Linking health states to subjective well-being: an empirical study of 5854 rural residents in China

doi:10.1016/j.puhe.2015.03.014

Public Health

Volume 129, Issue 6, June 2015, Pages 655-666

https://doi.org/10.1016/j.puhe.2015.03.014 Get rights and content

Highlights

•
First health-happiness correlation analysis of Chinese rural residents.
•
First application of EQ-5D to measuring subjective health of Chinese rural residents.
•
Mental health dimension has the strongest negative effect on SWB.
•
Chronic diseases reduce SWB significantly after subjective health is controlled for.

Abstract

Objectives

Despite a maturing literature on the association between subjective well-being (SWB) and health status of the general population in Western countries, little is known regarding the happiness–health relation in China, and rural populations in particular. This study was aimed to explore the correlation between SWB and health states of China's rural residents.

Study design

Cross-sectional survey.

Methods

Data derived from a household survey conducted in 2010 with 5854 rural residents included. The single-item self-reported happiness measure used in the World Values Survey was employed to measure SWB. EQ-5D dimensions and visual analogue scale (VAS) were applied to measure subjective health status. The number of chronic diseases was used as proxy of objective health status. OLS regressions were performed to estimate the variation in SWB by health status and β coefficients were employed as effect size measures.

Results

Among EQ-5D dimensions, anxiety/depression had the strongest negative effect on SWB. Having severe anxiety/depression problems could reduce SWB by 1.65 on a scale 1–4. Reporting severe problems in pain/discomfort could also reduce SWB by 0.41, while the impact of other dimensions was insignificant. The coefficient on VAS implied a difference in SWB of 1.60 between the worst health state and the best health state. And suffering from three chronic diseases could reduce SWB by 0.62, but the effect turned insignificant when all measures of subjective health status were entered in the regression.

Conclusions

The results from this study verify the strongly negative effect of the mental health dimension on SWB in the context of rural China. And suffering from chronic diseases has substantial negative effect on SWB even after subjective health status is controlled for. But the impact of chronic diseases on SWB could be fully captured when all measures of subjective health status are taken into account.

Introduction

Subjective well-being (SWB) is defined as people's emotional and cognitive evaluations of their lives.¹ These evaluations include people's emotional reactions to events, their moods, and judgments about their life satisfaction.² Happiness is used interchangeably with life satisfaction in literature as synonyms of SWB.³ But researchers have pointed out that happiness can mean a global evaluation of life satisfaction, living a good life, or a general positive mood.⁴ Life satisfaction is thus subsumed within happiness according to the definitions aforementioned, which implies that happiness is more akin to SWB.⁵ As a result, happiness was chose as SWB proxy in this study.

Psychologists have conducted numerous studies on the relationship between health states and happiness.⁶ But most of them were small in scale and had problems in generalizability.⁷ Despite the growing interest in the use of SWB for public policy purposes to gauge social progress and sustainable development,8, 9 the attempts to relate SWB and health states using large-sample national datasets are far from enough,¹⁰ and the role health states play in individuals' SWB remains indefinite as yet.¹¹

Health states can be indicated by either subjective health status (evaluated by respondents themselves) or objective health status (assessed by medical personnel). Studies that examined the association between subjective health status and SWB usually used answers to the self-rated health question as the health variable.¹² The typical question is ‘All in all, how would you describe your state of health these days?’ with answers ranging from very poor to very good on a five-point scale. There have been population-based researches in Sweden, US, Latin America and Russia, and the results all suggested a strongly positive health-happiness correlation.13, 14 The conclusion that self-rated health is a significant predictor for SWB has also been reached in Hsieh's study of older adults¹⁵ and in a nationally representative sample of Australian rural residents.¹⁶ Blanchflower & Oswald have made comparisons of the health-happiness relation in 16 European countries and found that happier nations report fewer blood-pressure problems.¹⁷

Since literature on the relationship between SWB and self-rated health has become maturing, researchers start to examine the association between SWB and different dimensions of subjective health status measured by health related quality-of-life (HRQoL) instruments. HRQoL is multifaceted and emphasizes the subjective evaluation of physical and mental health as well as functional capacity.¹⁸ By applying HRQoL measures, the effect of different dimensions on SWB could be prioritized. Michalos employed SF-36 in his research and found that good mental health made a substantial contribution to happiness.¹⁹ EQ-5D has been included in surveys of the general population in Latin America and the older residents in the United States. Results of both studies showed that anxiety/depression, pain/discomfort and difficulties with usual activities had substantially negative effect on SWB, while the negative effect of mobility and self-care was not significant.20, 21 In a patient sample in UK, the mental health dimension (anxiety/depression) of EQ-5D had a significantly negative association with happiness, pain was less so, and the physical health dimension (mobility) had no association.²² Despite the growing interest in determining the relationship between different dimensions of subjective health status and SWB in Western countries, hardly any literature has dealt with that issue among the Chinese population so far.

