Measuring Quality of Life - Joint Debate Slides

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Presentations from ILC-UK and the Actuarial Profession in partnership with ESRC Joint Debate: Measuring Quality of Life
Speakers:
Professor Ann Bowling, St. George's University of London and Kingston University
Mr Paul Allin, Office of National Statistics
Professor Emily Grundy, London School of Hygiene and Tropical Medicine
Mr Paul Cann, Age UK Oxfordshire

Further details can be found on the ILC-UK website: http://ilcuk.org.uk/record.jsp?type=event&ID=78 and http://ilcuk.org.uk/record.jsp?type=publication&ID=83

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  • Theory –e.g. Most measures of social support (eg having a close confiding relationship) and affiliation (involvement in community life, attending clubs) are associated with health status and wellbeing. Friendship is protective whether directly or via a buffer to stress is still debated. There is policy concern about how to encourage people to maintain their social networks throughout life, and promotion of social capital – the neighbourhood resources that enable people to network and participate – thus find supportive relationships. Putnam’s studies in Italy and the US showed that the rise and fall in social capital almost exactly reflects trends in income distribution, showing how income has a direct impact on the social fabric of society. Hence studies of QoL need to be multidimensional and aware that the concept is complex, multidimensional, and that dimensions can inter-relate.
  • Qol domains overlap CASP based on theory of human need and satisfaction WHOQOL –OLD mainly consists of WHOQOL with items judged by focus groups to me missing (e.g. on functioning)
  • Except for Japan, the world’s 15 oldest countries are all in Europe. The U.S. population is relatively “young” by European standards, with less than 13 percent age 65 or older, ranking as the 38 th oldest country. The aging of the baby-boom generation in the United States will push the proportion of older Americans to 20 percent by 2030; it will still be lower than in most Western European countries. The older share of the population is expected to more than double between 2000 and 2030 in Asia and Latin America and the Caribbean. Aging is occurring more slowly in sub-Saharan Africa, where relatively high birth rates are keeping the population “young.” Ageing Fastest increase in the ‘oldest old’ Population by age, UK, 1984, 2009 and 2034 The population of the UK is ageing. Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1984 to 16 per cent in 2009, an increase of 1.7 million people. Over the same period, the percentage of the population aged under 16 decreased from 21 per cent to 19 per cent. This trend is projected to continue. By 2034, 23 per cent of the population is projected to be aged 65 and over compared to 18 per cent aged under 16. The fastest population increase has been in the number of those aged 85 and over, the “oldest old”. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5 per cent of the total population. As a result of these increases in the number of older people, the median age of the UK population is increasing. Over the past 25 years the median age increased from 35 years in 1984 to 39 years in 2009. It is projected to continue to increase over the next 25 years rising to 42 by 2034.
  • Wb includes happiness, positive and negative affect Caspe based on maslows needs satisfaction – feel in control of friendships but doesn’t inform on quality or if they exist to the satisfaction of respondent
  • & 7-point QoL self-rating scale 77% r/r; ; 80 re-interviewed in-depth
  • MD Multi-dimensional
  • Green – not in most scales except caspe control
  • The OPQOL was conceptually grounded in lay views from the baseline QoL Survey, integrated with theory from a synthesis of the literature. First, older people’s responses to open-ended questioning about the ‘good things’ that gave life quality were examined. These were categorised into main themes by two researchers, independently. These were, in order of magnitude: social relationships (mentioned by 81%), social roles and activities (60%), solo activities (48%), health (44%), psychological outlook and well-being (38%), home and neighbourhood (37%), financial circumstances (33%), and independence (27%). Smaller numbers mentioned various other things. These responses were consistent with older people’s views about what took quality away from life. Poor health was most often mentioned as the thing that took ‘quality away’ from their lives (by 50%). Other commonly mentioned things that took quality away from life were home and neighbourhood (30%), financial circumstances (23%), psychological outlook (17%). Having health, followed by better finances (i.e. having enough/more money), were the two most frequently mentioned things that respondents said would improve the quality of their own lives. The sub-scale domains in the OPQOL reflected this common core of main constituents of quality of life. The common sub-themes are listed in (Bowling 2007). The pool of actual verbatim responses was examined next by two researchers, again independently, to inform the inclusion of the items within each sub-scale. The main reasons given by people, at survey and in-depth interview, to explain the importance of these themes to their QoL were categorized, by two independent coders, as: freedom to do the things they wanted to do without restriction (whether in the home or socially); pleasure, enjoyment and satisfaction with life; mental harmony; social attachment - having access to companionship, intimacy, love, social contact and involvement, help; social roles; and feeling secure. These cut across the main themes (Bowling & Gabriel, in press). The responses which were selected for inclusion in OPQOL represented the most commonly occurring sub-themes within each theme. The verbatim responses formed an initial pool of over 100 different statements, or attitudes. After reading and comparing the items, overlapping statements were deleted to leave 51 items. The revised items were first mailed to QoL Survey sample members in 2006 and 60% 179 of the respondents invited to participate returned the completed questionnaires). They were asked to complete the items, report any difficulties they had with it, and to make any other comments about it. Psychometric tests for item redundancy, reliability and validity, led to the removal of redundant items (over-high correlations), items with high missing data, items where the Cronbach’s alpha of the scale improved with their removal, items which did not correlate with the overall scale score or a self-rated global QoL item. Exploratory factor analysis was used to explore the dimensions underlying the questionnaire,
  • Sample ages: Ethnibus: 91% aged 65<75, 9% 75+ ONS Omnibus: 55% aged 65<75 , 45% 75+ QoL sample (follow-up): 17% aged 65<75 , 83% 75+ & 52-54% female Multivariable analyses controlled for age & sex. NB: patterns shown in results unaffected by age, sex, SES At baseline QoL 999 sample = 96% white British: baseline; 33% aged 75+]
  • Bear in mind Ethnibus= younger and QoL fup=older –same patterns when analysed by age within each sample 1. I enjoy my life overall 2. I am happy much of the time 3. I look forward to things 4. Life gets me down
  • All sample differences remain when controlling for their age differences Almost three-quarters (73%) of the Ethnibus sample scored in the worst two OPQOL categories indicating poor QoL, compared with 45% of the older QoL follow-up respondents, and 12% of ONS Omnibus respondents. Chinese people reported better QoL than other ethnic groups. Cronbach’s alphas all exceeded threshold criteria for acceptability of alpha (0.70+): α: 0.748 (Ethnibus survey), α: 0.876 (ONS Omnibus survey), α: 0.901 (QoL follow-up survey). Cronbach’s alphas for the OPQOL in the three samples satisfied the α: 0.70<0.90 threshold for internal consistency: α: 0.748 (Ethnibus survey), α: 0.876 (ONS Omnibus survey), α: 0.901 (QoL follow-up survey). The CASPE-19 and the WHOQOL-OLD both satisfied the threshold for Cronbach’s alpha in the ONS sample (α: 0.866 and α: 0.849 respectively), but not in Ethnibus (α: 0.553 and α: 0.415 respectively).
  • Differences remain when we compare age groups
  • Lends support top self management programs re chronic disease which build self-efficacy The mean sd for those with walking disabilities: Able to walk 400 yards-some diff. Unable without help/at all Mean sd Mean sd OPQOLTOT Ethnibus 116.595 (11.490) 109.310 (9.514) ONS new sample 139.037 (13.015) 122.724 (12.134) No of supporters x OPQOL tot 0-2 supporters 3+ supporters mean (sd) OPQOL TOTAL score Ethnibus 113.643 (9.742) 114.961 (11.140) ONS new sample 129.010 (14.836)*** 136.289 (13.653)
  • P10’s club provided assistance: those with poor eye sight employed SOC by optimizing their attendance at the club, where they met friends, and compensated for poor eye sight with binoculars/bowling against string:
  • The OPQOL performed well in national population and ethnically diverse samples of older people, reflecting its multi-dimensionality, the item-generation by older people themselves, and piloting with ethnically diverse focus groups. It is of potential value in the evaluation of interventions which have a multidimensional impact on people.
