- What is quality of life? Definition and examples
- Quality of life vs. standard of living
- Medical treatment vs. quality of life
- Quality of life – happiness
- The Meaning of Better Lives
- What Does “Quality of Life” Mean to You?
- WHOQOL: Measuring Quality of Life
- HRQOL Concepts
What is quality of life? Definition and examples
Quality of life refers to how well we live, i.e., the general well-being of people and societies. It is the standard of happiness, comfort, and health that a person or group of people experience.
It is an inherently ambiguous and subjective term. People who love sports may feel that their quality of life has suffered if local facilities close down. For a couch potato, on the other hand, the loss of sports facilities makes no difference.
Some people say quality of life is about wealth and owning things, while others may define it in terms of physical, mental, and emotional well-being.
Collins Dictionary has the following definition of the term:
“A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”
Quality of life vs. standard of living
We can use the term in several different contexts, including politics, economic or international development, and healthcare.
We should not confuse the term with ‘standard of living,’ which focuses mainly on economic factors.
According to Wikipedia, quality of life observes “life satisfaction, including everything from physical health, family, education, employment, wealth, safety, security to freedom, religious beliefs, and the environment.”
Standard of living
Standard of living refers to people’s level of prosperity (wealth), comfort, material possessions, and necessities.
When we calculate a society’s standard of living, we take into account factors such as employment, poverty rates, affordable housing, and GDP. GDP stands for Gross Domestic Product. We also take into account inflation, the cost of goods and services, infrastructure, and economic and political stability.
When calculating a person’s or society’s standard of living, we use things that we can quantify easily. GDP, prices, and employment/unemployment are factors we can measure.
Quality of life
The factors that make up quality of life are abstract, intangible, and subjective. The factors include the freedom to do things and freedom from bad things. Freedom of movement, of thought, and of religion, for example, are some of these factors. So are freedom from discrimination, slavery, and torture.
We also measure quality of life according to people’s rights, such as the right to education, human dignity, fair pay, and to have a family.
Most people would agree that we must consider levels of happiness when calculating quality of life. However, measuring or rating happiness is not easy. Happiness is a subjective thing.
We could, for example, send out a team of people to determine how often people smile. Researchers could then compare the same people today and in five years’ time. We could also compare how often people in the UK smile compared to Canadians.
Even with smiling, there are cultural factors that we would need to consider. In some countries, for example, telling jokes with a serious face makes it funnier. In other cultures, on the other hand, not smiling kills the joke.
Objective vs. subjective
Put simply, quality of life is subjective while standard of living is objective.
Medical treatment vs. quality of life
The instinct of most doctors and other healthcare professionals is to treat patients. In other words, to extend a person’s lifespan as long as possible.
However, especially with terminal illnesses, at which point should treatment stop? At which point should the quantity of life give way to quality of life? Especially if there is not much time left.
If a person has six months left to live, or seven months with treatment, which option is best?
Treatment and side-effects
Treatment often comes with side-effects such as pain, nausea, depression, diarrhea, and lethargy. If we chose to offer the terminal patient palliative/hospice care, would their last few months of life be better? Palliative care focuses on providing relief from pain and other unpleasant symptoms, as well as physical and mental stress.
This issue is going to get bigger as people in most advanced and emerging economies live longer and medical capabilities advance.
In a Psychology Today article, Ethan Remmel Ph.D. quotes Atul Gawande, who said:
“The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it.”
“Twenty-five percent of all Medicare spending is for the five percent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.”
Quality of life – happiness
The World Happiness Report ranks 156 countries according to how happy they are. It also ranks 117 countries according to the happiness of their immigrants.
The report ranks Finland as the happiest country in the world. The rest of the top ten, in order, are Norway, Denmark, Iceland, Switzerland, Netherlands, Canada, New Zealand, Sweden, and Australia. The United States and United Kingdom ranked 18th and 19th respectively.
