Incorporating culture into measurements of well-being : conceptual and methodological challenges and its importance for policy

Abstract

In 1948, the World Health Organisation adopted the definition of health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Despite this, health has mainly been measured in terms of disease, disability and death. However, subjective well-being (SWB) has received increasing attention in recent years, and has even been proposed as a complementary measure to GDP for tracking social progress. Nevertheless, as the understanding and experience of disease is intertwined with cultural factors, so is the concept of being well. In a recent report, the Lancet Commission on Culture and Health stated that the role of culture has been systematically neglected in medical science in the past, and that this neglect is the single biggest barrier to advancement of the highest attainable standard of health worldwide. However, adapting indicators to each culture would undermine methodological consistency and make international comparisons useless. On the other hand, seeing that culture affects both the idea of a life well lived and reporting of the same, cross-cultural comparability of SWB measures is already questionable.

The main aim of this thesis is to explore conceptual and methodological challenges in quantifying largely qualitative concepts such as culture and subjective well-being in surveys, and to investigate whether cultural determinants of subjective well-being can inform future public policy. For investigation, a literature review of challenges was conducted, alongside three case studies of existing surveys measuring SWB across Europe. Semi-structured interviews with experts within the field of SWB complemented the data collection.

Results show that current challenges for cross-cultural research on SWB are more conceptual than methodological in nature. The reification of ‘culture’ and ‘subjective well-being’ into variables can rather hamper understanding than expand it, and there is a major role for qualitative approaches to play in expanding knowledge. Expert interviews revealed both advantages and disadvantages in incorporating culture into policy for health and well-being, and the responsibility for improving well-being was raised as a major concern. However, seeing that health improvement is already dependent on development within the wider society, adding a cultural lens will not only improve understanding, but also add depth to existing models. Thinking of health, SWB and culture as three interlinked dimensions will allow for more complex, but also more accurate analyses of how to improve people’s lives.