Quality of Life
EPR has worked and focused for many years on the quality of life impact from services provided to persons with disabilities. In 2018 EPR developed an e-learning module on the topic. It aims to provide key information about Quality of Life, its definition, how it relates to persons with disabilities and the services provided to them, the tools and instruments to measure it.
The text below is an extract from the e-learning module. You can sign up to access the resources there for free here: https://epr.teachable.com/courses/275162
What is quality of life?
The World Health Organisation (WHO) defines Quality of Life (QOL) as 'individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to salient features of their environment”.
Quality of Life is a complex construct with both objective and subjective elements
From a universal perspective, QOL is something that everyone values and it is likely that when we make life decisions, in some intuitive way we check the impact on our QOL. Of course, there are circumstances where the decisions we make may satisfy our needs in the short-term but will have a long-term negative impact on our overall QOL. This is the subjective nature of experienced QOL. Every person will have a different set of priorities and needs and perceiving these to be in balance provides a sense of personal QOL.
However, there is also an objective aspect to QOL which involves economic, social, cultural, emotional dimensions. Eurostat regularly measures quality of life using what it refers to as the 8+1 QOL indicators. The recommended sub-indicators proposed by the Eurostat expert group can provide an insight into how it is being conceptualised and measured. [1] Some of the items listed below are not yet in place and the data published rebates to headline indicators.
1. Material living conditions
1.1. Income: Median disposable income; Income inequality; At-risk-of-poverty rate; At-risk-of-poverty rate; Satisfaction with financial situation
1.1. Income distribution and inequality; Risk of poverty; Severe material deprivation; Making ends meet, a subjective indicator of poverty
1.2. Consumption: Actual individual consumption (per capita); Constrained consumption (Basic expenses in the total household expenditure)
1.3. Material conditions: Material deprivation (Severe material deprivation rate and (In)ability to make ends meet)
1.4. Housing conditions: Structural problems of the dwelling; Space in the dwelling (overcrowding/under-occupation); Satisfaction with accommodation
2. Productive or main activity
2.1. Quantity of employment:Employment and unemployment: employment rate; unemployment rate; Long-term unemployment rate
2.2. Underemployment (in terms of intensity/quantity of work): People living in households with very low work intensity; Underemployed part-time workers
2.3. Quality of employment: Income and benefits from employment; Low-wage earners
2.4. Temporary work: Temporary contracts; ‘Involuntary’ temporary contracts
2.5. Over-qualification (underemployment in terms of quality of work): Over-qualification rate; Self-reported over-qualification
2.6. Health and safety at work: Incidence rate of fatal accidents at work
2.7. Work/life balance: Average number of usual weekly hours of work; Long working hours (more than 48 per week); Atypical working hours e.g. evenings, nights or weekends; Flexibility of the work schedule; Satisfaction with commuting time
2.8. Assessment of the job quality: Job satisfaction
2.9. Main reason for economic inactivity: Inactive population; Unpaid work
3. Health
3.1. Outcomes: Life expectancy;
3.2. Health status: Healthy Life Years; Self-perceived health; Self-reported mental health
3.3. Determinants (healthy and unhealthy behaviours): Body Mass Index; Daily smokers; Hazardous alcohol consumption; Practice of physical activity; Consumption of fruits and vegetables; Access to healthcare
4. Education
4.1. Competences and skills: Educational attainment (Tertiary educational attainment and Early leavers from education and training); Self-reported skills: (Individuals’ level of internet (digital) skills; Knowledge of foreign languages); Assessed skills: literacy, numeracy and problem solving in technology-rich environments)
4.2. Lifelong learning: Participation in adult education and training
4.3. Opportunities for education: Participation in education of children four-year-olds
5. Leisure and social interactions
5.1. Quantity of leisure: Non-participation in culture or sport activities; Satisfaction with time use; Quality of leisure; Access to leisure; Financial obstacles to leisure participation
5.2. Social interactions: Relations with people (Frequency of getting together with friends and Satisfaction with personal relationships); Activities for people (Participation in formal voluntary activities and Participation in informal voluntary activities)
5.3. Social support: Help from others (having someone to rely on in case of need and Having someone to discuss personal matters with)
5.4. Social cohesion: Trust in others; Perception of social inclusion; Economic and physical safety; Governance and basic rights; Natural and living environment; Overall experience of life
6. Economic security
6.1. Wealth (assets): Unable to face unexpected financial expenses;
6.2. Debt: in arrears; Income insecurity (Percentage of persons employed in the previous year transitioning to unemployment this year)
6.3. Physical safety: Crime (Homicide rate and Perception of crime, violence or vandalism in the living area) Perception of physical safety (Safety feeling (population feeling safe when walking alone in their area after dark)
7. Governance and basic rights
7.1. Institutions and public services: Trust in institutions (Trust in the legal system, Satisfaction with public services)
7.2. Discrimination and equal opportunities: Discrimination; Equal opportunities (Gender employment rate gap, Gender pay gap and Gap in employment rates between nationals and non-EU citizens
7.3. Active citizenship
8. Natural and living environment
8.1. Pollution (including noise): Urban population exposure to air pollution by particulate matter; Perception of pollution, grime or other environmental problems; Noise from neighbours or from the street
8.2. Access to green and recreational spaces: Satisfaction with recreational and green areas
8.3. Landscape and built environment: Satisfaction with living environment
9. Overall experience of life
9.1. Life satisfaction: Overall life satisfaction
9.2. Affects: Negative affects (being very nervous; feeling down in the dumps; feeling downhearted or depressed); Positive affects (being happy);
9.3. Meaning and purpose of life: Assessing whether life is worthwhile
For a more detailed discussion on the theory and models underpinning the indicators the final report of the expert group on quality of life indicators provides the basis and rationale for each of the indicators.[1]
The European Foundation for the Improvement of Living and Working Conditions carried out the European Quality of Life Survey (EQLS) in 2003, 2007, 2011 and 2016.[2] The EQLS is designed to gather data on living conditions and the social situation for European citizens. It contains both subjective and objective measures. The QOL model, upon which the EQLS is based, takes a broad perspective which incorporates both individual well-being and the quality of public services and society.
