Happiness in OlderAdulthoodWellbeing, Health & life satisfactionPaul Andrew Bourne
Happiness in OlderAdulthoodWellbeing, Health & life satisfactionPaul Andrew BourneSocio-Medical Research InstituteKingston...
©Paul A. Bourne, 2011First Published in Jamaica, 2011 byPaul Andrew Bourne66 Long Wall DriveStony Hill,Kingston 9,St. Andr...
PrefaceDr. George Engel has expanded the biomedical model in the 1960s, in which he emphasizes theimportance of socioecono...
elderly are people who are highly vulnerability to diseases, loneliness, fear, frustration,depression and frailty, and so ...
AcknowledgementThe completion of this book is owed to a number of people who offered their time, cognitiveskills and data ...
Table of ContentsPreface                                                                                     iiiAcknowledg...
Chapter 9                                                                                  230Comparative Analysis of Heal...
Introduction                                         Paul A. BourneHuman AgeingThe Caribbean has been identified as the mo...
Figure 6.1: Percentage change in elderly population by five year age groups, 1991-2001.              Global Issues on Agei...
the health status of people; as lived years is an indicator of living beyond certain healthconditions. Thus, health and we...
2005c, xxi). As early as 2005, some countries in the Caribbean had reached replacement levelfertility. Total fertility per...
total population for the year in question, the cumulated effect of this over a long period is equallyaiding in the explana...
phenomenon, Lawson‟s monograph adequately provides a summative position on the matter.She noted that:       Actually, it i...
Demographic Trends: JamaicaIn 2007, the annual growth rate for the Jamaican population since 1996 has always been less tha...
people) - as beginning at chronological age of 65 years and older, and not an individual who is60 years of age. Up to 1992...
given the definition chosen to measure health status. There is no published works on the generalwellbeing of the Jamaican ...
Life expectancy        Does the increase in life expectancy means a better quality of life or subjective wellbeingof elder...
definition of health and/or wellbeing, particularly among the elderly population because of thecomposition of this cohort ...
expectancy and mortality are among measures that are said to be limited in scope and justify theuse of subjective indexes ...
the aforementioned economists used happiness to evaluate subjective wellbeing as they acceptedthat happiness is an indicat...
2002).         Using data for developing countries, Camfield noted that subjective wellbeing constitutesthe existence of p...
conditions, social support and marital status were correlated with happiness. Some of these (i.e.,employment status, marit...
Clark AE, Frijters P, Shields MA. Income and happiness: evidence, explanations and economicimplication. Working paper No. ...
Easterlin, R. (1996). Growth Triumphant: The Twenty-first Century in Historical Perspective,Ann Arbor, MI: University of M...
Katz, D.L., Brunner, R.L., St. Jeor, S.T. et al. Dietary fat consumption in a cohort of Americanadults, 1985-1991: covaria...
Ng YK. Happiness Surveys: Some Comparability Issues and an Exploratory Survey Based onJust Perceivable Increments. Social ...
Summers R, Heston A. (1995). Standard of Living: SLPOP An Alternative Measure of NationsCurrent Material Well-Being. CICUP...
Happiness in OlderAdulthoodWellbeing, Health & life satisfaction                                   xxviii
Chapter 1Happiness among Older Men in Jamaica: Is it a health issue?              Paul Andrew Bourne, Chloe Morris & Denis...
2000; Huppert, 2006; Brannon & Feist, 2007) goes beyond the mere positive state of anindividual to physical health and soc...
happiness) than that of those who were lower wealthy (earned less than 10 million US annually)(Diener, Horwitz & Emmon, 19...
Human emotions are the coalesced of not only positive conditions but also negativefactors (Watson et al. 1999). Hence, dep...
and life satisfaction) (Diener, 1984; Easterlin, 2003; Diener, Larson, Levine & Emmon, 1999).Simply put, well-being is sub...
good predictors of each other. This paper examined whether (1) happiness is a function of healthstatus; (2) happiness is a...
subsequently selected with the probability of selection being proportional to population size(Table 1.1).       The enumer...
55+ years as a resident and he was not at home a call-back form was left indicating a proposedtime that the interviewer wo...
(emotional) from cognitive (life satisfaction). Life satisfaction is a binary variable, where 1=good-to-excellent self-rep...
ADL. This is a functional status of 12 events. These include eating; bathing; dressing; usingtoilet; shopping; preparing m...
predicted by happiness; what are the demographic factors that can predict either happiness orhealth status of elderly men ...
2006), Bourne and McGrowder‘s (2009) health status function as they allow for the analysis ofcurrent study.        Because...
0.001); and, income and education (correlation coefficient =0.356, p<0.001); employment andeducation category (correlation...
Of the sample (n=2,000), 24.0% indicated that they were rarely happy; 40.5% indicatedsometimes; 31.0% mentioned most times...
p<0.001), social support (95% CI: 0.016, 1.315, p=0.045) and area of residence (95% CI: -0.959,-0.085, p=0.019) (Table 1.4...
Easterlin, 2003; Brickman, Coates & Janoff-Bulman 1978; Stutzer & Frey 2003; Frey &Stutzer 2002a, 2002b; Blanchflower & Os...
always happy (approximately 5 out of every 100) compared to 24 out of every 100 whoclaimed they were rarely happy. Embedde...
being always happy and 30 out of 100 reported being happy most of the time. Like theliterature this paper concurs that the...
The literature has provided a plethora of studies that showed the correlation betweenhappiness and health status; but this...
that enhances economic wellbeing‖ (Becker, Philipson & Soares, 2004, 1) and that wellbeingdepends on both the quality and ...
health status which is keeping with literature (Grossman, 1972; Smith & Kington, 1997;Hambleton et al., 2005), but departs...
prioritizing of care and resources. Generally though, these should be seen as rough guidelines forthe assessment of a pati...
Hence, Functional status is the summation of ADL and IADL. Cohen & Holliday1 statedthat correlation can be low/weak (0–0.3...
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  1. 1. Happiness in OlderAdulthoodWellbeing, Health & life satisfactionPaul Andrew Bourne
  2. 2. Happiness in OlderAdulthoodWellbeing, Health & life satisfactionPaul Andrew BourneSocio-Medical Research InstituteKingston, Jamaica i
  3. 3. ©Paul A. Bourne, 2011First Published in Jamaica, 2011 byPaul Andrew Bourne66 Long Wall DriveStony Hill,Kingston 9,St. AndrewNational Library of Jamaica Cataloguing DataHappiness in Older Adulthood: Illness, Health & lifesatisfactionIncludes indexISBNBourne, Paul AndrewAll rights reserved. Published, 2011Covers designed by Paul Andrew BourneAll the photographs were taken by Paul A. BourneSocio-Medical Research Institute, 66 Long Wall Drive, Stony Hill,Kingston 9, Kingston, Jamaica ii
  4. 4. PrefaceDr. George Engel has expanded the biomedical model in the 1960s, in which he emphasizes theimportance of socioeconomic and psychological conditions in treating mentally ill patients, andthat this extended beyond this group to all patients. Other scholars have used happiness, lifesatisfaction, self-rated health and quality of life to evaluate health instead of the traditionalabsence of illness. Happiness, life satisfaction and health status are as close as possible to theideal definition of health as offered by the WHO. However, these are infrequently used in healthdiscourse, particularly among those in older adulthood in Jamaica. Understanding and planning for aged Jamaicans cannot rely on only illness, self-ratedhealth and mortality. Since 1989, the Statistical Institute of Jamaica and the Planning Institute ofJamaica have been collecting data on Jamaicans to guide policy formulation. Self-reportedillness is usually collected and this is used to assess the health status of the population. The firsttime that self-rated health status was collected from Jamaicans was in 2007. Therefore, planningfor the health of the population was primarily based on the traditional perspective (biomedicalmodel or the germ theory). Despite Dr. George Engel‟s proposition of the biopsychosocial model since the 1950s,the Planning Institute of Jamaica and the Statistical Institute of Jamaica have not seen it fitting tocollect data on different subjective indices of health such as happiness, life satisfaction, qualityof life and self-rated health status all at once (up to 2007). This means that researchers who usethe data from the aforementioned institutes as well the institutions cannot verify the validity ofdifferent subjective indices as well as whether there are differences among the measures. The iii
  5. 5. elderly are people who are highly vulnerability to diseases, loneliness, fear, frustration,depression and frailty, and so planning for their health cannot limit itself to health conditions andself-reported health. This is moreso on the premise that we do not know the coverage ofexogenous health, life satisfaction, wellbeing and illness. This book intends to commence a discourse on health that is expansive from the absenceof illness to include 1) self-rated health, 2) wellbeing, 3) life satisfaction, and 4) happiness.Happiness in Older Adulthood: Wellbeing, Health & life satisfaction comprises of 15 chapters,and the author intends for this to be a thrust in expanding the construct of health in datacollection as well as understanding peoples‟ perspective on health. iv
