Bryan Caplan  

Objective Facts About Subjective Health

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Lately economists have gotten awfully interested in subjective well-being, popularly known as "happiness." (Here's my take; here's Arnold's; and don't neglect Will Wilkinson's blog on the subject). And of course economists have long been interested in health - trying to improve it is 15% of GDP. But as far as I've seen, economists have neglected the topic of subjective health - how healthy people say they feel.

For example, the General Social Survey has been asking the following question for about 30 years:

Would you say your own health, in general, is excellent, good, fair, or poor? (Excellent=1, good=2, fair=3, and poor=4)

There is enough data in the General Social Survey to explore subjective health from almost any angle, and I plan on devoting a number of posts to it. For now, let me get the basics on the table.

1. There is more reason to accept the validity of subjective health measures than subjective well-being measures.

The standard objection to all subjective measures is that everyone uses his own personal comparison group. In happiness research, the best counter-argument I've seen is that subjective happiness is positively correlated with objective smiling frequency. That's interesting, but hardly overwhelming.

For health, in contrast, we can verify that subjective health clearly falls rapidly with age. In any given year, one year of age predicts a .014 less healthy (i.e. higher) response. The average 89-year-old is a full point less healthy than the average 18-year-old.

2. Age-adjusted health is improving, but at a glacial rate.

Every year, holding age constant, people say they are getting .003 healthier. In other words, over 30 years, the average person of a given age has come to say that on a scale of 1-4, he is .09 healthier. At this rate, it will take 333 years to raise subjective health by a full point.

3. Rising real income and education fully account for the rise in subjective health.

People today have higher real income and education than people 30 years ago, and people with higher real income and education are healthier. If you compare two people with the same real income, education, and age, you can expect them to have the same subjective health, regardless of whether they lived in 1972 or 1998.

Of course, many people will jump on this finding to prove that subjective health is a meaningless measure, but if you are willing to entertain the Hansonian view of medicine, you should think again.


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COMMENTS (4 to date)
Patri Friedman writes:

People today have higher real income and education than people 30 years ago, and people with higher real income and education are healthier. If you compare two people with the same real income, education, and age, you can expect them to have the same subjective health, regardless of whether they lived in 1972 or 1998.

But isn't this vulnerable to the same criticism as auto fatality rates remaining the same? In that case, cars got safer, but people chosen to engage in riskier driving. So the world as a whole got benefit from the increased safety, but it didn't show up in the accident rate.

Seems like the same could be true here (although it may not be).

Matthew Cromer writes:

Health-care spending is for the most part an attempt to appease the gods, visit the white-coated medicine man, and thereby draw good health and longevity into your life.

Hanson is dead on.

Now there is that 10-15% of medical spending that is something more -- antibiotics and surgery for compound fractures, and the like. But then again there's an awful lot of iatrogenic illness too.

daveg writes:

I actually like the happiness measure, but I can see problems as well. What if criminals were shown to be the happiest?

Certainly taking someone else money without working for it could make some people happy.

dearieme writes:

Happiness? It occurs to me that it's years since I heard anyone repeat the Scottish saw, applied to some old misery-guts, "He's always a pint below par". In my experience, it applies equally well to a glass of Australian Shiraz, an NZ Sauvignon Blanc, or one of those remarkable dessert Sherries. Presumably even Americans are allowed the glass that cheers?

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