1. 1 Lecture 3 Happiness, health and sustainable development Alessandro Vercelli (University of Siena) Based upon: Borghesi, S. and A.Vercelli: 2008, Global sustainability, Palgrave Macmillan, London 2012, Happiness and Health: two paradoxes, (with S.Borghesi), Journal of Economic Survey, 2012, Vol.26, 2, pp.203-233

2. 2 PURPOSE reflection on the limits to growth from the point of view of human well-being by studying the interaction between two streams of literature: - happiness social determinants { - health - happiness: mainly economists, sociologists and psychologists separate streams { - health: mainly social epidemiologists - happiness ↔ health cross-fertilization illuminating for both of them { - policy implications - the gap between growth and development to understand better { - why sustainable development should be the goal - the requirements of sustainable development

3. 3 APPROACH (1) - subjective indexes of happiness: “self-reported happiness” interrelations { -life expectancy - objective indexes of health { -mortality rates -morbidity rates sufficiently independent to be informative: the correlation between self-reported health and subjective happiness is too high to be informative: in 18 OECD countries r = 0.85 (Kahneman and Ris, 2004), - both are rooted in the personality of the individual who assesses them As { - almost everyone asserts that the main determinant of happiness is health The interaction between objective health and subjective happiness depends on a set of factors that we are going to consider in what follows

4. 4 APPROACH (2) self-reported health Significant correlation: objective health indexes { subjective happiness as it may change to some extent with time and space in particular it depends on cultural factors e.g. French people declare a much lower index of self-reported health than US citizens but have a better health (e.g. live three years longer) The record and analysis of self-reported health is now rapidly developing however, the analysis of a population health status is still based mainly on the objective indexes of health

5. 5 APPROACH (3) the objective health indexes are partial indexes of subjective health as they cannot cover the whole range of factors that affect it unconscious sources of happiness however they implicitly register { psychosomatic symptoms self-reported health this may help us to study the distortions { subjective happiness quality-adjusted life expectation indexes: they integrate mortality and morbidity indexes with other indexes of quality of life to express health status in terms of equivalents of well-years of life we ignore this category of indexes, notwithstanding their obvious appeal because: -their availability is still limited -unsettled methodological questions (Hansen and Østerdal, 2006)

6. 6 The determinants of self-reported happiness

7. 7 The role of absolute income The economists have traditionally stressed the role of per capita income Y → focus of economic policy on the growth of GDP A) Cross section analysis shows: ( 1 ) W* = f 1 ( Y ),f 2 ’>0, f 2 ’’<0. -saturation Utilitarian tradition { of needs -hierarchy $10,000 (Frey and Stutzer, 2002) However strong nonlinearity: threshold { $15,000 (Layard, 2006)

8. 8 The relationship between income per head and happiness

9. 9 The “happiness paradox” B) Time series show that, in developed countries after WWII, correlation with per capita income is generally nonexistent or slightly negative: -continuous growth of per capita income “happiness paradox” { -happiness did not increase, sometimes decreased Easterlin (1974) for the USA subsequently confirmed for other developed countries such as: the UK, Japan, France, Germany, Netherlands

10. 10 Happiness and income in the USA

11. 11 Happiness and per capita income in Japan

12. 12 Happiness in Italy (1975-2007) Source: Nicola Lucia, 2008

13. 13 Explanations of the paradox “hedonic treadmill” Easterlin (1974) from Brickman and Campbell (1971) however “stimulation goods” (Scitowsky, 1976) “the satisfaction treadmill”: aspiration theory ( 2 ) W* = f 2 (Y* – Y),f’ 2 < 0. elasticity of aspirations to ∆Y close to one (Frey and Stutzer, 2002): ( 3 ) ∆Y* = k ( ∆Y), k ≈ 1, from which we easily derive that ∆W* = f 2 (∆Y* – ∆Y) ≈ 0, i.e. that happiness does not tend to increase in consequence of ∆Y aged individuals: lower and declining elasticity However { no decline of happiness unless growing frustration

