Accounting for the richness of daily activities

Title: Accounting for the richness of daily activities
Authors: White, Mathew P. and Dolan, Paul
Publisher: Psychological Science, 20 (8). pp. 1000-1008
ISSN: 0956-7976
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Abstract: Serious consideration is being given to the impact of private behavior and public policies on people’s subjective well-being (SWB). A new approach to measuring well-being, the day reconstruction method (DRM), weights the affective component of daily activities by their duration in order to construct temporal aggregates. However, the DRM neglects the potentially important role of thoughts. By adapting this method to include thoughts as well as feelings, we provide perhaps the most comprehensive measure of SWB to date. We show that some activities relatively low in pleasure (e.g., work and time with children) are nonetheless thought of as rewarding and therefore contribute to overall SWB. Such information may be important to policymakers wishing to promote behaviors that are conducive to a broader conception of SWB. In general terms, there are three approaches to assessing how well people’s lives are going. The first focuses on a range of objective indicators (e.g., freedoms and liberties, health and education level; Nussbaum & Sen, 1993). The second concerns the degree to which people are able to satisfy their desires, as (albeit somewhat badly) indexed by income (Griffin, 1986; Harsanyi, 1982). The third focuses on subjective well-being (SWB) and is generally defined as how people think and feel about their lives (Diener, Suh, Lucas, & Smith, 1999). There is considerable debate about how to weight these three kinds of measures, but all are important, especially for policy purposes (Diener, Lucas, Schimmack, & Helliwell, 2008; Diener & Seligman, 2004; Dolan & Kahneman, 2008; Dolan & White, 2007). Rather than address this issue here, we focus on the comprehensiveness of measures of SWB. Much of the research on SWB that has involved large samples has investigated the thinking, or evaluative, component, focusing on judgments of overall life satisfaction (Dolan, Peasgood, & White, 2008). Research concerning the moment-to-moment feelings, or affect, associated with specific activities has largely been confined to smaller samples because of practical considerations (Hektner, Schmidt, & Csikszentmihalyi, 2007). Both approaches have tended to neglect how long people spend in activities associated with these thoughts and feelings, and this is a potentially serious omission because “time is the ultimate finite resource and the question of how well people spend it is a legitimate issue in the study of well-being” (Kahneman, Schkade, Fischler, Krueger, & Krilla, 2008, p. 11). In response to this concern, Kahneman, Krueger, Schkade, Schwarz, and Stone (2004) developed the day reconstruction method (DRM). This approach brings together measures that examine the feelings associated with specific activities (Hektner et al., 2007) with measures of how people spend their time (e.g., Bianchi, Robinson, & Milkie, 2006; Juster & Stafford, 1985). Specifically, it asks people to recall their previous day and divide it into episodes “like a series of scenes in a film”; for each episode, they record its duration, what they were doing, who they were with, and how they were feeling (using adjectives such as “happy” and “anxious”). In this way, the DRM allows subjective assessments of feelings to be weighted by their duration to derive a “hedonic calculus” for each episode and ultimately a person’s affective profile for an entire day. Because information about an entire day can be gathered at one time, responses can be obtained from reasonably large samples. However, the DRM has one major weakness: its focus on feelings. This has produced a number of puzzling and contentious findings. For instance, the data suggest that people spend considerable amounts of time in activities that provide relatively little SWB, such as commuting and spending time with their children. Richer people spend more time commuting, and Kahneman, Krueger, Schkade, Schwarz, and Stone (2006) suggested that this fact partly explains why income has a small effect on feelings. The relatively low levels of positive feelings reported for spending time with children are claimed to be a more accurate reflection of experience than belief-based generic judgments, such as “I enjoy my kids” (Kahneman et al., 2004). However, it is possible that driving to work or playing with one’s children brings SWB benefits that are not captured by measures of feelings alone. These activities may be absorbing (Csikszentmihalyi, 1990), have purpose (Ryff, 1989; Seligman, 2002), connect one to other people (Ryan & Deci, 2001), and contribute to important personal goals (Cantor & Sanderson, 1999). In other words, commuting and spending time with one’s children may be thought of as rewarding and may contribute to one’s SWB every bit as much as some of the more pleasurable activities (like sex and watching TV) appear to. It may be entirely rational and reasonable for people to choose activities that generate relatively low levels of moment-to-moment affect if this outcome is compensated for by positive evaluations. The aim of the research we report here, then, was to provide a more complete account of SWB that captures feelings, thoughts, and their duration.

