuring its progress simply as increased income per capita. In principle, many wellness activities such as physical exercise are available to all. In practice, though, the poor are disadvantaged by their relative lack of money and time to devote to wellness, of access to health facilities, and of ready knowledge of nutritious food. These gaps can be narrowed with public investment in wellness infrastructure such as community recreation centers and green parks in poor neighborhoods, as well as health education campaigns.

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The contours of wellness in Asia

Wellness in developing Asia is on a par with the rest of world.

This report constructs the Wellness Index designed to compare wellness across countries and regions.

The index measures four pillars of wellness—physical, intellectual, social, and environmental—using a number of outcome indicators. The Wellness Index reading for developing Asia is 47, close to the global figure of 52. Substantial differences across Asia only partly reflect variation in development stage. To be sure, rich countries such as the Republic of Korea tend to have higher wellness scores, but so do some lower-income countries, notably Bhutan.

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Wellness is a large and growing part of the regional economy.

The Global Wellness Institute describes the wellness economy as industries that enable consumers to incorporate wellness activities and lifestyles into their daily lives.

It estimates the global wellness economy at $4.5 trillion in 2018, equal to 5% of global GDP. It is an even bigger part of the economy of developing Asia. ADB estimates that the wellness economy provided 11% of regional GDP in 2017 and that it has been growing by about 10% annually in recent years. The rapid growth of the wellness economy reflects Asians’ growing demand for wellness. Demand is likely to expand further in the wake of the COVID-19 pandemic, which has restricted physical exercise and caused a lot of anxiety and stress.

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Holistic pathway to physical wellness

Physical inactivity is a worsening threat to regional public health.

Physical inactivity is a key lifestyle risk factor for chronic disease.

While 33.2% of Asians regularly participate in recreational physical activity, this is somewhat below the global average of 35.5%. Inactivity rates are generally worse in South Asia and better in East Asia, Southeast Asia, and the Pacific. Asia has one of the world’s largest and most diverse physical activity markets, valued at $240 billion in 2018, with sports and active recreation being the most popular activities. That said, many Asians spend little or nothing when pursuing leisure-time physical activity on the streets, at home, or in public parks, plazas, and free sporting facilities. Governments can support participation in physical activity after COVID-19 recedes by investing in venues for sports and physical recreation.

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Asia can ill afford its increasingly unwell workplace.

The region accounted for over two-thirds of the 2.8 million people estimated to have died worldwide in 2017 from work-related accidents or disease.

Workplace wellness is still a littleknown concept in Asia, benefiting primarily those who work for multinational corporations or live in the region’s wealthiest countries and cities. Only 5.2% of all employed workers in Asia stand to benefit from some form of workplace wellness program—barely half of the low 9.8% of workers globally. To be effective, a workplace wellness framework must be holistic and focus first on wellness challenges that arise within the workplace. Today, staying well while working from home is emerging as a new priority under widespread COVID-19 restrictions.

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Community planning, zoning, and infrastructure can promote wellness.

When human health and wellness are central to urban planning, real estate, and infrastructure development, the result is wellness real estate—a $134 billion industry in 2017, with Asia and the Pacific accounting for $47 billion.

Public investment can similarly focus built environments on wellness. For example, governments can invest in infrastructure that encourages physical activity: pedestrian sidewalks, paths and trails, and public parks. Such planning approaches create neighborhoods and communities that are healthier for residents and that enhance their well-being and the quality of life.

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The double burden of malnutrition is a growing risk to health.

Food has become more readily available across the region, reducing malnutrition but encouraging unhealthy eating as poor choices of calories sources bring too much sugar, salt, and fat.

As a result, the region has become a global hotspot for the double burden of malnutrition: concurrent undernutrition and obesity. Poor nutrition inflicts significant economic costs. Direct medical costs from obesity, for instance, are estimated to absorb 0.8% regional GDP. Policies can favor healthy foods, as through targeted taxes that drive down demand for sugary drinks. Public education on nutrition can guide consumers toward better diets and minimize the burden on the public health-care system.

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Leveraging Asian traditions for mental wellness

The path to mental well-being is self-managed and evidence-based.

The five pillars of mental wellness are emotional well-being, psychological well-being, resilience and balance, optimal functioning, and social well-being.

Poor mental health—evidenced by depression, is the third-biggest cause of years lost to disability, after lower-back pain and headache. Yet many Asian economies have fewer than one mental health professional per 100,000 population. Evidence supports the benefits to mental wellness from healthy everyday habits such as eating well and seeking social support, as well as such specialized wellness enablers as meditation, tai chi, yoga, dance, and social laughter. Benefits are amplified if wellness is practiced in tune with local culture by, for example, basing optimal nutrition on local cuisine.

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Asians can draw from a plethora of established wellness traditions.

Asia’s two major systems of traditional health knowledge—Chinese and ayurvedic medicine—are grounded on principles of healthy living and wellness through the whole of life.

These two systems have influenced the wellness traditions of East and South Asia, where they arose, but also Southeast Asia. Lifestyle is given primary emphasis over medicine. Individual wellness practices that leverage these traditions offer a low-cost avenue to mental and overall wellness that is culturally relevant, evidence-based, and self-managed. A growing body of scientific evidence confirms the wellness benefits of Asian wellness traditions. As a bonus, these traditions can reduce public health care costs and provide new economic opportunities.

