While Maholia has a distinctive and effective health care system, the good health of Maholians is due in greater part to the healthy society to which they belong. This includes a range of factors. People have strong social connections within a broad network of community organisations and within attractive, well-provisioned neighbourhoods. There is employment for all who want it, and great attention is paid in workplaces to the quality of people’s working life, to empowering them in the workplace, and to issues of work-life balance. There is a strong culture of contributing to others through voluntary work. Integrated social investment in the lives of once highly disadvantaged individuals and communities has significantly reduced educational failure, domestic violence and neglect, drug and alcohol abuse, criminal behaviour, homelessness, social isolation and the exacerbation of mental disorders. The high level of social and economic equality in Maholia enhances social relationships and helps to ensure that the less well-off have basic needs met, can be self-reliant, have opportunities to develop their potential, and can maintain dignity and self-respect. There is an education system that stresses the importance of good relationships and engages students in cooperative activities and mutual caring within both the school community and the wider community. Lastly, attention is given to maintaining good relationships between ethnic and other communities within Maholia, through programs promoting intercultural contact and cooperation. All of these changes have had major positive effects on health.

As well as this, the Maholian health system fosters relationships that support people in actively improving and maintaining their health. It works like this. Health care is free. Everyone is required to join a health organisation of their choice that contracts with (and in some cases employs) health providers to deliver health services to the client. The cost of this is met by the health organisation, which receives an annual payment from government for each client on its books. This payment goes up as clients get older, and is also greater if clients have health problems when joining. But other than these variations, the fee stays the same irrespective of a client’s health, the health services used or the cost of these to the health organisation. There is thus a strong incentive for health organisations to keep people as healthy as possible in order to avoid incurring treatment costs. The organisations can’t save money by refusing treatment or giving poor care because the client can simply change to another health organisation and the original one loses its fee. Most health organisations are non-profit bodies with connections to particular localities, industries and trade unions, and there are a few commercial ones and one government organisation. People who refuse to select a health organisation are distributed randomly among the organisations.

A major way in which health organisations keep people healthy is by encouraging them to join a health group. These are groups of people – usually of broadly similar age, health condition and background, and generally of the same sex – who support one another to improve and maintain their health, and participate in healthy activities together. They usually meet together regularly to discuss their health and strategies for improving it, and, as a whole group or in pairs or larger numbers, exercise together or attend such things as cooking or relaxation classes. As well as the specific attention these groups pay to health, the simple act of socialising and enjoying pleasant activities together in itself helps to make people healthier. Health organisations encourage people to join these groups by offering as inducements free or reduced-cost access to a range of activities and facilities, for example, to gyms, swimming pools, yoga classes and hiking trips.