  • The 4 questions on the IHS The HIS would cover 4 overall questions on subjective well-being covering evaluative, experience and eudemonic accounts allowing for overall monitoring of SWB in the UK and at the sub-national level This will be supplemented with domain specific and detailed questions asked regularly on our Opinions survey, which is a monthly survey with a random sample of around 1000 adults responding each moth
  • Measuring Quality of Life - Joint Debate Slides

    1. 1. Measuring Quality of Life Tuesday 10 th May 2011 www.ilcuk.org.uk
    2. 2. <ul><li>Baroness Sally Greengross </li></ul><ul><li>House of Lords </li></ul>Measuring Quality of Life
    3. 3. <ul><li>Professor Ann Bowling </li></ul><ul><li>St. George’s, University of London and Kingston University </li></ul>Measuring Quality of Life
    4. 4. Quality of Life in older age A. Bowling, D. Banister, P. Stenner, H. Titheridge, K. Sproston, T. McFarquhar
    5. 5. To measure QoL in people 65+ in Britain To develop & test new ‘bottom up’ measure of QoL (OPQOL) Aims of Studies
    6. 6. Why another measure of QOL? <ul><li>QoL: </li></ul><ul><li>Complex: objective & subjective concept </li></ul><ul><li>Existing measures developed ‘top down’ - are we measuring the right things? </li></ul><ul><li>Multidimensional measure with social relevance needed for use in multi -sector policy evaluation </li></ul><ul><li>Gap in market: global pop. ageing & increasing longevity </li></ul>
    7. 7. 15 ‘Oldest’ Countries Sources: Carl Haub, 2006 World Population Data Sheet . % age 65+
    8. 9. <ul><li>Existing QoL measures (top-down): </li></ul><ul><li>Life satisfaction & well-being (single QoL domain) </li></ul><ul><li>Physical & mental functioning (2 health-QoL domains) </li></ul><ul><li>Broader health status (SF-36) (health-QoL domain s ) </li></ul><ul><li>Economic utility measures (EQ-5D) (narrow health) </li></ul><ul><li>CASP-19 (single theory based: needs satisfaction & self-actualisation) </li></ul><ul><li>WHOQOL/WHOQOL-OLD (-24) multi-dimensional WHO perspective; tested across countries – convenience samples; ‘OLD’ ‘functioning added on’ by focus groups </li></ul>
    9. 10. <ul><li>ONS Omnibus 1999-2000: interviewed 999 people: </li></ul><ul><li>aged 65+ (77% r/r). ‘ Bottom-up’ Qs on QoL: </li></ul><ul><li>‘ Thinking about your life as a whole, what is it that makes </li></ul><ul><li>your life good - that is, the things that give your life </li></ul><ul><li>quality? You may mention as many things as you like.’ </li></ul><ul><li>‘ What is it that makes your life bad - that is the things that </li></ul><ul><li>reduce the quality in your life? You may mention as many </li></ul><ul><li>things as you like.’ </li></ul><ul><li>  </li></ul><ul><li>‘ Thinking about all these good and bad things you have </li></ul><ul><li>just mentioned which one is the most important to you?’ </li></ul><ul><li>7-point QoL self-rating scale: ‘QoL so good, could not be better’ – </li></ul><ul><li>‘ QoL so bad, could not be worse’ </li></ul><ul><li>National random sample, private PC files:77% r/r; 80 re-interviewed in depth </li></ul>
    10. 11. <ul><li>Measures also included: </li></ul><ul><li>Psychological: self-efficacy (mastery and control over life); social comparisons, expectations; optimism-pessimism </li></ul><ul><li>Health & functioning: Townsend ADL; Health status; health perceptions (SF-36), diagnosed conditions, longstanding illness </li></ul><ul><li>Psychological morbidity: General Health Questionnaire-12 </li></ul><ul><li>Social network: contacts & support: family/friends/neighbours, social participation; perceived neighbourhood social capital </li></ul><ul><li>ONS: socio-demographic & socio-economic Qs. </li></ul>
    11. 12. <ul><li>Main QoL themes mentioned & used to develop OPQOL: </li></ul><ul><li>* Social & family relationships </li></ul><ul><li>* Social roles & activities </li></ul><ul><li>* Health & functional ability </li></ul><ul><li>* Home & neighbourhood (perceived social capital) </li></ul><ul><li>* Psychological well-being & outlook (life satisfaction; contentment; optimism; social comparisons) </li></ul><ul><li>Income </li></ul><ul><li>Independence & being in control over one’s life </li></ul><ul><li>Plus: religion, culture, children prioritised by 4 ethnically diverse focus groups </li></ul><ul><li>* Independently predicted global self-assessed QoL </li></ul>
    12. 13. <ul><li>Example: 81% said social relationships gave quality to life: </li></ul><ul><li>‘ for companionship’ </li></ul><ul><li>‘ to do things with’ </li></ul><ul><li>‘ to take me out’ </li></ul><ul><li>‘ to make life bearable’ </li></ul><ul><li>‘ to know there is someone there willing to help me’ </li></ul><ul><li>‘ to look after me’ </li></ul><ul><li>‘ for ‘confidence’. </li></ul><ul><li>… .Oh, and my little cat. I talk to her a lot, she’s just like a little child. She doesn’t like being left alone, I love her to bits. Now and again I give her a little kiss.’ </li></ul>
    13. 14. Social relationships - neighbours & family: “ Four doors down the man called me to give me broad beans. When I did not put my washing line up he came round to see if there was any problem. The lady two doors down does my eye drops three times a week. They are all very good.” “ The quality of my life now is my family - my children and grandchildren. My life surrounds them. I go at weekends, they visit every week. Sometimes I have the younger grandchild staying overnight… I’m there if they need me.”
