"Wellness is functioning optimally within your current environment."
The Snapshot: If you read this week's Slightly Smarter, you got the main finding: researchers analyzed 44 wellness models and found no consensus on what wellness even includes. You got the 8-dimension framework we use and why we chose it. This is the full analysis—the history, the systematic review evidence, the competing frameworks, and why the lack of agreement actually makes wellness literacy more important. [If you want the short weekly version, Slightly Smarter is publishing a 2-minute snapshot of each topic—you can subscribe free and follow along there, too.]
The Problem: 379 Ways to Define Wellness
Let's start with what the research actually found.
Kauppi et al. (2023) conducted a systematic review of 44 generic wellness models spanning from 1974 to 2020. They weren't comparing specific interventions—they were mapping how researchers and practitioners have conceptualized wellness itself.
What they found was... a mess.
Across those 44 models, researchers identified 379 unique domains. These could be clustered into 70 groups, which could then be organized under 14 broad themes. The most common themes were Physical (17% of all domains), Psychological (14%), Social (13%), Emotional (12%), Spiritual (9%), and Environmental (8%).
But here's the key finding: despite almost 50 years of research, the authors concluded:
"No mutual understanding has been reached on the structure of wellness."
Not "we're getting closer to consensus." Not "these frameworks are converging." No mutual understanding.
Why the Fragmentation Exists
The wellness industry is now worth an estimated $6.8 trillion globally—larger than the pharmaceutical industry, sports, IT, and tourism combined (Global Wellness Institute, 2025). It includes everything from meditation apps to gym memberships to crystal healing to overpriced juice.
This vagueness isn't a bug—it's a feature.
A 2025 systematic review in the International Journal of Women's Health examined 13 major wellness frameworks from 1959 to 2024 (AlNujaidi et al., 2025). Their analysis confirmed what Kauppi found: there is no single "best" multidimensional wellness framework.
The reviewers identified six dimensions that recur most frequently across frameworks: Physical, Social, Emotional, Spiritual, Intellectual, and Occupational. But even this core set isn't universal—some frameworks add Financial wellness, others add Environmental, and the boundaries between dimensions vary.
When we conducted our own scoping review for Wellness Literacy Co. (January 2026), searching six academic databases, we found the same conclusion.
"There is no single 'best' multidimensional wellness framework, but several are strongly validated and widely supported for different purposes."
The key phrase: for different purposes.
Different frameworks serve different needs. PERMA (5 factors) fits positive psychology research. WB-Pro (15 factors) works for mental well-being policy. Swarbrick/SAMHSA (8 dimensions) suits wellness education and behavior change.
Asking "what's the best wellness framework?" is like asking "what's the best vehicle?" It depends on what you're trying to do.
A Brief History of Wellness
The concept of holistic health isn't new. Ayurveda (India, ~3000 BCE), Traditional Chinese Medicine, and the Greek concept of eudaimonia all recognized that wellbeing extends beyond physical health.
The modern wellness movement began in 1959, when physician Halbert Dunn introduced "high-level wellness" as a state beyond merely not being sick. Dunn argued that absence of disease wasn't the same as flourishing—a distinction that remains central to wellness thinking.
In 1976, Dr. Bill Hettler at the National Wellness Institute formalized this into six dimensions: Physical, Emotional, Intellectual, Social, Spiritual, and Occupational. This framework dominated wellness education for decades and is still widely used.
But the world changed. Financial stress became a documented health determinant. Environmental factors—from living conditions to attention management—gained recognition. Newer frameworks evolved to include these dimensions.
The AlNujaidi review found that 11 of 13 major frameworks were developed in the United States, with limited cultural adaptation for other contexts. They also noted that most frameworks don't address gender-specific factors that affect wellness differently for different populations.
We're still evolving.
The Framework We Use (And Why)
Given that no consensus exists, how do you choose a framework?
Here's the comparison we used:
Why we selected Swarbrick/SAMHSA:
Recent validation — The 2024 psychometric study (n=3,446) confirms the model holds up empirically, with rigorous factor analysis and construct validity testing (Swarbrick et al., 2024).
