Gendering Indicators of Health and Well-being: Is Quality of Life Gender Neutral?

The addition of social indicators and quality of life measures to the raft of traditional health indicators used to assess health and well-being has certainly provided a much-needed contextual understanding of health outcomes. However, most quality of life measures remain undifferentiated by gender. Outcomes can be disaggregated along age, class, ethnic, racial and gender dimensions but few quality of life measures (or social indicators for that matter) are sensitive to the subtle effects of gender socialization on health and well-being. Both social epidemiology and quality of life measures need to be gendered and differentiated to fully capture the diversity of womens and mens health experiences.     

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.     

Life Satisfaction as a Distinguishing Indicator of College Student Functioning: Further Validation of the Two-Continua Model of Mental Health

The two-continua model of mental health contends that both psychological distress and psychological well-being make related-yet-distinct contributions to our understanding of human health and its relations with other quality of life outcomes. Using self-reported somatization, depression, and anxiety symptoms as indicators of psychological distress and self-reported life satisfaction as an indicator of psychological well-being, the present study classified participants into one of four mental-health-status groups—mentally healthy, mentally unhealthy, symptomatic yet content, or asymptomatic yet discontent—and investigated between-group differences across three key indicators of college student functioning: academic achievement, interpersonal connectedness, and physical health. Findings provide further validation for the two-continua model of mental health among college students, showing that, when considered in conjunction with clinical symptoms, life satisfaction serves as a distinguishing indicator of college students functioning across academic, social, and physical health domains—as well as a strong predictor of the absence or presence of clinical symptoms and comorbidity. Implications for theory, practice, and future research are discussed.     

Subjective and objective indicators of regional quality of life in Switzerland

Mainly because of data limitations, direct comparisons between subjective and objective indicators of local or regional quality of life have been inconclusive until now. The 1978 opinion survey among more than 33 000 Swiss recruits representing about 80% of their age cohort allows one for the first time to disaggregate survey data regionally for all parts of a whole country. The portrait of 97 regions and 25 cantons of Switzerland, based on the recruits' assessments of their native commune, seem adequately to reflect the rich variety of quality of life experiences in this extremely decentralized and culturally heterogenous country. Evidence from several procedures for validating the opinion survey data is presented, among which comparisons between the subjective and selected objective indicators of regional quality of life prove to be most conclusive. In general, the intercorrelations between these two types of social indicators are astonishingly high. Some consequences of this result for the subjective vs. objective social indicator controversy are elaborated. Methodological considerations on the peculiar elusiveness of the quality of life category follow, indicating the outline of a workable methodology of usable social indicators knowledge.     

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.     

The Relative Importance of Health

This article seeks to extend Michalos’ [Social indicators research and health-related quality of life (QoL) research. Social Indicators Research, 65, 27–72, 2004] discussion on bridging social indicators research and health-related QoL (HRQoL) research through an examination of (1) the relative importance of satisfaction with one’s own health to another common measure of QoL—Life satisfaction, and (2) the relative importance of health in relation to other major life domains. Using data from two surveys, this article found that individuals may perceive health as most important in relation to other major life domains but satisfaction with one’s own health may not necessarily be the most important determining factor (in relation to satisfaction with other major life domains) of QoL as measured by life satisfaction. These findings support Michalos’ (Social indicators research and HRQoL research. Social Indicators Research, 65, 27–72, 2004) call for caution regarding the interpretation of research results on HRQoL since many HRQoL measures are measures of satisfaction with one’s own health and should not be considered as measures of QoL.     

The Shape of South African Society and its Challenges

South Africa's negotiated settlement and its transition to democracy reads like a modern fairy tale. A brief review of South Africa's social indicators serves to temper some of optimism about the country's future. The indicators reflect the society's quality of life which has been shaped by its turbulent history. Political “caste formation”, changing political alliances, the reforms intended to forestall the demise of apartheid, and the race for global competitiveness have left indelible marks on the society's social indicators. A comparison of living conditions in South Africa with those of roughly comparable economies indicates that the country lags behind in securing overall and widespread socio-economic upgrading of the population at large. A review of a cross-section of South African indicators and their trends over time shows that South Africa is still a very deeply divided society with a very large backlog in socio-economic development. There is evidence of breakdown in the society's social cohesion. Popular expectations of future quality of life indicate that the euphoria following on the first democratic elections has been replaced by a sense of realism among all sectors of the population. It is concluded that quality of life as reflected in South Africa's social indicators may get worse before it improves. The challenge will be to avoid new forms of economic “apartheid” which would depress the quality of life of marginal sectors of the population at the expense of the economically privileged.     