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An aging Asian population makes healthy aging an urgent priority.

The share of developing Asia’s population aged 65 or older is rising, from 6% in 2010 to 9% in 2020 and a projected 18% in 2050.

Evidence indicates that older populations generate greater demand for wellness. For example, a 1% increase in the share of population aged 65 or older boosts hot spring revenues by 0.29%. While mental and physical health naturally deteriorates with age, eating healthier food, including traditional Asian food, and exercising regularly can improve how well populations age. Optimizing home design helps, as does reducing isolation through technology and social support. The evidence is mixed about the impact of retirement on wellness, but it is clear that wellness in old age depends on staying mentally and physically active and fit, whether retired or not.

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Wellness tourism is a growing segment of the tourism industry.

While almost all tourism encourages rest and relaxation and is thus beneficial to mental wellness, a key driver of rapid tourism growth in Asia is wellness tourism, which lies at the intersection of the $2.7 trillion global tourism industry and the $4.5 trillion global wellness industry.

Wellness tourism, defined as travel designed to maintain or enhance personal well-being, generated $639 billion in revenue globally in 2017 and $137 billion in Asia and the Pacific. Global tourism has been hit very hard by COVID-19. Beyond the short term, countries with post-COVID recovery strategies that strengthen the sustainability of wellness tourism will be among those that benefit the most from global economic recovery.

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Wellness for happiness and inclusiveness

Subjective happiness is low in Asia relative to other regions.

Sustained rapid growth has lifted developing Asia’s living standards in recent decades. Yet research indicates that higher income does not necessarily translate into greater happiness.

As a result, happiness has recently attracted a lot of attention. The rise of positive psychology as a field of enquiry indicates burgeoning academic interest, and Bhutan’s famous gross national happiness index is emblematic of growing interest among policy makers. The World Happiness Report 2019 states that, despite rapid economic growth, self-reported happiness in Asia averages 5.17 on a scale of 0 to 10, substantially lower than in every other region except Africa and the Middle East and the global average of 5.46. Some poorer countries such as Pakistan and the Philippines are relatively happy countries.

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Empirical evidence associates wellness with happiness.

The wellness economy can, in principle, generate greater well-being.

Recreational physical therapy, workplace wellness programs, and spa therapy are examples of wellness enterprise geared toward better health outcomes, which are central to wellbeing. Empirical analysis across 146 countries confirms a significant positive association between wellness and happiness. Thus, if annual spending per capita on workplace wellness doubled from the current world average of $11 to $22, happiness would improve by 0.15 units on a scale of 0 to 10.

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The wellness economy can promote inclusive growth.

Developing Asia has a large, fast-growing wellness economy.

Wellness tourism expenditure in the region grew by 11% annually from 2015 to 2017, reaching $137 billion as the industry directly employed 3.74 million in India, 1.78 million in the PRC, and 0.53 million in Thailand. In addition, demand for many wellness products, such as local and traditional culinary experiences and goods, can encourage micro or small enterprises to leverage local heritage and indigenous ingredients toward their creation. As many wellness-related occupations, such as complementary medicine practioner, are dominated by women, growth in the wellness economy contributes to female employment. In these ways, the wellness economy can enable inclusive growth and reduce poverty.

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Policies for physical and mental wellness

Government policies that promote wellness offer broad benefits.

Individuals, the economy, and society as a whole benefit where wellness makes people happier and more productive and wellness industries are a growing part of the economy.

Yet, because wellness is poorly understood by governments, they do not incorporate it into policy making as an overarching framework or explicit priority. Meanwhile, wellness can bring an important perspective to policy making that complements public health, health policy, and the emerging field of happiness. Wellness policies are those that nudge people to proactively make healthy choices and live healthy lifestyles, while also creating living environments that support and encourage healthy behavior and lifestyles. Such policies are most effective if they address four cross-cutting domains and take a lifespan approach, as explained below.

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Wellness policies span four cross-cutting policy domains.

First, Asian governments can help create a healthy built environment by, for example, prioritizing walkability and physical movement in urban and regional planning.

Second, policy makers can enable and support physical activity by funding public infrastructure, facilities, and programs for it. Third, governments can encourage healthy eating by improving consumer awareness of nutrition and diet. Finally, Asian policy makers can enhance wellness in the workplace by ensuring a safe and healthy physical work environment. Taken together, policies in these four cross-cutting domains can promote mental and physical wellness.

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A lifespan approach safeguards mental and physical health from birth.

Healthy aging begins in childhood and progresses through an overarching lifespan framework such as Japan’s 100-Year Life Program.

Preventive interventions in an individual’s first 1,000 days bring lifelong benefits. Further, wellness is worth adding to the formal education system, embedded in curricula and in learning and social environments. Finally, a range of policies can support healthy aging, including lifelong learning, reskilling, personal growth and transformation, and, for seniors, better nutrition and safe homes that enable wellness. In conjunction with cross-cutting wellness policies, lifelong wellness policies can help Asians navigate the uncertain, stressful COVID-19 world toward a better new normal after the pandemic.

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