Institutional adoption — SAMHSA (Substance Abuse and Mental Health Services Administration) has adopted and implemented this framework with extensive free public resources.
Financial dimension — Financial stress is a documented determinant of health outcomes (Sweet et al., 2013). Older frameworks miss this entirely.
Environmental dimension — Includes both physical surroundings and attention management—increasingly relevant in a digital age.
Comprehensive coverage — Eight clearly defined dimensions that general audiences can understand without specialized training.
What we acknowledge:
No framework is perfect. The systematic reviews note several limitations:
Western-centric — 11 of 13 major frameworks were developed in the United States
Limited cultural adaptation — May not capture wellness concepts from other traditions
No gender-specific factors — The AlNujaidi review specifically called out this gap
We don't claim this is "the" definitive wellness framework—only that it's validated, comprehensive, and practical for developing wellness literacy skills.
The Eight Dimensions
The Skill That Actually Matters: Wellness Literacy
The framework you pick matters less than your ability to evaluate wellness claims.
Given that experts can't agree on what wellness includes, and that the industry has strong commercial incentives to keep things vague, the skill that cuts across everything is critical evaluation.
Wellness Literacy is the capacity to access, understand, appraise, and apply evidence-based wellness information to make informed, non-clinical health decisions.
This adapts the integrated health literacy model by Sørensen et al. (2012), which analyzed 17 definitions and 12 conceptual models to identify four core competencies:
The World Health Organization adopted this same framework in 2021 for their health literacy definition.
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Literacy Lesson: Why Fragmentation Is Actually the Point
The Kauppi finding—"no mutual understanding"—isn't a problem to be solved. It's a feature of how wellness works.
Wellness isn't like chemistry, where there's a periodic table everyone agrees on. It's a constructed concept, shaped by cultural values, commercial interests, and evolving research.
The skill: Instead of asking "Which framework is correct?", ask "What is this framework good for?" Different tools for different jobs.
When evaluating wellness claims, ask:
What framework is this claim operating within?
What dimensions does it address—and which does it ignore?
Is the framework validated for the purpose it's being used?
Picking the "right" answer matters less than asking better questions.
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The Series Ahead
This series will move through all eight dimensions, starting with Physical Wellness:
Week | Topic | Dimension |
|---|---|---|
1 | Misinformation + Wellness | (The Problem) |
2 | What is Wellness | (The Foundation) |
3 | Physical Wellness | Physical |
4 | Nutrition | Physical |
5 | Strength Training | Physical |
6 | Sleep | Physical |
7 | Flexibility | Physical |
8 | Neuromotor (balance, coordination, agility) | Physical |
9 | Cardio | Physical |
10+ | Remaining Dimensions | All Others |
Each week follows the same structure: what the research says, what's overstated, the myths, and how to verify.
Verify This
Kauppi et al. (2023): DOI: 10.5502/ijw.v13i2.2619
AlNujaidi et al. (2025): DOI: 10.2147/IJWH.S498027
Sørensen et al. (2012): DOI: 10.1186/1471-2458-12-80
Swarbrick et al. (2024): DOI: 10.1176/appi.ps.20230622
Holt-Lunstad et al. (2010): DOI: 10.1371/journal.pmed.1000316
Sweet et al. (2013): DOI: 10.1016/j.socscimed.2013.05.009
Alimujiang et al. (2019): DOI: 10.1001/jamanetworkopen.2019.4270
Global Wellness Institute (2025): 2025 Global Wellness Economy Monitor
SAMHSA 8 Dimensions: samhsa.gov/wellness-initiative
WHO Health Literacy (2021): who.int
National Wellness Institute: nationalwellness.org/
Editor’s Note
When I started building Wellness Literacy Co., I assumed I needed to pick "the right" wellness framework. I spent weeks comparing models, looking for the definitive answer.
The scoping review taught me something different: there is no definitive answer. There are only frameworks that are more or less useful for specific purposes.
That's not a cop-out—it's the actual state of the science. And it's why wellness literacy matters more than any particular framework. The skill that cuts across all eight dimensions isn't knowledge of any single domain. It's the ability to evaluate what deserves your attention.
That's what this series is about. Not telling you what wellness is. Teaching you how to decide.
—Brian
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