14. 14 The role of social factors After a threshold between $10,000 and $15,000 per year, the influence of absolute income on happiness rapidly fades away, while the crucial role is taken over by social factors The aspiration theory itself may be explained in sociological terms as positional goods (Hirsch, 1976) scarcity rent of socio-economic status: since the latter is in fixed supply, any conspicuous consumption generates negative externalities

15. 15 The role of social factors crucial after the threshold: relative income →↑ income inequality Y R makes people more unhappy: ( 4 ) W i * = f 4 ( Y R ),f’ 4 < 0, where Y R is an index of inequality (such as Gini or Theil indexes) Explanation: differential access to positional goods → relative deprivation: signals social ranking and depends on the gap between different classes of income In most OECD countries U-shaped behavior of inequality: This cannot explain the behavior of self-reported happiness since WWII, although it may contribute to explain the worsening of the trend observed since the early 1980s

16. 16 Gini index Source: Brandolini (2002) Fig. 5 24 28 44 48 52 56 40 36 32 20 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 1935 16 Inequality in the U.K., 1939-1996 (%)

17. 17 Source: Brandolini (2002) Fig. 6 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 16 24 28 36 44 52 20 32 40 48 56 Gini index Inequality in the USA, 1929-1996

18. 18 The role of social factors: relational goods The consumption of relational goods R is positively correlated with happiness: ( 5 )W* = f 5 ( R ),f’ 5 > 0. relational goods introduced only recently in order to capture the affective and communicative components of social relations (Gui, 1996): -end in themselves different goods{ -cannot be produced or consumed by a single individual -value depends on the interactions under reciprocity examples are love, friendship, and more in general direct personal social relations, i.e. not mediated by economic or political exchanges: - strong positive correlation between relational activity and happiness - loneliness is negatively correlated with happiness -altruism and voluntary service contribute to happiness (Frey & Stutzer, 2002)

19. 19 The role of social factors: relational goods the development of the market has suffocated the production and consumption of relational goods: the price of comfort goods decreased due to technical progress and standardization, while the costs of relational goods did not diminish or even increased (Bruni, 2006b) → substitution of cheap comfort goods for relational goods e.g.: TV watching is positively correlated with hours of work and negatively correlated with happiness (Bruni and Stanca, 2005) the deterioration of relational goods contributes to explain the happiness paradox (Bartolini and Bonatti, 2002; Bartolini, 2010), but its trend is slow

20. 20 Other social factors: unemployment Unemployment reduces well-being, even after controlling for the associated fall in income (Clark, Frijters, and Shield, 2007): ( 9 ) W* = f 9 ( U ),f’ 9 < 0. the unemployed is victim of anxiety, anger, depression and a loss of self- esteem and social status and that may disrupt his/her familiar and social life Remark: the strong correlation of unemployment with unhappiness is inconsistent with the conviction that unemployment is never involuntary (Lucas and New Classical Economics) However: unemployment diminished in the 1950s and 1960s, increased in the 1970s and 1980s and diminished again in the 1990s and first 2000s this diminution was correlated to growing flexibility of labour markets and industrial relations that contributed to declining job satisfaction

21. 21 Other social factors: education Personality and happiness are affected by the degree of education I: ( 10 )W* = f 10 ( I ),f’ 10 > 0. a higher degree of education correlates with a higher degree of subjective happiness independently of variations of p. c. income (Easterlin, 2004): education →↑ set of enjoyable goods: cultural and stimulating goods the average level of education increased continuously in most countries since WWII but apparently also in this field individual aspirations increased with the average level of education

22. 22 Other factors: psychogenetic factors Theory of adaptation maintains that individuals are characterized by a stable equilibrium state of happiness (Brickman et al. 1978): ( 6 ) W i * = f 6 (W* i –X i *), f’ 6 > 0 when W* i – X i *>0,and f’ 6 <0 when W* i – X i *<0. where X i * is the stable equilibrium point (or “set point”) of happiness of the individual i Theory of personality: equilibrium rooted in personality as established by genetic and psychogenetic factors G (e.g., Likken and Tellegen, 1996): ( 7 ) W i * = f 7 ( G i ). However, adaptation is not complete (Diener, 1996): shifting equilibrium

