Patterns and trends in quality of life:A ‘synthesis’ approach

Richard EckersleyNational Centre for Epidemiology and Population Health

The Australian National Universityrichard.eckersley@anu.edu.au

http://nceph.anu.edu.au

‘The central purpose of a nation should be to improve the quality of life of its people. It follows that the primary function of public policy should be to improve quality of life; it is an important means to that end.’

Source: Eckersley 2005

Two views of progress

Material progress:• Economic growth is paramount.• Aims to increase standard of living.• Wealth increases personal freedom and choice, and

provides resources to meet social goals. Sustainable development:

• Economic growth is not paramount.• Aims to improve and maintain quality of life. • Seeks balance and integration of social, economic and

environmental goals.

Bjorn Lomborg: The Skeptical Environmentalist

‘…mankind’s lot has improved vastly in every significant measurable field and it is likely to continue to do so…children born today – in both the industrialised world and developing countries – will live longer and be healthier, they will get more food, a better education, a higher standard of living, more leisure time and far more possibilities – without the global environment being destroyed.’

Lomborg, 2001, p 351-2

Synthesis

Synthesis is the drawing together and critical analysis, by individuals or groups, of knowledge from different fields, disciplines and sciences (and the humanities and arts) to address social and scientific questions.

Conceptual issues

Research seeks to improve understanding of the world by creating new knowledge; synthesis creates new understanding by combining existing knowledge.

Research seeks precision in the detail; synthesis strives for coherence in overall picture.

Conceptual issues

Challenges Occam’s Razor: ‘entities must not be unnecessarily multiplied’.

Questions concept of single reality: imposing story on world distorts its reality.

Dispenses with scientific certainty or ‘proof’; all positions provisional.

Replaces notions of simple cause-and-effect relationships with more complex patterns of interaction.

Strengths - synthesis:

Adds value to existing specialised knowledge. Reduces disciplinary biases. Transcends interdisciplinary tensions. Improves researchers’ knowledge outside

specialisation. Generates new research questions. Is especially useful in examining complex systems. Enhances application of knowledge.

Applications – synthesis:

Improves fit between research and policy. Strengthens links between research and advocacy. Is appropriate for the increasing scale and

magnitude of social problems, and hence of the necessary responses.

Suits the complex, diffuse processes of social change.

Systems thinking

If you optimise one aspect of a system without paying attention to the rest, you will sub-optimise overall.

Tampering without understanding in systems often produces unanticipated side-effects.

All systems are determined by the central purpose they are designed to serve; change the purpose, and the whole system changes.

Theoretical basis: biological

Evolutionary health principle:

‘…if an animal is removed from its natural habitat, or if the environment changes…it is likely the animal will be less adapted to the new conditions and will show signs of physiological or behavioural maladjustment.’

Source: Boyden 2004

‘[Critical social science] says that people are constrained by the material conditions, cultural context, and historical conditions in which they find themselves .…[and which] limit their options and shape their beliefs and behaviour.…

[But] people are not locked into an inevitable set of structures, relationships and laws. People can develop new meanings or ways of seeing that enable them to change these….people do shape their destiny but not under conditions of their own choosing.’

Source: Neuman 1994

Theoretical basis: social

Spanning disciplinary cultures

In current multidisciplinary project on young people’s potential and wellbeing, we could not agree on:

Whether trends in wellbeing can be generalised. Extent to which different findings can be reconciled. If potential and wellbeing are linked, or separate. The relative importance of social influences and

individual capacities. The relative influence of social and biological factors in

shaping wellbeing.

Source: Eckersley, Wierenga, Wyn (in press)

Is life getting better – or worse?

Streams of evidence: Patterns and trends in health, happiness Trends in mental health and wellbeing Public attitudes on QoL Effects of cultural factors Winds of change?

Life expectancy by income

Source: Inglehart, 2000

Subjective wellbeing by income

Source: Inglehart, 2000

Income and happinessUSA, 1956-98

Source: Myers and Diener, 1996

Satisfaction with life and finances, by income

4045505560657075808590

Personalwellbeing

Standardof living

Financialsecurity

Savings &investment

<$15K$15-30K$30-60K$60-90K$90-120K>$120K

Health-related QoL in USA

‘…during 1993-2001, the perceived physical and mental health of US adults worsened….Older adults reported more physically unhealthy days and activity limitation days, whereas younger adults reported more mentally unhealthy days.’

MMWR, 28 Oct 2005

Growing generation gap in malaiseUSA, 1975-1999

Source: Putnam 2000

Lifetime prevalence of depression,by birth cohort, USA

Source: Kessler et al 2003

Trends in conduct problems:age 15-16, UK, 1974-99

0.25

0.5

0.75

1

1.25

1.5

1974 1986 1999

mean

co

nd

uct sco

re

Boys

Girls

Source: Collishaw et al 2004

Mental health in America

Survey of mental disorders, >9,000 Americans, aged 18 and over, 2001-2003, found:

Lifetime prevalence: 46% 12-month prevalence: 26% Those aged 18-29 have lifetime risk 4 times that of

those 60 and over.

