There is a growing focus on public health initiatives that prioritize wellbeing. The main question of our study is whether this, in its current form, can really represent a new response to the challenges of previous strategies, or whether there is a greater chance that it will essentially reproduce the problems associated with the paradoxical situation of public health. Based on a review, analysis and evaluation of the literature on wellbeing in public health, we outlined the foundations of a new meta-theory of wellbeing and a possibility for its social application. In our view, wellbeing is seen as a social representation of a combination of positive and negative freedom of choice concerning the quality of everyday life, used in a positioning process involving both individual and collective aspects. Health is a particular aspect of the social representation and positioning of wellbeing, which encompasses aspects of the physical, psychological, social and spiritual functioning of individuals. The wellbeing meta-theory also opens up the possibility for more effective solutions to the social challenges related to wellbeing and salutogenetic health. It underscores the importance of the need for a dedicated social subsystem where the goals and organizational culture of the organizations involved are focused on wellbeing and health promotion. In our study, we consider this to be the Public Wellbeing System (PWS). Our conclusion is that the development and operation of a new set of institutions—the Public Wellbeing System (PWS)—based on the co-production of services that meet the needs and demands of society, and dedicated to the promotion of wellbeing, may provide an opportunity to overcome the public health paradox.

Introduction: We have quantified the healthy life years lost and the costs incurred in 2019 due to the poor health of the Hungarian population aged 30-64 from a societal perspective, but also from the perspective of several other social actors, calculating the indirect costs according to the human capital approach. Objective: The aim of our estimate is to shed light on the radically high losses that Hungary incurs year after year as a result of its inhabitants living significantly shorter and sicker lives than people in similar situations in other countries. Method: In the first part of the analysis, we aggregated the time lost due to illness and disability for the age group 30-64 in 2019. The aggregated Hungarian values for the studied age group were compared with the corresponding values for the Visegrad countries, Austria and the European Union. The second part of the analysis aggregates the social costs of time spent in ill health. A distinction is made between direct costs, which involve the movement of money, and indirect costs, which are embodied in lost income or production. Results: In Hungary, the nearly 4.8 million people aged 30-64 spent a total of 654,000 years on sick leave in 2019, which equated to an average of about 50 days per person. This means 14% of the total number of working days could have been working days in good health. The direct costs, i.e., the expenditure of the Health Insurance Fund and the expenditure financed by patients and voluntary insurance, amounted to HUF 1,446 billion. Indirect costs, i.e., expenditure due to the loss of working years as a result of premature death and illness, represented a further burden of HUF 2,279 billion. Conclusion: In 2019, the direct and indirect expenditure of people aged 30-64 amounted to HUF 3425 billion, or 7.21% of the GDP. It is well known that in developed countries, including Hungary, the greatest health losses are caused by non-communicable chronic diseases, which can be prevented by a healthy lifestyle. Therefore, the promotion of healthy lifestyles and the creation of a conducive physical and social environment are essential for improving the country s competitiveness.