The least happy country, according to the Report, is Burundi.
The World Happiness Report shows that standard of living and happiness are closely related. The happiest countries in the world also have the highest standards of living.
The Meaning of Better Lives
Oct 17, 2012
We all want a better life, but what does this mean, and how to measure it? We know that happiness and well-being are not just a question of GDP and that we also need to take into account elements such as education, your household’s income, standard of housing and access to vital elements such as clean water and breathable air.
The OECD and its partners have been looking at what measuring better lives means in the 21st century for almost 10 years, and will be sharing the latest developments at a major conference this week in New Delhi. We asked some of the OECD experts what measuring better lives means to them:
Rolf Alter (OECD Director for Public Governance and Territorial Development) says – “For me measuring better lives is a journey. People, policy makers, and experts gather to better understand the expectations and hopes of people, and the opportunities to do something about it together. “
Romina Boarini (Head of the OECD Monitoring Well-Being and Progress Section) says – “Going towards better lives means expanding people’s opportunities to chose the life they would like to live. Measuring better lives means measuring these opportunities, whether these are evenly shared among people today and over time.”
Nicholas Bridge (Ambassador & Permanent Representative of the UK to the OECD) says – ”It’s about measuring what really matters to people, and making that the central basis for policy.”
Martine Durand (OECD Chief Statistician) says – “Measuring better lives starts with understanding the key factors driving individual and society’s well-being. It then requires developing robust statistical information on what matters most to people. Finally, it is about using this information effectively to design and implement better policies.“
Stefan Flückiger (Permanent Representative of Switzerland to the OECD) says – “Measuring Better Lives Means” giving convincing arguments to ourselves, our governments and our companies that looking at the same problem in a different way can produce surprising insights and better policies.”
Anthony Gooch (OECD Director Public Affairs and Communications) says – “Better lives is about deepening our collective understanding of what matters to us as human beings, what provides us with our fundamental sense of well-being and what brings quality to our lives in today’s day and age. Efforts to capture and measure this are a fundamental element in empowering citizens the world over to convert their aspirations for better lives into reality.”
Barbara Ischinger (OECD Director for Education) says – “Measuring better lives means measuring what and how individuals learn in school – and beyond – to equip them to lead full, productive lives.”
John Martin (OECD Director for Employment, Labour and Social Affairs) says –“Measuring better lives implies reaching agreement on the key elements that make for a better life, devising ways of quantifying them and linking them eventually to policies that will increase the opportunities for more people to enjoy better lives”.
Marco Mira D’Ercole (Head of progress measurement division) says – “Measuring people’s life implies re-considering the distinction between means and ends. Most economists will acknowledge, when pressed, that economic production is, at best, only a means to achieving some higher level goals. These goals are expression of some notion of the “good life”. While there is no single representation of the “good life”, some basic ingredients are shared across cultures and continents. The dimensions put forward by the OECD are an attempt to put forwards a range of outcomes that could appeal to people around the world.”
Joaquim Oliveira Martins (Head of the OECD Regional Development Policy Division) says – “Better lives means being able to access jobs and income, environmental quality and a good social environment in the places where people live. Insofar as these three dimensions will remain largely disconnected across space, well-being will also remain an average concept with limited impact on individual people’s lives.”
Mario Pezzini (OECD Director of the Development Centre) says – “Measuring well-being means a shift in the way we look at development, one which takes into account disparities rather than averages. It means measuring what matters to people lives and finding the gaps in order to better focus on improving current quality of life while ensuring a sustainable future.”
Monika Queisser (OECD Head of Social Policy) says – “Better lives means taking the needs, wishes and aspirations of all generations, from young children to the elderly, on board when making policy.”
Conal Smith (OECD Leader on the development of international guidelines on the measurement of subjective well-being) says – “Measuring better lives means choosing to measure those things that we value in order to avoid simply valuing those things that we happen to measure. This implies measuring those aspects of quality of life that are important, not just those that are easiest to quantify.”
