Which are the countries in which people have the best opportunities for psychological well-being?

This might seem like an odd question, so I will begin by explaining why I think it is worth considering.

Psychological well-being was identified in a recent post on this blog as one of five basic goods that a flourishing human would be expected to have. The post listed a range of aspects involved in psychological well-being: emotional stability, positive emotion, satisfaction with material living standards, engagement in doing things for their own sake and learning new things, perception of life as meaningful, a sense of accomplishment, optimism, resilience, vitality, integrity, and self-respect.

It seems reasonable to expect that opportunities for individuals to experience some of those aspects of psychological well-being might be greater in some countries than in others.

In compiling my list of aspects of psychological well-being, my starting point was the definition of psychological flourishing adopted by Felicia Huppert and Timothy So in their article ‘Flourishing Across Europe’ (published in Soc.Indic.Res. in 2013). These authors view psychological flourishing as lying at the opposite end of a spectrum to depression and anxiety. They identified 10 symptoms of flourishing (competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self-esteem, and vitality) as the opposites of internationally agreed criteria for depression and anxiety (DSM and ICD). The study has previously been discussed on this blog.

My main modification to Huppert and So’s list is the addition of satisfaction with material living standards. In my view, people who feel miserable because they are dissatisfied with their material living standards are deficient in psychological well-being, even though they may not be suffering from the symptoms of depression or anxiety.

Despite my desire to modify the measure of psychological flourishing constructed by Huppert and So, it strikes me as providing a good basis for international comparison of psychological well-being. Unfortunately, this measure is only available for European countries, and for one year, 2006. That leads me to consider whether life satisfaction is a satisfactory alternative measure.

Is life satisfaction good enough?

The chart shown above suggests that, at a national level at least, the percentage of people who are satisfied “with how life has turned out so far” (ratings of 9 or 10 on a scale of 0 to 10) is a good predictor of psychological flourishing. In a simple linear regression, the percentage with high life satisfaction explains 83% of the inter-country variation in the percentage who are flourishing. (The chart was constructed using life satisfaction data from the 2006 European Social Survey used by Huppert and So to construct their psychological flourishing indicator.)

The idea that life satisfaction could a good enough measure of psychological flourishing might appear to be at variance with the findings of Huppert and So.  As discussed in an earlier post, Huppert and So found that only 46.0% of people who met the criterion for flourishing had high life satisfaction, and only 38.7% of people who had high life satisfaction met the criterion for flourishing.

 

However, the appropriateness of life satisfaction as an indicator of psychological flourishing depends on the purpose for which the indicator is to be used. If you want to know about an individual’s psychological well-being, it is hardly surprising that a single question about life satisfaction has been found to be a poor indicator. If your focus is on average psychological well-being at a national level, life satisfaction seems to be a good enough indicator because much of the measurement error at an individual level washes out in calculating national averages.

The countries with highest average life satisfaction

Average life satisfaction data from the Gallup World Poll is published annually in the World Happiness Report. This data set covers many countries and measures life satisfaction according to the Cantril ladder scale, with a rating of 10 being given to the best possible life and a rating of zero is given to the worst possible life.

In the 2018 survey, average life satisfaction ratings were greater than 7 in 15 countries: Finland, Denmark, Switzerland, Netherlands, Norway, Austria, Sweden, New Zealand, Luxembourg, United Kingdom, Australia, Canada, Costa Rica, Germany and Czech Republic. Average ratings tend to be fairly stable from year to year, but a decade earlier, Ireland, Spain, U.S, Israel, Belgium and France had average ratings above 7, and U.K, Costa Rica and Germany had ratings below 7.

Regression analysis undertaken by John Helliwell et. al. show that almost three-quarters of the variation in national annual average life satisfaction scores among countries can be explained by six variables: GDP per capita, networks of social support, healthy life expectancy, freedom to make life choices, generosity, and freedom from corruption. That list of variables has a strong overlap with determinants of other basic goods in my list of the five basic goods that a flourishing human could be expected to have. (See other posts in this series, here, here and here.) Apart from GDP per capita and healthy life expectancy, however, the data used in the analysis of Helliwell et al are based on perceptions of survey participants rather than objective measurement. (The analysis is a pooled regression using 1704 national observations from the years 2005 to 2018.)