Yea-saying and mood-of-the-day effects in self-reported quality of life

This paper focuses on some of the complications that may arise from errors of measurement in quality of life (QOL) scales based on self-report. It is argued that systematic errors as well as random errors (specifically in the shape of mood-of-the-day effects) will tend to suppress, mask or “wash out” statistical associations between “objective”, sociologically relevant, indicators of well-being and self-reported quality of life. Results from a Norwegian sample of middle-aged and old participants in a health screening operation (N=610) are reported. The findings indicate that response acquiescence (“yea-saying”) may be a source of systematic error even in balanced QOL-scales, and that this bias may lead one to underestimate QOL among the well-educated and overestimate it among older respondents. Utilizing over-time data we are able to show that self-reported QOL appears particularly vulnerable to mood-of-the-day effects among younger females. Implications for sociological research on subjective well-being are pointed out.     

The stability and validity of quality of life measures

Effective social indicators must be stable when individual or societal characteristics are unchanged and dynamic when circumstances alter. Highly reliable measures may be poor indicators because they are insensitive to change. Little evidence is available on the sensitivity or validity of objective and subjective indicators. A lack of panel data has restricted the assessment of the stability of subjective measures. This paper examines longitudinal data on a representative sample of 2162 Canadians interviewed in 1977 and again in 1979. Test-retest correlations of approximately 0.50 were obtained for satisfaction and self-anchoring ladder measures among respondents who reported no significant changes in their lives during the past two years. Correlations were substantially lower, as expected, for those reporting life changes. Comparisons of the absolute values of these subjective indicators show that very little change in quality of life measures occurs when stable circumstances are reported but the indicators rise or fall significantly when situations change with downward adjustments being more dramatic than upward modifications. Positive and negative life events had little effect on overall evaluations of life quality. In general, these findings provide very strong evidence for the stability and validity of subjective indicators over time. These measures, with one exception, were constant in unchanging situations and sensitive to change when it occurred.     

The Social Indicators Movement at 50: Onwards in Unity or Divided?

Before we can move forward with new topics in quality of life research, it would be useful to settle a number of issues that have been a source of debate over the last 50 years. Broadly speaking, this leads to seven principles for measuring and describing quality of life: the central focus is on people; quality of life is about more than just economics; a full measurement must incorporate both objective and subjective indicators; quality of life incorporates several dimensions; the outcome must be viewed separately from the determinants; there must be attention for distribution and difference; the domains can be combined into an index (though this is not essential). The main debate is perhaps about whether or not there should be an index. An index is necessary if we wish to give social indicators the same status as economic indicators have through GDP. In my view, that is desirable. Once these principles are established, the agenda for future social indicators research can be shaped using a model-based approach incorporating several recommendations from Land and Michalos.     

Subjective Quality of Life of Young Europeans. Feeling Happy but who Knows why?

Latest developments in modern societies have altered living circumstances. Upcoming insecurities concerning employment and family relationships make life more and more incalculable. Especially young adults throughout the modern world are forced to rethink their life concepts and to desist from the lives of former generations. As difficulties to achieve a successful life increase, one could assume that the young are confronted with the impossibility of feeling happy and satisfied with their lives anymore. Yet, latest social surveys prove wrong. Although increasing unemployment, lower net income and single parenthood make life more difficult for the young, they still enjoy very high subjective quality of life in comparison to the older population. Throughout the paper I argue that it is not the objective conditions that make young adults (15–29 years old) feel overwhelmingly happy. Looking for other sources of explanation of high quality of life among people aged 29 or below, I argue for indicators of social embeddedness as being influential on their assessment of life. But again, the proportion of explained variance is smaller compared to older people. With the help of empirical data taken from the European Social Survey I highlight the differences in life circumstances between the young and the total population. Concerning occupation, habitation (kind of inhabited household) and financial situation, most of the young live under different situations compared to the adult world. But surprisingly, the rates of perceived high quality of life among the young do not vary to such a large extent as among the adults. I show that young adults, often damned to fail social demands because of their withdrawal from social life, are still the most happy in modern (more and more individualizing?) societies. But it gets more difficult to account for the reasons of their happiness.     