José Manuel Viegas (OECD Director of International Transport Forum) says – “Better lives certainly include safe access to jobs, health, education, shopping and leisure, for all population segments. This requires integrated land use / transport planning, in parallel with adequate transport policies that promote efficient and equitable provision of infrastructure and regular services plus a range of measures that are necessary to ensure higher levels of road safety. For all these aspects regular measures can be made based on easily understandable indicators, allowing comparisons over time for the same city and transversally among cities.”
Find out more:
See OECD Secretary General Angel Gurría’s message on measuring better lives:
4th OECD World Forum – 16 to 19 OCTOBER 2012, New Delhi
“Measuring Well-Being for Development and Policy Making”
What Does “Quality of Life” Mean to You?
This is a question and a term we often hear bandied about. “I just want her to have quality of life,” or “How am I going to maintain quality of life?” Especially, for those of us who have compromised health, this is a matter of great concern. It’s being used in a political sense these days as people are living longer and maintaining quality in their daily life is often more challenging than it was in times gone by when life expectancy was much shorter. You can be certain that a young pioneer woman who could only expect to live to the ripe old age of 37 didn’t give quality of life much thought. She was too busy trying to make it through daily life, feed her family, scrub her laundry on a scrub board in cold water and survive the various plagues and influenzas that came by on a regular basis. Survival was her primary goal.
I was surprised by the definition of the word quality because it can have so many meanings from class consciousness to excellence. It’s one of those phrases, quality of life, which we use so often when confronting any changes in our health or the health of someone we love. It may come as a surprise to some of the population to know that those of us who have pain everyday and live with chronic illness are already there. We already worry about how we are maintaining our quality of life right now, today.
For many of us who are no longer able to work, we have lost part of our family’s income and had to make adjustments. We had to adjust our grocery shopping, give up that new car we were used to buying every few years and postpone that trip we had been looking forward to taking. We felt the loss of occupation and career by allowing it to make us “less” in our own eyes and in the eyes of others. Eventually, we worked it out as we asked ourselves who we were if we were no longer a nurse, a teacher, a banker or a business man or woman. Our quality was threatened as we grappled with the “who” of us and wondered “who” we now were if we were no longer the old “who.”
For others, their quality or excellence of life has been affected by the loss of a spouse or companion who didn’t expect chaos to visit them and decided they couldn’t live with chronic illness. In sickness and in health are only words to some who do not know the depths of love and sacrifice that many others have discovered. One has to wonder if they ever think about the shoe being on the other foot; what if? Tyler Perry made an interesting movie a few years ago called Diary of a Mad Black Woman. It brings up that very point as a young wife is thrown aside for a new, hotter model only to face her husband being injured and needing her before their divorce is finalized; and to see him jilted by his lover since he is now damaged goods. It’s worth watching if you’re interested in exploring the subject of loyalty in marriage when quality of life is threatened. It also has some hysterical moments in it thanks to Perry’s female alter ego who takes the form of his hilarious character, Madea.
Perhaps, the whole issue of our existence depends on the relativity of this whole subject, quality of life. Is it the end of the world if we lose our health? Some of us can testify that it is not. We may not have chosen the changes we’ve had to face, but we’ve survived and overcome. In many cases, we have actually surprised ourselves by our adjustments and adaptations. In most cases, our value system has shifted and changed. Those activities, possessions and accomplishments we once sought are now a thing of the past and we have embraced new values and goals. We are living proof of the ability of the human spirit to sink or swim, flee or fight as we face life’s sometimes overwhelming challenges. It’s still frightening at times as we contemplate the future and what it holds for us, just as it is a concern for healthy individuals. “Will I be able to maintain quality of life?”
For those of us who have already faced the threat and loss of the ordinary in our daily lives, we can probably agree to sum up our needs in four categories. Let me do that, okay?
