"Better the devil you know": Are stated preferences over health and happiness determined by how healthy and happy people are?

Most people want to be both happy and healthy. But which matters most when there is a trade-off between them? This paper addresses this question by asking 4000 members of the UK and US public to make various choices between being happy or being physically healthy. The results suggest that these trade-offs are determined in substantial part by the respondent's own levels of happiness and health, with unhappy people more likely to choose unhappy lives and unhealthy people more likely to choose unhealthy ones: "better the devil you know, than the devil you don't". Age also plays an important role; older people are more likely to choose being healthy over being happy. Information about adaptation to physical health conditions matters too, but less so than respondent characteristics. These results further our understanding of public preferences with important implications for policymakers concerned with satisfying those preferences.

The Asymmetric Experience of Positive and Negative Economic Growth: Global Evidence Using Subjective Well-Being Data.

Are individuals more sensitive to losses than gains in terms of economic growth? We find that measures of subjective well-being are more than twice as sensitive to negative as compared to positive economic growth. We use Gallup World Poll data from over 150 countries, BRFSS data on 2.3 million US respondents, and Eurobarometer data that cover multiple business cycles over four decades. This research provides a new perspective on the welfare cost of business cycles, with implications for growth policy and the nature of the long-run relationship between GDP and subjective well-being.

In fatal pursuit of immortal fame: Peer competition and early mortality of music composers.

We investigate the impact of peer competition on longevity using a unique historical data set of 144 prominent music composers born in the 19th century. We approximate for peer competition measuring (a) the number or (b) the share of composers located in the same area and time, (c) the time spent in one of the main cities for classical music, and (d) the quality of fellow composers. These measures suggest that composers' longevity is reduced, if they located in agglomerations with a larger group of peers or of a higher quality. The point estimates imply that, all else equal, a one percent increase in the number of composers reduces composer longevity by ∼ 7.2 weeks. Our analysis showed that the utilized concentration measures are stronger than the personal factors in determining longevity, indicating that individuals' backgrounds have minimal impact on mitigating the effect of experienced peer pressure. The negative externality of peer competition is experienced in all cities, fairly independent of their population size. Our results are reaffirmed using an instrumental variable approach and are consistent throughout a range of robustness tests. In addition to the widely known economic benefits associated with competition, these findings suggest that significant negative welfare externalities exist as well.

Now or later? Understanding the etiologic period of suicide.

Previous research shows that the announcement of austerity measures leads to an immediate and short-lived increase in behaviour that demonstrates anxiety, stress, frustration and other mental effects. This paper uses evidence from the same natural experiment to study whether, for a given decision to commit suicide (as documented by the overall increase over the study period), suicides follow immediately after the announcement of austerity measures in Greece; or whether this is an effect that matures in peoples' minds before being transformed into action. We use evidence from a natural experiment and follow an econometric approach. Our findings show that, despite an overall sharp increase in suicides over the study period, the increase does not follow immediately in the first few days after each such negative event. This suggests that suicides are not spontaneous. They are rather decisions that take time to mature. This time lag implies that suicides arguably attributed to recessions are, in principle, preventable and underlines the importance of mental health services.

Preparatory study for the revaluation of the EQ-5D tariff: methodology report.

BACKGROUND: EQ-5D is a widely used generic measure of health with a 'tariff', or preference weights, obtained from the general population, using time trade-off (TTO). PRET (Preparatory study for the Re-valuation of the EQ-5D Tariff project) contributes towards the methodology for its revaluation. METHODS: Stage 1 examined key assumptions typically involved in health-state valuations through a series of binary choice exercises, namely that health-state preferences are independent of (1) duration of the state; (2) whose health it is (i.e. perspective); (3) length of 'lead time' (a mechanism to value all states on the same scale, including those who are worse than being dead); (4) when health events take place (time preference); and (5) satisfaction associated with the state. Further topics addressed were (6) exhaustion of lead time in the worst state; (7) health-state valuation using discrete choice experiments (DCEs) with a duration attribute; and (8) binary choice administration of lead time - time trade-off (LT-TTO). Stage 1 consisted of an online survey with 6000 respondents. Stage 2 compared the results above to those of an identical survey conducted in 200 face-to-face computer-assisted personal interviews (CAPIs), covering topics (1) to (7). Stages 3 and 4 examined - in more detail and depth - issues taken from stage 1. Stage 3 consisted of CAPI surveys of a representative UK sample of 300, using examples of TTO, LT-TTO, and DCE with duration, each followed by extensive feedback questions. Stage 4 was a more intensive exercise involving a qualitative analysis of people's thought processes during both binary choice and iterative health-state valuation exercises. Data were collected through 'think-aloud' methods in 30 interviews of a convenience sample. RESULTS: Stage 1 found that health-state values are not independent of (1) duration of the state but there is no clear pattern; (2) whose health it is; (3) the duration of 'lead time' but there was no clear pattern; (4) when health events take place; or (5) satisfaction associated with the state. Furthermore, (6) exhaustion of lead time in the worst state was subject to substantial framing effects; (7) the five-level version of the EQ-5D (EQ-5D-5L) can be valued using DCE with duration as an attribute; and (8) binary choice LT-TTO can be administered in an online environment. Stage 2 found that although online surveys and CAPI surveys resulted in different compositions of respondents, at the aggregate, their responses to the experimental questions covering (1) to (7) above were not statistically significantly different from each other. Stages 3 and 4 found that TTO and LT-TTO were easier than DCE with duration; respondents did not necessarily trade across all attributes of EQ-5D; some respondents found it difficult to distinguish between the two worst levels of EQ-5D-5L, and some respondents may be thinking about the impact of their ill health on their family. CONCLUSIONS: In order for the National Institute for Health and Care Excellence to make the most appropriate decisions, the EQ-5D tariff needs to incorporate the latest understanding of health-state preferences. PRET contributed to the knowledge base on the conduct of health-state valuation studies. FUNDING: The Medical Research Council (MRC)-National Institute for Health Research (NIHR) Methodology Research Programme funded the PRET project (MRC ref. G0901500), and the EuroQol Group funded the PRET-AS project (Preparatory study for the Re-valuation of the EQ-5D Tariff project - Additional Sample) as an extension to the PRET project with formal agreement from the MRC.

Greasy roads: the impact of bad financial news on road traffic accidents.

We use evidence from a natural experiment in Greece to study the effect of the announcement of austerity measures on road traffic accidents (RTAs). We use daily RTA data from 2010 and 2011, during which a number of austerity measures were announced, including salary and pension cuts and an increase in direct and indirect taxes. We find that controlling for other factors potentially influencing RTAs, the number of RTAs increased significantly on the first two days following the announcements of austerity measures. We put forward some tentative suggestions for why this happens.

Sick but satisfied: the impact of life and health satisfaction on choice between health scenarios.

Preference elicitation methods require respondents to predict the impact a change in health might have on their future selves. The focus on the change in health is at the possible expense of other experiences of life once in that health state. We analyse personal preferences to a pairwise choice task involving trade-offs between quality and length of life, where satisfaction levels with life or health are introduced in the description of the health states. We find that a health scenario including low levels of satisfaction increases the likelihood of preferring to die sooner in full health, whereas scenarios including high levels of satisfaction increase the likelihood of preferring to live for longer in poor health. The differences highlight the sensitivity of preferences to what is described in health states and therefore show the importance of on-going discussions about precisely what respondents should be asked to consider in preference elicitation studies.