Since my focus is on identifying countries where a person chosen at random would have the best opportunities, the median life satisfaction for each country would be a better criterion than the mean. Unfortunately, I don’t have access to such data at a national level. Estimates of median life satisfaction for broad regions (based on data here) suggest that median life satisfaction is typically lower than the mean. The difference between mean and median tends to be small for countries with relatively high life satisfaction: Western Europe (6.6 for mean cf. 6.4 for median) and North America and ANZ (7.1 cf. 6.9). The difference more substantial in some other parts of the world e.g. South East Asia (5.4 cf. 4.8).

Avoiding and reducing misery

In considering which countries offer the best opportunities for psychological well-being, countries with high average life satisfaction would be less attractive to risk averse people (most humans) if a relatively high proportion of the population of those countries nevertheless lived in misery. However, available evidence suggests that factors that lead to high life satisfaction also tend to reduce misery. For example, it is apparent from the graph below that the regions of the world with highest average life satisfaction tend also to have the lowest percentages with low life satisfaction.

A study by Andrew Clark et al for the World Happiness Report 2017 used data for the U.S., Australia, Britain and Indonesia to examine how much misery would be reduced if it was possible to eliminate one or more key determinants. The factors considered were poverty, low education, unemployment, living alone, physical illness, and depression and anxiety disorders. The authors found that the most powerful impact would come from the elimination of depression and anxiety disorders.

Conclusions

Life satisfaction is not a particularly good indicator of individual psychological well-being, but it seems to be a good enough indicator to use in international comparisons.

Countries with the highest average life satisfaction are characterised by relatively high income levels and life expectancy, accompanied by perceptions of strong social support, freedom and low corruption. The percentage of the population who are dissatisfied with life tends to be relatively low in such countries.

Why do opportunities for positive human relationships differ among countries?

Positive relationships with family, friends, colleagues, acquaintances and trading partners was identified in a recent article on this blog as one of the five basic goods that a flourishing human would be expected to have. Positive relationships make contributions to individual flourishing that are universal, indispensable, not entirely incorporated in other basic goods such as physical and mental health, and they do not serve just as a means to a more basic good.

The meaning of positive in this context refers to motivations. Positive relationships are motivated by love, compassion, mutual benefit, or benign personal benefit, rather than by malice, or seeking personal gain at the expense of others. The dividing line between positive and negative motivations occurs at the point where there is an intention to infringe natural rights (as discussed here).

Opportunities for individuals to have positive relationships are more constrained in some countries than in others. That occurs to some degree because of constraints on liberty. Positive personal and business relationships of some kinds are not permitted in some parts of the world. Such constraints impinge on the capacity of individuals for self-direction, the basic good discussed in the preceding post.

Perceptions of the extent to which others can be trusted have a major differential impact on opportunities for positive human relationships in different countries. The following discussion makes use of the concept of generalized trust, as defined by Christian Welzel in Freedom Rising (2013). As Welzel explains, generalized trust “derives from trust in close others and then extends to unspecified others to eventually include even remote others”. In order to capture that idea, he combines variables from the World Values Survey representing close trust (trust of family, neighbours and people you know personally), unspecified trust (whether most people can be trusted, and whether most people try to be fair) and remote trust (trust of people you meet for the first time, people of another religion and people of another nationality). In the index construction, all variables are converted to a 0 to 1 scale, close trust is given a weight of 1, unspecified trust and weight of 2 and remote trust a weight of 3. 

The vertical axis of the accompany chart shows values of generalized trust for 58 jurisdictions included in the 2010-14 wave of the World Values Survey. Of those, the 5 jurisdictions with highest generalized trust were Sweden, Australia, Netherlands, Hong Kong and United States.