Subjective Health-Related Quality of Life in Homeless and Vulnerably Housed Individuals and Its Relationship with Self-Reported Physical and Mental Health Status

Although the association between homelessness and objective indicators of poor health is well-established, little research has focused on the subjective health-related quality of life of homeless and vulnerably housed (HVH) individuals. This study examined the subjective health-related quality of life of HVH individuals, using the Multiple Discrepancies Theory (MDT) Scale for Health of the Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) Inventory, and its association with self-reported functional health status, as measured by the SF-12, and self-reported physical and mental health conditions in a sample of 100 HVH individuals recruited in Vancouver, Toronto and Ottawa. Our findings indicate that physical and mental health conditions are highly prevalent among HVH individuals and that the SF-12 Physical and Mental Component Summary scores are substantially lower compared to US population norms. The MDT Health items were not statistically significantly associated with physical or mental health conditions and only showed correlations of small to moderate magnitude with the SF-12 Component Summary Scales. These findings suggest that the QoLHHI MDT Scale for Health can provide information about HVH individuals’ subjective health experiences that is different from, and can serve as a valuable complement to, health status information for use in research and evaluation studies, as well as for policy purposes to make informed decisions based on subjective health-related quality of life data from HVH individuals.     

Toward sociomedical health indicators

The various forms of mortality data and biomedical measures of morbidity have become inadequate measures of the level of health in economically developed countries. Measures of functional physical capacity have some advantages but do not reflect physical impairment. Current attempts to develop sociomedical health indicators include: measures of social disability; typologies of presenting symptoms, which have been used to estimate probable needs for care; measures which focus on behavioral expressions of sickness; research based on operational definitions of ‘positive mental health’, ‘happiness’ and perceived quality of life; assessments of met and unmet needs for health care, which are measures of social capacity to care for the sick. Sociomedical indicators reflect both objective conditions and social values. They are policy-oriented, serving as mobilizing agents for sociopolitical pressures concerned with raising the overall level of health of the population.     

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.     

Quality of life indicators: A preliminary investigation

Concern over the ‘quality of life’ in the United States seems to have increased proportionally with technological advancement and growth in material wealth. Growing public interest in social, economic, political and environmental conditions has led to the search for indicators which adequately reflect the overall ‘health’ of the nation and its citizens' well-being. This paper developed a systematic methodology for assessing social, economic, political, and environmental indicators to reflect the quality of life in the U.S. Nine indicators, including Individual Status, Individual Equality, Living Conditions, Agriculture, Technology, Economic Status, Education, Health and Welfare and State and Local Governments were compiled from more than 100 variables for 50 states and the District of Columbia. Based primarily on 1970 data, QOL indexes were generalized and the states were rated. Comparisons among similar studies were made and analyses among indicators were also performed.     

Quality of Life in College Students with and without Social Phobia

Prior studies demonstrating quality of life impairment in phobia and anxiety disorders have relied upon epidemiological samples or clinical data. Using the same quality of life scale, the Short Form 36-item Health Survey (SF-36), in Iranian college students allowed us to study the impact of social phobia (SP) on quality of life among the college students. This report summarizes findings from a cross sectional study on Iranian students with social phobia studying at Shahed University. Quality of life was measured using the Short Form 36-item Health Survey (SF-36) which is a widely used and valid questionnaire to measure quality of life in cross-sectional and longitudinal studies. Three standard instruments were used to measure social phobia severity, namely Social Phobia Inventory, Social Interaction Anxiety Scale, and Brief version of the Fear of Negative Evaluation Scale. The sample consisted of 202 college students, 72 with SP and 130 without SP. The main finding of this study was that students with social phobia reported significantly lower quality of life, particularly in general health (P = 0.02), vitality (P < 0.0001), social functioning (P < 0.0001), role functioning—emotional (P < 0.0001), and Mental health (P = 0.001) dimensions. Standardized summed scores for mental health components of the SF-36 showed that 36.2% of all the s with SP were severely impaired while 16.0% of the students in control croup were severely impaired. Findings demonstrated that Iranian socially anxious college students reported extensive functional disability, and lower well-being compared to those without SP. These findings should encourage education officers to implement systematic efforts to prevent and treat social anxiety among students.     

