The Contribution of Quality of Life Research to Policy Making

Abstract

This chapter identifies the obstacles and facilitators of the process of transmission of research results to policy making for the improvement of quality of life. It explores the impact of research on policy making, the importance of the availability of data and the methods and techniques used, and the issue of funding. In addition, the chapter provides a series of strategies to improve the use of quality of life research results in policy making and reflects on the role of oral communication and the importance of dialogue between researchers and policy makers. It also contains recommendations for writing quality of life research results that can be translated into a useful input for public policy formulation. It makes a step-by-step proposal to bridge the gap between researchers and policy makers and improve the use of research results in the field of public policies. The chapter concludes with the presentation of different cases.

Cases: Using Quality of Life Theory and Methodology for Policy Making

In this section we present different cases related by experts, who referred to the importance of the use of research results in quality of life and well-being for policy making.

7.1.1 Case 1: Quality of Life in Economics and Public Policy by Paul Anand

It is exciting to see how quality of life of research has been taken up particularly by the main international organizations within economics as well as some national governments, charities and businesses. The latest, global version of the quality of life agenda is the sustainable development goals (SDGs) which comprise 17 overarching goals to which all member states of the United Nations (UN) have subscribed. It builds on various policy initiatives but ultimately initiates and arguments for change that economists and others have proposed. Within economics there are now three approaches or paradigms for thinking about human wellbeing. The traditional approach focuses on income and takes the view that other aspects of wellbeing are closely correlated. The more recent alternatives take the view that income is an input into quality of life and that a more explicit approach to its monitoring is warranted Anand (2016).

The human and sustainable development derives ultimately from work by Nussbaum and Sen (1993) that argues for the importance of opportunities to things that we value and is informed primarily by foundational ideas in philosophy about morality and ethics. The other approach focused on the concept of life satisfaction as measured and understood primarily in social psychology. This approach has been used by a number of researchers including Layard (2006) and Graham et al. (2018) to understand what the drivers of experiential happiness are and how these can be supported. Occasionally these approaches come to different conclusions and these differences are often the focus of academic debate. But when it comes to improving the quality of people’s lives conclusions are often surprisingly similar even if the arguments by which they are reached differ. It is important to recognize that international and national initiatives often draw on both traditions when they seek to go beyond income based measures of success. An important question then is how have these two subfields been successful? In what follows, I offer some reflections that highlight eight factors that are worth considering when trying to formulate research that stands the chance of being able to address the needs of policy-makers and practitioners.

7.1.1.1 Resources and Possible Barriers

• Research: Coherent and innovative ideas

It seems obvious and I include the quality of research for completeness while recognizing that novelty is a necessary if not sufficient condition. The capability approach has enabled policy makers including the UNDP Report Office, OECD and EU as well as a range of countries from Bhutan to the UK to adopt a multi-dimensional approach to wellbeing. The life satisfaction approach has encouraged them also to include a subjective overall measure on their dashboards of indicators. Both ideas are simple but have hinterlands of research are linked to relevant analytical theories. To stand the chance of being adopted by decision-makers the analysis needs to have the capacity to shed light on problems as well as being a positive response to some research question. A guide for theory success can be taken from Kuhn (2012) who found that empirical accuracy, internal consistency as well as consistency with other theory, broad scope in the sense of being able to applied beyond the immediate use envisaged, simplicity of explanation (i.e. avoiding overly complicated explanations) as well as the ability to disclose new phenomena or relations, all matter. The capability approach does with its novel core theory while the life satisfaction literature uses a novel variable to bring novel insights from psychology into economics.

• Persuasion: Articulate Advocates

The movement of wellbeing into public policy has benefitted in all cases from individuals who have been successful advocates for their approach. Perhaps this goes without saying but it is important to recognise that ideas do not disseminate themselves but need advocates who can encourage those in policy and practice as well as research to invest the time and energy investing in them.

• Operationalisation: Easy to Use

When ideas start to gather momentum, it must be possible for others to operationalise and implement them. Alkire et al. (2015) illustrate the value of addressing this point. By developing a procedure for creating indices of data where commensurability is difficult, their work quickly became a standard for use in some literatures. Procedures that are difficult to use will only be replicated if the rewards are particularly salient while those that are tractable encourage others to consider investing in them.

