Health Services 482
Session 5
Health, happiness, inequality, and hierarchy
HSERV 482, Population Health REVISED Date 2008
Session No.
LECTURE TOPICS Room T 639 10:30-11:20 Course output materials
Mar 31 1
Orientation to Population H ealth
Apr 4 2
Unna tural Causes Screenin g: In Sickness & In Wealth Complete Population Health Quiz (Resources page of PHF web site)
Apr 7 3
Physi cal Environment and Population health Response to Great Leveller & to reading f or sessions 1 -2
Apr11 4
Determinan ts of Health in Rich and Poor Countries
Apr 14 5
Health, happiness, inequality, and hierarchy
Response to reading for sessions 3 -4
Apr 18 6
Early Lif e
Apr 21 7
Medical Care and it’s i mpact on health Response to reading for sessions 5 -6
Apr 25 8
Mental H ealth
Apr 28 9
Scandinavian Countries Response to reading for sessions 7 -8
May 2 10
J apan First dissemination exercise report due
May 5 11
Canada Response to reading for sessions 9 -10
May 9 12 Form er Soviet Union Countries
May 12 13 Biology of Population Health
Response to reading for sessions 11-12 May 16 14 Ind ia and China
May 19 15 Health and development in Poorer Count ries Response to reading for sessions 13-14
May 23 16 Africa
May 30 17 Beliefs about inequality and how they are shaped by the media Response to reading for sessions 15-16
June 2 18 Population Medicine I / Wh ere to go from here
June 6 19 Population Medicine II: Sharing Dis semination Experiences MANDATORY ATT ENDANCE Response to readi ng for sessions 17 - 19
Second disseminat ion exercise report d ue
Summary so farHierarchy and health appear to be related among
countries, and within some countries, at least when considering income distribution (how is lack of caring/nurture/cohesion tied to inequality?)
Learning Objectivesdescribe possible paths to producing happiness as a
population health concept
discuss social capital as a potential pathway through which hierarchy exerts its health effects
Challenging ideas and ideologiesEpistemology: how do we come to "know things"
– Education (how much do we ask for evidence to substantiate that what we are taught is "true?")
– Experience (how many have had a variety of experiences across populations that will enable them to consider what produces health?)
– What others think (friends, respected figures, the Josephine in the street)
– Hard-wired (language learning)
Wednesday's NYT front page on Alzheimer's drugs:
Challenging ideas and ideologiesEpistemology: how do we come to "know things"
– Education (how much do we ask for evidence to substantiate that what we are taught is "true?")
– Experience (how many have had a variety of experiences across populations that will enable them to consider what produces health?)
– What others think (friends, respected figures, the Josephine in the street)
– Hard-wired (language learning)
Measures of well-being, happiness, satisfaction studied over last 50
years"Hedonic Psychology"
Sociology
Economics
Happiness measuresTaken all together how would you say things are
these days would you say that you are very happy, pretty happy, or not too happy?" (National Opinion Research Center 1999 in US)-generally non-response rate low (<1%)
-question is subjective
-generally, validity & reliability studies suggest valid variance is measured (Gaussian or Normal Distribution)
WHAT ACTIVITIES PRODUCE HAPPINESS?
Happiness in Different Activities (UK)Happiness Hours/day
Sex 4.7 0.2
Socializing after work 4.1 1.1
Dinner 4 0.8
Relaxing 3.9 2.2
Lunch 3.9 0.6
Exercising 3.8 0.2
Praying 3.8 0.5
Socializing at work 3.8 1.1
Watching TV 3.6 2.2
Phone at home 3.5 0.9
Napping 3.3 0.9
Shopping 3.2 1.1
Computer at home 3.1 0.5
Housework 3 1.1
Childcare 3 1.1
Evening commute 2.8 0.6
Working 2.7 6.9
Morning commute 2 .4
USA
Happiness spending time with:Interacting with: UK Average Happiness US Satisfaction
RANK 1980
Friends 3.3 Family
Parents/relatives 3 TV
Spouse 2.8 friends
My children 2.7 music
Co-workers 2.6 reading
Clients/customers etc. 2.4 house or apt
Alone 2.2 meals
Boss 2 one's car
Do people want/need the same things?
"A house may be large or small; as long as the surrounding houses are equally small, it satisfies all social demands for a dwelling. But if a palace rises beside the little house, the little house shrinks into a hut" Karl Marx
EFFECT OF LIFE EVENTS?
