Health, capabilities and life satisfaction

Simon, Judit; Greco, Giulia; Anand, Paul; Roope, Laurence (2014). 'Health, capabilities and life satisfaction' Paper presented at the annual conference of the HDCA, 2-5 September 2014, Athens, Greece.

The debate around how to measure progress in society is growing rapidly (Stiglitz 2009). It is now accepted that measures such as GDP per capita and QALYs are imperfect in assessing people's quality of life. Two frameworks have emerged: Sen's capabilities approach and subjective wellbeing, or happiness.

The subjective wellbeing approach is very attractive: it is relatively easy and quick to collect data on happiness and life satisfaction, compared to data on people's capabilities. But how valid is such an approach? Sen's major concern with subjective measure of wellbeing such as happiness, is adaptive preferences: people sometimes do not see their own level of deprivation because they are used to it. This leads to the paradox of the content poor peasant and the depressed millionaire.

What is the relationship between capabilities, happiness and life satisfaction? What are the implications for policy in using these different measures of wellbeing?  What is the most adequate measure?

A short summary of the three studies proposed for the thematic panel session covering relevant data for maternal health, child health and mental health from different countries is provided below.


Study 1: Women's quality of life: capabilities, happiness or life satisfaction?

Giulia Greco1

1 Department of Global Health and Development, London School of Hygiene and Tropical Medicine  

This study sheds some lights on the aforementioned issues using data for a sample of women in rural Malawi on capabilities and subjective wellbeing. An index of capabilities is developed and validated to use for assessing women's quality of life. Data is also collected on women's happiness and life satisfaction. The capability approach and the subjective wellbeing measures are compared against standard deprivation indicators such as a wealth index and a poverty line.


Study 2: Happiness and development in very young children

Paul Anand1,2,  Laurence Roope2  

1 Economics Department, Open University

2 HERC, Nuffield Department of Population Health, University of Oxford

The paper reports an application of the capabilities approach to welfare economics to shed light on the activities, happiness and development of children aged 2 and 3 years. Using data from the German Socio-economic Panel (GSOEP), we estimate versions of all three of Sen's key equations, pertaining to happiness, functionings and capabilities. In doing so, we propose a simple three factor model of child development based on regime, affluence and environment. In addition, we suggest that for very young children it makes sense to think of activities as helping to develop a child's capabilities. Empirical results suggest that child happiness is positively related to engagement in more active activities, such as reading or telling stories, going shopping and (in one specification) painting or doing arts and crafts. In contrast, there is no discernible benefit from more passive activities, such as looking at picture books or watching television. There is also some evidence that more active activities can boost the development of children's capabilities. Painting or doing arts and crafts has a significant impact on the development of movement skills, while reading or telling stories and singing children's songs have a significant impact on both talking ability and social skills. We discuss some of the limitations inherent in the data used but conclude, notwithstanding, that the capabilities approach offers a theoretical framework well suited to understanding the happiness and development of very young children and may help generate significant implications for the education of parents.


Study 3: Well-being of people with severe mental health disorders: contrasting the concepts of quality of life, capabilities and life satisfaction

Judit Simon1,2

1 Department of Health Economics, Centre for Public Health, Medical University of Vienna

2 HERC, Nuffield Department of Population Health, University of Oxford

This study uses data collected as part of the Oxford Community Treatment order Evaluation Trial (OCTET) on the well-being of 'revolving door' psychosis patients in the UK. Quality-of-life was measured using the EuroQoL EQ-5D 3L. The capabilities approach was operationalised through a novel multi-dimensional instrument, the OxCAP-MH. The capability domains most affected by mental illness were: daily activities, influencing local decisions, enjoying recreation, planning one's life and discrimination. The instrument's psychometric properties indicated the feasibility, acceptability, construct validity and reliability of directly measuring capabilities in patients with severe mental illness.  Further well-being measures included life satisfaction and the Global Assessment of Functioning (GAF) scale. The current work sheds light on the association between these measures and their sensitivity to change in people's health status and their experienced levels of coercion.

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