Our economy, said John Maynard Keynes in 1933, “is not a success. It is not intelligent, it is not beautiful, it is not just, it is not virtuous—and it doesn’t deliver the goods.” Katherine Trebeck, Advocacy and Influencing Lead for the Wellbeing Economy Alliance, began her Patrick Geddes Lecture of the Royal Town Planning Institute with this arresting quote. She followed it with another quote from Keynes: when we consider “what to put in its place we are perplexed.” Trebeck argued that almost a century after Keynes’s quote we have a much better idea; and the covid-19 pandemic has given both urgency and impetus to finding our way through the perplexity to an economy that is sustainable and promotes wellbeing and equity.

A first step, Trebeck said, is to end the mindless pursuit of growth in trying to increase the Gross Domestic Product (GDP), a measure that is increased by cleaning up oil spills, making rubber ducks and cigarettes, and counselling people who are getting divorced. As Robert Kennedy said in 1968, GDP “measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile.” Trebeck pointed out that GDP favours treatment, which is counted, rather than prevention, which offers nothing to be counted: indeed, increased safety and health might well lead to GDP falling.

Pursuing growth in GDP has simply not delivered wellbeing and equity, as Keynes observed in his quote. Trebeck also noted that growth in GDP leads to diminishing returns. Increase in life expectancy is a good example: it increases rapidly as low income countries move out of poverty, but flattens off dramatically at a level of wealth well below that, for example, a country like Britain enjoys.

The second step to an economy that promotes wellbeing is to recognise that a wealthy country like Britain already has enough wealth. “Growth,” said Trebeck, “has done its job.” This is illustrated by the simple fact that even in Scotland (where the lecture is based) the wealthiest 1% own as much as the poorest 50%. She added that the top 10% globally are responsible for 50% of carbon emissions. The challenge is not to grow the economy, but to share and cherish what we already have.

Trebeck outlined the five principles that make for a wellbeing economy: connection, so that everybody feels they belong; participation in decision making; recognising that we are part of nature and that it is not an unlimited resource we can exploit; fairness; and dignity.  We need to move from “fixing, healing, and redistributing to getting it right in the first place.”

Patrick Geddes, whose lecture Trebeck was delivering, is described as “the father of town planning.” A biologist, sociologist, geographer, and philanthropist as well as town planner, he lived from 1854 to 1932 and conducted multiple social experiments, many of them in Edinburgh. He was what today would be called a “systems thinker,” and he demanded consideration of “primary human needs” in every act of planning.

Trebeck had studied his work and picked out seven lessons from his work.

The first was to “see the whole.” We need to recognise how systems are interlinked, and our emphasis on specialisation works against this. “Each of the various specialists remains too closely concentrated upon his single specialism,” said Geddes, “too little awake to those of the others. Each sees clearly and seizes firmly upon one petal of the six-lobed flower of life and tears it apart from the whole.” When thinking about the economy we should think about wellbeing, and when thinking about health we must think beyond health care, recognising that health has many components and that health care is only a small part of health.

Geddes urged people to see beyond “squirrel millionaires,” people who hoard wealth. Trebeck argued for predistribution not redistribution, and a problem with a few owning so much is “political capture”: those few having disproportionate power in the political process. She quoted a study that found of the 2000 billionaires in the world a third had made their money through entrepreneurship, but the wealth of two thirds came from inheritance and “crony capitalism.”

A third lesson from Geddes was the importance of local context. He was an advocate of working locally and regionally, and a related fourth lesson was that community involvement was essential for improvement. Trebeck is a supporter of deliberative democracy, and citizens’ assemblies, where a random sample of the population discuss issues and possible actions after being given substantial and unbiased information.

Another lesson that Trebeck drew from Geddes’s work was “beyond examinations.” This fitted with her arguments against pursuing growth in GDP, stock markets, productivity, and the value of real estate. She argued for a much more meaningful measures like the number of girls who ride their bikes to school.

I particularly liked the sixth lesson from Geddes the importance of “magnificent failures”—or, in other words, being bold. There are thousands of local experiments in promoting a wellbeing economy, and we can learn from those experiments, including those that fail. Geddes himself, Trebeck observed, might be described as a “magnificent failure.”

The final lesson was “follow your heart” not narrow orthodoxy. Trebeck quoted the five top regrets of the dying from the book of Bonnie Ware, a nurse who cared for the dying and collected their last regrets. They are:

• I wish I’d had the courage to live a life true to myself, not the life others expected of me 
• I wish I hadn’t worked so hard (Ware said this was true of all her male patients)
• I wish I’d had the courage to express my feelings 
• I wish I had stayed in touch with my friends 
• I wish that I had let myself be happier

In the questioning that followed her lecture, Trebeck made a point about the importance of collective institutions, like the NHS, supporting community initiatives. She ended by arguing that creating a wellbeing economy is like doing a 2000-word piece jigsaw, the result of thousands of local initiatives.

The lecture will be put online and available for free. Katherine Trebeck is the co-author along with Jeremy Williams of The Economics of Arrival: Ideas for a Grown Up Economy.

See also: The economy of wellbeing: what is it and what are the implications for health?

Richard Smith was the editor of The BMJ until 2004.

Competing interests: None declared