Quality of life as a concept and measurable entity

This chapter proposes that “quality of life” (QOL) is a multidimensional concept, the measurement of which must contain objective elements of a person's life. It is further suggested that in the development of QOL measurement instruments the selection of items must be influenced significantly by the views of the population under study. Instruments to measure quality of life have been flawed owing to their inadequate conceptual bases and the attempts to utilise general measures which are often the “broad brush” to detect changes in disease specific situations. The chapter outlines conceptual approaches to quality of life and provides an analysis of a range of definitions. It provides an overview of a number of approaches to measure QOL in specific populations. Finally, it addresses some of the potential uses and abuses involved in the measurement of QOL. The whole of science is nothing more than a refinement of everyday thinking. (Albert Einstein, 1950, p. 59)      

Basic Minimum Needs,Quality of Life and Selected Correlates: Explorations in Villages in Northern India

For those involved in international development, one of the major goals is an improvement in the quality of life of the poor. Bhargava and Chakrabati (1992: 133) see the “primary objective of development at any given time is to improve the quality of life”. Indeed, the mission statement for an international development organization explicitly commits itself to the improvement of the quality of life for the “poorest of the poor” (DID, 1994). Social indicators, as “transeconomic” measures of quality of life, have “become an integral part of 'development indicators”' (Kao and Liu, 1984: 400; see, also Kahn, 1991). The connection between quality of life and development extends beyond the Third World. For example, in the U.S. Myers (1987) found quality of life influenced inmigration to Austin, Texas, thus affecting its economic development. Undoubtedly the majority of the connections between social indicators and development has been examined at the macro, or national levels using economic, health, education and other objective, comparative indices. Recognizing that such measures as GNP are oftentimes inadequate, assorted indices have been derived to gauge the changes in social development over time, e.g., the well-known Physical Quality of Life Index (PQLI) constructed by the Overseas Development Council (Morris, 1976). Many of these tend to focus on objective, material indicators (commodity possessions) as opposed to the more subjective ones (Anand and Ravallion, 1993). It is not the purpose of this paper to examine the various critics' arguments about the strengths and weaknesses of extant macro versus micro indices, but rather to lend support for the general need to assess development and social change through social indicators, whether macro or micro, objective or subjective. Ultimately, the purpose of the assessment should guide which social indicators are selected. The purpose of this paper is to examine several issues arising from the linkages between development efforts and quality of life (QOL). Using empirical data which were gathered to evaluate a community development project in the Garhwal region of Northern India, several issues, germane to both social indicators and development, will be investigated. These include: (1) the relationship between “Basic Minimum Needs” (BMNs) and QOL, (2) some methodological innovations for measuring both BMNs and QOL, and (3) selected correlates of BMNs and social indicators of QOL for Garhwali villagers. Before describing the project and its findings, we will first place it in the overall development context.     

Innovativeness and Subjective Well-Being

What are the effects of innovativeness on well-being? This paper argues that research on subjective well-being has progressed to a point where measures of subjective well-being (or: happiness) can usefully be employed to assess the welfare effects of innovative change. Based on a discussion of the prospects and pitfalls associated with subjective well-being as welfare measure and benchmark of societal progress, an argument is put forward as to why these measures are particularly well-suited in the context of innovative change. Empirically well-founded and with an explicit dynamic foundation, theories of subjective well-being allow for a nuanced and comprehensive assessment of the effects that innovativeness has on a society. Two evaluation rules, the “life domain evaluation principle” and the “welfare dynamics principle” are suggested to guide such normative assessment.     

