Transcript Happiness and health: two paradoxes

Lecture 3
Happiness, health and
sustainable development
Alessandro Vercelli
(University of Siena)
Based upon:
Borghesi, S. and A.Vercelli:
2008, Global sustainability, Palgrave Macmillan, London
2012, Happiness and Health: two paradoxes, (with S.Borghesi),
Journal of Economic Survey, 2012, Vol.26, 2, pp.203-233
1
PURPOSE
•
reflection on the limits to growth from the point of view of human well-being
by studying the interaction between two streams of literature:
- happiness
social determinants {
- health
- happiness: mainly economists, sociologists and psychologists
separate streams {
- health: mainly social epidemiologists
- happiness ↔ health
•
cross-fertilization illuminating for both of them {
- policy implications
to understand better {
- the gap between growth and development
- why sustainable development should be the goal
- the requirements of sustainable development
2
APPROACH (1)
- subjective indexes of happiness: “self-reported happiness”
interrelations {
-life expectancy
- objective indexes of health { -mortality rates
-morbidity rates
sufficiently independent to be informative:
the correlation between self-reported health and subjective happiness is
too high to be informative: in 18 OECD countries r = 0.85 (Kahneman and Ris, 2004),
- both are rooted in the personality of the individual who assesses them
As {
- almost everyone asserts that the main determinant of happiness is health
The interaction between objective health and subjective happiness depends on a
set of factors that we are going to consider in what follows
3
APPROACH (2)
self-reported health
•
Significant correlation: objective health indexes {
subjective happiness
as it may change to some extent with time and space
in particular it depends on cultural factors
e.g. French people declare a much lower index of self-reported health than
US citizens but have a better health (e.g. live three years longer)
•
The record and analysis of self-reported health is now rapidly developing
however, the analysis of a population health status is still based mainly on the
objective indexes of health
4
APPROACH (3)
•
the objective health indexes are partial indexes of subjective health
as they cannot cover the whole range of factors that affect it
unconscious sources of happiness
however they implicitly register {
psychosomatic symptoms
self-reported health
this may help us to study the distortions {
subjective happiness
•
quality-adjusted life expectation indexes:
they integrate mortality and morbidity indexes with other indexes of quality of life
to express health status in terms of equivalents of well-years of life
we ignore this category of indexes, notwithstanding their obvious appeal because:
-their availability is still limited
-unsettled methodological questions
(Hansen and Østerdal, 2006)
5
The determinants of
self-reported happiness
6
The role of absolute income
The economists have traditionally stressed the role of per capita income Y
→ focus of economic policy on the growth of GDP
A) Cross section analysis shows:
(1)
W* = f1 ( Y ),
f2’>0, f2’’<0.
-saturation
Utilitarian tradition
{
of needs
-hierarchy
$10,000 (Frey and Stutzer, 2002)
However strong nonlinearity: threshold {
$15,000 (Layard, 2006)
7
The relationship between income per head and happiness
8
The “happiness paradox”
B) Time series show that, in developed countries after WWII,
correlation with per capita income is generally nonexistent or slightly negative:
-continuous growth of per capita income
“happiness paradox” {
-happiness did not increase, sometimes decreased
Easterlin (1974) for the USA
subsequently confirmed for other developed countries such as:
the UK, Japan, France, Germany, Netherlands
9
Happiness and income in the USA
10
Happiness and per capita income in Japan
11
Happiness in Italy (1975-2007)
Source: Nicola Lucia, 2008
12
Explanations of the paradox
•
“hedonic treadmill” Easterlin (1974) from Brickman and Campbell (1971)
however “stimulation goods” (Scitowsky, 1976)
•
“the satisfaction treadmill”: aspiration theory
W* = f2 (Y* – Y),
(2)
f’2 < 0.
