Health Services 482 Session 5 Health, happiness, inequality, and hierarchy.

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

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

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

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


Lowest Life ExpectancyAnd disability free years


Die

ner

et. a

l. 20

04

HA

PP

IER BIGGER ECONOMY


Lowest Life ExpectancyAnd disability free 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


New Scientist Oct 4, 2003

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)


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

Health Services 482 Session 5 Health, happiness, inequality, and hierarchy.

Documents

Transcript of Health Services 482 Session 5 Health, happiness, inequality, and hierarchy.