How health systems contribute to societal goals

Traditionally, health system performance assessments have focused on evaluating the health system itself, with less concern about the broader impacts of improved population health beyond the sector. However, in today's interconnected world, health is intricately linked with the environment, sociocultural dynamics, geopolitics and the economy, among others. These interconnections highlight the need for health system performance assessments to recognize that achieving health goals can also contribute to broader societal objectives, including population well-being, economic development, environmental sustainability and social cohesion.Recent health policy discussions have explored, for example, the environmental footprint of health systems, the effects of social factors such as loneliness on well-being, the breakdown of trust in politicians during events such as the coronavirus disease 2019 (COVID-19) pandemic, and the economic implications of mental health on employment and poverty status. These discussions underline that health systems are responsible for providing health services and have a pivotal role in the improvement of people's health, promotion of overall well-being, happiness and productivity.To better understand the contribution of health systems to broader societal well-being, such goals need to be adequately conceptualized and measured. Well-being is not captured by standard economic measures such as gross domestic product (GDP), which primarily focus on economic growth and fail to reflect income distribution, sustainability practices, non-market transactions and health and education outcomes, many of which contribute to societal well-being. Newer, more holistic measurement approaches to well-being, for example the Organisation for Economic Co-operation and Development's (OECD) well-being framework,1 attempt to quantify well being through various factors such as health, education, employment, housing, security, gender equality and social connections.In this article, we conceptualize societal well-being from the perspective of the health system's contribution to it. We break down well-being into three societal goals – social cohesion, environmental sustainability and economic development (Fig. 1). The health system contributes to these objectives through actions that primarily serve to achieve its own goals such as improving population health, equity, people-centredness or resilience. Therefore, achieving health system goals leads to consider abl