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

1. Patterns and trends in quality of life:A ‘synthesis’ approach Richard Eckersley National Centre for Epidemiology and Population Health The Australian National University richard.eckersley@anu.edu.au http://nceph.anu.edu.au

2. ‘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

3. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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

12. Theoretical basis: social ‘[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

13. 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)

14. 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?

15. Life expectancy by income Source: Inglehart, 2000

16. Subjective wellbeing by income Source: Inglehart, 2000

17. Income and happinessUSA, 1956-98 Source: Myers and Diener, 1996

18. 90 85 80 75 <$15K 70 $15-30K 65 $30-60K 60 $60-90K 55 $90-120K 50 >$120K 45 40 Personal Standard Financial Savings & wellbeing of living security investment Satisfaction with life and finances, by income

19. 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

20. Growing generation gap in malaiseUSA, 1975-1999 Source: Putnam 2000

21. Lifetime prevalence of depression,by birth cohort, USA Source: Kessler et al 2003

22. Trends in conduct problems:age 15-16, UK, 1974-99 Source: Collishaw et al 2004

23. 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

24. 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

25. 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

26. 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

27. 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 Mackay Mind & Mood, 1998, 2003

28. 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.

29. 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 & Mood Ipsos Mackay Report June 2005

30. 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 Mackay Mind & Mood, 2001

31. 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.

32. 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

33. Meaning or money?The goals of US college students Source: Myers 2004

34. ‘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 Mackay The Wrap: Understanding where we are now and where we’ve come from, 2003

35. ‘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 Whitmore Resurgence, 2005

36. 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.