In 2012, declines of more than 20% in optimism and happiness were identified by the EQLS in some countries and over 33% of respondents reported a deterioration in their financial situation over the previous 5 years. The survey was administered to a total of 43,636 people in 34 countries. Since the 2007 survey, a greater number of respondents who had good income and were in good quality housing, were struggling with unemployment, debts, housing insecurity and access to services. People had begun to lose confidence in key public institutions, governments and parliaments over the previous five years, with the largest declines obvious in those countries facing the most serious economic difficulties, such as Spain and Greece.[3]
The same survey reported on subjective wellbeing. It highlighted a number of interesting insights.[4] For example:
The most important components of the deprivation index were the social aspects e.g. not being able to invite guests over.
The most negative impact of housing on satisfaction with life was feeling insecure about being able to remain in the house.
Temporary employment that lasted more than a year did not have a negative impact on subjective wellbeing.
Having face-to-face contact with friends impacted very positively on subjective wellbeing, while phone and email contact had no effect.
Living in a rural area was associated with higher subjective wellbeing.
In addition to the country in which a person lived, the other factors that impacted most strongly on subjective wellbeing included being restricted by disabilities or ill health, being unemployed and being middle-aged.
The 2016 EQLS survey provided insight into social progress almost 10 years after the economic downturn.[5] It documented that progress had been made in the interim in terms of a reduction in financial hardship and increased satisfaction with the standard of living. Nevertheless, there were a number of countries where these challenges still existed. Life satisfaction remained high at 7.1 on a 10-point scale. Satisfaction ratings of public services had increased particularly relating to health and child care. People on lower incomes were less satisfied. Concern about air quality in urban areas had increased. People in rural areas felt less close to others in their locality. Feelings of social exclusion had decreased. Young people reported a higher level of trust in other people.
While demographic, social and economic tensions had declined, ethnic and religious tensions had increased. Self-reported health had improved for all segments of the population. However, those in the low-income groups were less positive about quality of public service, social exclusion and risks of mental ill-health.
The report concluded:
Greatest QOL improvements were identified in the second highest income group
The situation of the long term unemployed had worsened
The challenge of indebtedness and arrears needed to be addressed more effectively
Measures to promote resilience and access to support were required
A response to the deterioration of work-life balance needed to be developed
The increasing need for long-term care and the circumstances of informal carers was evident
An ageing society was an emerging challenge. Older people reported lower overall life satisfaction and difficulties in making ends meet.
References:
[1] European Union (2017). Final Report of the Expert Group on Quality of Life Indicators – 2017 Edition. LU: Publications Office of the European Union. Accessed 16/01/2019 at: https://ec.europa.eu/eurostat/web/products-statistical-reports/-/KS-FT-17-004
[2] Eurofound (2017), European Quality of Life Survey 2016: Quality of life, quality of public services, and quality of society LU: Publications Office of the European Union.
[3] EuroFound (2012). European Quality of Life Surveys (EQLS) 2012. Accessed 06/02/2019 at: https://www.eurofound.europa.eu/surveys/european-quality-of-life-surveys/european-quality-of-life-survey-2012
[4] EuroFound (2013). Quality of life in Europe: Subjective well-being Executive summary. Accessed at: https://www.eurofound.europa.eu/sites/default/files/ef_files/pubdocs/2013/591/en/1/EF13591EN.pdf
[5] Eurofound (2017). European Quality of Life Survey 2016: Quality of life, quality of public services, and quality of society. LU: Publications Office of the European Union.