  6. 6. AcknowledgementThe completion of this book is owed to a number of people who offered their time, cognitiveskills and data availability. In keeping with the aforementioned issues, I am grateful, pleased andindebted to the following people and/or institutions – including relatives such as my aged mother(Ms. Janet “Medda” Green), brother (Mr. Kervin Roger Smith), niece (Janet Smith), nephew(Kevin Smith). And, 1) Ms. Neva South-Bourne for her advice in penning my ideas, 2) Mrs.Evadney Bourne, my wife, for support, understanding and patience when things were difficultand surmountable at times, 3) all my co-writers, 4) God, for his wisdom, 5) the Data Bank in SirArthur Lewis Institute of Social and Economic Studies, the University of the West Indies, Mona,Jamaica for making the dataset available for use in this study, and 6) all my associates (includingbest friends) whose love, support and encouragement provided the impetus that I drew from tocomplete this project. I would also like to single out the different journals that gave me thepermission to reproduce some of the chapters – including North American North of MedicalSciences, and Current Research in Social Sciences. v
  7. 7. Table of ContentsPreface iiiAcknowledgement vIntroduction viiiChapter 1 1Happiness among Older Men in Jamaica: Is it a health issue?Chapter 2 33Happiness, life satisfaction and health status in a Caribbean nation: Using a cross-sectionalsurveyChapter 3 66A cross-sectional survey of the health status, life satisfaction and happiness of older men inJamaica - associations between questionnaire scoresChapter 4 89Good Health Status of Older and Oldest Elderly in Jamaica: Are there differences between ruraland urban areas?Chapter 5 118Decomposing Mortality Rates and Examining Health Status of the Elderly in JamaicaChapter 6 149An Epidemiological Transition of Health Conditions, and Health Status of the Old-Old-To-Oldest-Old in Jamaica: A comparative analysisChapter 7 179Health status of patients with self-reported chronic diseases in JamaicaChapter 8 205The changing faces of diabetes, hypertension and arthritis in a Caribbean population vi
  8. 8. Chapter 9 230Comparative Analysis of Health Status of men 60+ years and men 73+ years in Jamaica: Arethere differences across municipalities?Chapter 10 260Health in Older AdulthoodChapter 11 285Self-rated Wellbeing of Elderly JamaicansChapter 12 319Wellbeing in Older AdulthoodChapter 13 352Social Determinants of Subjective Wellbeing of Elderly in JamaicaChapter 14 393A conceptual framework of wellbeing in some Western nationsChapter 15 414The wellbeing discourse vii
  9. 9. Introduction Paul A. BourneHuman AgeingThe Caribbean has been identified as the most rapidly ageing region of the world. During the1960 -1995 period, there was a 76.8% increase in the elderly population (United Nations, 2005;Bourne, 2010). The mean growth rate in the elderly population was 5.3%, which was recordedfor the period 1995-2000. The Caribbean elderly as a percentage of total population has beenprojected to reach about 15% by 2020, an almost four-fold increase over the 1950 figure of 4.3%(United Nations, 2005; PAHO, 1997). Is this any different in Jamaica? Jamaica‟s elderly population (ages 60+ years) has increased significantly since the mid1960s (Eldemire, 1997; Bourne, 2010) indicating increased life expectancy. Life expectancy atbirth for males between 1879 and 1882 was 37.02 years and for females it was 39.80 years(Bourne, 2010; Statistical Institute of Jamaica, 2010). Between 2002 and 2004 males areexpected to live for 71.26 years and females 77.07 years (Appendix I), which is a clear indicationof demographic ageing of the Jamaican population. Statistics revealed that over 10% ofJamaicans were older than 60 years in 2009 (Bourne, 2010; Statistical Institute of Jamaica,2010). An examination of 5-year age cohorts of the elderly population in Jamaica revealed that85+ years is the fastest growing from the general elderly population (Figure 6.1). Thus, thesociety is experiencing an oldest-old population explosion never before seen in its history, andthis point to the gains made in public health measures, and improvements in the standard ofliving of the general populace since the 20th century. viii
  10. 10. Figure 6.1: Percentage change in elderly population by five year age groups, 1991-2001. Global Issues on Ageing Even though, the ageing process is lifelong and though this may be constructed withineach society differently, many decades have elapsed since Galton‟s study on the health status ofpeople. Despite changes in human development and the shifts in world population towarddemographic ageing – people living beyond 65 years (see ILO 2000; Wise 1997), the issues ofthe aged and their health status have not taken front stage on the radar of demographers unlikemany other demographic issues. This is equally true for many Caribbean nations. Demographershave spent years studying mortality, and this has been used as an indicator of life expectancysuch as the Coale and Demeny Model life tables and by extension health status. Life expectancy,on the other hand, has always been viewed as the avenue through which demographers evaluate ix
  11. 11. the health status of people; as lived years is an indicator of living beyond certain healthconditions. Thus, health and wellbeing are tied to mortality patterns, which is rightfully so butthis approach gives little emphasis on conditions that are likely to decrease morbidity andthereby reduce mortality. With this being the case, demographers have consumed more timeassessing mortality and life expectancy and morbidity because of their close approximation ofwellbeing (or health status), and this is similarly the case for Caribbean demographers. Caribbean Demographic TrendsDemographic development in the Caribbean has taken a similar path like the rest of the world(STATIN 2006; United Nations 2005c). Over the years, the movement as being such thatmortality and fertility has been declining, and the population 60 years and older has beenincreasing proportionately more than percentage who are children. Jamaica as well as the rest ofthe Caribbean and Latin America is said to be at the second stage of the demographic transitionmodel. (STATIN 2007). Several Caribbean countries such as Jamaica, Cuba, Barbados, Trinidadand Tobago could be said to be approaching the third stage of the transition. The demographictransition refers to the changes in population growth that is attributable to transition from high tolower levels of fertility and mortality. So for countries to be at the third stage of the transition,they would be experiencing population ageing due to persistently low fertility, even lowermortality. Like the rest of the world, these changes also brought improvement in livingconditions, advancement in medicine and improvement in health care and discovery and use offamily planning measures. Statistics revealed that the total fertility from 1970 to 1975 for the world was 4.49 andfrom 2000 to 2005, it fell to 2.65; whereas in Latin America and the Caribbean between 1970and 1975, it was 5.05 and this was further reduced to 2.55 from 2000 to 2005 (United Nations x
  12. 12. 2005c, xxi). As early as 2005, some countries in the Caribbean had reached replacement levelfertility. Total fertility per woman in the Bahamas reached is 2.2, Barbados 1.5, Jamaica 1.93(Demographic Statistics, 2006) and Trinidad and Tobago, 1.6 (United Nations 2006, 87-89).Barbados, Jamaican and the twin islands of Trinidad and Tobago are currently experiencingbelow replacement level fertility (Total Fertility Rate – TFR of 2.1 – United Nations 2000, 4).Since 2005, this has become a demographic reality for many developed nations. The exampleshere are some countries in Eastern Europe (TFR, 1.3) Southern Europe (TFR, 1.4) and NorthernEurope (TFR, 1.7) and the United States, 2.0 (United Nations 2007; 2005c, xxi). In addition,mortality in the Caribbean has been falling coupled with increased life expectancies that arecomparable with those in developed nations, beyond 71 years. (United Nations 2005c, xxii),which according to Rowland (2003, 18) are components within the demographic transitionmodel. Return migration also plays a significant role in the ageing of the Caribbean‟s population.Jamaica, like Trinidad and Tobago, and Barbados are experiencing the return of some of thosepeople who migrated in the 1950s-1960s, who are now elderly. In addition to return migration ofaged Jamaicans, the continuously high emigration of young people (Caribbean Food andNutrition Institute 1999) has further exasperated population ageing in the country. From the datareported in Table 1.14, at least 65 percent of the net migration is accounted for by ages less than30 years. Even though the negative net migration of Jamaicans has been reduced by more one-half since the last twenty years (1988-2006), the pattern of those who emigrate has remained thesame. This explains the return migration of elderly Jamaicans within the context of net outflowat the younger ages which is depletion of the human resources of the country. Although the netmigration outflow of migrants from Jamaica, for each year, has never surpassed 1 percent of the xi
  13. 13. total population for the year in question, the cumulated effect of this over a long period is equallyaiding in the explanation of the nation‟s ageing population. Therefore, many Caribbean countries began experiencing population ageing since asearly as in the 1950s and/or the 1960s. In 1950, 8.5 percent of Barbados‟ population was 60years and older; Suriname, 8.4, which was higher than 6.9 percent for the Caribbean and 8.2percent for world. Jamaica‟s population ageing, on the other hand, did not begin until the 1960s.Using the growth rate of the population for different age groups as an indicator of ageingpopulation, Jamaica‟s population 65 years and over doubled from 1960-1970 and 1943-1960,which only occurred in this age group. However, in the Caribbean, the matter has recently begunto be of concern (Caribbean Food and Nutrition Institute 1999, 192, 217). The reason for thisthrust is because the rate of increase of this age cohort compared to the other age cohort. By2050, the population of people 60 years and older in some Caribbean nations will more thandouble, while the young population (ages 0 to 14 years) would have been reduced by one-half. Some developing states such as Barbados, and Trinidad and Tobago, and Jamaica arecurrently experiencing a shift toward a population age. In 2007, all three Caribbean nations hadin excess of 10 percentages of their population ages 60 years and older. Barbados, on the otherhand, has the largest percentage of person ≥ 60 years (13.2%). The issue of the ageing of apopulation cannot be simply overlooked and has far reaching implication for labour supply,pension system, health care facilities, products demanded, mortality, morbidity, and publicexpenditure among other events. Ageing is not simply about mortality, fertility and/ormorbidity. The phenomenon is about people, their environment and how they must coexist inorder to survive. Ageing, therefore, is here to stay. In order to grasp the complexities of this xii