    14. 15. <ul><li>For 12% poor social relationships took quality away from life – e.g. difficulties maintaining contacts/relationships, due to: </li></ul><ul><li>geographical distance </li></ul><ul><li>families ‘too busy’ to visit </li></ul><ul><li>family feuds (‘If only we could be friends with our children.’) </li></ul><ul><li>Ill health/difficulties getting out </li></ul>
    15. 16. <ul><li>200+ lay items reduced to 50 & pre-tested with 100 </li></ul><ul><li>survey volunteers, & re-reduced: OPQOL-32 & -35: </li></ul><ul><li>Life overall (4) </li></ul><ul><li>Health (4) </li></ul><ul><li>Social relationships & participation (8) </li></ul><ul><li>Independence, control over life, freedom (5) </li></ul><ul><li>Area: home & neighbourhood (4) </li></ul><ul><li>Psychological & emotional well-being (4) </li></ul><ul><li>Financial circumstances (4) </li></ul><ul><li>Religion & culture (2) </li></ul><ul><li>5-point Strongly agree to Strongly disagree response scales; reverse coding of positive responses & summed: higher scores = higher QoL </li></ul><ul><li>Scale ranges: 35 (QoL so bad could not be worse) - 175 (QoL so good could not be better) PLUS IMPORTANCE RATINGS </li></ul>
    16. 17. <ul><li>Three QoL surveys 2007-8 to test </li></ul><ul><li>Older People’s </li></ul><ul><li>QoL questionnaire (OPQOL) </li></ul><ul><li>National ONS Omnibus Survey (sifted 65+: 589/61% r/r) </li></ul><ul><li>[94% white British; 45% aged 75+)] </li></ul><ul><li>National Ethnibus Survey (sifted 65+:400/70% r/r) </li></ul><ul><li>[Indian (38%), Pakistani (29%), Black Caribbean (22%), Chinese (11%) people; 9% aged 75+ ] </li></ul><ul><li>Postal follow-up of 1999-2000 ONS Omnibus QoL survey respondents (74+:287/58% r/r) </li></ul><ul><li>[100% white British; 83% 75+ at follow-up] </li></ul><ul><li>Analyses controlled for age, sex, SES </li></ul>
    17. 18. <ul><li>OPQOL item: 4. Life gets me down </li></ul><ul><li>Ethnibus ONS QoL follow-up </li></ul><ul><li>% % % </li></ul><ul><li>Strongly agree 14 1 2 </li></ul><ul><li>Agree 47 12 7 </li></ul><ul><li>Neither agree </li></ul><ul><li>nor disagree 23 17 25 </li></ul><ul><li>Disagree 12 48 44 </li></ul><ul><li>Strongly disagree 4 22 22 </li></ul>
    18. 19. <ul><li>OPQOL item: 11. I have someone who gives me love and affection </li></ul><ul><li>Ethnibus ONS QoL follow-up </li></ul><ul><li>% % % </li></ul><ul><li>Strongly agree 10 50 45 </li></ul><ul><li>Agree 45 38 35 </li></ul><ul><li>Neither agree </li></ul><ul><li>nor disagree --- 5 13 </li></ul><ul><li>Disagree 43 5 6 </li></ul><ul><li>Strongly disagree 2 2 1 </li></ul>
    19. 20. <ul><li>OPQOL item: 25. I have enough money to pay </li></ul><ul><li>for household bills </li></ul><ul><li>Ethnibus ONS QoL f/up </li></ul><ul><li>% % % </li></ul><ul><li>Strongly agree 17 25 29 </li></ul><ul><li>Agree 17 66 59 </li></ul><ul><li>Neither agree </li></ul><ul><li>nor disagree 37 5 9 </li></ul><ul><li>Disagree 25 3 3 Strongly disagree 4 1 --- </li></ul>
    20. 21. <ul><li>OPQOL Total Score </li></ul><ul><li>Ethnibus ONS QoL f/up </li></ul><ul><li>% % % </li></ul><ul><li>QoL bad as can be ≤99 6 1 7 </li></ul><ul><li>100-119 67 11 38 </li></ul><ul><li>120-139 25 52 43 </li></ul><ul><li>140-159 2 32 12 </li></ul><ul><li>QoL good as can be 160-175 --- 4 --- </li></ul><ul><li>Cronbach’s alpha of </li></ul><ul><li>internal consistency 0.75 0.88 0.90 </li></ul><ul><li>[Cronbach’s alpha threshold for consistency 0.70<0.90] </li></ul><ul><li>Current Gerontology and Geriatrics Research. Open access ‘Volume 2009 (2009). </li></ul>
