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Quality of life

Paper 2.3 - Part 1B - Human health issues

Richard Eckersley

Quality of life and sustainable development
Environment and health, present and future.
Material progress and quality of life
Suspicions of the Apocalypse: the psychosocial dynamics of global change

Quality of life and sustainable development

The central purpose of a nation should be to improve the quality of life of its people. This is not a nation’s only purpose, to be sure, but to say that it is the central purpose provides a useful framework for thinking about national priorities, including sustainable development.

Quality of life can be defined as the degree to which people enjoy (or societies provide) the living conditions (social, economic, cultural and environmental) that are conducive to total health and wellbeing (physical, mental, social and spiritual). Quality of life is both subjective and objective, as much a matter of how people feel about their lives as about the conditions in which they live.

Focusing on quality of life (or wellbeing) leads to a different perspective on sustainable development. Most importantly, it draws attention to the social dimension, which has been relatively neglected in a debate that has emphasized the economic and environmental aspects of sustainability. To the extent that quality of life has featured in discussions about sustainable development, the focus has been on future generations. A quality-of-life perspective changes this emphasis by acknowledging the important ways in which sustainability affects present wellbeing.

More specifically, this perspective provides a new approach to what has been seen as the key challenge of sustainable development, the issue that dominates political debate: reconciling the requirements of the economy - growth - with the requirements of the environment – conservation and sustainable resource use. This challenge stems from the defining difference between sustainable development and material progress, the dominant model of human development.

Material progress regards economic growth as paramount because it creates the wealth necessary to improve quality of life: to increase personal freedoms and opportunities, and to meet community needs and national goals. Sustainable development, on the other hand, does not accord economic growth overriding priority. Instead, it seeks a better balance and integration of social, environmental and economic goals and objectives to produce an equitable, optimal and enduring quality of life for all people.

Our growing understanding of the social basis of quality of life can make an important contribution to addressing the challenge of sustainable development. It provides a means of integrating different priorities by allowing them to be measured against a common goal or benchmark: improving human wellbeing. Rather than casting the core question in terms of being pro-growth or anti-growth, we need to go beyond growth, to see that growth itself is not the main game.

There are several key aspects of the relationship between quality of life and sustainability:

  1. Direct impacts of environmental changes (local, regional and global) on wellbeing (especially physical), now and in the future. The recent evidence of faster-than-expected climate change adds a powerful dynamic to this relationship; it raises the stakes enormously.
  2. The escalating adverse effects of material progress on wellbeing, which sustainable development would help to address. Put another way, current social priorities and directions that are putting increasing pressure on the natural environment are also becoming more hostile to human wellbeing. What we need to do to achieve sustainable development over the long term is also what we need to do to improve wellbeing in the short term.
  3. The effects on wellbeing of growing ‘apocalyptic suspicions’ about the future of the world, including the effects of environmental degradation. These suspicions impact on wellbeing both directly (in a psychological sense), and indirectly (in a sociopolitical sense) by weakening our capacity to respond appropriately to the global challenges.

Environment and health, present and future.

Environmental conditions have always been an important dimension of human health and wellbeing. Poor environmental quality is directly responsible for some 25 per cent of all preventable ill-health, especially diarrhoeal diseases and acute respiratory infections.

The Millennium Ecosystem Assessment, a major United Nations initiative involving more than 1,300 experts worldwide, provides an authoritative, up-to-date and comprehensive overview of the relationship between the environment and health in its health synthesis report. It notes that nature’s ‘goods and services’ are the ultimate foundations of life and health. These provisions range from the basic necessities of life such as food, shelter and clean air and water to less tangible, but highly valued, cultural, spiritual and recreational benefits.

Over the past 50 years, humans have changed natural ecosystems more rapidly and extensively than in any comparable period in human history, the assessment says. These changes have benefited humanity, especially by greatly increasing food production, but about 60 per cent of ecosystem services are currently being degraded or used unsustainably. The causal links between environmental change and human wellbeing are complex, being often indirect, displaced in space and time, and dependent on modifying forces.

