Trends and geographical variation in population thriving, struggling and suffering across the USA, 2008-2017: a retrospective repeated cross-sectional study.

Objectives: Well-being is a holistic, positively framed conception of health, integrating physical, emotional, social, financial, community and spiritual aspects of life. High well-being is an intrinsically worthy goal for individuals, communities and nations. Multiple measures of well-being exist, yet we lack information to identify benchmarks, geographical disparities and targets for intervention to improve population life evaluation in the USA.

Design: Using data from the Gallup National Health and Well-Being Index, we conducted retrospective analyses of a series of cross-sectional samples.

Setting/participants: We summarised select well-being outcomes nationally for each year, and by county (n=599) over two time periods, 2008-2012 and 2013-2017.

Main Outcome Measures: We report percentages of people thriving, struggling and suffering using the Cantril Self-Anchoring Scale, percentages reporting high or low current life satisfaction, percentages reporting high or low future life optimism, and changes in these percentages over time.

Results: Nationally, the percentage of people that report thriving increased from 48.9% in 2008 to 56.3% in 2017 (p<0.05). The percentage suffering was not significantly different over time, ranging from 4.4% to 3.2%. In 2013-2017, counties with the highest life evaluation had a mean 63.6% thriving and 2.3% suffering while counties with the lowest life evaluation had a mean 49.5% thriving and 6.5% suffering, with counties experiencing up to 10% suffering, threefold the national average. Changes in county-level life evaluation also varied. While counties with the greatest improvements experienced 10%-15% increase in the absolute percentage thriving or 3%-5% decrease in absolute percentage suffering, most counties experienced no change and some experienced declines in life evaluation.

Conclusions: The percentage of the US population thriving increased from 2008 to 2017 while the percentage suffering remained unchanged. Marked geographical variation exists indicating priority areas for intervention.