Social comparisons, health and well-being

Abstract

Health and well-being are socially determined. One of the ways in which this comes about is via social comparisons with other individuals in the same personal, geographic or social networks, with the comparisons referring either to income or other aspects of economic and social life. The existence of such comparison effects with respect to income may help to explain the social gradient in health.

Résumé

La santé et le bien-être sont déterminés socialement : une des raisons de cette détermination est l’existence des comparaisons sociales avec les autres individus appartenant au même groupe familial, géographique ou social, soit par rapport au revenu, soit par rapport à d’autres aspects de la vie économique et sociale. L’hypothèse présentée dans cet article est que ce phénomène de comparaison peut aider à comprendre le gradient social de santé.

Introduction

There are a number of parallels between health and subjective well-being, seen through the lens of someone who carries out micro-econometric research. In particular, both are very often measured on an ordinal scale and are subjective. There is an obvious similarity between the classic self-assessed health question (in the British Household Panel Survey: “Would you say that your health has on the whole been…?”, with the possible responses: Excellent, Good, Fair, Poor, and Very poor) and subjective well-being (“How dissatisfied or satisfied are you with your life overall”, with seven responses on an ordered scale). That this similarity did not lead to the analysis of well-being being so easily accepted as that of health is a subject potentially worthy of reflection.

Any teething problems involved in the empirical analysis of well-being in the social sciences seem to have died down by now. Here, I will take life satisfaction and so on as useful summary measures of how well overall the individual is functioning. Some of the research providing validating evidence for this hypothesis is mentioned in Section 4 of [1].

It is actually rather reassuring that the type of society is correlated with both our health and well-being: surely the big surprise would have been were they not to be so. Which is not to say that we understand perfectly why it is that some societies perform differently from others in this respect. Outcomes may differ due to societies’ different characteristics (their health-care systems, environmental quality and so on); or because of the type of people who live there (in the sense that what other people do may affect my health or well-being). In this latter case, there are spillovers or externalities between individuals, and it is this channel that I will reflect on here. I therefore ask: Do you make me sick, or do you make me happy?

Such spillovers are a very interesting area of research. It is however easy to come to the wrong conclusions. Individuals’ health/well-being may be correlated, but that does not show that they influence each other. As noted above, individuals within the same society (or the same region, town or even road) very likely share some of the same health environment (prices, health supply, exposure to environmental and health risk factors). Equally, it may be the case that individuals who are similar to each other choose to live in a certain area (birds of a feather flock together).

In both of the latter cases, the causal link is not a direct relationship from my own behaviour to others’ behaviour. We want to know whether an exogenous change to one individual's behaviour affects the health and well-being of others in his peer group. This is important to know for policy purposes. Will a policy that affects one individual's behaviour also spill over to the behaviour of another individual (if I am able to make A stop smoking, which might then encourage B to stop, which then leads C to stop, which then…)? Equally, from a social welfare point of view, is there a risk that making A better off might also make B worse off?