Historically, most environmental health problems have entailed specific risks within a local context, such as pollution and contamination. However, over the past two decades the focus of environmental concerns has shifted from local and regional impacts to the way humans are now changing planetary systems and processes, with huge consequences for wellbeing. As health researchers note, we must now extend our environmental health concerns to include the sustaining of natural systems that are the prerequisite to human survival, health and wellbeing.

Large-scale threats, whose effects are already being felt, include:

  • Climate change: While some health impacts would be beneficial (such as milder winters), most are likely to be adverse. These include more frequent and extreme weather events such as heat waves, storms and floods; the altered range, seasonality and intensity of vector-borne infectious diseases; changes to food yields, especially of cereal crops, which are likely to increase in temperate zones but decline in the tropics and subtropics; and inundation and salinisation resulting from rising sea levels.
  • The degradation and over-exploitation of natural resources such as land, water, fisheries and forests: all have implications for human health through their impacts on food production and nutrition.
  • Ozone depletion: This remains a problem because of the lag between phasing out ozone-depleting chemicals and the recovery of the ozone layer. Depletion is increasing ultraviolet radiation, which is expected to increase sunburn, skin cancers and various eye disorders; it could also impair the immune system and affect global food production.
  • Changes to global cycles of elements such as nitrogen, phosphorus and sulphur: the result of increased use of synthetic fertilisers, burning fossil fuels and other practices, these changes are affecting water quality and soil fertility, and so could impair global food production.
  • Biodiversity loss: this poses hazards to human health through restricting supplies of food and pharmaceuticals, both of which benefit from access to new plants and animals and their genes. Another potential hazard is the risk of unravelling functional ecosystems, affecting processes such as pollination and pest control.
  • Chemical contamination of food and water: for example, low-level exposure to some industrial and agricultural chemicals may be disrupting endocrine function, undermining disease resistance and reproduction.
  • Introduced ‘alien’ or ‘invasive’ species: these can affect food yields and storage, produce food-borne toxins and spread infectious disease.

The Millennium Ecosystem Assessment warns that the dual trends of growing exploitation of ecosystem services and the generally declining condition of most ecosystems are unsustainable. There is an increasing risk of ‘non-linear changes’ in ecosystems, including accelerating, abrupt and potentially irreversible changes. Ecosystem changes may occur on such a large scale as to have ‘a catastrophic effect on human health’.

The environmental health literature has focused on the more direct, physical health implications of environmental change – famines, natural disasters and epidemics of infectious disease, for example. However, the social consequences of environmental change and degradation also include growing flows of environmental refugees and escalating conflict over diminishing resources. Ecological losses, embedded in a mosaic of social, economic and political factors, could cause the failure or collapse of entire societies - on a local, regional, continental or even global scale - so magnifying hugely their health costs.

Material progress and quality of life

We pursue material progress in the belief that, overall, it makes life better. A quality-of-life perspective on sustainability encourages us to look more critically at the assumed relationships between wealth and wellbeing that underpin current strategies. It shifts the focus from means to ends.

The social basis of wellbeing is much more complex, and often less tangible and material, than present approaches assume. Of particular importance is the mounting evidence that money and what it buys constitute only a part of what makes for a high quality of life. And the pursuit of wealth can exact a high cost when it is given too high a priority – nationally or personally – and so crowds out other, more important goals.

There are several streams of evidence, some admittedly indirect and circumstantial, that demonstrate the extent to which material progress is undermining quality of life:

  • Diminishing returns to rising income: Comparing nations, increasing income confers large benefits to wellbeing at low income levels, but little, if any, benefit at high income levels. Life expectancy levels off at a per capita income of about US$5,000, and happiness at about US$10-15,000. Life expectancy is continuing to rise in most countries, but this is only partly due to greater wealth; happiness has not increased in recent decades in rich nations even though people have become, on average, much richer.

    Looking at the relationship between income and wellbeing within countries, the rich are both healthier and happier than the poor, especially in poorer countries but even in rich nations. However, the relationship is strongest at low incomes, where money improves living conditions and alleviates hardship. Above this level, wealth has symbolic value as a measure of social status, and status affects wellbeing through the social comparisons it defines. So income-related differences in wellbeing will persist no matter how much average incomes rise as a result of economic growth.
  • Adverse health trends: Young people’s lives reveal most clearly the tenor and tempo of the times. While their health, measured by life expectancy and mortality rates, continues to improve, and most say in surveys that they are healthy, happy and satisfied with their lives, adverse trends in young people’s health range across both physical and mental health problems, and from relatively minor but common complaints such as chronic tiredness to rare but serious problems such as suicide.