elasticity of aspirations to ∆Y close to one (Frey and Stutzer, 2002):
∆Y* = k ( ∆Y),
(3)
k ≈ 1,
from which we easily derive that ∆W* = f2 (∆Y* – ∆Y) ≈ 0, i.e. that
happiness does not tend to increase in consequence of ∆Y
aged individuals: lower and declining elasticity
However
{
no decline of happiness unless growing frustration
13
The role of social factors
After a threshold between $10,000 and $15,000 per year,
the influence of absolute income on happiness rapidly fades away,
while the crucial role is taken over by social factors
•
The aspiration theory itself may be explained in sociological terms as
positional goods (Hirsch, 1976)
scarcity rent of socio-economic status: since the latter is in fixed supply,
any conspicuous consumption generates negative externalities
14
The role of social factors crucial after the threshold:
relative income
→↑ income inequality YR makes people more unhappy:
(4)
Wi* = f4 ( YR ),
f’4 < 0,
where YR is an index of inequality (such as Gini or Theil indexes)
Explanation: differential access to positional goods → relative deprivation:
signals social ranking and depends on the gap between different
classes of income
In most OECD countries U-shaped behavior of inequality:
This cannot explain the behavior of self-reported happiness since WWII,
although it may contribute to explain the worsening of the trend
observed since the early 1980s
15
Inequality in the U.K., 1939-1996 (%)
56
52
48
44
Gini index
40
36
32
28
24
20
16
1985
1945
1955
1965
1975
1935
1995
1970
1990
1940
1950
1960
1980
2000
Fig. 5
Source: Brandolini (2002)
16
Inequality in the USA, 1929-1996
56
52
48
44
Gini index
40
36
32
28
24
20
16
1915 1925
1985 1995
1955
1965 1975
1935 1945
1970
1990 2000
1920 1930
1940 1950 1960
1980
Source: Brandolini (2002)
Fig. 6
17
The role of social factors: relational goods
The consumption of relational goods R is positively correlated with happiness:
(5)
W* = f5 ( R ),
f’5 > 0.
relational goods introduced only recently in order to capture the affective and
communicative components of social relations (Gui, 1996):
-end in themselves
different goods{ -cannot be produced or consumed by a single individual
-value depends on the interactions under reciprocity
examples are love, friendship, and more in general direct personal social
relations, i.e. not mediated by economic or political exchanges:
- strong positive correlation between relational activity and happiness
- loneliness is negatively correlated with happiness
-altruism and voluntary service contribute to happiness
(Frey & Stutzer, 2002)
18
The role of social factors: relational goods
the development of the market has suffocated the production and
consumption of relational goods:
the price of comfort goods decreased due to technical progress
and standardization, while the costs of relational goods did not
diminish or even increased (Bruni, 2006b)
→ substitution of cheap comfort goods for relational goods
e.g.: TV watching is positively correlated with hours of work and
negatively correlated with happiness (Bruni and Stanca, 2005)
the deterioration of relational goods contributes to explain the
happiness paradox (Bartolini and Bonatti, 2002; Bartolini, 2010),
but its trend is slow
19
Other social factors:
unemployment
Unemployment reduces well-being, even after controlling for the associated fall
in income (Clark, Frijters, and Shield, 2007):
(9)
W* = f9 ( U ),
f’9 < 0.
the unemployed is victim of anxiety, anger, depression and a loss of selfesteem and social status and that may disrupt his/her familiar and social life
Remark: the strong correlation of unemployment with unhappiness is
inconsistent with the conviction that unemployment is never involuntary
(Lucas and New Classical Economics)
However: unemployment diminished in the 1950s and 1960s, increased in the
1970s and 1980s and diminished again in the 1990s and first 2000s
this diminution was correlated to growing flexibility of labour markets and
industrial relations that contributed to declining job satisfaction
20
Other social factors:
education
Personality and happiness are affected by the degree of education I:
( 10 )
W* = f10 ( I ),
f’10 > 0.
a higher degree of education correlates with a higher degree of
subjective happiness independently of variations of p. c. income
(Easterlin, 2004):
education →↑ set of enjoyable goods: cultural and stimulating goods
the average level of education increased continuously in most
countries since WWII but apparently also in this field individual
aspirations increased with the average level of education
21
Other factors: psychogenetic factors
Theory of adaptation maintains that individuals are characterized by a
stable equilibrium state of happiness (Brickman et al. 1978):
( 6 ) Wi* = f6 (W*i –Xi*), f’6> 0 when W*i – Xi*>0,and f’6<0 when W*i – Xi*<0.
where Xi* is the stable equilibrium point (or “set point”) of happiness
of the individual i
Theory of personality: equilibrium rooted in personality as established
by genetic and psychogenetic factors G
(e.g., Likken and Tellegen, 1996):
(7)
Wi* = f7 ( Gi ).