  14. 14. phenomenon, Lawson‟s monograph adequately provides a summative position on the matter.She noted that: Actually, it is predicted (U.N) that developing countries are likely to have an oldergeneration crisis about the year 2030, that is about the same time as most developed countries(Lawson 1996, 1). This demographic transition is not only promulgated by Lawson, but was argued byCowgill (1983) who believed that during the next half-century (2050), there is strong possibilitythat this transition will be an issue for some developing nations. This implies that populationageing which has been the experience of many developed nations (Gavrilov and Heuveline 2003;Marcoux 2001; Lawson 1996) will be a reality for some lesser developed countries and moredeveloping regions in the future. Seniors cannot be neglected as they will constitute an increasingly larger percentage oftotal population and sub-populations in different regions than in previous centuries (UN 2005;WHO 2005; Chou 2005; STATIN 2004; Apt 1999; Caribbean Food and Nutrition Institute1999a; Randal and German 1999; US Census Bureau 1998; Eldemire 1995, 1994; EuropeanFoundation for the Improvement of Living and Working Conditions 1993; Mesfin et al. 1987;Grell, 1987; National Health and Welfare 1982). According to Randal and German (1999), thenumber of aged persons living in developing countries will more than double by 2025, „reaching850 million‟. The Caribbean is not different as according to Grell (1987), the English-speakingCaribbean from the 1970 census revealed that between 8.8 and 9.8 percent of the populace were60 years and older. A matter Lawson noted began in Jamaica since the 1900s (Lawson 1996, 1-37). To be more specific population ageing in Jamaica, began in the 1960s. xiii
  15. 15. Demographic Trends: JamaicaIn 2007, the annual growth rate for the Jamaican population since 1996 has always been less than1.0%, and the figure for 2006 is estimated to be 0.5% (Demographic Statistics 2006) which islower than the global average of 1.2 percent (CIA 2007). With regard to globe‟s population,10.4% of individuals are 60 years or older (United Nations 2005c). Jamaica‟s elderly populationin 2005 rose marginally by 0.3% to 10.7% in 2006 (PIOJ 2007). The United Nations data showthat 8% of people in the developing nations are 60 years or over (United Nations 2005c), whichis approximately 2% less than the number of aged people in Jamaica. According to theDemographic Statistics (2006), 10.9% of Jamaicans females are 60 years and older compared to10.3% of males. Eldemire notes that the increased aged populace in Jamaica began in the 1960‟s(Eldemire 1995). Despite the indecisiveness to reach consensus on a definition of ageing from the UnitedNations‟ perspective on the elderly, „old age‟ begins at 60 years while other scholarsconceptualize ageing to commence at age 65 years or older (See for example Lauderdale 2001;Elo 2001; Manton and Land 2000; Preston et al. 1996; Smith and Kington 1997a; Smith andWaitzman 1994; Rudkin 1993). The WHO says that we can either use the chronological age of60 or 65 years or over to indicate the beginning of ageing (WHO 2002, 125). So why is there nostandardized definition for the elderly or where ageing begins? Thane (2000) noted that „old age‟for all people was defined as 60 years in medieval times. She justified this by forwarding anargument for the established age. In medieval England, men and women ceased at 60 years to beliable for compulsory service under labour laws or to participate in military duties. AncientRome, on the other hand, „old age‟ began from early 40 to 70 years, with 60 years being „somesort of annus climactorius’. Some Demographers see seniors - the elderly or the aged (old xiv
  16. 16. people) - as beginning at chronological age of 65 years and older, and not an individual who is60 years of age. Up to 1992, the Statistical Institute of Jamaica defined old-age as those people65 years and older (Demographic Statistics 1992). At that time Professor of demographer at theUniversity of the West Indies at Mona was primarily responsible for the many of the output ofthat Institution, and the training of staff. This may explain why the Statistical Institute ofJamaica used 65 years in its conceptualization of old-age. Furthermore, Western societies use 65years and older to represent the elderly (seniors) as this is the period when people become fullyeligible for Social Security benefits. One Caribbean scholar emphasized that there is no absoluteness in the operationaldefinition of the “elderly” (Eldemire 1995, 1). She commented that from the World Assembly ofAgeing (which was held in Vienna in 1982), the “elderly” is using the chronological age of 60years and older „as the beginning of the ageing process‟. Jamaica having signed the ViennaDeclaration of Ageing, which defines ageing to begin at 60 years, Eldermire questionedacademics and other scholars for their rationale in using 65 years. This paper seeks to evaluatethe wellbeing of the age and not those who are eligible for Social Security benefits. Hence, forthis study „old age‟ or the elderly (seniors) will begin from the chronological age of 60 years andolder. From the JSLC reports published by the PIOJ and STATIN, which is primarily focusedon the traditional construct of health using the biomedical model, the researcher is forwarding aposition that if we were to more effectively capture the wellbeing status of Jamaicans, we mustoperationally expand the definition of health in such a manner that it encompassesbiopsychosocial factors such as – (i) biological; (ii) psychological; (iii) social; (iv) economic, and(v) environmental conditions, as this vulnerable group may even be worse off than reported, xv
  17. 17. given the definition chosen to measure health status. There is no published works on the generalwellbeing of the Jamaican elderly in which the researchers have sought to capture a quality oflife index which encompasses biological, sociological, psychological and environmentalconditions. It is within this general framework, that this study of the elderly is timely as it seeksto expand an assessment of the subjective wellbeing of aged Jamaicans from the perspective ofmore comprehensive model. The rationale that explains the use of 65+ to represent elderly is solely due to thestatistical data that are available prior to 1991. Before 1991, the Statistical of Jamaica‟soperational definition for the elderly was 65 years and older. Hence, their publication between1844 and 1991 did not produce years for 60+. However, post 1992; the organization beganproviding data for both ages. As such, the researcher used 65+ because he wanted to examinefigure from 1844 to 2006. However, in the Caribbean, the matter has recently begun to be of concern (CaribbeanFood and Nutrition Institute 1999, 192, 217). The reason for this thrust is because the rate ofincrease of this age cohort compared to the other age cohort. By 2050, the population of people60 years and older in some Caribbean nations will more than double, while the young population(ages 0 to 14 years) would have been reduced by one-half. Some developing states such as Barbados, and Trinidad and Tobago, and Jamaica arecurrently experiencing a shift toward a population age. In 2007, all three Caribbean nations hadin excess of 10 percentage of their population ages 60 years and older. Barbados, on the otherhand, has the largest percentage of person ≥ 60 years (13.2%). xvi
  18. 18. Life expectancy Does the increase in life expectancy means a better quality of life or subjective wellbeingof elderly Jamaicans? A study by Powell, Bourne and Waller (2007) found that the psychosocialwellbeing of Jamaicans was moderately high (mean score = 6.8 out of 10), and offers anexplanation for the quality of life of its people. Furthermore, they found that the subjectivewellbeing of those in the lower subjective social class had a minimal score (mean score = 5.8 outof 10) compared with those in the upper class (mean score = 6.5 out of 10) and those in themiddle class (mean score = 6.8 out of 10) (Powell, Bourne and Waller 2007). They continuedthat Jamaicans (69%) indicated that their current economic situation was at most average, with19% reporting that it was bad. Nothing was mentioned about the elderly‟s population quality oflife, but can we assume that a two-fold increase in life expectancy over 1880-1882 means betterquality of life? Using the antithesis of illness to measure health (not reporting an illness), many studieshave examined health of the Jamaican elderly population (Bourne, 2008a; 2008b; Bourne, 2009a;Bourne, 2010) and another decomposed the mortality rate of the aged population (Bourne,McGrowder and Crawford, 2009). The use of illness to evaluate health is both narrow andnegative in scope (Bourne, 2009b; Longest, 2002; Brannon & Feist, 2007), which is thejustification of the World Health Organization‟s (WHO) broadened conceptualization of healthto more than the absence of illness to social, physical and psychological wellbeing (WHO,1948). Within the broadened conceptualization of health forwarded by the WHO in the preambleto its Constitution in 1946, the use of illness or antithesis of illness is emphasizes the absence ofsome disease causing pathogens, and not really health (Bourne, 2009b). Thus there is the need toexpand the measurement of health from illness or the antithesis of illness to evaluate a broader xvii