The Latent Profiles of Life Domain Importance and Satisfaction in a Quality of Life Scale

The present study aimed to use a latent profile analysis to distinguish between populations in terms of life domain importance and satisfaction profiles. Then, a multinomial logistic regression was used to determine how background variables (e.g., gender, living areas, and school levels) and self-perceived health predict each latent quality of life (QoL) profile. We also investigated how the latent groups of adolescents predicted negative and positive well-being indicators (e.g., problem behaviors and overall life satisfaction). The sample consisted of 720 Taiwanese secondary school students. Three latent groups were established as follows: “unimportant-unsatisfied,” “important-unsatisfied,” and “important-satisfied.” The results indicate the following: (a) boys were more likely to fall into the “unimportant-unsatisfied” group than were girls; (b) better health increased the likelihood of being in the “important-satisfied” group; (c) high school students were more likely to be in the “unimportant-unsatisfed” group than were middle school students; and (d) no relationship was found between latent groups and living areas. The function of importance rating was not present when evaluating the importance-satisfaction profiles and their relationship with problem behaviors and overall life satisfaction. The problems of the “unimportant-unsatisfied” profile among youth are discussed.     

The Well-Being of the Canadian Arctic Inuit: The Relevant Weight of Economy in the Happiness Equations

Which of the three dimensions of Allardt’s model, “having, loving, and being”, best predicts the incidence of subjective feeling of well-being among the Canadian Arctic Inuit adults? To answer this question, two logistic regression equations have been constructed, one based on a negative assessment of well-being (feeling of despair), and the other on a positive assessment (satisfaction with life in the community). Each of them took first the form of a global model, and then of three scale models, one for each dimension of the Allardt’s model. The equations are likely to be more effective for predicting the incidence of Inuit’s feeling of satisfaction than for anticipating their feeling of despair. Furthermore, the “being” scale model is the one that will have contributed most to the predictive performance of the global model. In other words, what the Inuit “ARE” contributes more to the incidence of their satisfaction with life than what they “HAVE” or what they “LOVE”.     

The systemic life quality model: A basis for urban renewal evaluation

This paper develops, on the basis of explicit assumptions and axioms, a conceptual framework for observing the effectiveness of functioning of action systems, and, in particular of the human individual. The framework is used to construct a facet definition of human quality of life (QOL) which is claimed to be exclusive and exhaustive: The contents of the observational items it produces do not overlap and cover the entire QOL universe. A specification of two facets: the subsystem facet (personality, physical, social, cultural-value) and the functioning mode facet (expressive, adaptive, integrative, conservative) results in 16 content areas, each of which can be represented or covered by an observational item. The systemic QOL measuring represented or covered by an observational item. The systemic QOL measuring instrument is examined with respect to its reliability and validity. Structural hypotheses whose rationale is grounded in the elementary considerations that led to the systemic model of QOL are formulated, tested and are largely confirmed. Finally, the systemic QOL model is applied to the evaluation of life quality and environmental conditions in a neighborhood designated as “distress neighborhood” within national urban renewal project.     

The stability and sensitivity of subjective well-being measures

A longitudinal investigation of the stability and sensitivity of several subjective social indicators is presented. Over a seven year period, data collected from 93 Canadians indicated moderate stability for measures of enjoyment, satisfaction, and life quality. When respondents were divided into “change” and “no change” groups on the basis of their self-reported health status, the self-anchoring ladder of present life quality was found to be sensitive to change. Implications of this methodological inquiry are examined.     

Unpacking Self-Rated Health and Quality of Life in Older Adults and Elderly in India: A Structural Equation Modelling Approach

The Study on global AGEing and adult health (SAGE) aims at improving empirical understanding of the health and well-being of older adults in low- and middle-income countries. A total of 321 adults aged 50 years and older were interviewed in rural Pune district, India, in 2007. We used Structural Equation Modelling (SEM) to examine the pathways through which social factors, functional disability, risk behaviours, and chronic disease experience influence self-rated health (SRH) and quality of life (QOL) amongst older adults in India. Both SRH and QOL worsened with increased age (indirect effect) and limitations in functional ability (direct effect). QOL, socio-economic status (SES), and social networking had no significant effect on SRH. Smoking was associated with the presence of at least one chronic illness, but this did not have a statistically significant effect on SRH. Higher social networking was seen amongst the better educated and those with regular income, which in turn positively affected the QOL rating. QOL had a direct, but statistically not significant, effect on SRH. In conclusion, the indirect effects of age on SRH mediated through functional ability, and the effects of SES on QOL mediated through social networking, provide new understanding of how age and socio-economic status affect SRH and QOL. By allowing for measurement errors, solving for collinearity in predictor variables by integrating them into measurement models, and specifying causal dependencies between the underlying latent constructs, SEM provides a strong link between theory and empirics.     