1.LOVE: The importance of giving and receiving love is what makes life worthwhile. Love in both directions is life-giving, purposeful and enjoyable.
2.INDEPENDENCE: Our independence becomes our greatest desire. When one cannot perform life’s simplest deeds for oneself, your self-worth suffers greatly. Independence takes many forms but for most of us it means staying in our own homes or environs, calling our own shots as to when, what, who and where. It doesn’t have to be grand; just ours.
3.FUNCTION: Most of us have figured out, in order to remain independent or to achieve our highest level of independence we have to be able to function. If the word in real estate is “location, location, location,” the word in disability is “function, function, function.” This creates an impetus in us to walk, swim, go through surgeries, and always seek the physicians who can help us achieve this goal. We learn the vital importance of moving, trudging on and remaining as strong as possible.
4.COMFORT: Like all living things, most animals and also the plant world, we long for comfort. Food, drink, a comfortable temperature and a place to lay our heads for rest is what we seek. This is no small feat for those of us who live with chronic pain. We have to find that place of comfort with our pain medications short of addiction. We have to discover our area of daily movement short of injury and we learn the delicate art of compromise in our needs for the material comforts of this world. Many of us discover over the years that comfort comes not just from a down pillow or a warm coverlet alone but from the warmth and discovery of the depths of the human spirit, a loving friend and faith in the future.
WHOQOL: Measuring Quality of Life
Introducing the WHOQOL instruments
The Constitution of the World Health Organization (WHO) defines health as “A state of complete physical, mental, and social well-being not merely the absence of disease . . .”. It follows that the measurement of health and the effects of health care must include not only an indication of changes in the frequency and severity of diseases but also an estimation of well being and this can be assessed by measuring the improvement in the quality of life related to health care. Although there are generally satisfactory ways of measuring the frequency and severity of diseases this is not the case in so far as the measurement of well being and quality of life are concerned. WHO, with the aid of 15 collaborating centres around the world, has therefore developed two instruments for measuring quality of life (the WHOQOL-100 and the WHOQOL-BREF), that can be used in a variety of cultural settings whilst allowing the results from different populations and countries to be compared. These instruments have many uses, including use in medical practice, research, audit, and in policy making.
WHO defines Quality of Life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person’s physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment.
Why is quality of life of important?
Quality of life is important to everyone. Although the World Health Organization (WHO) defined health very broadly as long as a half century ago, health in the United States has traditionally been measured narrowly and from a deficit perspective, often using measures of morbidity or mortality. But, health is seen by the public health community as a multidimensional construct1 that includes physical, mental, and social domains.
As medical and public health advances have led to cures and better treatments of existing diseases and delayed mortality, it was logical that those who measure health outcomes would begin to assess the population’s health not only on the basis of saving lives, but also in terms of improving the quality of lives.
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What is quality of life?
Quality of life (QOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life.2 What makes it challenging to measure is that, although the term “quality of life” has meaning for nearly everyone and every academic discipline, individuals and groups can define it differently. Although health is one of the important domains of overall quality of life, there are other domains as well—for instance, jobs, housing, schools, the neighborhood. Aspects of culture, values, and spirituality are also key domains of overall quality of life that add to the complexity of its measurement. Nevertheless, researchers have developed useful techniques that have helped to conceptualize and measure these multiple domains and how they relate to each other.
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The concept of health-related quality of life (HRQOL) and its determinants have evolved since the 1980s to encompass those aspects of overall quality of life that can be clearly shown to affect health—either physical or mental.3-6
- On the individual level, HRQOL includes physical and mental health perceptions (e.g., energy level, mood) and their correlates—including health risks and conditions, functional status, social support, and socioeconomic status.
- On the community level, HRQOL includes community-level resources, conditions, policies, and practices that influence a population’s health perceptions and functional status.