23. 23 Other factors: environmental externalities Growth of per capita income produces negative externalities E that deteriorate the happiness of citizen: ( 8 ) W* = f 8 ( E ),f’ 8 <0, in consequence of pollution and exhaustion of environmental goods Crucial explanation of the happiness paradox but the quantification of its impact is strictly dependent on the list of relevant externalities and their evaluation, issues that are very controversial

24. 24 Health and the second happiness paradox When people are asked to evaluate the importance of various factors of happiness, good health obtains the higher rating (Frey-Stutzer, 2002, p.56): ( 10 ) W* = f 11 ( H ), f 11 > 0. → a new happiness paradox emerges: the most comprehensive objective indexes of health (life expectancy and mortality rates) improved continuously in most countries after WWII but this did not translate in increasing self-reported happiness FIRST: self-reported happiness and per capita income happiness paradoxes { SECOND: self-reported happiness and objective health

25. 25 The happiness function None of the main determinants of happiness is sufficient to explain the happiness paradox but they do not exclude each other: we can thus summarize the acquisitions of the research surveyed above through the following “happiness function”: ( 12 )W* = F (Y, Y R, Y – Y*, G, R, E, I, U, H), where we assume that the partial derivatives for each factor have the same signs already specified The capital letters that appear in the argument of the function F may be considered as vectors of variables each of which has both a flow dimension and a stock dimension

26. 26 The social determinants of “objective” health

27. 27 Health and the second happiness paradox Subjective happiness is a crucial determinant of health: -length of life (Palmore, 1969) e.g. {-heart disease (Sales and House, 1971) -suicide (Koivumaa and Honkanen et al., 2001) Health is reported to be a crucial determinant of subjective happiness → a new happiness paradox emerges: the most comprehensive objective indexes of health (life expectancy and mortality rates) improved continuously in most countries most of the time after WWII but this did not translate in increasing self-reported happiness FIRST: self-reported happiness and per capita income happiness paradoxes { SECOND: self-reported happiness and objective health

28. 28 The role of absolute income The per capita income of a community is generally considered as a major determinant of its average health An increase in absolute income: - relaxes the budget constraints: access to therapies -higher expenditures in health programs -better medical/pharmaceutical technologies -higher education levels → ↑ updated medical knowledge and know-how

29. 29 The role of absolute income The empirical literature shows that the relationship between Y and H -is strongly non linear -has a pattern very similar to that of the relationship between Y and W*: ( 13 ) H = φ 1 ( Y ), φ 1 ’ > 0, φ 1 ’’ < 0. cross-section studies: -the health of the poor has higher income elasticity than that of the rich A) cross-country evidence: -life expectancy increases with average per capita income in poor countries -this relationship tends to vanish for relatively rich countries (Preston, 1975)

30. 30 The role of absolute income similar results emerge also in single-country cross-section studies: using a survey on health and income in Britain, Wilkinson (1992) finds that several health indicators increase rapidly as income rises from the lowest to the middle classes of the income distribution, while no further health improvements occur at higher income levels similarly, using data from the National Longitudinal Mortality Survey in the USA, Deaton (2001) observes that the male (age adjusted) probability of death decreases rapidly as income grows at low family income levels, while it flattens out at high family income levels

31. 31 Cross-country relationship between per capita GDP and health (2000) Source: World Bank

32. 32 Happiness and health: the relationship with p.c. GDP

33. 33 The role of relative income The concave relation between Y and H implies: ↓ income inequality → ↑ the average population health In recent years several studies have argued that: Y R, independently of Y, has a crucial influence on health: ( 14 ) H = φ 2 ( Y R ), φ’ 2 > 0, where Y R is the relative income that may be measured in different ways: “relative income hypothesis” After a threshold of about $5,000 p. y. ($4,000 in Cornia et al, 2007): income inequality emerges as a crucial determinant of health even by controlling for other factors including absolute income