However, adaptation is not complete (Diener, 1996): shifting equilibrium
22
Other factors: environmental externalities
Growth of per capita income produces negative externalities E that
deteriorate the happiness of citizen:
(8)
W* = f8( E ),
f’8 <0,
in consequence of pollution and exhaustion of environmental goods
Crucial explanation of the happiness paradox but the quantification of
its impact is strictly dependent on the list of relevant externalities
and their evaluation, issues that are very controversial
23
Health and the second happiness paradox
When people are asked to evaluate the importance of various factors of
happiness, good health obtains the higher rating
(Frey-Stutzer, 2002, p.56):
( 10 )
W* = f11 ( H ),
f11 > 0.
→ a new happiness paradox emerges:
the most comprehensive objective indexes of health (life expectancy and mortality
rates) improved continuously in most countries after WWII but this did not
translate in increasing self-reported happiness
FIRST: self-reported happiness and per capita income
happiness paradoxes {
SECOND: self-reported happiness and objective health
24
The happiness function
None of the main determinants of happiness is sufficient to explain the
happiness paradox but they do not exclude each other:
we can thus summarize the acquisitions of the research surveyed above
through the following “happiness function”:
( 12 )
W* = F (Y, YR, Y – Y*, G, R, E, I, U, H),
where we assume that the partial derivatives for each factor have the
same signs already specified
The capital letters that appear in the argument of the function F may be
considered as vectors of variables each of which has both a flow
dimension and a stock dimension
25
The social determinants of
“objective” health
26
Health and the second happiness paradox
•
Subjective happiness is a crucial determinant of health:
e.g. {
•
-length of life (Palmore, 1969)
-heart disease (Sales and House, 1971)
-suicide (Koivumaa and Honkanen et al., 2001)
Health is reported to be a crucial determinant of subjective happiness
→ a new happiness paradox emerges:
the most comprehensive objective indexes of health (life expectancy and
mortality rates) improved continuously in most countries most of the time
after WWII but this did not translate in increasing self-reported happiness
FIRST: self-reported happiness and per capita income
happiness paradoxes {
SECOND: self-reported happiness and objective health
27
The role of absolute income
The per capita income of a community is generally considered as a major
determinant of its average health
An increase in absolute income:
- relaxes the budget constraints: access to therapies
-higher expenditures in health programs
-better medical/pharmaceutical technologies
-higher education levels → ↑ updated medical knowledge and know-how
28
The role of absolute income
The empirical literature shows that the relationship between Y and H
-is strongly non linear
-has a pattern very similar to that of the relationship between Y and
W*:
( 13 ) H = φ1 ( Y ),
φ1’ > 0,
φ1’’ < 0.
cross-section studies:
-the health of the poor has higher income elasticity than that of the rich
A) cross-country evidence:
-life expectancy increases with average per capita income in poor
countries
-this relationship tends to vanish for relatively rich countries
(Preston, 1975)
29
The role of absolute income
similar results emerge also in single-country cross-section studies:
using a survey on health and income in Britain, Wilkinson (1992) finds that
several health indicators increase rapidly as income rises from the lowest
to the middle classes of the income distribution, while no further health
improvements occur at higher income levels
similarly, using data from the National Longitudinal Mortality Survey in the USA,
Deaton (2001) observes that the male (age adjusted) probability of death
decreases rapidly as income grows at low family income levels, while it
flattens out at high family income levels
30
Cross-country relationship between per capita GDP and health (2000)
life expectancy at birth (years)
80
70
60
50
40
0
10000
Source: World Bank
20000
30000
40000
GDP per capita (costant '95 US$)
50000
31
Happiness and health: the relationship with p.c. GDP
life expectancy at birth (years)
80
70
60
50
40
0
10000
20000
30000
40000
GDP per capita (costant '95 US$)
50000
32
The role of relative income
•
The concave relation between Y and H implies:
↓ income inequality → ↑ the average population health
•
In recent years several studies have argued that:
YR, independently of Y, has a crucial influence on health:
( 14 )
H = φ2 ( YR ),
φ’2 > 0,
where YR is the relative income that may be measured in different ways:
“relative income hypothesis”
After a threshold of about $5,000 p. y. ($4,000 in Cornia et al, 2007):
income inequality emerges as a crucial determinant of health even by
controlling for other factors including absolute income
33
The role of relative income
In a pioneering cross-country study on a data set referring to nine OECD
countries, Wilkinson (1992) found evidence of a strong correlation
between life expectancy and inequality that is argued to be independent of
absolute income
Similar results emerged in several other studies that focused on different
groups of countries and periods of time (see Borghesi and Vercelli, 2007)
Also at the local level a close relationship emerged between inequality and
mortality rates in the US states (Kaplan et al., 1996)
Among the 282 US metropolitan areas the ones with the most unequal
income distribution turned out to have the highest mortality rates (Lynch et
al, 1998)
34
The role of relative income
• Income inequality → relative deprivation:
people compare themselves with reference groups and suffer from
chronic stress and depression when comparison is unfavorable
(Deaton, 2001)
→ the most egalitarian developed countries have the highest life
expectancy
A close relationship between income inequality and mortality rates
emerges also in time series referring to single countries (Russia, UK)
• Physiological mechanism: activation of hormones that affect the
cardiovascular and immune systems (Wilkinson, 2002, pp.15-16)
→ similar to economic “short-termism”
35
The role of other social factors
Health is strongly affected by a series of social factors connected with relative income
but in part independent of it (see, e.g., Ryff and Singer, 2000)
First, relational goods R:
( 15 )
H = φ3 ( R ) ,
φ3 > 0.
For example, stress-related mortality of married people is significantly lower than of
widowed, divorced and single people (Cornia et al., 2007)
In order to withstand physiological and psychological shocks, a crucial role is played
by the intensity and quality of social relations, or what is often called “social
capital” (social trust, hostility)
-the lack of social trust was shown to be positively and significantly correlated with
mortality in the USA (Kawachi et al., 1997)
-analogously hostility is positively correlated with mortality (Williams et al.,1995)
36
The role of other social factors
•
A fundamental determinant of health is unemployment U:
( 19 )
H = φ7 ( U ),
φ7 < 0.
Loss of employment, especially if unanticipated and in the absence of a
public safety net, heavily affects health (Cornia et al., 2007)
Unemployment implies not only a lower income but also a loss of social
status and self-respect (Sen, 1997)
•
Another crucial determinant of health is education:
( 18 )
H = φ6 ( I ),
φ’6 <0,
φ’’6 >0,
the relationship between education and health is strongly non linear as health
increases sharply by moving from primary to secondary education and above
the level of education of mothers is a major determinant of health of all
family members, especially the children (Hertzman 1995)
37
The influence of environmental externalities and happiness
•
Bad environmental conditions are directly responsible for about 25% of all
cases of preventable illness all over the world (WHO, 1997)
we have thus to consider negative environmental externalities E :
( 16 )
H = φ4 ( E ),
φ’4< 0,
from atmospheric, water and soil pollution
•
Finally, subjective happiness is a crucial determinant of health:
( 17 )
H = φ5 ( W* ),
φ’5 > 0.
-length of life (Palmore, 1969)
e.g. {
-heart disease (Sales and House, 1971)
This closes the feed-back between reported happiness and objective health
38
Other factors: genetic factors and medical technology
•
Progress in medical-pharmaceutical technology T played a crucial role in
the progressive improvement of the indexes of health in the last century:
( 17 )
H = φ5 ( T ),
φ’5 > 0.
In order to get insights on the other determinants of health we have to study
the deviations from this common trend due to specific factors
•
Also genetic factors G may have a sizable impact on health:
( 20 )
H = φ8 ( G ).