If you want to explain why trust levels vary between countries, it makes sense to look for reasons why people in some countries might consider their compatriots to be untrustworthy, such as the incidence of crime. The accompany chart shows the jurisdictions with highest levels of generalized trust also score highly on the World Bank’s rule of law index. That index incorporates data relating to the likelihood of crime and violence as well as information on the quality of contract enforcement, property rights, the police and the courts. In a recent article on this blog, I suggested that by penalising plunder rule of law encourages trust and improves incentives for mutually beneficial trade, as well as enabling societies to avoid the violence associated with do-it-yourself (DIY) justice.

The association between trust and rule of law might also reflect causation running from trust to incidence of crime. Societies with high levels of generalized trust could be expected to have stronger incentives for mutually beneficial, rather than predatory activity, a lower incidence of crime and hence, higher rule of law index scores.

The chart also suggests that higher levels of generalized trust tends to be associated with greater endorsement of emancipative values, as indicated by the size of the bubbles. Christian Welzel’s index of emancipative values incorporates twelve items from the World Values Survey covering values relating to autonomy, choice, equality and voice (e.g. protecting freedom of speech and giving people more say in government and workplace decisions). Emancipative values remain relatively dormant when people are poor, illiterate and isolated in local groups, but emerge strongly as people acquire more action resources (wealth, intellectual skills and opportunities to connect with others).

Since emancipative values involve greater tolerance of diversity it is not surprising that people holding such values would be more likely to trust people of different religions and nationalities. Welzel’s analysis in Freedom Rising shows that at an individual level people who endorse emancipative values tend to have higher levels of generalized trust, and that this impact is amplified in societies where those values are more prevalent.

In addition to trust, positive relationships are reflected in networks of individuals who can rely on each other for social support when they need it. Responses to a Gallup World Poll question which asks people whether they have relatives or friends to count on for help when they are in trouble, suggests that support networks tend to be stronger in relatively high-income countries. Of 136 countries in the data set used, 8 of the 10 with strongest support networks are relatively high-income countries: Norway, Finland, Denmark, New Zealand, Slovenia, Australia, Netherlands and Ireland. (The other 2 countries in the top 10 are Turkmenistan and Mongolia.) Some relatively high-income countries also appear well down the rankings, e.g. U.S.A. in 37^th place, Japan, 48^th place and Greece in 89^th place.

Conclusions

Positive human relationships can be motivated by love, compassion, mutual benefit, or benign personal benefit. The extent to which others can be trusted has an important impact on the opportunities for positive human relationships. Trust levels tend to be higher in countries with relatively low crime rates. Trust improves incentives for trade and other mutually beneficial activities.

Generalized trust, which gives greatest weight to trust of people who have just met and people from different religions and nationalities, tends to be greatest where people hold emancipative values, involving greater tolerance of diversity.

Networks of individuals who can rely on each other for social support tend to be strongest in high-income countries.

What determines the opportunities for individuals to develop a capacity for self-direction?

A capacity for wise and well-informed self-direction was identified in a recent post on this blog as one of five basic goods that a flourishing human could be expected to have. A flourishing human could be expected to have developed that capability because it is integral to the process of human flourishing. The nature of humans is such that as individuals mature, they have a unique potential to direct their own flourishing in accordance with values they endorse and goals they choose.

Wise and well-informed self-direction helps individuals to maintain other basic goods of human flourishing that are necessary to their pursuit of chosen goals.  The exercise of practical wisdom helps individuals to live long and healthy lives, maintain positive relationships, manage their emotional health, and live in harmony with nature.

How do individuals develop a capacity for wise and well-informed self-direction? It is possible to teach people about the virtue of practical wisdom, but it doubtful whether anyone has ever learned to exercise much practical wisdom without having responsibility to make choices in the real world. Individuals have the strongest incentive to learn how to make wise and well-informed choices in an environment that provides both great scope for freedom of choice and an obligation to accept responsibility for the consequences of the choices they make.

However, the opportunities for individuals to be well-informed also vary among countries depending on the knowledge that is readily available to them. Some of that knowledge is obtained through formal education, some is obtained on-the-job and some is absorbed through less formal interactions with family and friends. Individuals could be expected to have better opportunities to make well-informed choices if they live in countries where workforce skill levels are relatively high. That increases the chances that individuals will have easy access to relevant information for the important decisions they must make.