34. 34 The role of relative income In a pioneering cross-country study on a data set referring to nine OECD countries, Wilkinson (1992) found evidence of a strong correlation between life expectancy and inequality that is argued to be independent of absolute income Similar results emerged in several other studies that focused on different groups of countries and periods of time (see Borghesi and Vercelli, 2007) Also at the local level a close relationship emerged between inequality and mortality rates in the US states (Kaplan et al., 1996) Among the 282 US metropolitan areas the ones with the most unequal income distribution turned out to have the highest mortality rates (Lynch et al, 1998)

35. 35 The role of relative income Income inequality → relative deprivation: people compare themselves with reference groups and suffer from chronic stress and depression when comparison is unfavorable (Deaton, 2001) → the most egalitarian developed countries have the highest life expectancy A close relationship between income inequality and mortality rates emerges also in time series referring to single countries (Russia, UK) Physiological mechanism: activation of hormones that affect the cardiovascular and immune systems (Wilkinson, 2002, pp.15-16) → similar to economic “short-termism”

36. 36 The role of other social factors Health is strongly affected by a series of social factors connected with relative income but in part independent of it (see, e.g., Ryff and Singer, 2000) First, relational goods R: ( 15 ) H = φ 3 ( R ), φ 3 > 0. For example, stress-related mortality of married people is significantly lower than of widowed, divorced and single people (Cornia et al., 2007) In order to withstand physiological and psychological shocks, a crucial role is played by the intensity and quality of social relations, or what is often called “social capital” (social trust, hostility) -the lack of social trust was shown to be positively and significantly correlated with mortality in the USA (Kawachi et al., 1997) -analogously hostility is positively correlated with mortality (Williams et al.,1995)

37. 37 The role of other social factors A fundamental determinant of health is unemployment U: ( 19 ) H = φ 7 ( U ),φ 7 < 0. Loss of employment, especially if unanticipated and in the absence of a public safety net, heavily affects health (Cornia et al., 2007) Unemployment implies not only a lower income but also a loss of social status and self-respect (Sen, 1997) Another crucial determinant of health is education: ( 18 ) H = φ 6 ( I ),φ’ 6 0, the relationship between education and health is strongly non linear as health increases sharply by moving from primary to secondary education and above the level of education of mothers is a major determinant of health of all family members, especially the children (Hertzman 1995)

38. 38 The influence of environmental externalities and happiness Bad environmental conditions are directly responsible for about 25% of all cases of preventable illness all over the world (WHO, 1997) we have thus to consider negative environmental externalities E : ( 16 ) H = φ 4 ( E ),φ’ 4 < 0, from atmospheric, water and soil pollution Finally, subjective happiness is a crucial determinant of health: ( 17 ) H = φ 5 ( W* ), φ’ 5 > 0. -length of life (Palmore, 1969) e.g. { -heart disease (Sales and House, 1971) This closes the feed-back between reported happiness and objective health

39. 39 Other factors: genetic factors and medical technology Progress in medical-pharmaceutical technology T played a crucial role in the progressive improvement of the indexes of health in the last century: ( 17 ) H = φ 5 ( T ),φ’ 5 > 0. In order to get insights on the other determinants of health we have to study the deviations from this common trend due to specific factors Also genetic factors G may have a sizable impact on health: ( 20 ) H = φ 8 ( G ). mutation of genes two factors { polygenic inheritance: bias towards specific chronic diseases

40. 40 The main determinants of health The main determinants of health considered in the epidemiological literature do not exclude each other Health Function:H = Φ (Y, Y R, G, R, E, I, U, T, W*) where we assume that the partial derivatives for each factor have the same signs already discussed The capital letters that appear in the argument of the function Φ may be considered as vectors of variables each of which has a flow dimension and a stock dimension