mutation of genes
two factors {
polygenic inheritance: bias towards specific chronic diseases
39
The main determinants of health
The main determinants of health considered in the
epidemiological literature do not exclude each other
Health Function:
H = Φ (Y, YR, G, R, E, I, U, T, W*)
where we assume that the partial derivatives for each factor
have the same signs already discussed
The capital letters that appear in the argument of the function Φ may be
considered as vectors of variables each of which has a flow
dimension and a stock dimension
40
Determinants of health and determinants of happiness:
a comparative analysis
Although the literature on the determinants of happiness and health developed quite
independently, they pointed out about the same list of main determinants
Happiness function
W* = F (Y, YR, Y – Y*, G, R, E, I, U, H)
Health function
H = Φ (Y, YR, G, R, E, I, U, T, W*)
The only substantial differences:
•
the absence in the health function of frustrated income aspirations
(in the case of health frustration matter but less focused on income; Marmot, 2005)
•
the presence of the health technology
(general technology matters for happiness through income)
41
Further determinant of happiness
•
Leisure: the necessary disaggregation of leisure activities sends back
to
factors already considered such as social relations,
absolute and relative income, health
•
Inflation: we have doubt about the genuine independence of its
influence as inflation acts mainly through modifications of
absolute and relative income and disruption of social relations
•
Institutional factors: this line of research is certainly stimulating and
inspiring but it is not yet clear to what extent the influence of
institutions on happiness are independent of their impact on
factors already considered such as social relations.
42
The second happiness paradox: the ageing population
↑life expectancy → ageing of pop. → ↓ self-r. health →↓ subjective happiness
- self-reported health declines with age
empirical evidence
{
-the importance of health increases with age
Happiness declines from youth to working age but increases again, though
moderately, since around the age of retirement (Frey-Stutzer, 2002)
this may be related to:
-increasing free time of senior people
-decreasing responsibilities
-downsizing of aspirations
-progressive natural selection of the healthier and happier individuals
The negative effect exerted by ageing on health and happiness is more than
compensated by other factors correlated with age
43
The second happiness paradox:
the shortcomings of general objective health indexes
the comprehensive objective health indexes do not capture all the
effects of health on happiness
In particular there are specific health indexes strictly correlated with
subjective unhappiness, such as frequency of depression and
suicides, that increased progressively in the post-war period
Subjective health and happiness depend not only on the length of
life but crucially also on its quality:
a long life is not necessarily a happy life
this is well known since long: e.g. “STRULDBRUGS”, Swift, 1726)
44
Policy implications: the first paradox
The twin paradoxes are not genuine paradoxes:
many convincing explanations (over-determination may be solved through
more sophisticated statistical methods)
First Paradox: the real paradox is that policy makers still focus on GDP and
its growth (Bhagwati, 2004; B.Friedman, 2005)
We know since long that GDP is an inadequate index of well-being:
-the exhaustion of natural resources
Not registered { -the deterioration of natural and social capital
-environmental and social externalities
-relational goods
Unduly registered -defensive expenditure
45
Policy implications: the first paradox
Alternative indexes that aimed to correct the shortcomings:
•
NEW (Net Economic Welfare) suggested by Nordhaus and Tobin (1973)
has grown more slowly than GDP in the post-war period in industrial
countries
•
ISEW (Index of Sustainable Economic Welfare) by Daly and Cobb (1989):
while the US GNP increased from 1951 to 1986 at an average rate of
1.90%, the ISEW grew much less (0.53%) and became negative since the
early 1970s
→ the alternative indexes of well-being focus on the same
determinants considered in the literature on happiness
46
Policy implications: the second paradox
Also the second happiness paradox is basically explained by the
inadequacy of the general indexes of objective health
there are specific health indexes strictly correlated with subjective
unhappiness, such as frequency of depression and suicides, that
increased progressively in the post-war period
Self-reported health depends not only on the length of life but also on
their quality:
-a long life is not necessarily a happy life
-this is well known since long: e.g. the immortal “STRULDBRUGS” are
very unhappy (Swift, 1726)
The quantitative indexes of health should be corrected to take account of
the quality of life (quality-adjusted indexes of health should be
systematically computed solving unsettled methodological problems)
(Zeckhauser-Shepard, 2006)
47
Policy implications
We have to focus both analysis and policy not on GDP but on indexes of
sustainable development that take account of the social, environmental,
psychological and health factors that determine human well-being (or
happiness)
Analysis of happiness and health determinants suggest similar policy
measures:
•
•
•
•
•
•
↓ poverty
↓ inequality
↓ unemployment and precarious jobs
↑ investment in education
↑ investment in art and creative activities
↑ investment in environmental and social capital
health
All these policy measures are likely to improve
{
of citizens
well-being
48