• Richness: Productive and Sustaining Dialogue

An idea that is readily operationalizable also needs to be able to sustain interest and dialogue. The capability approach with its simple formal structure and discursive discussions has proven particularly useful in this regard. Indeed, it promotes the idea that public deliberation is both instrumentally and intrinsically valuable for the promotion of wellbeing. The ability to stimulate debate within and between disciplines has been important but the capability approach seems also to have filled a gap in the need for a vehicle to discuss policy priorities though a lens that sees financial resources as a means to an end.

• Experiment: Listen, Respond, Revise and Persist

A vital part of any communication is the ability to listen and respond and this has applied to the field of wellbeing also. Sen is a particularly good example and has modified and added to his account over the decades in response to the comments and thoughts of others. In some ways his own ideas appear to emerge early on and not change that much but the way he elaborates and discusses those ideas has clearly changed as new issues are raised and new audiences were found for this work. The psychologists Duckworth and Quinn (2009) has emphasised also the importance of persistence and this too is important for interactions between policy-makers and academics. Policy-making requires ideas that are in some sense authoritative and this in turn implies that academics need to balance their own interests in new ideas against the value of sticking to and elaborating on a particular theme.

• Luck: Right Time Right Place

Notwithstanding the importance of planning and preparation there is an element of luck in what we do which depends on researchers being in the right place at the right time. Getting close and finding ways to interact with those we wish to engage with essential in this regard. Individuals can make, or at least contribute to, our own luck but still there are things that we can all do that make some outcomes more or less likely.

• Relevance and Value: Co-evolution with Evolving Agendas

Research that draws on the capability approach or the analysis of life satisfaction has proven amenable to evolution. A life satisfaction equation can always be developed for new groups or be updated with new data. However, the capability has proven particularly adept at being used to reconsider how a particular field might be judged—for example Robeyns (2006) has used it to argue that the intrinsic value of education should be considered in policy alongside the contributions to human capital formation for instrumental purposes.

• Mixed Methods: Ability to Engage Audiences with Appropriate Narratives

There is growing mainstream interest in economics in the role of narratives, (for example see Shiller (2019)) and I would suggest also that different communities are amenable to receiving particular kinds of narratives. Researchers in economics are particularly interested in concepts of freedom while social scientists in other disciplines have focussed more, at least in recent years, on the concept of social justice. Work on life satisfaction now has literatures in psychology focussing on internal aspects and some correlates and the field of positive psychology promises to be one in which narratives related to the individual and their internal capacities are important. By contrast, the capability approach has focussed on external elements that contribute to wellbeing and so is more amenable to many of the current policy imperatives.

While some of the earliest work on wellbeing and quality of life had psychological and sociological roots, the translation into policy and practice has been given a shot in the arm by the development of interests and subfields in economics. Beyond the factors discussed above, commitment to long-term dialogue with policy-makers and practitioners may also involve coproduction in which the boundary between research and practice becomes blurred. All these issues have played an important role in helping the main international organizations bring wellbeing more explicitly into their thinking.

7.1.2 Case 2: The Luxembourg Index of Well-Being (LIW) by Francesco Sarracino

Well-being, as a single indicator of quality of life, allowed starting a debate that can successfully lead policy makers to pursue quality of life directly. The well-being approach often entails the adoption of a dashboard of indicators to monitor countries’ performance in a number of domains that are relevant to quality of life. This implies that Governments can now resist the temptation to focus only on economic performance, and can consider the effects of their policies on a broader set of indicators. Additionally, a well-being approach lends itself to disaggregated analysis, thus naturally addressing the issue of multi-dimensional inequality of distribution within the population. Finally, as the quality of the environment plays an important role for well-being, it is reasonable to expect that integrating a well-being approach in policy making will favor a sustainable development.

