Quality of life

The well-being or quality of life of a population is an important concern in economics and political science. There are many components to well-being. A large part is standard of living, the amount of money and access to goods and services that a person has; these numbers are fairly easily measured. Others like freedom, happiness, art, environmental health, and innovation are far harder to measure. This has created an inevitable imbalance as programs and policies are created to fit the easily available economic numbers while ignoring the other measures, that are very difficult to plan for or assess.

Debate on quality of life is millennia-old, with Aristotle giving it much thought in his Nicomachean Ethics and eventually settling on the notion of eudaimonia, a Greek term often translated as happiness, as central. The neologism liveability (commonly but less correctly livability), from the adjective liveable, is an abstract noun now often applied to the built environment or a town or city, meaning its overall contribution to the quality of life of inhabitants.

Understanding quality of life is today particularly important in health care, where monetary measures do not readily apply. Decisions on what research or treatments to invest the most in are closely related to their effect of a patient's quality of life.

Quality of Life also refers to the first White House regulatory review program started in the Nixon Administration. See quality of life in (5)"See Also" below.

Measuring quality of life
The measures often used in the study of health care are 'quality-adjusted life years' (QALYs) and the related 'disability-adjusted life years' (DALYs); both equal 1 for each year of full-health life, and less than 1 for various degrees of illness or disability. Thus the cost-effectiveness of a treatment can be assessed by the cost per QALY or DALY it produces; for example, a cancer treatment which costs $10,000 and on average gives the patient 2 extra years of full health costs $5000 per QALY. Assessing treatments in this way avoids the much greater problems associated with putting a monetary value on life, as required in other areas of economics; saying that a treatment costs $5000 per QALY (i.e. per year of life) does not say or assume anything about the monetary value of a year of life.

Another method of measuring quality of life is by subtracting the "standard of living", according to the technical definition of the term. For example, people in rural areas and small towns are generally reluctant to move to cities, even if it would mean a substantial increase in their standard of living. One can thus see that the quality of life of living in a rural area is of enough value to offset a higher standard of living. Similarly people must be paid more to accept jobs that will lower their quality of life, night jobs, ones with extensive travel all pay more and the difference in salaries can also give a measure of the value of quality of life.

There is a growing field of research concerned with developing, evaluating and applying quality of life measures within health related research (eg within randomised controlled trials). Many of these focus on the measurement of health related quality of life (HRQoL), rather than a more global conceptualisation of quality of life. They also focus on measuring HRQoL from the perspective of the patient and thus take the form of self completed questionnaires. The International Society for Quality of Life was founded in response to this research and is a useful source of information on this topic.

A number of groups and agencies around the world have tried to develop ways of assessing quality of life:
 * The Economist: Quality-of-life index
 * Vanderford-Riley well being schedule
 * Physical quality-of-life index
 * UN Human Development Index
 * Genuine Progress Indicator
 * Gross National Happiness

New Zealand
The Green Party of Aotearoa New Zealand uses Quality of life as a slogan.

North America
The term has often been used, since the 1980s, in connection with the presence or absence of so-called victimless crimes, its users in this sense citing the incidence of these to gauge the inherent level of disorder in a society at a particular time. Users of the term in this application &mdash; who tend to be political and/or social conservatives &mdash; often refer to victimless crimes by the alternate name of "quality-of-life crimes." In conjunction with this, American sociologist James Q. Wilson has articulated what he calls the Broken Window Theory, which asserts that relatively minor problems left unattended (such as public urination by homeless individuals) send a subliminal message that disorder in general is being tolerated, and as a result, more serious crimes as well end up being committed (the analogy being that a broken window left unrepaired exudes an image of generalized dilapidation). Wilson's theories have been expounded by many prominent American mayors, most notably Rudolph Giuliani in New York City and Gavin Newsom in San Francisco. Their cities have instituted so-called zero tolerance policies, i.e. that do not tolerate even minor crimes.

One attempt to take quality of life more into account in government decisions is the notion of a seventh generation standard, which argues that the effect of any decision today should be judged by its effect in six generations. These measures are often associated in the United States with the proposed Seventh Generation Amendment proposal to the U.S. Constitution, and in Canada with the Canada Well-Being Measurement Act co-authored by Mike Nickerson of the Green Party of Ontario and Joe Jordan, a Liberal Party of Canada Member of Parliament. This strategy still would be very difficult to implement as predicting the future is never easy. Decision makers seven generations ago in the early mid-nineteenth century would have great difficulty comprehending today's realities.

Several First Nations in both Canada and U.S. seem to have independently originated this standard, prior to European contact, which seems to represent the age ratio between the longest-lived elders and newborns expressed in terms of generations, i.e. humans live at most 100-115 years, and reproduce in most tribal cultures at about 15-17 years old, a ratio of about seven to one. So, according to the standard, any child born as a decision was being made would be able to assess its impact over their entire life as an elder.

Although laws to require standards for measuring well-being have not yet been adopted, they are growing in popularity in the labor movement, forced attention to these matters to the NAFTA level and have begun to challenge assumptions of economics regarding inflation and money supply.

Early negotiations on NAFTA adopting the U.S. dollar (i.e. in both Canada and Mexico) have been drastically complicated by proposals to agree, as a prerequisite, on measuring well-being, which is still a very new subject. In part to stall or block currency union, the Canadian Labour Congress, Green Party of the United States, Green Party of Ontario and Green Party of Canada have all backed well-being measures very strongly. However, there is broad agreement among green economists that a common standard for measuring well-being, and possibly also Bioregional Democracy measures, would be required in order to ensure biosecurity after a currency union.