  19. 19. definition of health and/or wellbeing, particularly among the elderly population because of thecomposition of this cohort and the importance of understanding their wellbeing for the purposeof planning. This study investigates health, happiness and satisfaction with life for older men in amiddle-income developing country, Jamaica. Happiness, life satisfaction, and health status areamong some of the subjective indexes used to evaluate health (or wellbeing) of an individual,community or population. Happiness is well established in the scientific literature as a goodpredictor of subjective wellbeing and/or overall life with satisfaction as it covers a number ofpositive psychological conditions such as marriage, a job, success in life, adaptation to lifeevents, and negative affective conditions such as the lost of life or property, failed examinations,and dissolution of union deteriorate both health and further deepen the negative impact on lifeand by extension happiness (Diener, 1984; 2000; Easterlin, 2001a; 2001b; 2003; 2004; Stutzer &Frey, 2003; Frey & Stutzer, 2000; 2002; Ng, 1996; 1997). Subjective indexes cover a wider gamut of an individual‟s life compared to diagnosedhealth conditions, morbidity, reproductive health and life expectancy. Yet, the planning andstatistical agencies in Jamaica have been collecting national living conditions data includinghealth conditions since 1989 (Planning Institute of Jamaica (PIOJ) and Statistical Institute ofJamaica (STATIN), 1989-2008), and health condition has been used to measure the health of thepopulation, gender of the participants and health within areas of residence. For the first time in2007 both agencies added health status to health conditions in the yearly national cross-sectionalsurvey that is used to evaluate the population‟s living conditions. Happiness therefore, like lifesatisfaction and health status, provides a better idea of people‟s quality of life than does illhealth. The use of objective indexes such as diagnosed illness, gross domestic product, life xviii
  20. 20. expectancy and mortality are among measures that are said to be limited in scope and justify theuse of subjective indexes by some scholars (Diener, 1984; 2000; Easterlin, 2001a; 2001b; Stutzerand Frey, 2003; Frey and Stutzer, 2000; Ng, 1996; 1997; Oswald, 1997). Despite theaforementioned rationale on happiness, no national study has been conducted in Jamaica onhappiness, life satisfaction and health status, particularly on older men. Initially, when happiness was put forward by Diener (1984) as a measure of wellbeing, itwas rigorously opposed by some scholars as subjective who said it could not be used to measurehealth or wellbeing. Many traditional economists believed that happiness was subjective and thatthis could not be precisely measured, and this accounted for their reservations about accepting it.They believed that Gross Domestic Product per capita (GDP per capita) or income per capita wasan objective measure and that could in fact be precisely quantified. Unlike traditionaleconomists, Diener (1984; 2000), a psychologist, theorized that happiness could in fact be usedto measure subjective wellbeing and this was later adopted by economists (Oswald, 1997; Ng,1996; 1997; Blanchflower and Oswald, 2004; Veenhoven, 1991; 1993; Easterlin, 2001a; 2001b;Stutzer and Frey, 2003; Frey and Stutzer, 2000; DiTella, et al., 2003). Easterlin (2001a, 2001b, 2003, 2004) found a statistical association between happinessand income. He argued that, “The relationship between happiness and income is puzzling”,(Easterlin, 2001a: 465) and that people with higher incomes were happier than those with lowerincomes, but that economic growth does not mean happiness. Easterlin used happiness tomeasure subjective wellbeing, which was found to be highly correlated with income. He wentfurther when he said that, “Those with higher income will then be better able to fulfill theiraspirations and, other things equal, will, on average, feel better off…This is the point-of-timepositive association between happiness and income”(Easterlin 2001a:472). Like Easterlin, all xix
  21. 21. the aforementioned economists used happiness to evaluate subjective wellbeing as they acceptedthat happiness is an indicator of people‟s judgement of their overall quality of life (Veehnoven,1991; 1993). Randomly selecting Europeans and Americans from the 1970s to 1990s, Di Tella etal. (2003) did not find this complex relation between income and happiness. They however notedthat some variables such as unemployment, unemployment benefits and others are exogenousvariables as they are influenced by political decisions and do influence income. Diener (2000) argued that wellbeing can be explained outside of welfare theory or apurely objective utility approach, and this was supported by other scholars (Liang, 1984; Dieneret al., 1999; Diener and Suh, 1997; Cummins, 1997). Arthaud-day et al.‟s (2005) work appliedstructural modeling and found that subjective wellbeing comprised of (1) cognitive evaluationsof ones life (i.e., life satisfaction or happiness); (2) positive affect; and (3) negative affectiveconditions. Unlike Arthaud-day et al., Diener (2000) proposed that subjective wellbeing can beoperationalized by some basic indicators such as emotional components („Taking all thingstogether, how happy would you say you are?‟) and cognitive components or life satisfaction(„All things considered, how satisfied are you with your life as a whole nowadays?‟). Summers & Heston noted that, “…GDPPOP is an inadequate measure of countriesimmediate material well-being, even apart from the general practical and conceptual problems ofmeasuring countries national outputs” (Summer & Heston, 1995:2) From that perspective, themeasurement of quality of life is highly economic and excludes psychosocial factors as theemphasis is on objective indexes of wellbeing (Gaspart, 1998) and not in keeping with thebreadth of wellbeing offered by the World Health Organization in the preamble to itsConstitution (WHO, 1948). Thus, quality of life (wellbeing) extends beyond financial resources(money), although they improve wellbeing or the „human lot.‟(Easterlin, 1974; 1995; Marmot, xx
  22. 22. 2002). Using data for developing countries, Camfield noted that subjective wellbeing constitutesthe existence of positive emotions and the absence of negative ones within a space of generalsatisfaction with life. Cummins (1997) argued that subjective and objective indexes of materialwell-being along with the absence of illnesses, efficiency, social closeness, security, place incommunity, and emotional wellbeing means that life‟s satisfaction comprehensively envelopessubjective wellbeing. Diener (2000) in an article titled „Subjective Well-Being: The Science ofHappiness and a Proposal for a National Index‟ theorized that the objectification of wellbeing isembodied within satisfaction of life. This explains the rationale for the use of life satisfactionand/or happiness to operationalize wellbeing instead of GDP per capita (or income per capita). Extensive review of the literature turned up just one study in Jamaica that examined lifesatisfaction (Hutchinson, et al., 2004). In this study, the scholars found that women had a loweroverall life satisfaction (72%) than men (76%). Employment status, education, gender, unionstatus, church attendance, self-esteem, and current health status were determinants of lifesatisfaction. In Di Tella et al.‟s work, they found income, employment status, interpersonal trust,health status, marital status, education, sex and inflation, the rate of change of consumer prices inthe country, unemployment benefits, and the number of children in households was predictors ofhappiness. In descending order, they found that marital status, income and employment statushad the greatest influence on happiness. Although there is very little or research study in the English speaking Caribbean onhappiness of the general populace or on the elderly population, Stutzer & Frey (2003) hasidentified a few predictors of happiness: income; aspiration; and unemployment. Konow &Earley‟s study (1999) revealed that employment status, positive and negative affective xxi
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  29. 29. Happiness in OlderAdulthoodWellbeing, Health & life satisfaction xxviii
  30. 30. Chapter 1Happiness among Older Men in Jamaica: Is it a health issue? Paul Andrew Bourne, Chloe Morris & Denise Eldemire-ShearerThis paper seeks to expand the literature by investigating the effect of health status on happiness,happiness on health status, life satisfaction on happiness as well as some demographic variablesin order test the existing knowledge on elderly men (ages 60 years and older) in Jamaica. Astratified random sample of 2,000 elderly men in Jamaica was used to carry out this paper. Thedata were collected with a 137-item self-administered questionnaire, and entered, retrieved andstored in SPSS for Windows 16.0 (SPSS Inc; Chicago IL, USA). Happiness was found not to becorrelated with health status of elderly men in Jamaica nor was health status associated withhappiness; and that there was no difference based on area of residence. Happiness and healthstatus cannot be used to proxy each other for the elderly cohort as they are independent events.IntroductionHappiness is well established in scientific publications as a good predictor of subjectivewellbeing and/or overall life satisfaction (Graham, 2008; Selim, 2008; Borghesi, & Vercelli,2007; Mahon et al., 2005; Layard, 2006; Seligman & Csikszentmihalyi, 2000; Diener, Lucas, &Oishi, 2002; Diener, 1984, 2000; Easterlin, 2001; Veenhoven, 1993). A group of scholars foundthat the statistical association between happiness and subjective wellbeing was a strong one -correlation coefficient r = 0.85 in the 18 OECD countries – (Kahneman, & Riis, 2005), whichemphasizes the importance that people place on happiness in assessing their subjectivewellbeing. Happiness which is an area in positive psychology (Seligman & Csikszentmihalyi, 1
