"Another really good one that I love about Alaska, within the purpose element, is learning something new and interesting every day," Witters explained, "which is an important psychological need." That metric is a reason that college towns tend to score highly on the well-being index. And there, too, Alaska is number one in the nation, with 72 percent of residents feeling daily intellectual stimulation.
The state is held in stark contrast to the opposite end of the spectrum, the cases of Kentucky and West Virginia. If nothing else, the two states attest to the validity of the ranking system in that there is consistency in its results: The pair has managed to hold down spots 49 and 50 for six consecutive years.
"Kentucky and West Virginia are really in bad shape," said Witters. There diagnoses of depression are perennially among the highest in the nation, as are stress levels and high blood pressure. Nearly a third of West Virginians smoke tobacco, compared to 19 percent of people nationwide.
Behind those disheartening numbers is another particularly important metric: having someone in your life who encourages you to be healthy. There West Virginia also ranks last in the country. "That is a really good leverage point that they could take advantage of, that cultural change of encouraging accountability to one another," said Witters, when I asked them how West Virginia could learn from Alaska. "It's about having someone who has fundamental expectations of you, in how you live your life."
Even for all their shortcomings, these rankings are fodder for growth and improvement, and they only stand to become more so. In places, the index is already being used by policy makers and businesses, with an eye to bringing programming and investment to their states. In Iowa, for example, governor Terry Branstad boasted on his website in 2013 when Iowa moved from number 16 to number nine, taking that as evidence of success in his Healthiest State Initiative. The program is actually predicated entirely on the Gallup well-being rankings, explicitly aiming to take Iowa to the top spot by 2016.
The state can get there, Branstad believes, through a variety of public-health programs. Focus Five, for example, imposes a handful of goals for individual citizens that specifically address areas where the state has performed poorly. One of the five is "increasing the number of Iowans who feel their boss treats them like a partner at work." Another program, Get Your Bib On, encourages Iowans to visit the dentist.
Apart from seeking glory or avoiding shaming, motivation for improvement can also come from bald financial arguments. These well-being factors are interdependent, but also influence healthcare spending, notes Janet Calhoun, a senior vice president at Healthways. She frequently invokes the rejoinder that communities with high well-being scores spend less money on healthcare, and their people are more productive overall. The argument, then, is that there can be significant regional economic return when communities invest in improving the wellbeing of a population. And similarly in the private sector, Calhoun said, "When employers invest in improving the well-being of their work force, they have a healthier bottom line for their business."
"These metrics don't move a lot if you're not addressing them," Witters said. "Until there are statewide initiatives that are meant to address these basic problems in places like Kentucky and West Virginia, they're going to be stuck at the bottom."