Gwyneth Paltrow, actress, wellness queen and avid fan of jade balls (google with care), will probably live a long time and in excellent health. Her longevity however, will have little to do with the various wellness remedies she sells, and a lot to do with her extraordinary wealth. This is because of the wealth-health gradient. The wealthier you get the better your health, the longer you live. Conversely the less wealth you have, the shorter your life. This imbalance is independent of a person’s access to healthcare, education, income or where they live (or use of jade balls).

It is visible to many of us that health and wellness is contingent on who you are, and what you have. What is less visible is the pervasive and often invisible social narratives that lead people to think that this is inevitable and simply “the way things will always be”. Dig into the cultural beliefs that dominate public thinking about health and wellness, and what emerges is a series of assumptions that good health and wellness is something that individuals determine for themselves, something we need to work hard for, and at its most extreme form, something we buy from the health and wellness industry. While such thinking pervades our shared understanding about health and wellness, those with lower incomes and fewer resources get blamed when they become unwell, injured or die sooner than others.

Yet personal choice and individual effort is not nearly as important as the upstream conditions that influence our health and wellbeing. The places we live, work, learn and play are a large part of what determines our health and wellbeing. For example the type of political system, and the policies that flow from that, can benefit specific groups in a society over others: the health of the climate (or otherwise) affects the survival of entire countries through sea level rise and extreme weather patterns; the quality of the air we breathe, and the water we drink; the way our neighbourhoods and cities are built and the transport that it encourages us to use (active or sedentary); the way our workplaces and employers structure our working life and the conditions we work under; the way we are treated based on our identity by people in institutions like health and education. These are all much greater determinants of our health than our individual efforts and choices. Yet these conditions can be hard for people to see, we have a propensity to explain and understand the world through our senses. And it is easy to see individual behaviour and responses.

It is not surprising that we have a huge wellness industry built on the idea that health is entirely in your own hands. And its profits rely on the continued dominance of this thinking. There are major harms that result from this model, even to the well off. Quackery is rife - the internet is full of alternative ‘treatments’ that are not just a waste of money but are also harmful to people’s health (bleach to treat Covid-19 is the tip of this particular iceberg).

A more subtle harm is the blame that is attributed to people when they become unwell but didn’t “look after themselves better”. There are big profits to be made when individuals are encouraged to learn to be ‘mentally resilient’. Businesses and individuals pay for mental resilience training instead of restructuring of work and employment and even economic systems to support people’s full selves. When people are negatively impacted by such systems, the explanation is “they are not resilient/tough enough”. While individual approaches to wellness should be taken, the balance is wrong. Focus needs to be tipped towards amending upstream conditions that create wellness.

It is not surprising that we have a huge wellness industry built on the idea that health is entirely in your own hands.

What would an effective and balanced approach look like that made wellness accessible for everyone?

There is no lack of research on how to create communities, workplaces, institutions that lead to a healthy and well population. Generally speaking wealthier counties enable people to have better health overall, but that doesn’t mean in wealthy countries all people have the same opportunities for good health. In New Zealand, there are significant inequalities in the health and wellbeing between Māori and non-Māori and Pacific and non-Pacific people.

People in politics need to take a much stronger stance on shaping people’s health through innovative and pragmatic policies and practices. Creating cities that put health at the heart of our transport is one such common sense approach. Making it easy to get where you need without a car (and hard to use a car if you don’t need to), creates more opportunities for more people to get where they need for work, play, learn, live, it is healthier, more pleasant and good for the environment. It’s all the conditions you need for future focussed and resilient economies.

People in business are key. Innovative policy making that specifically focuses on creating healthy systems in society needs partners across society with a similar set of big goals. Big Street Bikers, a social enterprise, putting e-bike charging stations on our streets is the kind of enterprise policy makers can enable to improve access to good health to more people. People in government are key in the development of innovative new industries that focus on delivering opportunities to everyone in society, not just some.

In New Zealand, the unique opportunity that exists for people in government is in building strong high trust relationships with iwi and hapū to shape healthy contexts and environments for people. For example urban developments, communities, houses, that build health and wellbeing is something iwi are ideally positioned to help deliver at a larger scale. Supporting and elevating exciting indigenous solutions, like papakāinga.

Supporting and shaping wellness in our homes, workplace, neighbourhoods, streets and natural environment, is how those with the power to do so can make health more accessible for more people. The jade balls are just an expensive and useless distraction.