  31. 31. 2000; Huppert, 2006; Brannon & Feist, 2007) goes beyond the mere positive state of anindividual to physical health and social life, and economic state to life in general (Borghesi, &Vercelli, 2007; Lima & Nova, 2004; Stutzer & Frey, 2003; Easterlin 2003; Frey & Stutzer,2002a, 2002b; Brickman, Coates, & Janoff-Bulman, 1978). Happiness is as a result of a number of positive psychological factors such as marriage, ajob, success in life, adaptation to life events, and negative affective conditions such as the lost oflife or property, failed examinations, and dissolution of union deteriorate both health and furtherdeepen the negative impact on life and by extension happiness (Borghesi & Vercelli, 2007;Easterlin, 2003; Kahneman, & Riis, 2005). In seeking to unearth ‗why some people are happier‘,Lyubomirsky (2001) approached it from the perspective of positive psychology. She noted that,to comprehend disparity in self-reported happiness between individuals, ―one must understandthe cognitive and motivational process that serve to maintain, and even enhance happiness andtransient mood‖ (Lyubomirsky, 2001, 239) Lyubomirsky identified ‗comfortable income‘,‗robust health‘, supportive marriage‘, and ‗lack of tragedy‘ or ‗trauma‘ in the lives of people asfactors that distinguish happy from unhappy people (see also, Borghesi & Vercelli, 2007;Kahneman, & Riis, 2005; Frey & Stutzer, 2002a, 2002b; Easterlin, 2003). Those findings onlyconcurred with an earlier work by Diener, Suh, Lucas, & Smith (1999). Diener, Horwitz &Emmon (1985) were able to add value to the discourse when they showed that income affectssubjective wellbeing. Frey & Stutzer (2002a) provided more information on the aforementioneddiscourse, when he opined that absolute income does not seem to have a strong influence onhappiness or health (or subjective wellbeing). Researchers found that the wealthy (those earningin excess of US 10-million, annually) had a marginally greater self-reported wellbeing (personal 2
  32. 32. happiness) than that of those who were lower wealthy (earned less than 10 million US annually)(Diener, Horwitz & Emmon, 1985). People‘s cognitive responses to ordinary and extraordinary situational events in life areassociated with subjective wellbeing (Chida & Steptoe, 2008; Steptoe et al., 2008; Pressman &Cohen, 2005; Lyubomirsky, 2001; Sheldon & Lyubomirsky 2006). It is found that happierpeople are more optimistic and as such conceptualize life‘s experiences in a positive manner.Studies revealed that positive moods and emotions are associated with wellbeing (Fowler &Christakis, 2008; Leung, Moneta, & McBride-Chang, 2005) as the individual is able to think,feel and act in ways that foster resource building and involvement with particular goalmaterialization (Lyubomirsky, King, & Diener, 2005). This situation is later internalized,causing the individual to be self-confident from which follows a series of positive attitudes thatguide further actions (Sheldon & Lyubomirsky, 2006). Positive mood is not limited to activeresponses by individual, but a study showed that ‗counting one‘s blessings‘, ‗committing acts ofkindness‘, recognizing and using signature strengths, ‗remembering oneself at one‘s best‘, and‗working on personal goals‘ all positively influence wellbeing (Sheldon & Lyubomirsky, 2006;Abbe, Tkach, & Lyubomirsky, 2003). Recently conducted meta-analysis longitudinal studiesrevealed that happiness and other positive moods are not only positively correlated with healthstatus; but that they are negatively associated with mortality Chida Y, Steptoe A. (2008),suggesting the value of happiness to life. Happiness is not a mood that does not change with timeor situation; hence, happy people can experience negative moods (Diener & Seligman, 2002);and happiness is a good proxy for assessing subjective wellbeing. 3
  33. 33. Human emotions are the coalesced of not only positive conditions but also negativefactors (Watson et al. 1999). Hence, depression, anxiety, neuroticism and pessimism are seen asa measure of the negative psychological conditions that affect subjective wellbeing (Evans et al.2005; Harris & Lightsey, 2005; Kashdan 2004). From Evans and colleague, Harris & Lightseyand Kashdon‘s monographs, negative psychological conditions affect subjective wellbeing in anegative manner (i.e. guilt, fear, anger, disgust); and positive factors influence self-reportedwellbeing in a direct way– this was concurred in a study conducted by Fromson (2006); and byother scholars (McCullough et al. 2001; Watson and Clark et al 1988a, 1988b). Acton & Zodda(2005) aptly summarized the negative affect of subjective wellbeing in the sentence that says―expressed emotion is detrimental to the patients recovery; it has a high correlation with relapseto many psychiatric disorders.‖ Previously mentioned studies using happiness to examine wellbeing were on populationand not on elderly cohorts (ages 60 years and older). McConville et al. (2005) in ‗Positive andnegative mood in the elderly: the Zenith study‘ established that different moods of people affectboth their physical as well as their mental well-being. They argued, ―Poor quality moods wereassociated with deficits in diverse areas of cognitive function, health, and social relationship‖(McConville et al., 2005). The Zenith study was to examine the quality of positive and negativeattitudes on health status. The population was 387 individuals from three European countries(France, Italy and Ireland). Another study on the elderly population found that biologicalchanges of humans do affect their psychological state, and that psychological and psychosocialchanges influence biological functioning (or physical health) (Kart, 1990) Well-being for some scholars, therefore, is a state of happiness (ie positive feeling status 4
  34. 34. and life satisfaction) (Diener, 1984; Easterlin, 2003; Diener, Larson, Levine & Emmon, 1999).Simply put, well-being is subjectively what is ‗good‘ for each person (Crisp 2005). It issometimes connected with good health. Crisp offered an explanation for this, when he said that―When discussing the notion of what makes life good for the individual living that life, it ispreferable to use the term ‗well-being‘ instead of ‗happiness‘ (Crisp, 2005). O‘Donnell and Tait(2003) believed that health is a primary indicator of well-being; and so provide an understandingof the correlation between health, subjective wellbeing, happiness, and life‘s satisfaction(O‘Donnell & Tait, 2003; Ringen, 1995). From the scientific literature, self-rated health status ishighly reliable to proxy for health which ‗successfully crosses cultural lines‘ (Ringen 1995).O‘Donnell and Tait concluded from their study that self-reported health status can be used toindicate wellbeing as all respondents who had chronic diseases reported very poor health. From the literature, happiness and health status, happiness and wellbeing, and happinessand life satisfaction are associated. Using the scientific findings on the aforementioned issue, anextensive review of the literature found no study that has every examined happiness and healthstatus of elderly men in Jamaica, which is the rationale for this paper. Given that happinesscovers life satisfaction and health, an examination of happiness and health status of elderly menin Jamaica will provide invaluable information as to the state of this group. An extensive review of the literature revealed that there has never been a study done inthe Caribbean, in particularly Jamaica on happiness of this vital cohort, so this is a criticalrationale for the study as it will provide insight in this cohort along with an understanding of howthey perceive things and life which can guide public policy. Another rationale is happiness, apredictor of health status which would allow for the collection of data on whether or not they are 5
  35. 35. good predictors of each other. This paper examined whether (1) happiness is a function of healthstatus; (2) happiness is a function of health status and some demographic variables; (3) healthstatus is a function of happiness; (4) health status is a function of happiness and somedemographic variables in order to provide information on this cohort. Using probit analysis, thispaper sought to model the aforementioned issues from data on elderly men (ages 55 years andolder) in Jamaica.MethodsParticipants and questionnaireThe study used primary cross-sectional survey data on men 55 years and older from the parish ofSt. Catherine in 2007; it is also generalizable to the island. The survey was submitted andapproved by the University of the West Indies Medical Faculty‘s Ethics Committee. Stratifiedmultistage probability sampling technique was used to draw the sample (2,000 respondents).A132-item questionnaire was used to collect the data. The instrument was sub-divided intogeneral demographic profile of the sample; past and current health status; health-seekingbehaviour; retirement status; social and functional status. The overall response rate for the surveywas 99% (n=1,983). Data was stored, retrieved and analyzed, using SPSS for Windows (16.0). The Statistical Institute of Jamaica (STATIN) maintains a list of enumeration districts(ED) or census tracts. The parish of St. Catherine is divided into a number of constituenciesmade up of a number of enumeration districts (ED). The one hundred and sixty-two (162)enumeration districts in the parish of St. Catherine provided the sampling frame. Theenumeration districts were listed and numbered sequentially and selection of clusters werearrived at by the use of a sampling interval. Forty (40) enumeration districts (clusters) were 6
  36. 36. subsequently selected with the probability of selection being proportional to population size(Table 1.1). The enumeration districts in the parish of St. Catherine provided the sampling frame andthe sample size was determined with the help of the Statistical Institute of Jamaica (STATIN).The enumeration districts were listed and single-stage cluster sampling was used to select thesample. The enumeration districts were numbered sequentially and selection of clusters wasarrived at by calculating a sampling interval. From a randomly selected starting point, forty (40)enumeration districts (clusters) were subsequently selected with the probability of selectionbeing proportional to population size. The sample of 2000 was selected based on a proportion ofthe Census Data (Table 1.1). The parish of St. Catherine had approximately 233,052 males, (preliminary census data2001) of which 33,674 males were 55+ years. STATIN maintains maps with enumerationdistricts or census tracts which included the selected EDs and access routes and had references tothe selected site of a starting point household within each ED. The starting point was determinedby randomly selecting a household with a man 55 years and over from the list of persons in theED. With this information the interviewers travelled in a north-easterly or closest to north-easterly direction beginning with the first selected household, and conducted interviews in eachhousehold that had a male 55 years and older. Only one male per household was selected; and inhouseholds with more than one individual fitting the characteristic of the sample, a coin wastossed to determine the person who will be interviewed. (North-East was randomly selected bySTATIN as the direction of travel from the starting point). Where the selected household was found to be subsequently devoid of an older man (dueto out-migration or death), an adjacent household was canvassed. Where households had a man 7
