Objective Facts About Subjective Health
By Bryan Caplan
Lately economists have gotten awfully interested in subjective well-being, popularly known as “happiness.” (Here’s my take; here’s Arnold’s; and don’t neglect Will Wilkinson’s blog on the subject). And of course economists have long been interested in health – trying to improve it is 15% of GDP. But as far as I’ve seen, economists have neglected the topic of subjective health – how healthy people say they feel.
For example, the General Social Survey has been asking the following question for about 30 years:
Would you say your own health, in general, is excellent, good, fair, or poor? (Excellent=1, good=2, fair=3, and poor=4)
There is enough data in the General Social Survey to explore subjective health from almost any angle, and I plan on devoting a number of posts to it. For now, let me get the basics on the table.
1. There is more reason to accept the validity of subjective health measures than subjective well-being measures.
The standard objection to all subjective measures is that everyone uses his own personal comparison group. In happiness research, the best counter-argument I’ve seen is that subjective happiness is positively correlated with objective smiling frequency. That’s interesting, but hardly overwhelming.
For health, in contrast, we can verify that subjective health clearly falls rapidly with age. In any given year, one year of age predicts a .014 less healthy (i.e. higher) response. The average 89-year-old is a full point less healthy than the average 18-year-old.
2. Age-adjusted health is improving, but at a glacial rate.
Every year, holding age constant, people say they are getting .003 healthier. In other words, over 30 years, the average person of a given age has come to say that on a scale of 1-4, he is .09 healthier. At this rate, it will take 333 years to raise subjective health by a full point.
3. Rising real income and education fully account for the rise in subjective health.
People today have higher real income and education than people 30 years ago, and people with higher real income and education are healthier. If you compare two people with the same real income, education, and age, you can expect them to have the same subjective health, regardless of whether they lived in 1972 or 1998.
Of course, many people will jump on this finding to prove that subjective health is a meaningless measure, but if you are willing to entertain the Hansonian view of medicine, you should think again.