Commentary: Governments should consider people's pain as a measure of a nation's well-being

With the utility of GDP under increased scrutiny as a metric of well-being, Dr. Lucía Macchia argues that people's experience of pain and, how it affects their lives, needs to be better measured and incorporated into policy decision-making.

Dr. Macchia is a behavioral scientist and Lecturer in Psychology (Education & Research) at City, University of London. Sharing her Comment piece in Nature Human Behaviour, she argues that the concept of Gross Domestic Product (GDP) as a measure of a nation's economic success, and thereby an indicator of well-being, has been comprehensively challenged and increasingly distrusted.

As alternate, real-world metrics of well-being continue to be sought and used by policy makers and in government parlance: from metrics like "happiness" and "life satisfaction" to "employment," "relationships," "accommodation" and "health," Macchia argues that pain needs to be added to the equation.

While most people think of pain as a solely physical phenomenon, of the body hurting, there is a large, growing body of evidence showing that pain affects how we think and feel, and that our environments can effect the degree of pain we experience.

There are many reasons to specifically measure pain to inform policy-making, including to provide context to other measures of well-being such as life satisfaction. Pain is also closely linked to negative emotions, such as anxiety and depression. As a physical symptom, pain may be more likely to be reported than emotions by people concerned about reporting mental health difficulty.

In terms of relative impact, Macchia highlights how trends in the experience of pain across the world are on the rise from 23% in 2009 to 32% in 2021, and how pain is incredibly costly to national economies. For example, the U.S. spends more than $600 billion dollars annually to treat pain, a figure that surpasses the comparable cost of heart disease and diabetes to the country.

She argues that a simple, brief question included on government disseminated surveys, such as "how much bodily pain do you have right now?" where a respondent could answer anything from 0 (no pain) to 10 (worst imaginable pain), could be transformative to a nation's understanding of its well-being, helping governments to monitor pain in an efficient and affordable way.