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Carol Graham Happiness And Health: Lessons—And Questions—For Public Policy Health Affairs, January/February 2008; 27(1): 72-87. [Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

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Electronic letters published:

Participation And Understanding Of Health Issues Are More Important Than Income For Happiness

Amith Abraham Koleth, Alec Holt   ( 15 January 2008 )

Response To Koleth Letter

Carol L. Graham   ( 18 January 2008 )

Re: Response To Koleth Letter

Amith Abraham Koleth, Alec Holt   ( 28 January 2008 )

Participation And Understanding Of Health Issues Are More Important Than Income For Happiness 15 January 2008
Amith Abraham Koleth, PhD Candidate, Health Informatics University of Otago, Alec Holt Send letter to journal: Re: Participation And Understanding Of Health Issues Are More Important Than Income For Happiness akoleth{at}infoscience.otago.ac.nz Amith Abraham Koleth, et al.	We agree with Graham that health and happiness do appear to be related. The World Health Organization defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Well-being is used as a comprehensive term encompassing physical, mental, and social influences of an individual. Aristotle describes well-being in his Nicomachean Ethics as "eudaimonia," a Greek term translated as happiness. Graham mentioned that health correlates more strongly with happiness than any other variable included in the study. However, it is difficult to understand how happiness can be totally related to income. Happiness is not a commodity and can not be bought with money, though it may seem that people use money to buy happiness. As mentioned by the "Easterlin paradox," happiness at a national level does not increase with wealth once basic needs are fulfilled. One of the basic needs in discussion is the access to health care. In many villages in Pacific island countries an individual does not exist alone but as part of a community. Fish from the ocean and the crops from the fields are shared among all members according to their needs. The village is not owned by any individual but by all its members, and due to this, there is no disparity or inequality among the members. As there is minimal trade and the monetary income is totally negligible in the villagers, it will be interesting to study their happiness scores. From our research, a main factor for unhappiness is the lack of (or perceived lack of) access to health care services. Graham also mentioned that technological advances have now enabled poor countries to enjoy better health. As access to information is power, the use of information technology has empowered citizens in developing countries with facts on health and health services. Internet services, especially open source and Health 2.0 technologies, provide new ways in which the government and citizens interact and communicate. Information technology enables a broader cross-section of citizens to participate in various levels of governance and decision making. The government benefits by providing better services in terms of participation and time, making governance more efficient and effective. It may be that with better health governance, the health of the people will improve, leading to happier people.
Response To Koleth Letter 18 January 2008
Carol L. Graham, Senior Fellow The Brookings Institution Send letter to journal: Re: Response To Koleth Letter cgraham{at}brookings.edu Carol L. Graham	I agree with Koleth that there is much about happiness that is not determined by income and that in turn mediates the happiness and health relationship. This is a major point in my article. I also agree that better health governance could go a long way to improving people's health, leading to greater happiness. However, I think that in a very poor and isolated community such as the Pacific islands, Koleth is wrong in assuming unhappiness about lack of or pereived lack of access to health services. Indeed, one of the clear patterns that is noted in my article is the surprisingly high levels of health satisfaction in countries with remarkably low standards, such as in Africa. Satisfaction with health is often lower in places with higher standards and better care. This is likely due to lack of information and awareness in the former contexts, a lack of awareness which is surely heightened by remote location. I refer in the article to the "happy peasant/frustrated achiever" problem as related to the happiness-income relationship, and then suggest that the same issues -- differences in norms, expectations, and information -- likely mediate the happiness and health relationship.
Re: Response To Koleth Letter 28 January 2008
Amith Abraham Koleth, PhD Candidate University of Otago, Alec Holt Send letter to journal: Re: Re: Response To Koleth Letter akoleth{at}infoscience.otago.ac.nz Amith Abraham Koleth, et al.	Our differences of opinion are fruitful and deserve further discussion. We are thankful that Health Affairs allows such discussion. First, we would like to emphasize that Pacific Island countries have enormous intercultural diversity; together with the characteristics of being island nations, this makes them incomparable with many developing countries on larger continents. Second, access to information empowers people to make more informed choices for their well-being and for the community as a whole. It may be argued that source of unhappiness of people in developed countries may be due to the human expectation of excellence and not because of their increased access to health services. We believe it would be unethical to stop research in communities with high levels of health satisfaction with remarkably low standards of health services. Using sight as a metaphor for knowledge, consider this hypothetical scenario. A congenitally blind person may not know the value of sight and may be satisfied with the state of blindness, but to restore sight or to inform the individual about the value of sight is our approach, and we see it as good ethics. Once the individual has experienced sight, for the person to then choose blindness would be an informed decision towards his/her happiness or well-being, but not the converse. Our argument is participation, empowerment, and community ownership of new knowledge. You only need to see the recent unrest in the Pacific such as the Kingdom of Tonga, Solomon Islands, and other smouldering spots including the Marshall Islands, to understand that people want to participate, they want their voices heard, and they want community ownership of new knowledge. We want to show them the other side; we want the reverse of lack of information and awareness. This change is a big change, but we think it will, contrary to Graham's belief, improve satisfaction and happiness, in relation to health and well-being for developing countries.