International Journal of Health Policy and Management

International Journal of Health Policy and Management

Determinants of Socioeconomic Inequalities in Well-Being in Canada: Evidence From the Nova Scotia Quality of Life Survey

Document Type : Short Communication

Authors
Daniel Keays 1
Mohammad Hajizadeh 2
1 Sobey School of Business, Saint Mary’s University, Halifax, NS, Canada
2 School of Health Administration, Dalhousie University, Halifax, NS, Canada
10.34172/ijhpm.8643
Abstract
There are relatively few studies that have measured and explained socioeconomic inequalities in the well-being of populations. Using unique information available in the 2019 Nova Scotia Quality of Life Survey (NSQLS, n = 9388), this study provides analysis of the determinants of socioeconomic inequalities in well-being of adults aged 18 and above in Nova Scotia, Canada. The population’s well-being was measured using the Canadian Index of Wellbeing (CIW), which encompasses quality of life across eight domains. The Concentration index (C) approach was utilized to quantify and identify factors explaining socioeconomic inequality in well-being. A positive value of the C (0.0294; 95% confidence interval: 0.0267 to 0.0321) indicated pro-rich inequality in well-being among Nova Scotian residents. Results of the decomposition analysis indicated that the concentration of favorable mental health, education levels, and income among high socioeconomic status (SES) groups accounted for over 86% of the observed socioeconomic inequality in the population’s well-being. Our findings demonstrated that inequalities in mental health, education, and income are significant obstacles to reducing inequality in well-being in Nova Scotia, Canada. Thus, policies aimed at alleviating inequalities in these factors may help to reduce socioeconomic inequality in well-being in Nova Scotia, Canada.

Highlights

Daniel Keays (Google Scholar) (PubMed)

