Bringing the data to life: A tale of two cities in North Carolina (Download options)
Hickory resident Susan Smith shares her thoughts on Well-Being (Download options)
Raleigh resident Lisa Wojcik outlines her concerns when it comes to Well-Being (Download options)

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A Million People Have Spoken: Gallup, Healthways Unlock the Meaning of Well-Being

Differences revealed by “Tale of Two Cities” in North Carolina

What combination of factors impacts a life’s fulfillment and well-being? Is it health, work, stress, marriage, friends, money, or does where you live make a difference? Today, we are closer to knowing the answers as a million people have spoken through the Gallup-Healthways Well-Being Index™ (WBI), the nation’s largest and most comprehensive look at overall well-being.

“Prior to this work, how well-being was intertwined with daily life was unknown. We didn’t know the impact elements such as happiness, anger, stress, health status, employment status and neighborhood safety had on the whole,” said Nikki Duggan, Healthways (NASDAQ: HWAY) lead WBI data analyst. “Through these million people sharing their lives we have uncovered incredibly valuable insight for our country and its people. We have heard both concern and hope over the past three years of our surveying.”

In a historic partnership for American health transformation, Gallup and Healthways have developed a national measure of well-being that provides leaders with the information they need to create solutions for making Americans healthier. Gallup and Healthways initiated this 25-year partnership by merging decades of clinical research and development expertise, health leadership, and behavioral economics research to track and understand the key factors that drive well-being.

The survey’s inception in January 2008 provided researchers a snapshot of America prior to the recession, and also a baseline against which to measure the devastation of the stock market crash in October of that year. Within two months, overall well-being fell 2.8 points, while Life Evaluation Index (LEI) scores, the measure of people’s current life perception and hope for the future, fell 5.6 points within one month.

The WBI revealed fluctuations in Americans' well-being throughout 2008 and 2009. Further analysis of the six individual domains comprising the WBI, revealed the LEI metric alone held up the overall score as each of the five other domains declined in 2009. With unemployment still high and consumer confidence lagging, 2010 has been a year with many lingering concerns. In September 2010, the WBI hit its lowest point for the year and the LEI index fell to a new 13-month low.

A Tale of Two Cities

Due to the unprecedented reach and intensity of the WBI – 1,000 surveys completed every day for 25 years – researchers are able to track these trends nationally and statewide, as well as focusing on the well-being of specific communities.

“We were surprised when we started looking at the city-level metrics to see such variations in communities close to each other, especially in their life experience and physical, emotional and social health,” Duggan said. “We looked at North Carolina as an example of the country and noted how differently people in the communities of Hickory and Raleigh in particular were experiencing life.”

Metropolitan Raleigh is a capital city and home to a million people, while the Hickory area is home to leading manufacturers of furniture and fiber optic cable and boasts a population of 360,000.

While only 177 miles apart, well-being in Raleigh and Hickory differs significantly. Raleigh ranks 16 out of 185 MSAs in national overall Well-Being, with 53.6 percent of the population thriving and only 4 percent suffering. Conversely, Hickory scored last in the nation in both Life Evaluation and Emotional Health. 8.6 percent of Hickory residents indicate they are suffering, the second-lowest score of MSAs, while only 41.2 percent are thriving. The city also ranks in the bottom ten MSAs for overall Well-Being.

There are economic disparities between the two cities, with significant differences in unemployment. Raleigh is more than a point higher, while Hickory is three points lower, than the national average.

“Hickory was hardest hit by job loss and when people lose their jobs, they lose their income, they lose their healthcare and then they lose their purpose, so it doesn’t surprise me at all that we would be suffering,” said Hickory resident Susan Smith.

Despite being among the lowest in the nation overall and in five of the six domains, Hickory rates second of the 185 MSAs nationally in Work Environment. This ranking reflects high scores in areas such as collaborative supervision and working in an open and trusting environment. The disparity between the high rank for Work Environment in Hickory and the low rankings recorded in the other domains indicates that the well-being of employed Hickory residents is significantly higher than the well-being of those residents that are unemployed or underemployed.