Ideology and social indicators of the quality of life

This paper explores the possibility that social-psychological, evaluative measures of social well-being/quality of life (QOL) perceptions may embody unintended ideological elements. We argue that individual QOL satisfactions are likely caused, in part, by ‘satisfactions’, or conservative orientations, vis-à-vis societal institutions. Four dependent measures of QOL attitudes-overall life satisfaction, service satisfaction, community satisfaction, and powerlessness-are derived from factor analyses and established measurement procedures. Each of these QOL indicators is found to exhibit significant bivariate associations with measures of political-economic ideology. These relationships are somewhat reduced, but persist at statistically significant levels, when socio-demographic background variables are held constant. We then discuss the implications of our results for theory and method in the social indicators field.     

Measuring Household Wealth with Latent Trait Modelling: An Application to Malawian DHS Data

Public perceptions of crime and victimisation can influence an individual’s subjective well-being. Research into the impact of the fear of crime and victimisation on subjective well-being, however, has been limited; particularly with respect to the relative contributions of real versus perceived crime towards an individual’s self-reported life satisfaction. Improving our understanding of the relationship between crime and well-being is important, as public resources assigned to reducing or controlling crime could be assigned to addressing other social concerns. This paper extends the literature by exploring the contribution of real and perceived crime in an individual’s local area to their self-reported life satisfaction. Our results indicate that: (1) individuals’ perceptions of crime in their local area are far greater than actual levels of crime; (2) the gap between perceived and real crime is widening as real crime rates fall faster than the perceived rate of crime; (3) real crime rates detract more from an individual’s self-reported life satisfaction than perceived rates of crime; however, (4) perceived rates of crime have an adverse impact on life satisfaction beyond those associated with real crime; and (5) there is significant heterogeneity in the life satisfaction effects of real and perceived crime among groups of individuals. These results, together with empirical evidence highlighting successful strategies for moderating perceptions of crime, facilitate the development of more informed public policy that will improve individual life satisfaction and, ultimately, community well-being.     

MEASURING QUALITY OF LIFE: ECONOMIC,SOCIAL, AND SUBJECTIVE INDICATORS

Thinkers have discussed the “good life” and the desirable society for millennia. In the last decades, scientists offered several alternative approaches to defining and measuring quality of life: social indicators such as health and levels of crime, subjective well-being measures (assessing people's evaluative reactions to their lives and societies), and economic indices. These alternative indicators assess three philosophical approaches to well-being that are based, respectively, on normative ideals, subjective experiences, and the ability to select goods and services that one desires. The strengths and weaknesses of the various approaches are reviewed. It is argued that social indicators and subjective well-being measures are necessary to evaluate a society, and add substantially to the regnant economic indicators that are now favored by policy makers. Each approach to measuring the quality of life contains information that is not contained in the other measures.     

Is the Easy Life Always the Happiest? Examining the Association of Convenience and Well-Being in Taiwan

Social scientists have under-examined neighborhood stores and other “resources” and their relationships to community welfare and personal happiness. Because the presence of neighborhood conveniences may signify that a neighborhood caters to residents’ needs and smoothes out the hassles of their daily lives, it could be hypothesized that commercial amenities and services enhance individuals’ satisfaction with their neighborhoods, with their health, and even with their lives as a whole. This study used a national probability sample from Taiwan, a densely populated society in East Asia, to test if service-oriented commercial and religious enterprises in neighborhoods are associated with positive estimations of well-being by those who occupy these spaces. We empirically examine whether proximity to main roads, night markets and temples or proximity to smoky food stands and other shops that produce pungent products affects well-being. Our findings from multivariate analyses suggest that if nearby conveniences are conceived as annoyances, they tend to lower satisfaction with neighborhood, but they do not lower life satisfaction in general. In contrast, air quality, along with “peace and quietness” is reported by respondents to be key in enhancing general well-being. We discuss the policy implications in the concluding session.     