In what follows I consider how individual opportunities vary among countries, first in respect of freedom to choose, and then skill levels.

Freedom to choose

The accompany graph shows scores for perceived freedom and the Human Freedom Index for 126 countries for which matching data are available. Perceived freedom is the national average of positive responses to the Gallup World Poll (GWP) question: “Are you satisfied or dissatisfied with your freedom to choose what you do with your life?” The Human Freedom Index (HFI), developed by the Fraser Institute, incorporates 79 indicators of personal, civil and economic freedom to provide an objective measure of the state of freedom in each of the countries covered.

The graph shows that the countries ranked most highly using the HFI are also ranked highly in terms of perceived freedom. (Matching perceived freedom data is not available for Hong Kong, which was still one of the most highly ranked countries in the most recent HFI.) Switzerland, New Zealand, Ireland, Australia, Finland, Norway, Denmark, Netherlands, U.K. and Canada are presented as relatively free according to both indicators. However, perceived freedom also appears relatively high in some countries that more objective measures suggest are relatively unfree e.g. China. This may be a consequence of the binary nature of the GWP question. It would be more difficult for a survey respondent living under an authoritarian regime to tell a questioner that they are unsatisfied with their freedom to choose, than to give a moderately low score if asked to rate how much freedom they enjoy on a numerical scale. China’s score was close to the average in the 2010-14 World Values Survey (WVS) which asked respondents to rate on a scale of 1 to 10 “how much freedom of choice and control you feel you have over the way your life turns out”.

If you want a reliable indication of differences in human freedom among different countries it makes sense to use objective indicators, where possible. However, perceptions can sometimes provide useful information. For example, if women and men have different perceptions about the amount of freedom in their lives, that might reflect a gender equality issue. In fact, WVS data indicate that in most countries women and men have similar perceptions of the amount of freedom of choice in their lives. The few jurisdictions in which women rate the amount of freedom in their lives substantially lower than do men include Pakistan, Palestine and India.

Skill levels

The indicator of skill levels constructed for the Global Competitiveness Index (GCI) provides an appropriate basis for international comparisons of the knowledge that people are likely to be able to access readily in making important decisions. The GCI skills indicator incorporates perceptions of participants in a survey of executives coving questions relating to staff training, skillsets of graduates, digital skills of the population, ease of finding skilled employees and critical thinking in teaching, as well as education statistics such as years of schooling.

The top 10 ranked countries in terms of skill levels (for a data set of 118 countries) were Switzerland, Denmark, Finland, Netherlands, Germany, Norway, Sweden, U.S., N.Z. and U.K. If that list looks familiar it might be because it overlaps strongly with the list provided earlier of the countries ranked most highly in the Human Freedom Index. A simple regression shows a strong association between skills and human freedom (R2 = 0.50).

It seems unlikely that much of that association can be explained by direct causal links between freedom and skill acquisition. The most likely causal linkage is via the link between economic freedom and economic development. Economic development increases the demand for skilled labour.

Conclusion

Individuals have strong incentives to learn how to make wise and well-informed choices in countries where there is a great deal of economic and personal freedom. They are likely to have easier access to relevant information in countries with relatively high skill levels.

There is a strong overlap between the countries ranked most highly in the Human Freedom Index and the skill levels indicator of the Global Competitiveness Index. Both measures rank Switzerland, New Zealand, Finland, Norway, Denmark, Netherlands and U.K. among the top 10 countries. 

What determines opportunities for a long and healthy life?

This post is about the reasons why opportunities for people to live long and healthy lives are much greater in some countries than in others. In the preceding post the prospect of a long and healthy life was identified as one of five basic goods of a flourishing human.

So, which are the countries in which an individual chosen at random would be likely to have the best prospects of a long and healthy life? The OECD’s Better Life Index gives top ratings on health to Canada, New Zealand, Australia, Israel and Ireland. The health indicator used in that index may not be reliable, however, because it incorporates self-reported health along with life expectancy at birth to take account of the quality of life as well as its length. Self-reported health seems to be unduly influenced by cultural factors. For example, while life expectancy in Japan is among the highest in the world (more than 2 years greater than in Canada) less than 40% of people in Japan rate their health as good or very good (the comparable figure for Canada is 88%). 