    21. 22. <ul><li>CASP-19 Total Score (2 new samples only) </li></ul><ul><li>Ethnibus ONS </li></ul><ul><li>% % </li></ul><ul><li>≤ 19 ‘Absence of QoL’ ---- 1 </li></ul><ul><li>20-29 23 7 </li></ul><ul><li>30-39 68 27 </li></ul><ul><li>40-49 8 46 </li></ul><ul><li>50-57 ‘Satisfaction in all domains’ 1 19 </li></ul><ul><li>Cronbach’s alpha 0.55 0.87 </li></ul><ul><li>Scale range 0-57 (response scales 0-3; - reversed so positive=better & summed) </li></ul>
    22. 23. WHOQOL-OLD Total Score (2 new samples only) Ethnibus ONS % % ≤ 69 Lowest possible QoL 2 4 70-79 23 11 80-89 58 24 90-99 15 40 100-120 Highest possible QoL 2 27 Cronbach’s alpha 0.42 0.85 Scale range 24-120 (24 x 5-point response scales 1-5; - reversed so positive=better & summed)
    23. 24. <ul><li>WHOQOL QoL scale module: death & dying: </li></ul><ul><li>Ethnibus ONS </li></ul><ul><li>% % </li></ul><ul><li>7. Extreme fear of </li></ul><ul><li>not being able to </li></ul><ul><li>control death 43 17 </li></ul><ul><li>9. Extreme fear of </li></ul><ul><li>pain before death 52 34 </li></ul><ul><li>Extreme fears on any </li></ul><ul><li>1 of 4 DD items 77 41 </li></ul><ul><li>& items: 8. Fear of dying; 6. Fear of way in which will die; Postgraduate Medical Journal, 2010: 86: 197-202. </li></ul>
    24. 25. <ul><li>Adjusted odds of OPQOL score being good (1 referent) vs. not good (0) (all p<0.001) </li></ul><ul><li>ONS sample (65+) QoL follow-up (74+) </li></ul><ul><li>O.R. (95% CI) O.R. (95% CI) </li></ul><ul><li>Unable to walk </li></ul><ul><li>400 yards </li></ul><ul><li>without help </li></ul><ul><li>or at all vs. rest 0 .128 (0.070 – 0.236) 0 .443 (0.312-0.631) </li></ul><ul><li>Actual number of </li></ul><ul><li>supporters </li></ul><ul><li>who would help in </li></ul><ul><li>a personal crisis 1 .159 (1.062 – 1.265) 1 .183 (1.070 – 1.308) </li></ul><ul><li>Self-efficacy+ </li></ul><ul><li>High vs. rest N/A 3 .449 (1.681 – 7.078) </li></ul><ul><li>(+our belief in our ability to succeed) </li></ul>
    25. 26. <ul><li>Validity: OPQOL items (n. 273) </li></ul><ul><li>8. ‘I am healthy enough to get out & about’ </li></ul><ul><li>Strongly disagree/ Neither Agree/ </li></ul><ul><li>Disagree Strongly agree </li></ul><ul><li>% % % </li></ul><ul><li>10. ‘I would like </li></ul><ul><li>more companionship/ </li></ul><ul><li>contact </li></ul><ul><li>with other people’ </li></ul><ul><li>Strongly agree/Agree 48 21 19*** </li></ul><ul><li>Neither 32 57 43 </li></ul><ul><li>Strongly disagree/Disagree 20 22 39 </li></ul>
    26. 27. <ul><li>Essential requirement for coping with challenges of older age: </li></ul><ul><li>Build up reserves of social support & psychological resources (self-efficacy) to optimise: </li></ul><ul><li>Skills </li></ul><ul><li>Opportunities </li></ul><ul><li>Abilities </li></ul><ul><li>To help compensate when unable to do things </li></ul>
    27. 28. SOC: 84 year old widower (carpenter): <ul><li>After his wife died he had no-one to help him put on his socks, so he made a ‘ sock horn ’ ; ... to dry between his unreachable toes he made a V-shaped wooden implement. </li></ul><ul><li>“… I can ’ t reach. I made this up … this frame … stretches out, tightens up … I have given some of these to other people to help them … .a couple of people at the Church ... this woman ..keeps making me cakes (laughs). ” </li></ul>
    28. 29. SOC: A keen bowler: <ul><li>“ The beauty of the bowling, of course, is the fact is that if a partner dies they ’ ve got somewhere to go. </li></ul><ul><li>I mean they literally … play at our bowling club till 95 and even some of them have got new knees … some of them can hardly see, they have binoculars to see where the jack is, but there ’ s that companionship, somewhere to go... ” </li></ul>