  37. 37. 55+ years as a resident and he was not at home a call-back form was left indicating a proposedtime that the interviewer would return which would not be longer than two days after the initialvisit. The sample population does not only speak to the parish of St. Catherine, it isgeneralizable to the island of Jamaica. The sampling frame was men fifty-five years and older inthe parish of St Catherine. The parish of St. Catherine was chosen as previous data suggested thatit has the mix of demographic characteristics (urban, rural and age-composition) which typifyJamaica surveys (Statistical Institute of Jamaica 2004; Wilks 2007; Jackson et al. 2003) For this paper descriptive status was employed to provide background information on thesample; and chi-square was used to examine non-metric variables. Level of significance waspvalue<0.05 and the only exclusion criteria was if more than 20% of the cases of the variablewere missing.MeasureHappiness is measured based on people‘s self-report on their happiness (Frey & Stutzer, 2002a,2002b; Easterlin 2001; Borghesi, & Vercelli, 2007). This operationalization is based on a basicindicator proposed by Diener (2000), including a more emotional component referring tohappiness (‗Taking all things together, how happy would you say you are?‘). It is a Likert scalequestion, which ranges from high to low happiness. It was coded into a binary variable, whetheror not the individual had moderate-to-high or low happiness: 1=moderate to high happiness, 0 =otherwise.Life satisfaction. Diener (2000) had proposed that happiness includes emotional components anda more cognitive component referring to life satisfaction (‗All things considered, how satisfiedare you with your life as a whole nowadays?‘), for this paper the researcher separated happiness 8
  38. 38. (emotional) from cognitive (life satisfaction). Life satisfaction is a binary variable, where 1=good-to-excellent self-reported overall satisfaction in life, 0=otherwise.Health Status is measured using people‘s self-rate of their overall health status (Kahneman, &Riis, 2005), which ranges from excellent to poor health status. The variable used in this paperfor health status is a binary one, whether or not the person had good-to-excellent or poor healthstatus. It was then coded as a dummy variable, 1=good-to-excellent health status, 0=otherwise.Age group is categorized into three sub-groups. These are (1) ages 55 to 64 years; (2) ages 65 to74 years; and (3) age 75 years and older (ie 75+ years).Listing of covariatesResidence is a binary variable, 1=lives in urban area, 0=lives in rural area.Employment status is a binary variable, where 1=employed, 0=otherwise.Health retirement plan is a binary variable, where 1=having a health retirement coverage,0=otherwise.Occupation is a binary variable, where 1=current or past occupation which was in the categoryof professional, 0=otherwise.Marital status is a non-binary variable, where 1=married, 0=otherwise; 1= separated, divorced orwidowed, 0=otherwise and single is the reference group.Childhood health status is a binary variable, 1=self-reported poor health status, 0=otherwise.Household head is a binary variable, 1=self-reported head of household, 0=otherwise.Social networking is operationalized based on yes or no to being a member of a social club;civic organization; or community organization. This was dichotomized to be 1 if yes and 0 ifotherwise. This variable excludes being a member of a church. 9
  39. 39. ADL. This is a functional status of 12 events. These include eating; bathing; dressing; usingtoilet; shopping; preparing meals; feeding oneself; continence; taking or using transportation;managing medication; money management; and laundry.ModelTheoretical backgroundAccording to micro econometric happiness function, subjective wellbeing (ie happiness) is afunction of different variables (including some demographic ones) (Stutzer & Frey 2003) [Model(1)]. Wit = + Xit + it…………………………………………………..……….. [1] Where Wit represents subjective well-being, Xit denotes x1, x2, x3, and so on, in whichx1 to xn are variables – ‗sociodemographic‘, ‗environmental‘, and ‗social‘, ‗institutional‘ and‗economic conditions‘ In this paper, the literature (ie micro econometric happiness function) will be expanded toinclude health status in childhood, current health status, life satisfaction, and area of residence bytesting this theory using elderly men in Jamaica [Model (1)]. In addition to the aforementionedmicro econometric happiness function, the study will also seek to examine health status.Variables such as happiness, life satisfaction and some demographic variables will beinvestigated simultaneously [Model (2)].Estimation ModelThe interests of this paper are to examine whether happiness can be predicted by health status aswell as the role of life satisfaction, and self-reported childhood health status on happiness ofelderly men in Jamaica. Continuing, it is also to investigate whether health status can be 10
  40. 40. predicted by happiness; what are the demographic factors that can predict either happiness orhealth status of elderly men in Jamaica as well as determine, if there is a difference between ruraland urban areas. The multivariate model used in this paper is an expansion of the literature(Stutzer and Frey‘s work on happiness) which is displayed in equations (2) and (3).Hit = β0 + β1HSit + β2HSi(t-1) + β3LSit+ βijDij+ εi ...……….………………..………...[2]HSit = β0 + β1Hij + β2HSi(t-1) + β3LSit + βijDit+εi ………………………….…….…….[3]where Hit denotes happiness of person i in time period t (current period); HSit means healthstatus of person i in current time period t; HSi(t-1) denotes the childhood health status of period iprevious period (t-1); LSit is life satisfaction of person i in current time period (t); Dit = d1, d2,d3, d4…..dn, which include sociodemographic and socioeconomic variables of individual i incurrent time period (t). β0 indicates happiness at the beginning of the period; β1 to βij denotesthe parameter for each variable from variable 1 to j. The models [Eqn. (2) and (3)] allow for each factor that is associated with happiness[Eqn. (2)] or health status [Eqn. (3)] to be examined separately. Those approaches have beenwidely and successfully applied in a plethora of studies on the correlates of happiness (Easterlin2001; Veenhoven 1993, Stutzer & Frey 2003; Frey & Stutzer 2002; Frey & Stutzer 2002;Blanchflower & Oswald 2004; Argyle 1999) and/or health status (Bourne 2008a, 2008b;Grossman 1972; Smith & Kington 1997; Hambleton et al. 2005; Bourne & McGrowder 2009)This is the rationale for the usage of micro-econometric happiness function (Lima & Nova 11
  41. 41. 2006), Bourne and McGrowder‘s (2009) health status function as they allow for the analysis ofcurrent study. Because the dependent variable for this paper, happiness or health status, is a binary one,probit analysis was used to estimate the impact of life satisfaction, current health status,childhood health status, including other socio-demographic variables (such as employmentstatus, education, marital status, age of elderly, social support, and church attendance) onhappiness or current health status of elderly men in Jamaica. Furthermore, this paper will mainlyreport the results of those variables that are statistically significant (p<0.05). Furthermore, the variables used in this paper are based on (1) literature review whichshows that these are likely to correlate with the particular dependent variable, and 2) thecorrelation matrix was examined in order to ascertain if autocorrelation (or multicollinearity)existed between independent variables. Based on Cohen and Holliday (1982), correlation can below (weak) - from 0 to 0.39; moderate – 0.4-0.69, and strong – 0.7-1.0. This was used to exclude(or allow) a variable in the model. Any of the independent variables which had moderate to highcorrelation was excluded from the model. The correlation between life satisfaction and happinesswas 0.633; happiness and social networking (correlation coefficient = 0.12, p = 0.003); happinessand marital status (correlation coefficient = 0.107, p = 0.026); marital status and income category(correlation coefficient =0.193, p< 0.001); social networking and marital status (r=0.205,p<0.001); social networking and age group (correlation coefficient = 0.188, p<0.001); socialnetworking and occupation (correlation coefficient =0.320, p< 0.001); social networkingeducational category (correlation coefficient =0.420, p<0.001); ADL and age cohort (correlationcoefficient =-0.813, p=0.032); income and occupation (correlation coefficient =0.7775, p < 12