In terms of the association between objective health status and SWB, few studies have ever been done. Uppal found that happiness of Canadians decreased with severity of disability and was independent of type of physical disability and mental disability had the strongest effect.²³ Böckerman et al. found that among the Finnish population, psychiatric disorders had the largest negative impact on SWB, while other types of chronic conditions all had a significantly negative effect but were less so. Those conditions included in the study were pulmonary, cardiovascular, musculoskeletal, neurological, hearing and visual problems and other disorders.²⁴ Under the context of China, no research has reported the association between objective health status and SWB yet.

The past decade has witnessed an emerging volume of literature exploring SWB of Chinese people. But most were limited to urban areas,25, 26 centred on the elderly,²⁷ and generally investigated the relationship between SWB and socio-economic status.28, 29 In 2010, there were an estimated 674 million rural residents in China, comprising 50.3% of the population.³⁰ Yet, the SWB literature provides few data regarding this group of people. As to the health-happiness relation among Chinese people, two studies have been conducted, one in urban areas³¹ and the other in rural regions.³² Researchers in both studies used the typical self-rated health question with five answer options to measure health status and confirmed the result found in Western countries that there was a significantly positive correlation between happiness and self-rated health. To better understand the contribution of health to SWB of Chinese people, it is important to examine the effect of both subjective health status and objective health status and it would be more reliable to compare the impact of different dimensions of subjective health status. By far, no such research has been carried out with representative samples of China's rural population.

To fill these gaps in current literature, the correlation was examined between health status and happiness of the general population in rural China, with special attention paid to the effect of objective health status and the multidimensional characteristics of subjective health status. Through empirical studies, the authors aimed to testify which dimension(s) of subjective health status had stronger effect on SWB than the others and whether subjective health status could adequately capture the full impact of objective health status on SWB in the context of rural China.

Section snippets

Methods

Data were drawn from ‘The Household Health Survey of Health-Related Quality of Life of China's General Population’, which was conducted from July to August in 2010. The questionnaire mainly included questions on socio-economic conditions, chronic and other diseases, hospitalization, health-related behaviour, SWB and EQ-5D. In the survey, 1800 households were sampled through the multistage stratified sampling, and the selection criteria were in line with those applied in China's 2008 National

Results

Over 20% of respondents in this study felt very happy, 68.8% reported rather happy, while only 9.4% and less than 1% reported not very happy and not at all happy respectively. The mean SWB was 3.1 in general (Table 1).

The proportion of male respondents was around 50%. Respondents in the age group of 15–44 years occupied 49.7%. And the educational level of primary school and below was reported by 56.1% of the respondents. The distribution of basic socio-economic statistics in this study were

Discussion

Through a unique dataset containing rich and relatively new information, the health-happiness correlation of Chinese rural residents was analysed. It is the first population-based analysis of the association between SWB and health states under the context of rural China. And it is also the first study that applies EQ-5D instead of the traditional single-item self-rated health question to examine the effect of different dimensions of subjective health status on SWB. These results showed that

Acknowledgements

The authors would like to thank Yunqiu Dong for her helpful comments, the two anonymous reviewers for their enlightening suggestions, the investigators for their contribution to the household survey, and the National Natural Science Foundation of China for the funding support (70873064).

Ethical approval

Informed consent was obtained from each respondent before the corresponding interview was conducted. No private information was leaked during data analyses or used for non-academic purposes.

Funding

This research was

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Original ResearchLinking health states to subjective well-being: an empirical study of 5854 rural residents in China

Highlights

Abstract

Objectives

Study design

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Ethical approval

Funding

J Soc Econ

J Econ Psychol

Res Soc Stratif Mobil

J Socio Econ

J Health Econ

Health Place

Soc Sci Med

Soc Sci Med

Health Policy

World Dev

China Econ Rev

Environ Impact Assess Rev

Health Policy

Health Place

Value Health

World Dev

Subjective well-being: three decades of progress

Psychol Bull

Personality, culture, and subjective well-being: emotional and cognitive evaluations of life

Annu Rev Psychol

Guidelines for national indicators of subjective well-being and ill-being

Appl Res Qual Life

On subjective well-being and quality of life

J Health Psychol

Beyond money toward an economy of well-being

Psychol Sci Public Interest

Report by the commission on the measurement of economic performance and social progress

How's life? 2013-measuring well-being

Original Research
Linking health states to subjective well-being: an empirical study of 5854 rural residents in China