    29. 30. <ul><li>Cont. </li></ul><ul><li>“ We ’ ve got a section for blind bowlers ... Amazing what they can do. We put a string down the centre ... so they can feel initially where they ’ ve got to go … </li></ul><ul><li>We ’ ve actually got somebody that could beat most of the club members … . he can ’ t see the jack, so we put the jack up for him. He then bowls against the string. </li></ul><ul><li>Then there ’ s another one who ’ s got tunnel vision, he uses binoculars. And he will put on these binoculars- there ’ s two of them - they will see where the jack is, and bowl … . ” </li></ul>
    30. 31. <ul><li>Cont. </li></ul><ul><li>“ We ’ ve had so many people having new knees … </li></ul><ul><li>The Australians have come out with an assistance for knees, bad arthritic knees, and it ’ s an extension of your arm … … mechanical, it fits the bowl at the end and you swing it. You don ’ t have to bend and you just release it. And you ’ d be surprised how proficient they are.&quot; </li></ul>
    31. 32. <ul><li>Summary </li></ul><ul><li>OPQOL: good reliability & validity in British pop. & ethnically diverse samples </li></ul><ul><li>There were marked differences between British pop. & ethnically diverse samples ’ OPQOL items & score </li></ul><ul><li>(& controlling x age) </li></ul><ul><li>Independent predictors of good Qol (OPQOL) in each sample: </li></ul><ul><li>Good health/functioning – esp. mobility, </li></ul><ul><li>More supporters, </li></ul><ul><li>Perceived self-efficacy (belief in our ability to succeed) </li></ul>
    32. 33. <ul><li>Mr Paul Allin </li></ul><ul><li>Office of National Statistics </li></ul>Measuring Quality of Life
    33. 34. Delivering wider measures of national well-being and quality of life – Paul Allin, Programme Director
    34. 35. Overview <ul><li>What is national well-being (and how different from quality of life)? </li></ul><ul><li>Why measure national well-being? </li></ul><ul><li>How to measure it? </li></ul><ul><li>What matters to people? </li></ul><ul><li>What next? </li></ul>
    35. 36. What is national well-being? <ul><li>Sum of individual well-being </li></ul><ul><li>How’s the UK doing? (more to life than GDP) </li></ul><ul><li>Measuring progress, true wealth and the well-being of the UK </li></ul><ul><li>Overall societal development and progress </li></ul><ul><li>The state of the nation </li></ul><ul><li>The ‘health’ of the nation </li></ul><ul><li>Economic performance and social progress (not forgetting sustainability and pressures on the environment) </li></ul>
    36. 37. Why measure it? <ul><li>Better decision making (government, markets, public) </li></ul><ul><li>“ not focussing on the right set of statistical indicators” </li></ul><ul><li>“ to steer our economies better through and out of crises” </li></ul><ul><li>“ facing a looming environmental crisis” </li></ul><ul><li>What does this mean in practice? </li></ul>
    37. 38. How to measure national well-being? Stiglitz measurement framework: Economic Measures , e.g. Net national income per household Distribution of wealth, income, disposable income Effects of tax and benefits on distribution Human capital and growth rate Environmental Measures , e.g. Stocks of natural resources and depletion rates Indicators of climate change Quality of Life e.g. Health: life expectancy, expected disability free life years, Indicators of family life e.g. Single parent households Problem indicators e.g. Crime rate, Children in care, drugs, imprisonment rate Subjective wellbeing
    38. 39. Well-being New Economy Resources Environment Well-being Green Growth Quality Growth