Do Cultural Values Affect Quality of Life Evaluation?

Schwartz defines cultural values as motivational types, where each value reflects goals and objectives to be achieved. According to Schwartz, cultural values are related to an orientation that is individualistic (values referred to as power, achievement, hedonism, stimulation and self-direction), collectivistic (benevolence, tradition and conformity) or mixed (security and universalism). Today, there is a theoretical consensus that cultural values are mediators in the evaluation of quality of life (QOL); nonetheless, there are few published studies to date relating them to QOL. To determine whether a significant relationship exits between cultural values and QOL in three Spanish-speaking countries. A total of 821 persons participated: 321 from Chile, 200 from Spain and 300 from Cuba. The Schwartz Cultural Values Survey and the WHOQOL-BREF Quality of Life Scale were used. Analysis of variance, and correlation and regression analyses were preformed after collecting data. Only hedonism was significantly correlated with the global evaluation of QOL in Spain and Chile. Few correlations were found in all three countries between cultural values and the QOL domains evaluated, with the exceptions of the value of self-direction, which was related to physical well-being, and the value stimulation, which was correlated with psychological as well as social well-being in all three countries. Certain values may be associated with a better perception of QOL, depending on the particular culture of the population evaluated.     

Spiritual well-being: A neglected subject in quality of life research

The social indicators and quality of life (QOL) movements have given scant attention to religiosity, in spite of theoretical and empirical evidence that it is related to personal and social well-being. Reasons for this include the constitutional provisions pertinent to religion, problems of funding, the lack of measuring instruments, conceptual and theoretical difficulties, biases of researchers, and the lack of consensus regarding the definition of QOL. A partial solution to this neglec is to engage in conceptual, theoretical, qualitative, and empirical research on spiritual well-being (SWB). The authors indicate its potential and some initial steps toward bringing SWB into the QOL movement.     

Welfare production: Public versus private

Welfare is one of the highest values in modern societies and refers primarily to the living conditions and the perceived life quality of individuals and families. This paper is asking how welfare is generated in society, what are the producers, the products, the production processes, the limits of particular productions, and new innovative “mixes”. After a survey of the literature (theory of social production, well-being accounting, political productivity, social policy intervention), a scheme of four major institutions of welfare production is discussed: markets, bureaucracies, associations, private households. Next, the present dilemmas and the innovative potential of each particular institution and of pair-and triple combinations are briefly explored, e.g. new “corporatist” patterns. Two case studies (“shadow economy”, household production) are investigating the policy question of how private initiatives, the resources of associations and private households, and new combinations of public and private efforts may overcome some of the deadlocks in the present “market failure” and “state failure”.     

Quality of life in retirement: A case study of Zulu return migrants

The quality of late life in technologically advanced societies has been well-researched. In contrast, very little systematic research has been conducted among the aged in less developed societies. An interesting case of retirement in a society in transition is that of returning Zulu contract workers. The apartheid laws of South Africa constrain migrant movements: contract workers typically spend their working lives in the urban-industrial milieu of the core economy and later return to a rural lifestyle in their areas of origin in the peripheral “homelands”. The retirement circumstances of 253 male return migrants in five rural areas of KwaZulu were assessed in an in-depth study. The subjective well-being of the Zulu retirees was found to be influenced mainly by such factors as health, perceived financial security, social activity and participation, and positive sentiment towards retirement life. The conclusion is drawn that migrant workers’ needs in retirement have a universal quality. This finding has social welfare policy implications in a society which is characterised by unequal distribution of privilege.     