Objective evidence published in The Lancet articles on Global Burden of Disease indicate that the difference between life expectancy and healthy life expectancy (the number of years people can expect to live in good health) is about the same in Japan and Canada (13 years for females and 10 years for males).

The Lancet study, which covers 195 countries and territories, indicates that healthy life expectancy (HALE) is highest in Singapore and Japan, but also relatively high in other high income countries. 

HALE is strongly correlated with life expectancy (LE). The difference between HALE and LE rises somewhat as LE rises: on average from 6.4 years for a country with LE of 50 years, to 10.8 years for one with an LE of 80 years. The difference is typically about 2 years greater for females than males, but LE for females is about 5 years greater than for males in middle and higher income countries.

The accompanying graph shows that substantial increases in HALE have occurred in many countries since 1990. The increases have generally been most pronounced in countries with relatively low life expectancy.

There seems to be little support for concerns that additional years of life are frequently not worth living. For countries with low LE in 1990, average increases in LE of 12 years were associated with increases in HALE of 10.5 years. For countries that already had high life expectancy in 1990, average increases in LE of 5 years were associated with increases in HALE of 3.7 years. It seems likely that many individuals would consider an additional year of life to be preferable to the alternative, even if accompanied by some ill-health.

Research seeking to explain differences in longevity among countries suggests that health care spending, higher income and education have beneficial impacts. An OECD study of 35 countries (mostly high-income) found that health expenditure made the greatest contribution to increased longevity (42 months) over the period 1990 to 2010, followed by education (15 months) income growth (13 months) and reduced smoking (5 months). The study found the impact of increased health spending to vary between countries, with relatively small gains in longevity experienced in the U.S. despite large increases in health care spending.

War and violent crime have a major impact on life expectancy in some parts of the world. For example, life expectancy among men who live in the north of Mexico apparently declined by about 3 years in the period 2005 to 2010 as a result of an increase in the homicide rate associated with drug wars.

Some of the important drivers of increased longevity have a common cause: health care spending has tended to account for a higher share of GDP as per capita GDP has risen. Econometric studies have suggested that this increased spending may be driven largely by demographic and technological factors, but income growth makes it possible.

The more fundamental determinants of opportunities for a long and happy lives are the factors contributing to the economic development that has led to high average income levels. There are virtuous circles involved in this process. As previously discussed on this blog, a plausible story of economic development also needs to take account of virtuous circles involved in interactions between culture and economic freedom. Where culture and economic freedom support markets, people have added incentives to gain reputations as being worthy of trust others in order to obtain the benefits of mutually beneficial exchanges. As people become more trustworthy and trusting, and more respectful of the rights others, they could be expected to support greater economic freedom. Economic freedom, and a culture supporting innovation, result in further economic development and economic development promotes a culture supporting greater economic and personal freedom. As part of this process, improvements in population health could be expected to contribute to higher labour productivity and further enhance income levels.

The economic development story outlined above implies that we should expect healthy life expectancy (HALE) to be higher, on average, in countries with higher levels of economic and personal freedom. In order to test that, HALE data for 155 countries have been matched with data from the Fraser Institute’s Human Freedom Index. The chart below shows that average HALE is about 10 years greater for the countries in the fourth quartile, with the highest freedom levels, than for countries in the first quartile, with the lowest freedom levels.

Conclusions

The countries in which a person chosen at random seems likely to have the best prospects of having a long and healthy life are characterised by high average income levels. Estimates of healthy life expectancy (HALE) published in The Lancet’s global burden of disease project are highest in Singapore and Japan. Since 1990, there have been substantial increases in HALE in most countries.

Health spending, income growth and education have contributed substantially to increased longevity. The more fundamental determinants of opportunities for people to have long and healthy lives are the cultural and institutional factors that have contributed to economic development. Evidence that high HALE is associated with high levels of human freedom supports an economic development story taking account of virtuous circles involving market freedom, cultures supporting freedom and health improvements.