    39. 40. How to measure national well-being? <ul><li>Aggregate subjective well-being (only) </li></ul><ul><ul><li>“ Happiness is the new GDP” (discuss!) </li></ul></ul><ul><li>Wider measures </li></ul><ul><ul><li>Many separate numbers – indicator sets </li></ul></ul><ul><ul><li>Few key numbers – based on consensus of what is important – dashboard </li></ul></ul><ul><ul><li>Combined index, using fixed weights? </li></ul></ul><ul><ul><li>Help-yourself index? - starting point: UK personal inflation calculator </li></ul></ul><ul><ul><li>Adjusted national accounts measures? - eg index of sustainable economic welfare </li></ul></ul>
    40. 41. Measuring subjective well-being <ul><li>Four overall monitoring questions from April 2011 in IHS (with socio-demographics) </li></ul><ul><li>Sample of 200,000 directly questioned adults each year across UK </li></ul><ul><li>Detailed questions – sample of 1,000 adults per month </li></ul><ul><li>Questions drawn from research and tested for use in IHS </li></ul><ul><li>Annual data available from July 2012 </li></ul><ul><li>Experimental </li></ul>
    41. 42. Measuring subjective well-being <ul><li>Overall, how satisfied are you with your life nowadays? </li></ul><ul><li>Overall, how happy did you feel yesterday? </li></ul><ul><li>Overall, how anxious did you feel yesterday? </li></ul><ul><li>Overall, to what extent do you feel the things you do in your life are worthwhile? </li></ul><ul><li>(all on scale 0 – 10) </li></ul>
    42. 43. What matters to people? <ul><li>Wide range </li></ul><ul><li>Most frequently voted for: </li></ul><ul><ul><ul><li>Health (83% of survey monkey responses) </li></ul></ul></ul><ul><ul><ul><li>Friends & relatives (82%) </li></ul></ul></ul><ul><ul><ul><li>Job satisfaction (77%) </li></ul></ul></ul><ul><ul><ul><li>Partner/spouse relationship (71%) </li></ul></ul></ul><ul><ul><ul><li>Economic security (68%) </li></ul></ul></ul><ul><ul><ul><li>Environment now and future (67%) </li></ul></ul></ul><ul><ul><ul><li>* </li></ul></ul></ul><ul><ul><ul><li>* </li></ul></ul></ul><ul><ul><ul><li>Income and wealth (48%) </li></ul></ul></ul><ul><ul><ul><li>* </li></ul></ul></ul><ul><ul><ul><li>* </li></ul></ul></ul>
    43. 44. What next? <ul><li>ONS work programme </li></ul><ul><li>Testing out what we’ve learned from the national debate and how to take forward </li></ul><ul><li>What do the subjective well-being data tell us? </li></ul><ul><li>Issues </li></ul><ul><li>Engagement </li></ul><ul><li>Meeting differing requirements </li></ul><ul><li>Well-being measurement and policy </li></ul>
    44. 45. <ul><li>Professor Emily Grundy </li></ul><ul><li>London School of Hygiene and Tropical Medicine </li></ul>Measuring Quality of Life
    45. 46. <ul><li>Professor Emily Grundy </li></ul><ul><li>( collaborators George Ploubidis and Harriet Young) </li></ul><ul><li>London School of Hygiene and Tropical Medicine </li></ul><ul><li>Older Europeans’ happiness and well-being </li></ul>Measuring Quality of Life
    46. 47. Country level differences in well-being <ul><li>Why of interest? </li></ul><ul><li>Large differences between European countries in, for example, older people’s incomes; living arrangements and extent of family social activity – do these lead to differences in indicators of subjective well-being? </li></ul><ul><li>Might reveal policy relevant factors that potentially could be modified </li></ul><ul><li>Might increase our understanding of ageing and well-being processes </li></ul><ul><li>Problems and limitations: </li></ul><ul><li>Even if you ask the same questions, there may be differences between and within countries in how people answer them (c.f. Ann Bowling’s ‘bottom up’ approach). </li></ul><ul><li>Methods which aim to produce measures less subject to measurement bias are quite complex </li></ul>
    47. 48. Living arrangements of Europeans aged 60+ and 80+ by region. Source: Analysis of ESS 2002/4. North : DK, Fin, Norw, Swe; West : Aust, Belg, Ger, Neths, UK; East : CzR, Est, Hung, Pol, SlovK, Sloven, Ukr; South : Gre, Port, Esp.