    Growing numbers of children and youth are overweight or obese, placing them at risk of a wide range of health problems later in life, including diabetes, heart disease and some cancers. A fifth to a third of young people in western societies today are suffering significant psychological distress at any one time; they are experiencing higher levels of mental health problems than older people, and carrying this increased risk into later life. Estimates of the prevalence of a more general malaise (frequent headaches, stomach aches, sleeplessness) reach 50 per cent.
  • Trends in personality and other psychological qualities that affect wellbeing: US researchers have analysed psychological tests of children and youth spanning over forty or more years and found marked increases in trait anxiety (or neuroticism), self-esteem and extraversion, while sense of control over life had declined. They say the findings show that broad social trends - not just genes and the family environment, as psychologists have assumed - are important influences on personality development. They link these changes to increasing individualism and declining social connectedness. Anxiety and lack of control are associated with diminished wellbeing; even high self-esteem, once regarded as a source of wellbeing, is now seen as problematic by many psychologists.
  • The direct effects of sociocultural factors on health: Material progress is intimately associated with the cultural qualities of individualism and materialism. The costs of individualism (placing the individual at the centre of a framework of values, norms and beliefs) relate to a loss of both social support and personal control, and include: a heightened sense of risk, uncertainty and insecurity; a lack of clear frames of reference; a rise in personal expectations, coupled with a perception that the onus of success lies with the individual, despite the continuing importance of social disadvantage and privilege; a surfeit or excess of freedom and choice, which is experienced as a threat or tyranny; increased self-esteem, but of a contingent or narcissistic form that requires constant external validation and affirmation; and the confusion of autonomy with independence or separateness.

    Materialism (the pursuit of money and possessions), research shows, seems to breed not happiness but dissatisfaction, depression, anxiety, anger, isolation and alienation. People for whom ‘extrinsic goals’ such as fame, fortune and glamour are a priority in life tend to experience more anxiety and depression and lower overall wellbeing - and to be less trusting and caring in their relationships - than people oriented towards ‘intrinsic goals’ of close relationships, personal growth and self-understanding, and contributing to the community. In short, the more materialistic we are, the poorer our quality of life.
  • Public perceptions of quality of life: Studies over the past decade, both qualitative and quantitative, reveal levels of anger and moral anxiety about changes in society that were not apparent thirty years ago. They show that many people are concerned about the materialism, greed and selfishness they believe drive society today, underlie social ills, and threaten their children’s future. They yearn for a better balance in their lives, believing that when it comes to things like individual freedom and material abundance, people don’t seem ‘to know where to stop’ or now have ‘too much of a good thing’.

    A growing proportion of Australians believe quality of life is declining despite a decade-and-a-half-long economic boom that has seen sustained, strong economic growth, declining unemployment, low interest rates and rising incomes. Indeed, some studies make explicit the tension between public concerns about quality of life and the political emphasis on economic growth.
  • People’s views of the future of society, the world and humanity: Futures studies across many countries consistently reveal, in people’s expected futures, concerns about the pace of life, loss of community, too much consumerism, and destruction of the natural environment. Preferred futures, perhaps revealing humanity’s evolutionary and historical origins, emphasize closer-knit communities, more conviviality and intimacy, human-scale settlements and technologies, and a clean, healthy environment.

    A recent survey offered Australians two positive scenarios of the future: one focused on individual wealth, economic growth and efficiency, and enjoying ‘the good life’; the other emphasized community, family, equality and environmental sustainability. Asked to choose which scenarios came closer to the future they both expected and preferred, 73 per cent expected the former, but 93 per cent preferred the latter.

These lines of evidence show that the costs of material progress to wellbeing are not just material and structural: increasing inequality, job stress and insecurity, family pressures and environmental degradation, for example. They are also cultural and ethical: material progress depends on the pursuit of individual and material self-interest that, morally, cannot be quarantined from other areas of our lives. The patterns and trends in wellbeing cannot be regarded as unfortunate side-effects of a model of progress whose effects remain largely beneficial. Instead they need to be seen as a direct and fundamental consequence of how we currently define and pursue progress.