What are Necessities?Happiness often tied up with "necessities"
– 1996 in USA • 93% said automobile (1991 was 82%)• 86% clothes washer• 51% home air conditioning (1973 was 26%)• 32% microwave• 26% a home computer
64% of those making <$10,000 said they can't afford to buy everything they need as did 27% of those making >$100,000 (1995)
Schor 1998
Kahneman Science June 30, 2006
2004 survey
Happiness Income QuartilesUS people over 16 Top Quartile
1975 1998
Bottom Quartile
1975 1998
Very Happy 39 37 19 16
Pretty Happy 53 57 51 53
Not too happy 8 6 30 31
Given individual in a given country becomes happier if richer
When whole society becomes richer, nobody seems happier
Birth cohort studieshappiness is flat despite rising incomes
younger cohorts with less education appear to have happiness decline with age
16 nations, 169,776 people
Easterlin 2002
NYT June 13, 2004
TREND STUDIES
NYT June 13, 2004
NYT June 13, 2004
NYT June 13, 2004
NYT June 13, 2004
US % reporting very happy
All Women
Early 1970s 34 36
Late 1990s 30 29
Oswald 2002
Highest Life ExpectancyAnd disability free years
Life expectancy disparityis 16 years
General Social Survey 1972-2006
Highest Life ExpectancyAnd disability free years
Life expectancy disparityis 16 years
General Social Survey 1972-2006
Highest Life ExpectancyAnd disability free years
Life expectancy disparityis 16 years
General Social Survey 1972-2006
Highest Life ExpectancyAnd disability free years
Life expectancy disparityis 16 years
General Social Survey 1972-2006
Highest Life ExpectancyAnd disability free years
Life expectancy disparityis 16 years
General Social Survey 1972-2006
George Bernard Shah 1927• "The woman from the brick box maintains her social
position by being offensive to the immense number of people whom she considers her inferiors, reserving her civility for the very few who are clinging to her own little ledge on the social precipice; for inequality of income takes the broad, safe and fertile plain of human society and stands it on edge so that everyone has to cling desperately to her foothold and kick off as many others as she can."– Intelligent Woman's Guide to socialism and capitalism pg
418
Happiness /Life SatisfactionAmong Nations?
Cross-sectionally
Trends
Culture effects
Highest Life ExpectancyAnd disability free years
Lowest Life ExpectancyAnd disability free years
Life expectancy disparityis 16 years
Die
ner
et. a
l. 20
04
HA
PP
IER BIGGER ECONOMY
16 nations, 169,776 people
Highest Life ExpectancyAnd disability free years
Lowest Life ExpectancyAnd disability free years
Life expectancy disparityis 16 years
Die
ner
et. a
l. 20
04
Associations of happiness withincome within nations is weak (<.25)
– .13 in World Values Survey II – but stronger in poor nations than in rich ones
Economic growth: strong correlation in poor countries, but not in rich ones
Inequality: Strong with Income inequality (Gini -.43 correlation among nations with happiness
16 nations, 169,776 people
New Scientist Oct 4, 2003
16 nations, 169,776 people
New Scientist Oct 4, 2003
16 nations, 169,776 people
Happiness trends over timeUS: 1946 happiest among 4 advanced economies
1970s 8th among eleven advanced countries1980s 10th among 23 nations including poor ones
US, UK-- depression, alcoholism and crime have risen during golden economic growth period (1950-1973)
1850-1914 alcoholism and crime both fell while having considerable economic growth
Japan since 1950: 6-fold rise in income/cap no change in happiness and similarly in Europe
television showed us how other people lived– Differs from previous medium by immediacy and sheer amount of
exposure (25 hours a week for average UK person)– Study showing women's mood fell after watching female
models, and after seeing models, most men felt less good about their wives (Kenrick, 1989, 1993)
16 nations, 169,776 people
Rifkin Below
Well-beingEUDIAMONIC HEDONIC
Aristotle wrote about eudaimonia as realization of one's true potential
1. Self-acceptance strengths and weaknesses
2. Purpose in life goals and objectives giving life
meaning
3. Personal growth4. Positive relations with others5. Environmental mastery
Managing demands of everyday life
6. Autonomy strength to follow personal
convictions
+vely correlated with SES
Hedonic-well being rooted in ideas of pleasure, happiness and satisfaction of human appetites
1. Subjective well-beinglife satisfaction
2. Presence of positive affect
3. Absence of negative affect
Speculative well-being links to biologyEUDIAMONIC HEDONIC
Positive correlations with
-salivary cortisol slope: with personal growth, purpose in life
-noradrenaline: autonomy
-Weight, Waist-Hip ratio, HDL cholesterol, HgA1c: (positive relations with others, personal growth, purpose in life)
-sleep
Negative correlations with -IL-6 (inflammatory cytokine)
No correlations with cortisol, noradrenaline or immune measures
Positive correlation with HDL cholesterol
Culture and HappinessWestern Europe, USA: approval and praise for having
and being willing to express high self-esteem
Hispanic cultures emphasize personal pride
Pacific rim cultures are downbeat
East Asian nations: personal satisfaction downplayed and get adjustment, sympathy and compassion for having and being willing to express self-critical attitude
Self-Esteem CULTURE Mutually Approving Relationship
Self-efficacy
In Control
Personal choice
Personal initiative
Social exchange
Trust
Fairness
Decency
INDEPENDENCE OF SELF Texts: "declaration of independence" all created equalNarratives: story of MayflowerMoral imperatives: "God helps those who help themselves"
Self-Criticism CULTURE Mutually Sympathetic Relationship
Self-control
Effort
Social role
Filial piety
Community values
Warm-heartedness
Empathy
Perspective taking
INTERDEPENDENT SELF Texts: "Confucious, TaoNarratives: story of benevolence, diligenceMoral imperatives: compassion of Buddha, modesty
Balance
Wilkinson et. al. SSM forthcoming
MORE EQUALITY
Prisoners
Mor
e P
RIS
ON
ER
S
Social Capital Measurements
Network: numbers in a group
Pro-social: voter turnout, confidence in public institutions
Helping behaviors that promote economic well-being: informal sources of credit, insurance or child support, job creation
Micro level: presence of parents in the home, reading to children, books in the home