Determinants of Health and the Quality of Life in the Bella Coola Valley

The aim of this investigation is to obtain some baseline self-reported data on the health status and overall quality of life of all residents of the Bella Coola Valley of British Columbia aged 17 years or older, and to measure the impact of a set of designated health determinants on their health and quality of life. In the period from August to November 2001, a variety of procedures were used to ensure that all eligible residents of the Valley received a copy of our questionnaire, and 687 useable questionnaires were obtained for our working dataset. Health status was measured by SF-36 and the U.S. Centers for Disease Control healthy days items. Thirty-one items were used to measure the Provincial Health Officer’s designated determinants of health in four clusters, namely, biological, social and economic, health behaviours and health services determinants. Quality of life was measured by satisfaction levels in 13 specific domains of life (e.g., family, financial security), four global items (e.g., happiness, life satisfaction) and one global Subjective Well-Being Index. Besides obtaining baseline figures on all our measures for the Valley, we made some comparisons among our figures and those from other areas, e.g., Prince George, BC. Most of the measures indicated that the health status and quality of life of Bella Coola Valley residents were lower than those of Prince George residents. For the sample as a whole, SF-36 scores on the eight dimensions ran from 82.3 (physical functioning) to 50.0 (social functioning), with a mean of 62.7. Residents in the Valley averaged 6.5 days in the past 30 in which their health was physically not good, 5.5 days when it was mentally not good and 4.1 days when their health limited their usual daily activities. Eleven percent of respondents described their general health as “excellent” and another 27% said it was “very good”. On a 7-point scale from 1=very dissatisfied to 7=very satisfied, respondents had average life satisfaction and satisfaction with the overall quality of life scores of 5.5. For specific domains of life, the lowest mean level of satisfaction was reported for federal and provincial government officials (3.3) and the highest was reported for living partners and personal safety around home (5.8). Regarding bivariate relations, each of the eight dimensions of SF-36 was significantly correlated with a single item measure of general health, and five of the eight were significantly correlated with the number of good health days. Happiness and the Subjective Well-Being Index were positively but moderately correlated with six of the eight dimensions, and life satisfaction was positively correlated with five. Age was negatively related to general health, but positively related to life satisfaction. Not being of aboriginal descent was positively related to all of the four global health indicators and to the Subjective Well-Being Index. Education was positively related to the four global health measures but not to the three global quality of life measures. The Social Support and Good Family Indexes were positively related to all seven global measures. There was a positive correlation between six of the seven global measures and the frequency with which respondents participated in activities sponsored by voluntary organizations. Frequency of smoking was negatively associated with every global dependent variable except the Physical Health Index. Frequency of skipping meals was negatively associated and average hours of sleep per night was positively associated with all seven global measures. Turning to multivariate relationships, the four clusters of health determinants explained from 12% (SF-36 Mental Health Index) to 24% (general health) of the variance in the dependent global health variables, and from 20% (happiness) to 26% (Subjective Well-Being Index) of the variance in the dependent global quality of life variables. Adding domain satisfaction scores to the total set of predictors allowed us to explain from 20% (SF-36 Mental health Index) to 29% (general health) of the variance in the dependent global health variables, and from 39% (happiness) to 62% (life satisfaction) in the dependent global quality of life variables. By including measures of social support and good family relationships in our set of health determinants, we practically guaranteed that the latter would be relatively strongly predictive of global quality of life.     