Keywords
Socioeconomic Inequalities
Canadian Index of Wellbeing
Concentration Index
Nova Scotia
Canada
  1. Deeming C. Addressing the social determinants of subjective well-being: the latest challenge for social policy. J Soc Policy. 2013;42(3):541-565. doi:1017/s0047279413000202
  2. Dolan P, Metcalfe R. Measuring subjective well-being: recommendations on measures for use by national governments. J Soc Policy. 2012;41(2):409-427. doi:1017/s0047279411000833
  3. Kollamparambil U, Ndlovu M. Assessing the income and subjective well-being relationship across sub-national developmental contexts. J Happiness Stud. 2023;24(2):769-790. doi:1007/s10902-023-00623-9
  4. Burton P, Phipps S. Families, time, and well-being in Canada. Can Public Policy. 2011;37(3):395-423. doi:3138/cpp.37.3.395
  5. Gardes F, Merrigan P. Individual needs and social pressure: evidence on the Easterlin hypothesis using repeated cross-section surveys of Canadian households. J Econ Behav Organ. 2008;66(3-4):582-596. doi:1016/j.jebo.2006.06.009
  6. Hill R. Happiness in Canada since World War II. Soc Indic Res. 2004;65(1):109-123. doi:1023/a:1025596332111
  7. Brunstein JC. Personal goals and subjective well-being: a longitudinal study. J Pers Soc Psychol. 1993;65(5):1061-1070. doi:1037/0022-3514.65.5.1061
  8. Campbell JL. Ideas, politics, and public policy. Annu Rev Sociol. 2002;28(1):21-38. doi:1146/annurev.soc.28.110601.141111
  9. Kollamparambil U. Socio-economic inequality of well-being: a comparison of Switzerland and South Africa. J Happiness Stud. 2021;22(2):555-574. doi:1007/s10902-020-00240-w
  10. Schneider SM. Income inequality and subjective well-being: trends, challenges, and research directions. J Happiness Stud. 2016;17(4):1719-1739. doi:1007/s10902-015-9655-3
  11. Kangmennaang J, Elliott SJ. Towards an integrated framework for understanding the links between inequalities and well-being of places in low- and middle-income countries. Soc Sci Med. 2018;213:45-53. doi:1016/j.socscimed.2018.07.002
  12. Krieger N. Epidemiology and the People’s Health. Oxford University Press; 2011.
  13. Kelley J, Evans MDR. Societal inequality and individual subjective well-being: results from 68 societies and over 200,000 individuals, 1981-2008. Soc Sci Res. 2017;62:1-23. doi:1016/j.ssresearch.2016.04.020
  14. Cooper D, McCausland WD, Theodossiou I. Income inequality and well-being: the plight of the poor and the curse of permanent inequality. J Econ Issues. 2013;47(4):939-958. doi:2753/jei0021-3624470407
  15. Decancq K, Lugo MA. Inequality of well-being: a multidimensional approach. Economica. 2012;79(316):721-746. doi:1111/j.1468-0335.2012.00929.x
  16. Budria S. Are relative-income effects constant across the well-being distribution? J Happiness Stud. 2013;14(4):1379-1408. doi:1007/s10902-012-9384-9
  17. Diener E, Sandvik E, Seidlitz L, Diener M. The relationship between income and subjective well-being: relative or absolute? Soc Indic Res. 1993;28(3):195-223. doi:1007/bf01079018
  18. Easterlin RA. Does economic growth improve the human lot? Some empirical evidence. In: David PA, Reder MW, eds. Nations and Households in Economic Growth. Academic Press; 1974:89-125. doi:1016/b978-0-12-205050-3.50008-7
  19. Griffin DW, Gonzalez R. The endowment–contrast model: a lens for happiness research. In: Oxford Handbook of Happiness. Oxford University Press; 2013. doi:1093/oxfordhb/9780199557257.013.0004
  20. Wu HF. Relative income status within marriage and subjective well-being in China: evidence from observational and quasi-experimental data. J Happiness Stud. 2021;22(1):447-466. doi:1007/s10902-020-00237-5
  21. Oishi S, Kesebir S, Diener E. Income inequality and happiness. Psychol Sci. 2011;22(9):1095-1100. doi:1177/0956797611417262
  22. Wu HF, Tam T. Economic development and socioeconomic inequality of well-being: a cross-sectional time-series analysis of urban China, 2003-2011. Soc Indic Res. 2015;124(2):401-425. doi:1007/s11205-014-0803-7
  23. Baker M, Gruber J, Milligan KS. Retirement Income Security and Well-Being in Canada. Working Paper, 14667. Cambridge, MA: National Bureau of Economic Research; 2009. doi:3386/w14667
  24. Hilbrecht M, Smale B, Mock SE. Highway to health? Commute time and well-being among Canadian adults. World Leis J. 2014;56(2):151-163. doi:1080/16078055.2014.903723
  25. Berry JW, Hou F. Immigrant acculturation and well-being in Canada. Can Psychol. 2016;57(4):254-264. doi:1037/cap0000064
  26. Dilmaghani M. Religiosity and subjective well-being in Canada. J Happiness Stud. 2018;19(3):629-647. doi:1007/s10902-016-9837-7
  27. Statistics Canada. Population Estimates, Quarterly. Statistics Canada; 2023. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000901.
  28. Smale B, Gao M, Jiang K. An Exploration of Wellbeing in Nova Scotia: A Summary of Results from the Nova Scotia Quality of Life Survey. Waterloo, ON: Canadian Index of Wellbeing and University of Waterloo; 2020. https://static1.squarespace.com/static/5d388a67fad33f0001679229/t/5e71250812d3805459021b82/1584473359939/NSQofLifeSurvey-AnExplorationOfWellbeing-March2020+%281%29.pdf.
  29. Engage Nova Scotia. Nova Scotia Quality of Life Initiative. Engage Nova Scotia; 2019. https://engagenovascotia.ca/about-qol.
  30. Elliott SJ, Dixon J, Bisung E, Kangmennaang J. A GLOWING footprint: developing an index of well-being for low to middle income countries. Int J Wellbeing. 2017;7(2):1-27. doi:5502/ijw.v7i2.503
  31. Berry JW, Hou F. Immigrant acculturation and well-being across generations and settlement contexts in Canada. Int Rev Psychiatry. 2021;33(1-2):140-153. doi:1080/09540261.2020.1750801