Source: Kessler et al 2005

Flourishing or languishing in the US?

1995 survey of >3,000 Americans, aged 25-74. Mental health as a continuum, ‘syndrome of symptoms

of positive feelings and positive functioning’. 26% ‘languishing’ or depressed, or both. 57% neither mentally ill nor fully healthy. 17% ‘flourishing’. Younger people more likely to be languishing.

Source: Keyes 2002

Satisfaction vs health: ATS

Large, longitudinal study of Victorian children. At age 19-20:

Over 80% satisfied with their lives – including lifestyle, work or study, relationships with parents and friends, accomplishments and self-perceptions.

50% experiencing one or more problems associated with depression, anxiety, anti-social behaviour and alcohol use.

Source: Smart & Sanson 2005

Declining quality of life

Average satisfaction with national conditions rates at about 60 per cent, 15 percentage points below personal satisfaction.

Twice as many think QoL is getting worse as think it is getting better.

Reasons for decline (in order): • Too much greed and consumerism• Breakdown in community and social life• Too much pressure on families, parents and marriages• Falling living standards• Employers demanding too much

Source: Eckersley 2000; Pusey 1998

Perceptions of QoL - 1

‘Against (a) background of general anxiety about ‘the state of the world’ and the relentlessness of ‘bad news’…we are disturbed by the many signs of ‘degeneration’ in the Australian way of life.’

‘…We are “tending our own patch” and becoming absorbed in our own concerns….our focus has narrowed to an extent that allows us to exclude some of the “nasty stuff” which has become too unpalatable to think about.’

Hugh MackayMind & Mood, 1998, 2003

Perceptions of QoL - 2

‘Personal aspirations and aspirations for the nation appeared to be largely unrelated….Few participants believed that Australia would become their ideal society (and) they had distanced themselves from this goal….they manage, or control, their reactions to social issues so they can maintain a comfortable and self-focused life.’

Values and Civic Behaviour in Australia Brotherhood of St Laurence, 2002.

Perceptions of QoL - 3

‘…we seem to be lurching from one difficulty to another with the prospect of a serious crisis emerging…Who to blame? Repeatedly, the finger is pointed at politicians who seem to have…neglected investment in Australia’s future. “Short-term thinking” is one of the most common accusations levelled at political leaders.’

Mind & MoodIpsos Mackay ReportJune 2005

And the future?

‘If the mood is a bit depressed at present, then it turns even bleaker when Australians contemplate the future. They fear further degradation in our quality of life – through excessive development, excessive materialism, excessive reliance on technology, excessive speed.’

Hugh MackayMind & Mood, 2001

Materialism and wellbeing

Materialism:• correlated with dissatisfaction, depression, anxiety,

anger, social alienation and poorer personal relationships.

• ‘extrinsic goals’ such as fame, fortune, glamour associated with lower overall wellbeing, compared to ‘intrinsic goals’ of intimacy, personal growth, contributing to community.

• The more materialistic our values, the poorer our quality of life.

Individualism and wellbeing

Individualism:• Increased risk, uncertainty, insecurity.• Lack of clear frames of reference.• Higher expectations.• Onus of success rests with individual.• ‘Tyranny’ of excessive choice.• Reduced social support and personal control

Meaning or money?The goals of US college students

Source: Myers 2004

‘The gap between “what I believe in” and “how I live” is uncomfortably wide for many of us and we are looking for ways to narrow it….We want to express our values more clearly and live in ways that make us feel better about ourselves….to feel that our lives express who we are and that we are living in harmony with the values we claim to espouse.’

Hugh MackayThe Wrap: Understanding where we are now and where we’ve come from, 2003

‘In my work, I meet more and more business people who secretly despise the system they are part of, who deplore the lack of corporate values, who know their products and services are of little consequence, and who would love to be out of it and do something more meaningful.’

…But they feel trapped in their expensive lifestyles. ‘So they don their suit and tie and serve the system, but they glance more often out of the window. The spirit is stirring in such people, and they are increasingly asking themselves tough questions.’

Sir John WhitmoreResurgence, 2005

Sustainability and health:a new bottom line?

…understanding the social basis of health and wellbeing contributes to working towards sustainability. It allows us to integrate different priorities by measuring them against a common goal or benchmark – improving human health and wellbeing.

…making health, not wealth, the bottom line of progress takes us deeper into questions of quality of life: how well societies provide the conditions that are conducive to total wellbeing – physical, mental, social, spiritual.