Mobility,Perceptions of Quality of Life and Neighbourhood Stability in Saskatoon

Why people move, their well-being or self-assessed quality of life and the impact that this has on the stability of neighbourhoods are linked in many ways. One of the expected outcomes related to the attachment to and meaning of place is the level of intra-urban mobility by individuals and families. Those who have negative or neutral feelings towards the place they reside are expected to experience a greater level of intra-urban mobility. The objective of this paper is to examine the relationship between residential mobility and perceived well-being or self-assessed quality of life in Saskatoon, Saskatchewan across three clusters of neighbourhoods representing different socio-economic status (SES) (low, middle and high). The paper begins with a review of the literature on residential mobility and highlights concepts such as the life-cycle, social cohesion and social isolation. It employs data from three sources: a telephone survey collected from residents in 2001, a series of face-to-face interviews and 2001 Census data. The data are analysed statistically using a mixed model approach. The results show that mobility is an important feature of Saskatoon, and that a significant difference exists in the length of residency among the three neighbourhood clusters. However, the analysis indicates that there is no relationship between residential mobility and well-being as measured by self-reported quality of life and health.     

The Interplay between Educational Achievement, Occupational Success, and Well-Being

Many studies have examined the effect of life events, education, and income on well-being. Conversely, research concerning well-being as a predictor of life course outcomes is sparse. Diener’s suggestion “to inquire about the effects of well-being on future behavior and success” has, with some exceptions, not yet come to fruition. This article contributes to this body of research. We conceptualize and analyze the interplay between educational achievement, occupational success, and well-being as a complex process. The relationship between these domains is examined drawing on a structure-agency framework derived from Bourdieu and Social Comparison Theory. Social comparison between adolescents and their parents is suggested to be the mechanism explaining the effects of successful and unsuccessful intergenerational transmission of educational achievement and occupational success on well-being. It is further argued that well-being may serve as an individual resource by fostering educational and occupational outcomes. Panel data from the Transition from Education to Employment (TREE) project, a Swiss PISA 2000 follow-up study, was used. The interplay between well-being and successful and unsuccessful intergenerational transfer of educational attainment was analyzed in an autoregressive cross-lagged mixture model framework. Social comparison was found to be related to well-being, while well-being proved to significantly increase the probability of successful intergenerational transfer of educational attainment.     

Work-Related Demands Emanating from Social Change and Their Relation to Trait-Like and Occasion-Specific Aspects of Subjective Well-Being

Following current macro-level social change people are increasingly confronted with new demands encompassing perceived uncertainties concerning their job and career prospects. Studies utilizing concurrent assessments showed that perceiving a high accumulation (“load”) of such demands is negatively related to individuals’ subjective well-being. Without further evidence the interpretation of the direction of these effects, however, is equivocal. Based on the concept that individuals have a rather stable trait-like level of subjective well-being from which they may vary when confronted with changes of the external ecology, the current study examined the relationship between the reported load of demands and subjective well-being assessed as general life satisfaction and average satisfaction in domains of life (i.e., family, work, finances, and leisure). We expected that a higher load of demands corresponds to a temporary decline in well-being, while at the same time differences in the stable trait-like level of well-being account for differences in the reported demand load. For the purpose of our study, we analyzed three annual waves of assessment of German adults aged between 18 and 43 years (N = 488). Utilizing a trait-state-occasion model, we separated trait-like aspects of well-being from occasion-specific deviations. Overall, our results confirmed our expectation that effects indeed run in both directions. The higher the reported load of work-related demands, the more respondents’ well-being negatively deviated from the stable trait-like level. Beyond that a higher trait-like level of well-being corresponded to a lower demand load. Both effects revealed almost equal strength and remained stable after controlling for participants’ employment status, family status, and educational attainment.     

A value based index for measuring national quality of life

A new index of the quality of life (QOL) of nations was created. The measured variables are selected based on a universal set of human values derived from the work of Schwartz (1994). The Basic QOL Index, designed primarily to discriminate between developing countries, includes seven variables: purchasing power, homicide rate, fulfillment of basic physical needs, suicide rate, literacy rate, gross human rights violations, and deforestation. The Advanced QOL Index, designed primarily to assess QOL in highly industrialized nations, includes seven variables: physicians per capita, savings rate, per capita income, subjective well-being, percent attending college, income equality, and environmental treaties signed. Combining the two indices produced a reliable measure of QOL that systematically covers diverse human values. The nations scoring highest on the Combined QOL Index were Canada, Switzerland, Netherlands, U.S.A., and Norway, and those scoring lowest were Ethiopia and Rwanda.