  32. Dabravolskaj J, Khan MKA, Veugelers PJ, Maximova K. Mental health and well-being of 9-12-year-old children in Northern Canada before the COVID-19 pandemic and after the first lockdown. Int J Public Health. 2021;66:1604219. doi:3389/ijph.2021.1604219
  33. Crouse DL, Pinault L, Christidis T, Lavigne E, Thomson EM, Villeneuve PJ. Residential greenness and indicators of stress and mental well-being in a Canadian national-level survey. Environ Res. 2021;192:110267. doi:1016/j.envres.2020.110267
  34. Muhajarine N, Labonte R, Winquist BD. The Canadian index of well-being: key findings from the healthy populations domain. Can J Public Health. 2012;103(5):e342-e347. doi:1007/bf03404438
  35. Wilson J, Tyedmers P. Rethinking what counts. Perspectives on well-being and genuine progress indicator metrics from a Canadian viewpoint. Sustainability. 2013;5(1):187-202. doi:3390/su5010187
  36. University of Waterloo. Canadian Index of Wellbeing. University of Waterloo; 2020. https://uwaterloo.ca/canadian-index-well-being/what-well-being.
  37. Helne T, Hirvilammi T. Wellbeing and sustainability: a relational approach. Sustain Dev. 2015;23(3):167-175. doi:1002/sd.1581
  38. Panelli R, Tipa G. Placing well-being: a Maori case study of cultural and environmental specificity. EcoHealth. 2007;4(4):445-460. doi:1007/s10393-007-0133-1
  39. Parker RN, Fenwick R. The Pareto curve and its utility for open-ended income distributions in survey research. Soc Forces. 1983;61(3):872-885. doi:1093/sf/61.3.872
  40. Belfield C, Blundell R, Cribb J, Hood A, Joyce R. Two decades of income inequality in Britain: the role of wages, household earnings and redistribution. Economica. 2017;84(334):157-179. doi:1111/ecca.12220
  41. Bentley R, Baker E, Mason K, Subramanian SV, Kavanagh AM. Association between housing affordability and mental health: a longitudinal analysis of a nationally representative household survey in Australia. Am J Epidemiol. 2011;174(7):753-760. doi:1093/aje/kwr161
  42. Economou A, Theodossiou I. Poor and sick: estimating the relationship between household income and health. Rev Income Wealth. 2011;57(3):395-411. doi:1111/j.1475-4991.2010.00416.x
  43. Krieger N, Chen JT, Selby JV. Comparing individual-based and household-based measures of social class to assess class inequalities in women's health: a methodological study of 684 US women. J Epidemiol Community Health. 1999;53(10):612-623. doi:1136/jech.53.10.612
  44. Macintyre S, Hunt K. Socio-economic position, gender and health: how do they interact? J Health Psychol. 1997;2(3):315-334. doi:1177/135910539700200304
  45. Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545-557. doi:1016/0277-9536(91)90212-u
  46. World Bank. Quantitative techniques for health equity analysis: Concentration curve. Oxford: Oxford University Press; 2017:225-243.
  47. Kakwani N, Wagstaff A, van Doorslaer E. Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econom. 1997;77(1):87-103. doi:1016/s0304-4076(96)01807-6
  48. O'Donnell O, van Doorslaer E, Lindelow M. Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. World Bank Publications; 2008.
  49. Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom. 2003;112(1):207-223. doi:1016/s0304-4076(02)00161-6
  50. Austin A. On well-being and public policy: are we capable of questioning the hegemony of happiness? Soc Indic Res. 2016;127(1):123-138. doi:1007/s11205-015-0955-0
  51. Bache I. Measuring quality of life for public policy: an idea whose time has come? Agenda-setting dynamics in the European Union. J Eur Public Policy. 2013;20(1):21-38. doi:1080/13501763.2012.699658
  52. Nilsson B, Holmgren L, Stegmayr B, Westman G. Sense of coherence--stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study. Scand J Public Health. 2003;31(4):297-304. doi:1080/14034940210164920
  53. Nilsson KW, Leppert J, Simonsson B, Starrin B. Sense of coherence and psychological well-being: improvement with age. J Epidemiol Community Health. 2010;64(4):347. doi:1136/jech.2008.081174
  54. Fields EC, Kensinger EA, Garcia SM, Ford JH, Cunningham TJ. With age comes well-being: older age associated with lower stress, negative affect, and depression throughout the COVID-19 pandemic. Aging Ment Health. 2022;26(10):2071-2079. doi:1080/13607863.2021.2010183
  55. Waite L, Das A. Families, social life, and well-being at older ages. Demography. 2010;47(Suppl 1):S87-S109. doi:1353/dem.2010.0009
  56. Bender KA. An analysis of well-being in retirement: the role of pensions, health, and ‘voluntariness’ of retirement. J Socio Econ. 2012;41(4):424-433. doi:1016/j.socec.2011.05.010
  57. Easterlin RA. Building a better theory of well-being. In: Economics and Happiness: Framing the Analysis. Oxford: Oxford University Press 2005.
  58. Latif E. The impact of retirement on psychological well-being in Canada. J Socio Econ. 2011;40(4):373-380. doi:1016/j.socec.2010.12.011
  59. Cloninger CR. The science of well-being: an integrated approach to mental health and its disorders. World Psychiatry. 2006;5(2):71-76.
  60. Slade M. Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Serv Res. 2010;10:26. doi:1186/1472-6963-10-26
  61. Elgar FJ, Gariépy G, Torsheim T, Currie C. Early-life income inequality and adolescent health and well-being. Soc Sci Med. 2017;174:197-208. doi:1016/j.socscimed.2016.10.014
  62. Katic I, Ingram P. Income inequality and subjective well-being: toward an understanding of the relationship and its mechanisms. Bus Soc. 2017;57(6):1010-1044. doi:1177/0007650317701226
International Journal of Health Policy and Management
Volume 14, Issue 1
2025
Pages 1-9

  • Received Date 11 June 2024
  • Revised Date 15 December 2024
  • Accepted Date 01 January 2025
  • First Published Date 04 January 2025
  • Published Date 01 December 2025