Valuing health directly

Title: Valuing health directly
Authors: Dolan, Paul and Lee, Henry and King, Dominic and Metcalfe, Robert
Publisher: British medical journal, 339 (jul20 )
ISSN: 0959-8138
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Abstract: Valuing the relative benefits of different treatments helps us to allocate scarce healthcare resources to where they do the most good. The National Institute for Health and Clinical Excellence (NICE) advises on the cost effectiveness of treatments and recommends that health benefits should be valued in terms of gains in quality adjusted life years (QALYs). This approach assigns a value between 0 (for death) and 1 (for full health) to each health state and then multiplies that value by how long the state lasts. It makes good sense to value health benefits by accounting for duration in this way. We do, however, have serious concerns about NICE’s recommendations for the “quality adjustment” part of the QALY. NICE suggests asking members of the general public to think about how many years of life they would be willing to trade to avoid different states of health. The trouble is that these hypothetical preferences often bear little relation to the real experiences of those in the health states. This article offers an alternative means of valuation that could help direct resources to treatments in proportion to the real suffering they alleviate.

The social welfare function and individual responsibility: some theoretical issues and empirical evidence

Title: The social welfare function and individual responsibility: some theoretical issues and empirical evidence
Authors: Dolan, Paul and Tsuchiya , Aki
Publisher: Journal of health economics, 28 (1). pp. 210-220
ISSN: 0167-6296
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Abstract: The literature on income distribution has attempted to evaluate different degrees of inequality using a social welfare function (SWF) approach. However, it has largely ignored the source of such inequalities, and has thus failed to consider different degrees of inequity. The literature on egalitarianism has addressed issues of equity, largely in relation to individual responsibility. This paper builds upon these two literatures, and introduces individual responsibility into the SWF. Results from a small-scale study of people’s preferences in relation to the distribution of health benefits are presented to illustrate how the parameter values of a SWF might be determined.

Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism

Title: Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism
Authors: Tsuchiya, Aki and Dolan, Paul
Publisher: Health economics, 18 (2). pp. 147-159
ISSN: 1057-9230
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Abstract: When deciding how to weigh benefits to different groups, standard economic models assume that people focus on the final distribution of utility, health or whatever. Thus, an egalitarian is assumed to be an egalitarian in the outcome space. But what about egalitarianism in the gains space, such that people focus instead on how equally benefits are distributed? This paper reports on a study in which members of the public were asked to rank a number of health programmes that differed in the distribution of benefits and final outcomes in ways that enabled us to distinguish between different types of egalitarianism. The results suggest that outcome egalitarianism dominates, particularly for differences in health by social class, but a sizeable minority of respondents appear to be gain egalitarians, especially when the health differences are by sex. These results have important implications for how we think about outcome-based social welfare functions in economics.

Examining the attitudes and preferences of health care decision-makers in relation to access, equity and cost-effectiveness: a discrete choice experiment

Title: Examining the attitudes and preferences of health care decision-makers in relation to access, equity and cost-effectiveness: a discrete choice experiment
Authors: Ratcliffe , Julie and Bekker , Hilary L. and Dolan , Paul and Edlin, Richard
Publisher: Health policy, 90 (1). pp. 45-57
ISSN: 0168-8510
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Abstract: To describe the views of health care decision-makers and providers operating in the UK National Health Service (NHS) concerning the concepts of cost-effectiveness, equity and access through a series of attitudinal questions; to evaluate the preferences of health care providers in relation to each of these concepts using a discrete choice experiment (DCE); to assess the impact of prior completion of an attitude questionnaire on preferences elicited through a DCE.