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

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

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3 Summary so far Hierarchy 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?)

4 Learning Objectives describe possible paths to producing happiness as a population health concept discuss social capital as a potential pathway through which hierarchy exerts its health effects

5 Challenging ideas and ideologies Epistemology: 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:

6 Challenging ideas and ideologies Epistemology: 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)

7 Measures of well-being, happiness, satisfaction studied over last 50 years "Hedonic Psychology" Sociology Economics

8 Happiness measures Taken 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?

9 Happiness in Different Activities (UK) HappinessHours/day Sex Socializing after work Dinner40.8 Relaxing Lunch Exercising Praying Socializing at work Watching TV Phone at home Napping Shopping Computer at home Housework31.1 Childcare31.1 Evening commute Working Morning commute2.4

10 USA

11 Happiness spending time with: Interacting with: UK Average Happiness US Satisfaction RANK 1980 Friends3.3Family Parents/relatives3TV Spouse2.8friends My children2.7music Co-workers2.6reading Clients/customers etc.2.4house or apt Alone2.2meals Boss2one's car

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13 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?

14 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 $100,000 (1995) Schor 1998

15 Kahneman Science June 30, survey

16 Happiness Income Quartiles US people over 16Top Quartile Bottom Quartile Very Happy Pretty Happy Not too happy Given individual in a given country becomes happier if richer When whole society becomes richer, nobody seems happier

17 Birth cohort studies happiness is flat despite rising incomes younger cohorts with less education appear to have happiness decline with age

18 16 nations, 169,776 people Easterlin 2002

19 NYT June 13, 2004 TREND STUDIES

20 NYT June 13, 2004

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24 US % reporting very happy AllWomen Early 1970s3436 Late 1990s3029 Oswald 2002

25 Highest Life Expectancy And disability free years Life expectancy disparity is 16 years General Social Survey

26 Highest Life Expectancy And disability free years Life expectancy disparity is 16 years General Social Survey

27 Highest Life Expectancy And disability free years Life expectancy disparity is 16 years General Social Survey

28 Highest Life Expectancy And disability free years Life expectancy disparity is 16 years General Social Survey

29 Highest Life Expectancy And disability free years Life expectancy disparity is 16 years General Social Survey

30 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

31 Happiness /Life Satisfaction Among Nations? Cross-sectionally Trends Culture effects

32 Highest Life Expectancy And disability free years Lowest Life Expectancy And disability free years Life expectancy disparity is 16 years Diener et. al HAPPIER BIGGER ECONOMY

33 16 nations, 169,776 people

34 Highest Life Expectancy And disability free years Lowest Life Expectancy And disability free years Life expectancy disparity is 16 years Diener et. al. 2004

35 Associations of happiness with income 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

36 16 nations, 169,776 people New Scientist Oct 4, 2003

37 16 nations, 169,776 people New Scientist Oct 4, 2003

38 16 nations, 169,776 people

39 Happiness trends over time US: 1946 happiest among 4 advanced economies 1970s 8th among eleven advanced countries 1980s 10th among 23 nations including poor ones US, UK-- depression, alcoholism and crime have risen during golden economic growth period ( ) 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)

40 16 nations, 169,776 people Rifkin Below

41 Well-being EUDIAMONIC 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 growth 4.Positive relations with others 5.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-being life satisfaction 2.Presence of positive affect 3.Absence of negative affect

42 Speculative well-being links to biology EUDIAMONIC 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

43 Culture and Happiness Western 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

44 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 equal Narratives: story of Mayflower Moral imperatives: "God helps those who help themselves"

45 Self-Criticism CULTURE Mutually Sympathetic Relationship Self-control Effort Social role Filial piety Community values Warm-heartedness Empathy Perspective taking INTERDEPENDENT SELF Texts: "Confucious, Tao Narratives: story of benevolence, diligence Moral imperatives: compassion of Buddha, modesty Balance

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48 Wilkinson et. al. SSM forthcoming MORE EQUALITY Prisoners More PRISONERS

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50 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

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