  42. 42. 0.001); and, income and education (correlation coefficient =0.356, p<0.001); employment andeducation category (correlation coefficient =0.283, p<0.001). However, there was no correlationbetween happiness and present occupation (p=0.761); happiness and income (p=0.233);happiness and employment status (p=0.516); as well as life satisfaction and employment status(p=0.261). Hence, life satisfaction and happiness; occupation and income category will not besimultaneously used as explanatory variables.Results: Socio-demographic Characteristics of SampleThe sample was 2,000 men ages 55 years and older (42.6% were 55 to 64 years; 35.6% were 65to 74 years; 21.9% were 75 years and older). Fifty one percent of the sample lived in rural areas;59.1% had social network; 55.4% reported good health status and 25.6% indicated poor healthstatus; 53.9% were retired, 25.6% were actively employed and 20.6% unemployed; 58.8% didnot own their homes, and 34.3% were single and 44.7% were married elderly men. Majority ofthe sample had primary or elementary level education (83.1%); 85.9% reported that they do notregularly exercise; 82.5% reported good health in childhood; and 88.12% were heads of theirhouseholds (Table 1.2). One half of the sample indicated that they spent Ja. $100 (US $1.45)monthly for medical expenditure; 34% of the respondents bought their prescribed medication;17.1% reported that they have been hospitalized since their sixth birthday and 65.8% reportedthat they took no medication. Of those who mentioned that they were ill during childhood(17.5%, n=350), 34.9% said that the illness was measles or chicken pox, 26.3% mentionedasthma, 10.0% pneumonic fever, 8.9% polio, 6.6% accidents, 4.6% jaundice, 1.7% hernia, and5.1% indicated gastroenteritis. Twenty four percent of elderly men indicated that they wererarely happy, 40.5% said sometimes, 31.0% mentioned often and only 4.5% reported always.Furthermore, 17.7% of the sample reported that they were seriously ill as children. 13
  43. 43. Of the sample (n=2,000), 24.0% indicated that they were rarely happy; 40.5% indicatedsometimes; 31.0% mentioned most times and 4.5% reported always. Hence, approximately 65%of the sample was happy at least sometimes. With respect to life satisfaction, 32.9% of thesample indicated that they were rarely satisfied with their life; 33.7% revealed sometimes; 29.9%mentioned most times and 3.5% reported always. Of the sample, 62.7% revealed that they were able to carry out particular daily activitiescompared to 37.4% who reported that they were unable to perform daily activities.Results: Multivariate AnalysisThe results from the probit regression analyses of happiness are presented in Table 1.3. Theresults for the current health status are presented in Table 1.4. Therefore, this paper willmainly report the results of those variables that are statistically significant (p<0.05). Current happiness of elderly men in Jamaica was found to be statistically influence bylife satisfaction (95% CI: 0.417, 1.215; p <0.001) and aged men 75 years and beyond (95% CI: -1.193, -0.054; p=0.032) with reference to those 55 to 64 years of age. For life satisfaction,Current and childhood health status as well as education, age of elderly men, social support,church attendance, occupation (both current and past), and marital status were found not toinfluence current happiness (p > 0.05). Continuing, current happiness of elderly men was thesame whether they live in urban or rural areas (p=0.813) (Table 1.2). Based on Table 1.3, themodel is a good fit for the data (log likelihood=153.039; chi-square = 106.479, P=0.985). Current health of the sample was found be significantly statistically influenced by age ofthe elderly (ages 65 to 74 years – 95%CI: -1.513, -0.622; ages 75+ - 95% CI: -2.130, -1.022; 14
  44. 44. p<0.001), social support (95% CI: 0.016, 1.315, p=0.045) and area of residence (95% CI: -0.959,-0.085, p=0.019) (Table 1.4). Continuing, urban elderly men had a lower current health statusthan their rural counterparts. Variables such as life satisfaction, employment status, education,head of household, occupational type (both past and current), health status in childhood, churchattendance and happiness were not found to statistically influence current health status of elderlymen in Jamaica. Based on Table 1.4, the model is a good fit for the data (log likelihood=149.068;chi-square = 102.798, P=0.971).DiscussionThe study revealed 24 elderly men in every 100 were rarely happy, 41 in every 100 werehappy sometimes, 31 in every 100 indicated most times and 5 in every 100 reported always;and that 55 out of every 100 were in good health, 26 in every 100 said fair and 19 out ofevery 100 said excellent health status. The survey evidence presented here suggested thatthere was no statistical correlation between happiness and health status of elderly men inJamaica, and it goes further to show that happiness cannot be a predictor of health status aswell as health status cannot be a predictor of happiness. Happiness was found not to correlatewith health status of elderly men in Jamaica nor was health status associated with happiness;and that there was no difference based on area of residence. This denotes that happiness doesnot provide an understanding of health status and vice versa as well as the fact that overalllife satisfaction of elderly men in Jamaica is not explained by health status. However, lifesatisfaction was a predictor of happiness for older men. In this research health status does not influence happiness which is contrary to theother studies (Siahpush et al., 2008; Borghesi, & Vercelli, 2007; Kahneman, & Riis, 2005; 15
  45. 45. Easterlin, 2003; Brickman, Coates & Janoff-Bulman 1978; Stutzer & Frey 2003; Frey &Stutzer 2002a, 2002b; Blanchflower & Oswald, 2003; Argyle 1999; Michalos, Zumbo, &Hubley, 2002). One scholar went further than the negative statistical association betweenhappiness and health status when he argued that over life‘s course, happier people werehealthier people which suggest that correlation is even in later life for both sexes. This papercannot concur with such a finding as there is no statistical relationship between happinessand health status at older ages for men in Jamaica, suggesting that happiness is not a goodpredictor of health status. Happiness therefore can be used to proxy health status of oldermen in Jamaican. Research literature has long established that life satisfaction and happiness areestimates for each other and encapsulate the overall experiences of the individual (Selim,2008; Siahpush et al., 2008). Happiness is a crucible pursuit of human existence (James1902). It is multidimensional and thus justifies its usage in measuring wellbeing instead of atraditional approach of income per capita (Gross Domestic Product per capita, GDP) (Diener,Lucas, & Oishi, 2002; Diener, 1984, 2000; Easterlin, 2003; Diener, Larson, Levine, &Emmon, 1999) Happiness which was first introduced by a psychologist (Diener, 1984) as asubjective measure in assessing wellbeing has been accepted by some economists as a goodproxy for wellbeing (Graham, 2008; Borghesi, & Vercelli, 2007; Mahon et al., 2005; Layard,2006; Easterlin, 2001; Veenhoven, 1993; Argyle, 1999; Stutzer & Frey 2003; Easterlin,2003; Brickman, Coates & Janoff-Bulman, 1978; Frey & Stutzer, 2002a, 2002b;Blanchflower & Oswald, 2004). Based on this established fact, information is now availableon the multidimensional state of elderly men in Jamaica. Although happiness is fluid, thispaper has revealed that a small proportion of elderly men in Jamaica reported that they were 16
  46. 46. always happy (approximately 5 out of every 100) compared to 24 out of every 100 whoclaimed they were rarely happy. Embedded in this finding is the negative psychological stateof many elderly people as this is reflected in their happiness (or unhappiness); and theirhappiness is not influenced by their health status. Lyubomirsky (2001) forwarded a number of issues that justified happy from unhappypeople. She identified ‗comfortable income‘, ‗robust health‘, supportive marriage‘, and ‗lackof tragedy‘ or ‗trauma‘ in the lives of people as factors that distinguish happy from unhappypeople. In this paper, 44% were married; 88% heads of household; 26% employed; 54%retired, 83% had primary or elementary education, for those who are employed 93% earnedless than US $283.23 per month (Ja$70.61=1US$) and although those variables were foundnot to statistically influence happiness, the aforementioned studies declared that they do.According to Borghesi, & Vercelli (2007), education, employment status, social capital andenvironmental variables influence happiness, this is not the case for older men in Jamaica.Neither is marital status, occupational type, social support or church attendance. However,Borghesi & Vercelli Kim-Prieto et al. (2005) and Smith et al. (2005) identified thateducational attainment; employment status; social support; genetic endowment; and thesocial (Fowler & Christakis, 2008) and physical milieu are correlated with happiness andwhile this is not the case for older men in Jamaica; those variables do influence lifesatisfaction (Mroczek, & Spiro, 2005; Gwozdz, & Sousa-Poza, 2009) which indirectlyimpact health status. According to Gwozdz & Sousa-Poza (2009) life satisfaction decline with old age,which may explain why in this paper only 4 out of every 100 Jamaican older men reported 17
  47. 47. being always happy and 30 out of 100 reported being happy most of the time. Like theliterature this paper concurs that there is a correlation between life satisfaction and maritalstatus; life satisfaction and occupation; and life satisfaction and area of residence; but theywere weakly related to each other. However, it was revealed also that there was nosignificant statistical association between employment status and life satisfaction, and lifesatisfaction and income, suggesting that the variables which influence life satisfaction as wellas happiness for the elderly men are not necessarily the same as those that affect happiness orlife satisfaction of the population (Selim, 2008; Siahpush et al., 2008). Furthermore, anotherimportant finding is the disparity in factors that influence life satisfaction or health status ofolder men in Germany and Jamaica (Gwozdz, & Sousa-Poza, 2009). With the down turn in the American economy, Jamaicans have been experiencing asignificant reduction in remittances which act as an income for many families including theelderly. This will further erode the life satisfaction of elderly men as they will beincapacitated by the inability to afford basic necessities and their independence will bethreatened as they must now seek the assistance of church, friends and other social networksin order to survive. Although social networking and employment status were not found to bestatistical associated with happiness in the current work, men equate the ability to provide fortheir families and spend on particular things as they desire, as apart of their happiness.Hence, income or wealth is a good predictor of happiness for this cohort (see also, Frey &Stutzer, 2002a, 2002b; Borghesi & Vercelli, 2007; Graham, 2008), not having data on wealthhampers a possible explanation instead of many of the other variables that were tested. 18