    48. 49. Dataset 1: European Social Survey <ul><li>Two cross-sectional rounds of data – 2002 and 2004 </li></ul><ul><li>Used data from 19 countries </li></ul><ul><li>Sample size 18,131 people aged 60+ </li></ul><ul><li>Scale: ‘Taking all things together, how happy would you say you are?’ – respondents rated their answer on a scale of 0 (extremely unhappy) to 10 (extremely happy). </li></ul>
    49. 50. Country groupings North West South East Sweden Norway Finland Denmark Germany Belgium UK Austria Netherlands Portugal Greece Spain Poland Slovenia Slovakia Hungary Ukraine Estonia Czech Republic N=3621 N=5867 N=3857 N=4786
    50. 51. Happiness among unmarried older women by European region: results from ordinal logistic models (Higher =happier), 2002-4 Analysis of European Social Survey; models control for age, widowhood indicator, long term illness & Whether living alone or with others. ( ) results from models not including social ties. North West South East Low education 1.27 (1.17) 1.19 (1.15) 0.76 (0.73) 1.10 (1.02) Low income 0.75 (0.74) 0.86 (0.87) 0.94 (0.81) 0.53** (0.45**) Moderate social ties 0.76 0.69** 0.62 0.92 Low social ties 0.41** 0.56** 0.34** 0.48** Least social ties 0.08** 0.19** 0.45** 0.24** N 840 1664 1055 1507
    51. 52. Associations between living arrangements and happiness (higher=better) by region; ref. group=living alone : results from analysis of ESS 2002-4. ***P<.001, *P<0.05 Controlling for age, education, income, social meetings, social activities, long term illness, availability of confidante, widowhood. Men Women Spouse only Spouse+others Others only Spouse only Spouse+others Others only North 2.59*** 3.36*** 0.73 1.94*** 1.86* 1.09 West 2.11*** 1.82* 1.34 2.11*** 2.69*** 2.06*** East 1.04 1.09 0.60 1.81* 1.50 1.36* South 1.61 1.47 1.10 1.77* 1.82* 2.08*
    52. 53. What is associated with happiness in the older population of Europe? (from ESS) <ul><li>Region: N(best)W S E (worst) </li></ul><ul><li>Comfortable income </li></ul><ul><li>Frequent social meetings and social activities </li></ul><ul><li>Availability of confidante </li></ul><ul><li>No long-term illness </li></ul><ul><li>Older age </li></ul><ul><li>Lower education </li></ul><ul><li>Living with spouse; </li></ul><ul><li>For unmarried women those living with others (children) in S, E & W Europe happier than those living alone; not the case in Northern Europe. </li></ul>Analysis of ESS, combined sample 18 countries fully adjusted ordinal logistic regression.
    53. 54. Dataset 2 <ul><li>We used data from 14 European countries included in the second wave of the Survey of Health and Retirement in Europe SHARE (n = 33,528) </li></ul><ul><li>The countries included are drawn from Northern (Denmark and Sweden), Western (Austria, France, Ireland, Germany Belgium, and the Netherlands), Mediterranean (Spain, Italy and Greece) and Eastern (Poland and the Czech Republic) regions of Europe. </li></ul><ul><li>Measure of well-being derived from several individual questions using a latent variable approach </li></ul>
    54. 55. Life satisfaction Look forward to each day Life has meaning Look back with happiness Full of opportunities Future looks good Optimistic about future Feel prepared for my future Happiness Enjoyed life Well-being Factor 1 Factor 2 Factor 3 Factor 4 Best fitting/invariant well-being model
    55. 56. Well-being country level comparison
    56. 57. Depression country level comparison
    57. 58. <ul><li>Conclusion </li></ul><ul><li>There is considerable between country variance in late-life mental health in Europe </li></ul><ul><li>The Scandinavian countries seem to do best (low depression/high well being) followed by central European countries, while residents of Mediterranean countries report the worst mental health (NB Eastern Europe not considered) </li></ul><ul><li>Results from analysis of ESS data also show older Northern Europeans happier than older Southern Europeans </li></ul><ul><li>Social factors and social support important in all analyses – but countries with the most family based social support systems have worse rather than better indicators of well-being </li></ul><ul><li>More innovatory approaches such as Ann Bowling’s needed to unravel meaning of measures and their implications. </li></ul>
    58. 59. <ul><li>Mr Paul Cann </li></ul><ul><li>Age UK Oxfordshire </li></ul>Measuring Quality of Life
    59. 60. <ul><li>* What are the best measures of wellbeing and happiness across the lifecourse? * How does wellbeing differ across the lifecourse and do we need to take age into account when developing measures of happiness? * What factors predict quality of life amongst older people? * How can quality of life amongst older people be improved? * How will the new ONS measures of national well-being, including quality of life, impact on public policy? </li></ul>Measuring Quality of Life
    60. 61. Measuring Quality of Life Tuesday 10th May 2011 www.ilcuk.org.uk

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