For most of the post-war era, European governments measured success by a single number. Gross domestic product — the aggregate market value of all goods and services produced in a year — became the default shorthand for national progress, for political legitimacy, and for the allocation of public resources. Health systems, in this logic, were costs to be managed rather than investments to be made. The Economy of Wellbeing framework challenges that premise directly, arguing that health and social outcomes are not a drag on the economy but a precondition for it.
Whether that argument can compete with the institutional momentum behind GDP is a different question — and one that European policymakers are still working through.
Finland’s Presidency and the 2019 Council Conclusions
The concept reached its highest point of formal EU recognition in October 2019, when the Council of the European Union adopted conclusions on the Economy of Wellbeing under Finland’s Presidency. The timing was deliberate. Finland had made the framework a centrepiece of its six-month stint leading the Council, pushing for language that would require member states and the Commission to incorporate a wellbeing perspective horizontally across national and Union policies.
The core of the conclusions was a reframing: people’s wellbeing is not merely a desirable outcome but a driver of economic growth, productivity, long-term fiscal sustainability, and societal stability. The document called for action in areas including occupational health, gender equality, mental health, and disability policy — all understood as inputs into a healthy economy rather than items on a social spending ledger.
Finland was not working in isolation. The Finnish approach drew on Nordic traditions of high public investment in health and education, but it also reflected a broader intellectual movement that had been building since the 2008 financial crisis exposed the limits of growth-centric policymaking. The Stiglitz-Sen-Fitoussi Commission report, commissioned by French President Nicolas Sarkozy and published in 2009, had already made the academic case for moving beyond GDP. Finland’s Presidency gave that case a formal institutional address in Brussels.
The Council conclusions represented a political commitment rather than a regulatory instrument. No binding targets were set, no enforcement mechanism was attached. But the document’s significance lay in establishing Economy of Wellbeing as legitimate vocabulary for EU health and social policy — a framing that subsequent Commission communications would build upon, even if unevenly.
The EU’s Beyond GDP Framework — and Its Limits
Following the 2019 conclusions, the European Commission developed its own Beyond GDP infrastructure, largely through the Joint Research Centre. The 2023 Strategic Foresight Report called for the development of metrics for sustainable and inclusive wellbeing. By 2024, the JRC had produced a 50-indicator dashboard — the Sustainable and Inclusive Wellbeing (SIWB) framework — designed to sit alongside GDP in policy evaluation and investment decisions.
The 2025 Strategic Foresight Report described the dashboard as “mature enough to be embedded into policy evaluation, and investment and reform decision-making” — careful language that stops well short of proposing that GDP be displaced. At the international level, the UN’s updated System of National Accounts, expected to be implemented in EU statistics by 2029, will give greater prominence to environmental and wellbeing measures, though the timeline reflects the institutional inertia involved.
The OECD’s Health at a Glance data and its Better Life Index, which has tracked 11 dimensions of current wellbeing across member countries since 2011, provides an independent reference point. Its well-being database covers more than 80 indicators updated quarterly. On the health dimension specifically, the OECD data shows a consistent pattern: countries with stronger social investment and lower inequality tend to produce better health outcomes per euro of healthcare spending. That finding is central to the Economy of Wellbeing argument — and consistently contested by finance ministries operating under short-term budget pressures.
For a detailed look at how European health systems compare on access, outcomes, and spending efficiency, the variation between member states illustrates exactly the kind of structural differences the wellbeing framework tries to address.
Seven Governments Piloting a New Approach
The most substantive testing ground for Economy of Wellbeing principles has not been in Brussels but in a small network of national governments. The Wellbeing Economy Governments partnership (WEGo), established in 2018 with Scotland, Iceland, and New Zealand as founding members, has since expanded to include Finland, Wales, and Canada. The network shares approaches to wellbeing budgeting, policy design, and measurement — with health investment as a recurring focus.
Scotland’s approach embeds wellbeing outcomes into its national performance framework and has linked spending decisions to indicators including healthy life expectancy and child poverty rates. Iceland developed a comprehensive wellbeing budgeting proposal that integrates wellbeing indicators directly into its fiscal planning process. Wales passed its Future Generations Act in 2015, legally requiring public bodies to consider the long-term wellbeing of future generations — a structural constraint on short-term budget thinking that no EU directive has yet replicated.