  48. 48. The literature has provided a plethora of studies that showed the correlation betweenhappiness and health status; but this is not the case for elderly men in Jamaica. Usingstratified probability sampling technique of 2,000 elderly men, this paper found noassociation between the happiness and current health status, and vice versa. What accountsfor this disparity? While health and happiness are correlated in the general populace of theworld, other nations, and many countries outside of Jamaica, it is not the case for men ages55 years and older in Jamaica based upon men‘s unwillingness to seek openly and truthfullyabout their health. This brings into question the validity of value judgement or the self-reported health of this paper. The validity of using people‘s assessment of their life satisfaction and health is old and hasalready been resolved. Nevertheless, it will be succinctly forwarded here for those who are notcognizant of this discourse. Scholars have established that there is a statistical associationbetween subjective wellbeing (self-reported wellbeing) and objective wellbeing (Diener, 2000;Lynch, 2003) and Diener (1984) went further when he found a strong correlation between thetwo variables. Gaspart (1998) opined about the difficulty of objective quality of life (GDP percapita) and the need to use self-reported wellbeing in assessing wellbeing of people. He wrote,―So its objectivism is already contaminated by post-welfarism, opening the door to a mixedapproach, in which preferences matter as well as objective wellbeing‖ (Gaspart, 1998) whichspeaks to the necessity of using a measure that captures more to the this multidimensionalconstruct than continuing with the traditional income per capita approach. Another group ofscholars emphasized the importance of measuring wellbeing outside a welfarism and/or purelyobjectification, when they said that ―Although GDP per capita is usually used as a proxy for thequality of life in different countries, material gain is obviously only one of many aspects of life 19
  49. 49. that enhances economic wellbeing‖ (Becker, Philipson & Soares, 2004, 1) and that wellbeingdepends on both the quality and the quantity of life lived by the individual (Easterlin 2001). The discourse of subjective wellbeing using survey data cannot deny that it is based on theperson‘s judgement, and must be prone to systematic and non-systematic biases (Schwarz &Strack, 1999). In an earlier work, Diener (1984) argued that the subjective measure seemed tocontain substantial amounts of valid variance. This will not be addressed in this paper as this isnot the nature or its scope. Despite this limitation, a group of economists noted that ‗happiness orreported subjective well-being is a satisfactory empirical approximation to individual utility‘(Frey & Stutzer, 2005) and this is a rationale for its usage in wellbeing research. This paper has not only provided pertinent research information on happiness v healthstatus in elderly men in Jamaica, it also examined health status and happiness as well as othervariables such as childhood health status, life satisfaction and some other sociodemographicvariables. Life satisfaction; employment status; education; health insurance; head of household;marital status; childhood health status; church attendance; and happiness of elderly Jamaicans donot statistically influence health status. All those variables are well established in researchliterature as statistically significant correlates with health status. Studies have moved beyondthose variables being mere correlates to predictors of health status (Bourne, 2008a, 2008b;Grossman, 1972; Smith & Kington, 1997; Hambleton et al., 2005; Bourne & McGrowder, 2009).A recently published study on rural Jamaican by Bourne and McGrowder (2009) identified 12explanatory predictors of good health and another by Bourne (2008b) found 11 predictors ofwellbeing of aged Jamaicans. The aforementioned studies are different from the current as thereis a difference in regards to the measurement of health status. Those studies operationalizedhealth (or subjective wellbeing) as health conditions whereas this one used general self-reported 20
  50. 50. health status which is keeping with literature (Grossman, 1972; Smith & Kington, 1997;Hambleton et al., 2005), but departs in respects to the predictors. There is a convergence of predictors as this paper concurred with the literature thatageing is associated with lower health status; social support (Fowler & Christakis, 2008), and theplace of residence are determinants of health status. Area of residence is not only a correlate ofhealth status; but this paper found that elderly men who lived in urban areas have lower healthstatus, suggesting that healthier old men in Jamaica resided in rural areas. Functional capacity of the elderly is well established in health literature as influencinghealth status and by extension happiness (Yi & Vaupel, 2002; Bogue, 1999). The young-old(ages 60 to 64 years) are more likely to be the most functioning as the organism is just beginningthe transition into the aged arena (see for example Erber 2005; Brannon & Fiest, 2004). Thisphenomenon means that human mortality increases with age of the human adult, but that thisbecomes less progressive in advance ageing. Thus, biological ageing is a process where thehuman cells degenerate with years (i.e. the cells die with increasing age), which explains theinverse association between ageing and subjective wellbeing (Netuveli et al. 2006; Prause et al.2005). Bogue (1999:3) summarized the characteristics of three elderly cohorts (young-old – ages60 to 74; aged or old-old – 75 to 84 years and oldest old - 85+ years), when he showed that as theelderly ages from young-old to aged their health problems increased from low to moderate andthus increased to high for the oldest-old and that this is similar to their physical disability. Performance of Activities of Daily Living (ADL) is used to describe the functional statusof a person. It is used to determine a baseline level of functioning and to monitor improvementin activities of daily living (ADL) overtime. There are systems such as the Katz ADL tool thatseek to quantify these functions and obtain a numerical value. These systems are useful for the 21
  51. 51. prioritizing of care and resources. Generally though, these should be seen as rough guidelines forthe assessment of a patient‘s ability to care for themselves. Scoring the ADL findings (Katz)Independence on a given function received a score of 1 point while if dependent, 0 point wasgiven. There were 14 items (including daily activities; household chores; shopping; cooking;paying bills). The reliability of the items was very high, α = 0.801. Total scores thus could rangefrom 0-14 with lower scores indicating high dependence and higher scores indicating greaterindependence. Instrumental Activities of Daily Living (IADL) The Instrumental Activities ofDaily Living tool (IADLs; Lawton & Brody, 1969) was the basis for assessing participants‘difficulty with IADL. IADL are those activities whose accomplishment is necessary forcontinued independent residence in the community. The independent activities of daily living are more sensitive to subtle functionaldeficiencies than ADL‘s and differentiate among task performance including the amount of helpneeded to accomplish each task. Due to the fact that the study was being conducted among menonly, some tasks which are normally done by women would not apply. Thus consistent withinternational practice, the University of Wollongong‘s modified IADL functional ability scalewhich uses a scale of 5 points for men and eight for women to assess the IADL functional abilityof men in the study (Centre of Health Service Development 2001). Consequently the domains offood preparation, laundry and housekeeping were omitted in this paper with regard to theInstrumental Activities of Daily Living for older men. Scoring the IADL: IADL scores reflectthe number of areas of impairment, i.e. the number of skills/domains in which subjects aredependent. Scores range from 0-5. Higher scores thus indicate greater impairment anddependence. 22
  52. 52. Hence, Functional status is the summation of ADL and IADL. Cohen & Holliday1 statedthat correlation can be low/weak (0–0.39); moderate (0.4–0.69), or strong (0.7–1). Hence, highdependence ranges from 0 to 5.5; moderate dependence is from 5.6 to 9.7 and low dependence(ie independence) ranges from 9.8 to 14. Independence means without supervision, direction, oractive personal assistance. The performance on the functions can be further classified andanalyzed using the format below. The classification recognizes that combinations ofindependence/dependence with respect to particular functions reflect the different degrees oflevels of capability with respect to ADL. The classification outlined below (as developed basedon Katz et al 1970 and Katz et al 1993) was used to further describe the functional status of menwith regard to ADL. Based on the aforementioned discussion on ageing and health status as wellas ageing and functional capacity, ADL and IADL are strongly correlated which indicates thatageing and functional capacity should not be a separate independent variable as there would behigh multicollinearity between those two factors. Hence, ageing category was used instead offunctionality capacity as an independent variable.ConclusionThe current work has shown that happiness is not influenced by health status nor is it determinedby employment status, educational attainment; marital status; church attendance or any otherform of social networking which means that health status is not synonymous with happiness noris happiness equivalent to health status for older men in Jamaica. Happiness is not correlatedwith health status and vice versa for elderly Jamaicans, and so understanding happiness is notcomprehending health status. Happiness and health status cannot be used to proxy each other for 23

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