Cigna released results of its annual global 360 well-being survey, Well and Beyond, which found that America is the 9th ranked country for health and well-being. Well and Beyond findings also reveal that more Americans than ever are stressed, particularly about physical, family and workplace wellness, less rested, and spending less time with family and friends.

Well and Beyond is an annual study that explores perceptions of well-being across 5 key indicators—physical, family, social, financial, and work—in 22 countries, including the United States. It found that overall health and well-being of Americans declined by 1.2 points, placing the United States slightly above the global average and on par with European countries, Thailand, and the United Arab Emirates. The decline was driven primarily by deterioration of workplace wellness, followed by physical and family wellness. All demographics show some level of decline, and the sandwich generation aged 35-49 is the least positive.

“We’re seeing high incidences of stress, poor sleep quality, and less time connecting with loved ones, which all can have a profound impact on one’s physical health. Instead of treating medical conditions after they arise, we want to take a proactive and preventive approach to improve our customers’ total health and well-being,” says Jose Quesada, chief medical officer, international markets at Cigna, in a release. “These new actionable insights better enable us to deliver the right tools and supportive resources to surround each individual, treating each person as a whole person, body and mind as one.”

Key Well and Beyond findings show:

More Americans not prioritizing physical health

More Americans reported insufficient sleep in quantity and quality, less exercise, and worsening eating habits negatively impacting their physical well-being. Only 28% reported being at a healthy weight and just 33%  know their body mass index (BMI). More than 60% know their blood pressure and 85% believe that high blood pressure is curable with lifestyle change, but nearly one in three reported not taking action to address potentially problematic symptoms.

High incidence of stress across demographics

Four of five Americans report feeling stressed and 15% feel that stress is unmanageable. Working women report higher levels of stress (88%) than working men (80%). Despite the high incidence of stress, Americans feel a profound lack of support from employers in managing this important health issue. Only 25% of Americans report any assistance or support from their employer in managing stress—a 17% decline from 2018. Nearly three of five Americans (61%) reported that their employer did not provide or sponsor any form of workplace wellness program.

For those with programs in place, more than a third feel that they fail to address mental well-being. Self-help solutions like exercise, talking to friends, and sleep are the top avenues people are trying to beat stress. Seeking professional help is not widely common in America yet (10%), though many find it quite and/or very effective once tried (44%). Comparatively, Americans are less stressed than the global average, with unmanageable stress ranking similar to European markets and Oceania.

Americans lacking quality sleep

Only 35% of Americans report they get sufficient sleep at night, down six points from 2017 and just 32 percent of Americans report having “good quality sleep,” down 8 points from 2017. American men (36%) claim to be sleeping better and longer than women (28%).

Time spent with family and friends on the decline

Only 45% of Americans attested to feeling excellent or very good about the amount of time they spend with their family, compared to 51% in 2017. Just 62% of Americans spend sufficient time with friends, down 5 points from the previous year. Americans reported having fewer friends to talk openly with, and less in-person interactions with both family and friends. This is consistent with Cigna’s U.S. Loneliness Index finding that nearly half of Americans lack daily meaningful in-person social interactions. Cigna has made a short, 10-item questionnaire available to everyone, age 18 and over at no cost, to help assess feelings of loneliness and also receive tips to help increase social connections and improve feelings of vitality.

“The connection between our physical health and our mental well-being is more apparent than ever. Well and Beyond data affirms the connection, and we hope these findings will increase awareness and inspire action so that individuals, families, employers and communities can work together to put America on a healthier path,” says Ann Asbaty, Cigna Global Health Benefits Americas CEO.

The study was conducted online, via a 20-25 minute assessment and based on sample size of 13,200 adults globally, including 1,012 adults in the United States.