41. 41 Determinants of health and determinants of happiness: a comparative analysis Although the literature on the determinants of happiness and health developed quite independently, they pointed out about the same list of main determinants Happiness function W* = F (Y, Y R, Y – Y*, G, R, E, I, U, H) Health function H = Φ (Y, Y R, G, R, E, I, U, T, W*) The only substantial differences: the absence in the health function of frustrated income aspirations (in the case of health frustration matter but less focused on income; Marmot, 2005) the presence of the health technology (general technology matters for happiness through income)

42. 42 Further determinant of happiness Leisure: the necessary disaggregation of leisure activities sends back to factors already considered such as social relations, absolute and relative income, health Inflation: we have doubt about the genuine independence of its influence as inflation acts mainly through modifications of absolute and relative income and disruption of social relations Institutional factors: this line of research is certainly stimulating and inspiring but it is not yet clear to what extent the influence of institutions on happiness are independent of their impact on factors already considered such as social relations.

43. 43 The second happiness paradox: the ageing population ↑life expectancy → ageing of pop. → ↓ self-r. health →↓ subjective happiness - self-reported health declines with age empirical evidence { -the importance of health increases with age Happiness declines from youth to working age but increases again, though moderately, since around the age of retirement (Frey-Stutzer, 2002) this may be related to: -increasing free time of senior people -decreasing responsibilities -downsizing of aspirations -progressive natural selection of the healthier and happier individuals The negative effect exerted by ageing on health and happiness is more than compensated by other factors correlated with age

44. 44 The second happiness paradox: the shortcomings of general objective health indexes the comprehensive objective health indexes do not capture all the effects of health on happiness In particular there are specific health indexes strictly correlated with subjective unhappiness, such as frequency of depression and suicides, that increased progressively in the post-war period Subjective health and happiness depend not only on the length of life but crucially also on its quality: a long life is not necessarily a happy life this is well known since long: e.g. “STRULDBRUGS”, Swift, 1726)

45. 45 Policy implications: the first paradox The twin paradoxes are not genuine paradoxes: many convincing explanations (over-determination may be solved through more sophisticated statistical methods) First Paradox: the real paradox is that policy makers still focus on GDP and its growth (Bhagwati, 2004; B.Friedman, 2005) We know since long that GDP is an inadequate index of well-being: -the exhaustion of natural resources Not registered {-the deterioration of natural and social capital -environmental and social externalities -relational goods Unduly registered -defensive expenditure

46. 46 Policy implications: the first paradox Alternative indexes that aimed to correct the shortcomings: NEW (Net Economic Welfare) suggested by Nordhaus and Tobin (1973) has grown more slowly than GDP in the post-war period in industrial countries ISEW (Index of Sustainable Economic Welfare) by Daly and Cobb (1989): while the US GNP increased from 1951 to 1986 at an average rate of 1.90%, the ISEW grew much less (0.53%) and became negative since the early 1970s → the alternative indexes of well-being focus on the same determinants considered in the literature on happiness

47. 47 Policy implications: the second paradox Also the second happiness paradox is basically explained by the inadequacy of the general indexes of objective health there are specific health indexes strictly correlated with subjective unhappiness, such as frequency of depression and suicides, that increased progressively in the post-war period Self-reported health depends not only on the length of life but also on their quality: -a long life is not necessarily a happy life -this is well known since long: e.g. the immortal “STRULDBRUGS” are very unhappy (Swift, 1726) The quantitative indexes of health should be corrected to take account of the quality of life (quality-adjusted indexes of health should be systematically computed solving unsettled methodological problems) (Zeckhauser-Shepard, 2006)

48. 48 Policy implications We have to focus both analysis and policy not on GDP but on indexes of sustainable development that take account of the social, environmental, psychological and health factors that determine human well-being (or happiness) Analysis of happiness and health determinants suggest similar policy measures: ↓ poverty ↓ inequality ↓ unemployment and precarious jobs ↑ investment in education ↑ investment in art and creative activities ↑ investment in environmental and social capital health All these policy measures are likely to improve { of citizens well-being