Finland’s own implementation includes a 2023–2025 Economy of Wellbeing action plan. The country’s structural health reform of January 2023, which reorganised services into 21 Wellbeing Service Counties, was explicitly framed as a mechanism to reduce socioeconomic inequalities in health access — a direct application of wellbeing economy principles to health system design. Results so far are mixed: life expectancy recovered to above its 2019 level by 2024, but access problems persist, with approximately one third of patients reporting that user charges have made it difficult to access services.
New Zealand’s Wellbeing Budget, introduced in 2019, was perhaps the most prominent early experiment. It directed new spending toward five priority areas — mental health, child poverty, indigenous wellbeing, a low-emissions economy, and the digital age — rather than distributing it through conventional sectoral allocations. The approach attracted significant international attention, though critics noted that the wellbeing framing did not prevent subsequent governments from returning to more conventional fiscal priorities.
Ireland’s connections to the wellbeing economy network are less formalised. The country has adopted wellbeing indicators through the National Economic and Social Council, but has not joined WEGo as a full member government. The variability within even this small network points to a wider challenge: what counts as a “pilot” and what counts as sustained structural change are often different things. Questions about patient mobility across borders illustrate how even well-intentioned frameworks run into the reality of uneven implementation across national systems.
The Budget Logic — and Its Discontents
The central claim of Economy of Wellbeing proponents is that investing in health and social outcomes generates positive returns across multiple policy domains. WHO/Europe articulated this in its European Well-Being Economy Initiative, arguing that characterising health spending as a drain on the economy is empirically inaccurate and that health systems both improve population health and have direct and indirect effects that positively support national economic objectives.
The European Observatory on Health Systems and Policies reinforced this argument in a 2023 policy brief, identifying concrete win-win solutions showing health investment benefits not only health outcomes but also labour productivity, social cohesion, and fiscal sustainability. The return-on-investment argument is designed specifically to speak to finance ministries — to translate wellbeing language into the metrics those institutions already use.
But the translation has limits. GDP remains dominant not only because it is politically familiar but because it is operationally convenient. It is measured consistently, reported quarterly, and comparable across countries. Wellbeing indices — however theoretically sophisticated — are, by contrast, multidimensional, partially subjective, and still evolving in their methodological consensus. The JRC’s 50-indicator dashboard is a genuine technical achievement, but it does not yet offer the same parsimony as a single growth figure.
More fundamentally, the political economy of budget negotiations tends to reward near-term gains. Health investment, particularly in prevention, produces returns over years and decades. The fiscal pressures that led Finland to reintroduce a three-month maximum waiting time for non-urgent primary care in 2024 — as part of a broader package of austerity measures — illustrate how quickly wellbeing commitments can yield to short-term fiscal logic, even in the country most identified with the framework.
What Would Structural Change Require?
For Economy of Wellbeing principles to move from framework to policy reality at the EU level, several changes would be required that none of the current initiatives have yet delivered.
The first is statistical architecture. If EU fiscal rules, structural fund criteria, and policy evaluation frameworks remain anchored to GDP, wellbeing indicators function as commentary rather than constraint. The expected 2029 update to EU national accounts, incorporating the revised UN standards, would represent a partial step — but observers note that updating statistical methodology does not automatically change the political weight attached to different numbers.
The second is institutional mandate. The EU has no competence over member state health systems. The Council conclusions of 2019 invited action but could not require it. The variation in how member states have responded — from Finland’s structural reform to minimal engagement elsewhere — reflects the limits of soft governance in a policy area that remains firmly national.
The third is political cycle alignment. The WEGo network has shown that wellbeing budgeting can survive changes of government in some countries, but not in others. New Zealand’s experience suggests that without embedding wellbeing frameworks in legislation or constitutional structures — as Wales has done — they remain vulnerable to reprioritisation. At the EU level, the parliamentary cycle and the competing pressures of competitiveness, defence spending, and energy transition make sustained political attention to long-term health investment structurally difficult.
A fourth condition — less discussed but arguably foundational — is public literacy about the relationship between health and economic output. As long as voters and media treat health budgets primarily as expenditure lines rather than productive investments, political incentives will favour cutting them during fiscal downturns rather than protecting them. The Economy of Wellbeing is, at its core, a claim about what economies are for. Whether that claim gains traction in European politics will depend less on indicator dashboards than on whether it can reshape the terms of democratic debate.
The Economy of Wellbeing remains, for now, a framework with genuine institutional backing, a coherent evidence base, and a handful of serious national pilots — but not yet the dominant logic of European economic governance. The distance between the Council conclusions of 2019 and the fiscal decisions of 2025 is not primarily a technical gap. It is a political one.