Comparison of City Well-Being Rankings










    City Ranking   WBI Score   City Ranking   WBI Score   Average
Overall Well-Being   16   68.6   176   62.5   66.5
Life Evaluation   44   49.5   185   32.5   47.7
Emotional Health   54   79.5   185   74.1   78.8
Physical Health   13   79.2   181   72.1   77.5
Healthy Behavior   81   63.4   167   58.9   63.3
Work Environment   17   54.2   2   60.0   48.7
Basic Access   20   85.7   172   77.7   82.8

Source: Gallup-Healthways Well-Being Index

* Rankings of 185 cities, following the U.S. Census Bureau Definitions for Metropolitan Statistical Areas (MSAs)

Smith also worries about the physical health of her city, another measure where Hickory ranks in the bottom 10 cities in the nation. “Most of the people in North Carolina who are struggling and have a low quality of well-being are either unemployed, underemployed or are the working poor. People are living off cheap, processed foods and that affects your health,” she said.

Variations in City Characteristics from the Well-Being Index
    Raleigh   Hickory  


Learned or Did Something Interesting   66.2   53.0   63.2
Experienced Enjoyment   86.3   76.9   83.7
Health Problems Do Not Prevent Normal Activities   81.5   71.8   70.0
Diagnosed with High Blood Pressure   27.5   38.1   29.0
Experienced Recurring Neck/Back Pain   27.0   35.0   30.6
Non-Smokers   81.4   72.8   80.2
Think the City/Area is Getting Better   69.1   45.5   54.6
Dental Care/Maintenance   69.0   51.8   67.4

Source: Gallup-Healthways Well-Being Index

Although Raleigh is faring much better in terms of well-being, national difficulties are not lost upon its residents.

“People I work with, when they get sick, they don’t have the option of going to the doctor – they don’ t have that level of security,” said Raleigh resident Lisa Wojcik. “Catastrophic illness frightens me. Not just for our son, but also for my aging parents. I worry about being able to provide for not only our immediate family, but for our extended family as well.”

“Somehow we can work with people, get them to identify their goals, and help provide the support that they need to reach them,” said Tony Gurley, Commissioner, Wake County Government, Raleigh.

“Nobel Prize Winner Joseph Stiglitz said, ‘if you don’t measure the right thing, you don’t do the right thing’,” said Ben R. Leedle, Jr., CEO of Healthways. “Gallup and Healthways created this Index because we both care deeply about the health and well-being of this country, and without this knowledge we don’t know where to go first, communities don’t know where to look first to make real, sustainable changes and improve life for their constituents. Now, each community, big or small, can take notice of what’s driving the well-being of people in their area and respond thoughtfully to those needs.”

Every day, 1,000 surveys are being conducted across America. Find out more, and see how your city and state ranked, at A picture of America’s Well-Being past, present and future will be available on the site November 8, 2010.

Gallup-Healthways Well-Being Index by the numbers:

Start Date: January 2, 2008
Millionth Survey Complete Date: October 23, 2010
Survey Methodology: Live telephone interviews (landline and cell)
Total time spent with respondents on the survey: over 14,500,000 minutes
Number of people surveyed:

  Diagnosed with diabetes   109,604
  Diagnosed with high blood pressure:   302,183
  Who’ve had a heart attack:   43,835
  Who were stressed most of the day before:   393,374
  Who experienced physical pain yesterday:   235,600
  Who were treated with respect yesterday:   917,283
  That did not have enough money to buy food:   149,284
  Who ate healthy yesterday:   668,676
  That had neck or back pain:   314,536
  Who smoke:   208,898
  Who are categorized as obese:   247,920

About Healthways

Healthways is the leading provider of specialized, comprehensive solutions to help millions of people maintain or improve their health and well-being and, as a result, reduce overall costs. Healthways' solutions are designed to keep healthy people healthy, mitigate or eliminate lifestyle risk factors that can lead to disease and optimize care for those with chronic illness. Our proven, evidence-based programs provide highly specific and personalized interventions for each individual in a population, irrespective of age or health status, and are delivered to consumers by phone, mail, internet and face-to-face interactions, both domestically and internationally. Healthways also provides a national, fully accredited complementary and alternative Health Provider Network and a national Fitness Center Network, offering convenient access to individuals who seek health services outside of, and in conjunction with, the traditional healthcare system. For more information, please visit

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To learn more about the Well-Being Index, visit us online at