Social Indicators Research and Health-Related Quality of Life Research

The aim of this essay is to build a bridgebetween two intersecting areas of research,social indicators research on the one hand andhealth-related quality of life research on theother. The first substantive section of thepaper introduces key concepts and definitionsin the social indicators research tradition,e.g., social indicators, positive, negative,input and output indicators, social reports andquality of life. After that, there is asection reviewing some historical origins andmotives of social indicators researchers,beginning roughly with Jeremy Bentham's`felicific calculus' and ending with the searchfor a comprehensive accounting scheme capableof measuring the quality of human existencewith social, economic and environmentalindicators.Results of eleven surveys are reviewed whichwere undertaken to explain happiness on thebasis of levels of satisfaction thatrespondents got from a dozen specific domainsof their lives, e.g., satisfaction with theirjobs, family relations and health. On average,for the eleven samples, we were able to explain38% of the variance in reported happiness fromsome subset of the predictor variables. Satisfaction with one's own health was never the strongest predictor of happiness inany sample. In five of the eleven samples,satisfaction with one's own health failed toenter the final explanatory regression equationfor lack of statistical significance. Theresults in this section of the essay show thatdifferent groups of people with different lifecircumstances, resources and constraints usedifferent mixtures of ingredients to determinetheir happiness.After examining some research revealing therelative importance of people's satisfaction with their health to theiroverall happiness, I consider some studiesrevealing the importance of people's self-reported health to their overallhappiness. Self-reported health is measuredprimarily by the eight dimensions of SF-36.When a variety of additional potentialpredictors are entered into our regressionequation, 44% of the variance in happinessscores is explained, but only one of the eightdimensions of SF-36 remains, namely, MentalHealth. The latter accounts for a mere four%age points out of the total 44. Thus,self-reported health has relatively little tocontribute toward respondents' reportedhappiness, and its measured contribution issignificantly affected by the number and kindsof potential predictors employed.Two approaches to explaining people'ssatisfaction with their own health areconsidered. First, using the same set ofhealth-related potential predictors of overallhappiness, we are able to explain 56% of thevariance in respondents' satisfaction withtheir own health. Then, using MultipleDiscrepancies Theory, we are able to explainabout 51% of the variation in satisfactionwith one's own health scores for 8,076undergraduates, with highs of 76% for a sampleof Finnish females and 72% for Korean males.Accordingly, it is reasonable to conclude thatif one's aim is to explain people'ssatisfaction with their own health, thepotential predictors assembled in MDT canprovide quite a bit and sometimes even moreexplanatory power than a reasonably broad setof measures of self-reported health.In the penultimate section of the essay it isargued that there are good reasons forcarefully distinguishing ideas of health andquality of life, and for not interpreting SF-36and SIP scores as measures of the quality oflife. It is suggested that we might all bebetter off if the term `health-related qualityof life' is simply abandoned. However, sincethis is unlikely to happen, it is stronglyrecommended that researchers be much morecareful with their usage of the phrase andtheir interpretation of purported measures ofwhatever the phrase is supposed to designate.     

Social Exclusion and Quality of Life: An Empirical Study from Turkey

We examine the perception of social exclusion and quality of life and their interactions among a group of Turkish citizens. For this purpose we used the social exclusion scale developed by Jehoel-Gijsbers and Vrooman and the WHOQOL-BREF scale. The study group consists of 2,493 participants who are residents of a city in Turkey. Our study was based on self reporting and voluntary participation. We used SEM (Structural Equation Modeling) for the analysis. We observed significant paths among several dimensions of quality of life and social exclusion. We found that the material deprivation dimension of social exclusion has a direct and negative impact on the environment and social relationships domains of quality of life. The material deprivation dimension explains 36% of the variation in the environment and 16% of the variation in social relationship domains of quality of life. This finding indicates that the material deprivation and social participation play an important role in the perception of environmental and psychological life quality. Physical health, social relationships, and environmental domains of life quality are important in the social participation dimension of perceived social exclusion.     

CONSTRUCTING A HEALTH AND SOCIAL INDICATOR FRAMEWORK FOR INDIGENOUS COMMUNITY HEALTH RESEARCH

Health and social indicators that capture the distinct historical, social, and cultural contexts of Indigenous communities can play an important role in informing the planning and delivery of community interventions. There is currently considerable interest in cataloguing and vetting meaningful community-level health and social indicators that could be applied to research and health promotion activities in Indigenous communities in Australia, Canada, and New Zealand, inclusive of conventional indicators as well as measures developed specifically for use in or with Indigenous communities. To avoid haphazard selection of indicators, and to assure the comprehensiveness and relevance of any given set of indicators, a framework that can accommodate and conceptually classify indicators representing a full range of domains is required. We report here on the development of a conceptual framework, by which Indigenous community indicators, and more general community-level social indicators, can be sorted, catalogued, and systematically classified within four hierarchical levels. The indicator framework was developed across Canada, Australia and New Zealand in consultation with academic researchers and Indigenous community stakeholders, building from established health and social indicator systems. The Indigenous indicator framework permits Indigenous communities, public health researchers, and funding agencies to compare and select the most appropriate indicators for application in specific contexts from the multitude of existing indicators.