Suspicions of the Apocalypse: the psychosocial dynamics of global change

The widespread perception that quality of life is declining is significant, regardless of whether it is ‘factually’ or ‘objectively’ true. The resulting erosion of faith in society and its future influences the way people see their roles and responsibilities, and their relationship to social institutions, especially government. It denies people a social ideal to believe in and a wider framework of meaning in their lives, so increasing the psychological ‘load’ on personal expectations.

This dimension of the relationship between sustainable development and wellbeing is virtually ignored in both the scientific literature and political debate, but is extremely important. Environmental changes such as global warming are feeding growing apocalyptic suspicions about the century ahead. This pessimism impacts directly on individual wellbeing, but also has wider, indirect implications for wellbeing through its influence on how societies respond to this century’s challenges.

One reason this factor deserves greater attention is that our perceptions of the future are increasingly shaped by the images of global or distant threat and disaster to which people are exposed: earthquakes, hurricanes, floods, disease pandemics, terrorist attacks, genocide, and famine. While these hazards are not new, previous fears were never so sustained and varied, nor so powerfully reinforced by the immediacy and vividness of today’s media images. This effect seems certain to intensify as global warming and other threats begin to impact more deeply on our lives.

Our responses to this situation involve subtle and complex interactions between the world ‘out there’ and the world ‘in here’ (in our minds). At an individual level, for example, adaptability, being able to set goals and progress towards them, having goals that do not conflict, and viewing the world as essentially benevolent and controllable are all associated with wellbeing. Future visions would certainly affect the last, and may well bear on the other qualities, such as setting and attaining congruent goals. The loss of faith in the future may also affect wellbeing by reinforcing materialism and individualism.

At a societal level, we are being drawn in at least three directions by the prospects of dramatic, even catastrophic, social, economic and environmental changes. These responses highlight how people, individually and collectively, can react very differently to the same perceptions of threat and hazard. They are:

  1. Apocalyptic nihilism: the abandonment of belief – thinking and acting as though ‘it’s a late hour in the day and nothing much matters any more’; the focus is on ‘tending our own patch’; politics is driven by fear and self-interest; decadence rules.
  2. Apocalyptic fundamentalism: the retreat to certain belief – in the extreme, ‘end time’ thinking, where global war and warming are embraced as harbingers of the Rapture and Christ’s return to Earth; politics is framed as a contest between good and evil; dogma rules.
  3. Apocalyptic activism: the transformation of belief – the desire to create a new conceptual framework or system (stories, values, beliefs) that will make a sustainable future possible; politics is reframed according to a new worldview and ethic; hope rules.

All three responses are growing in social intensity, a head-to-head contest that, sooner or later, will shatter the status quo. Nihilism and fundamentalism represent maladaptive responses to threat, whatever their short-term or personal appeal. Because they do not address the root causes of a problem, they risk amplifying the costs to human wellbeing. Such strategies have led in the past to the collapse of societies confronting environmental strains. Activism is an adaptive response, closely associated with the drive for sustainable development.


I have argued that the associations between sustainable development and quality of life embrace three different, important dimensions: the direct effects, current and projected, of environmental change on human wellbeing; the adverse effects on wellbeing associated with the current model of material progress (which sustainable development would address); and the psychosocial effects of global environmental change on both individual wellbeing and societies’ capacity to respond adaptively – and so move towards sustainability.

Put another way, a quality-of-life perspective on sustainability means looking at not just the relationships between the physical environment and wellbeing, but also those between economic, social and cultural conditions and quality of life. While wellbeing is not the only consideration, it may be critical to achieving a real public and political commitment to sustainable development. Wellbeing provides an important framework for integrating and reconciling different social goals and priorities to achieve the goal of a high, equitable and lasting quality of life.

Richard Eckersley has written extensively about progress and wellbeing, including a book, ‘Well & Good’ (Text Publishing, 2004, 2005). He is a director of Australia 21 Ltd and a visiting fellow at the National Centre for Epidemiology and Population Health at the ANU.

This paper as a [136KB pdf]