- On the basis of a synthesis of the scientific literature and advice from its public health partners, CDC has defined HRQOL as “an individual’s or group’s perceived physical and mental health over time.”3
The construct of HRQOL enables health agencies to legitimately address broader areas of healthy public policy around a common theme in collaboration with a wider circle of health partners, including social service agencies, community planners, and business groups.7
HRQOL questions have become an important component of public health surveillance and are generally considered valid indicators of unmet needs and intervention outcomes. Self-assessed health status is also a more powerful predictor of mortality and morbidity than many objective measures of health.9-10 HRQOL measures make it possible to demonstrate scientifically the impact of health on quality of life, going well beyond the old paradigm that was limited to what can be seen under a microscope.
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Why is it important to track HRQOL?
Focusing on HRQOL as an outcome can bridge boundaries between disciplines and between social, mental, and medical services. Several recent federal policy changes underscore the need for measuring HRQOL to supplement public health’s traditional measures of morbidity and mortality. Healthy People 2000, 2010, and 2020 identified quality of life improvement as a central public health goal.
- HRQOL is related to both self-reported chronic diseases (diabetes, breast cancer, arthritis, and hypertension) and their risk factors (body mass index, physical inactivity, and smoking status).3
- Measuring HRQOL can help determine the burden of preventable disease, injuries, and disabilities, and can provide valuable new insights into the relationships between HRQOL and risk factors.
- Measuring HRQOL will help monitor progress in achieving the nation’s health objectives.
Analysis of HRQOL surveillance data can identify subgroups with relatively poor perceived health and help to guide interventions to improve their situations and avert more serious consequences. Interpretation and publication of these data can help identify needs for health policies and legislation, help to allocate resources based on unmet needs, guide the development of strategic plans, and monitor the effectiveness of broad community interventions.
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How can HRQOL be measured?
During the early 1990s, CDC’s Division of Adult and Community Health, Disability Prevention Program, Women’s Health Program, National Center for Health Statistics Questionnaire Development Research Lab, and Epidemiology Program Office worked to develop and validate a compact set of measures that states and communities could use to measure HRQOL.8 These are the Healthy Days measures, an integrated set of broad questions about recent perceived health status and activity limitation. On the basis of a synthesis of the scientific literature and advice from its public health partners, the CDC has defined HRQOL as “an individual’s or group’s perceived physical and mental health over time.”3
Learn more about how CDC measures HRQOL on the Methods and Measures page.
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- CDC Healthy Living
- CDC Physical Activity Basics
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- Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no 2, p. 100) and entered into force on 7 April 1948.
- The WHOQOL Group. The World Health Organization Quality of Life Assessment (WHOQOL). Development and psychometric properties. Soc Sci Med 1998;46:1569-1585.
- Centers for Disease Control and Prevention. Measuring healthy days: Population assessment of health-related quality of life. Centers for Disease Control and Prevention, Atlanta, Georgia 2000.
- Gandek B, Sinclair SJ, Kosinski M, Ware JE Jr. Psychometric evaluation of the SF-36 health survey in Medicare managed care. Health Care Financ Rev 2004;25(4):5-25.
- McHorney CA. Health status assessment methods for adults: past accomplishments and future directions. Annual Rev Public Health 1999; 20:309-35.
- Selim AJ, Rogers W, Fleishman JA, Qian SX, Fincke BG, Rothendler JA, Kazis LE. Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res. 2009;18(1):43-52.
- Kindig DA, Booske BC, Remington PL. Mobilizing Action Toward Community Health (MATCH): metrics, incentives, and partnerships for population health. Prev Chronic Dis 2010;7(4). http://www.cdc.gov/pcd/issues/2010/jul/10_0019.htm.
- Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R. Measuring health-related quality of life for public health surveillance. Public Health Rep 1994;109(5):665–672.
- Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res 2002;14(6):499–508.
- DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. J. Mortality prediction with a single general self-rated health question. A meta-analysis. Gen Intern Med2006;21(3):267-75.
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