Who Flourishes Despite Health Limitations? Evidence from 22 Countries

Abstract

Abstract Background Physical health is associated with holistic well-being, yet evidence on how this association varies across sociodemographic groups and diverse populations remains scarce. Methods Using data from the Global Flourishing Study — a longitudinal survey of adults across 22 countries (N = 207,919) — we examined sociodemographic moderators of the association between self-reported health limitations and multidimensional well-being approximately 1 year later. Well-being was measured with the validated Flourishing Index, encompassing happiness, meaning, health, character, relationships, and financial security. Survey-weighted linear and quasi-Poisson regression models with interaction terms assessed seven moderators (age, gender, marital status, employment, education, religious participation, immigration) on additive and multiplicative scales, within each country and pooled across countries using meta-analytic techniques. Results Preliminary analyses revealed considerable cross-country heterogeneity. In Australia, older adults showed a stronger inverse association, particularly those aged 70–79 (additive interaction = −0.52, 95% CI: −0.97, −0.06). In Kenya, retired individuals with health limitations had notably lower flourishing than employed peers (additive interaction = −0.80, 95% CI: −1.47, −0.12). In China, being divorced strengthened the inverse association (additive interaction = −0.76, 95% CI: −1.49, −0.02). In Poland, marriage attenuated it (+0.42, 95% CI: 0.16, 0.68). In the UK, attending religious services more than once/week buffered the negative association (+0.34, 95% CI: 0.05, 0.63). Additional context-specific patterns are also observed in other countries. Conclusions The relationship between health limitations and flourishing varies by sociodemographic group and country, offering evidence to help healthcare providers and policymakers identify vulnerable groups and promote equity in flourishing. Key messages • Health limitations do not affect flourishing equally: who you are and where you live shapes your vulnerability. Identifying these groups is the first step toward well-being for all. • Across 22 countries, sociodemographic factors modify how health limitations impact flourishing, offering policymakers a roadmap to reach the most vulnerable populations.