By focusing on well-being, policy making switches its approach from focusing on what is expected to make people better off (economic growth) to what people think will make them better off. Moreover, the shift to well-being approach would empower people, who could more easily relate to policies and their expected consequences. The fact that the analysis of inequalities is embedded in the well-being approach facilitates tackling inequalities. For instance, the Statistical Office of Luxembourg produces a dashboard of 63 indicators organized in 11 domains to monitor quality of life. Whenever possible, the distribution of indicators is analyzed across various dimensions: gender, age, income distribution, education, and so on. To summarize this large amount of data, the Statistical Office introduced the Luxembourg Index of Well-being (LIW). This is a tool that allows researchers to navigate the data hierarchically, and it can be directly compared with prominent indicators of welfare such as Gross Domestic Product (GDP). To navigate data hierarchically means that the LIW is first built by domain (aggregating the indicators belonging to each domain separately), and then across domains. In this way it is possible to move forth and back between the LIW and the dashboard of indicators to trace which indicators play a major role in explaining the changes in LIW. Once identified the critical indicators, researchers can verify possible differences within the population and inform policy makers about urgent areas of intervention, and eventual social groups at risks of exclusion.

For the sake of curiosity, LIW—as a measure of quality of life—is basically flat in Luxembourg since 2009. This is at odds with the information provided by the Gross Domestic Product per capita, which follows a positive trend. The contrast between the LIW and GDP is an example of the value added of a well-being approach: with the lenses of business as usual, policy makers should feel reassured because the economy grows and this suggests that quality of life should be improving. However, the LIW signals that something is not as expected, and informs about which are the areas on which policy making could intervene to improve quality of life, such as health, personal security, housing, and governance. These are some of the reasons why I believe that a well-being approach is desirable, and it constitutes an unprecedented opportunity to contribute to the quality of the political outcome. It is therefore important to support and maintain the change made available by the maturity of the research on quality of life.

This means, for instance, to pay attention to any example showcasing the benefits of policies inspired by a well-being approach, to disseminate the value of the results achieved, and to persuade policy makers and civil servants at every level of the importance of adopting a well-being approach. As this will likely change the way institutions work, this approach will likely face resistance and heavy criticism at the first failures. To this end, it can be useful to introduce changes stepwise, possibly by involving people affected by the changes in the design of the new ways of work organization.

7.1.3 Case 3: The Work of the Social Weather Stations in The Philippines by Mahar Mangahas

I’ll take up important policy areas that have been affected (or not affected) by research.

Direct cash transfer to the poor. It’s been very clear, for many decades, that trickle-down economics doesn’t work. The poor aren’t able grow out of their poverty by themselves; what works is to help them directly. A program that has been shown to work in several developing countries is Conditional Cash Transfer (CCT)—this means transferring cash to the poor (identified by a set of practical objective criteria) on condition that they (a) keep their children properly fed while in pre-school age, and (b) keep them in school when they reach school age, up to completion of secondary school. It took many decades for the World Bank (WB) and the Asian Development Bank (ADB) to try out this kind of a program, because of the trickle-down model that these banks had maintained for so long.) CCT was finally introduced in the Philippines, with the help of WB/ADB, in 2009, when the government first began to build a database of poor families, called Listahanan (which means “Listing”). The implementation of the cash transfers has been accompanied by impact-evaluation survey research projects, financed by WB/ADB to ascertain their efficacy; SWS participated in these survey projects, and delivered the data to WB, ADB and the Philippine government analysts, who have pronounced CCT a success. The government’s database of the poor is now proving invaluable in the distribution of emergency assistance to families during the 2020 Covid pandemic.

Family planning. In my opinion, overpopulation is the single most important reason for Philippine poverty. In 1975, the Philippines with 44 million was the 18th most populous country in the world; and Thailand, close behind with 43 million, was the 19th. Now, 45 years later, the Philippines with 110 million is the 13th, while Thailand with 70 million is the 20th. The relative economic pressure put on the Philippines has been tremendous. Back in 1975, I was one of the Filipino social scientists working on the research project called “Population, Resources, Environment and the Philippine Future,” which called for the government to adopt a serious family planning program. The government did not respond, however, obviously for fear of antagonizing the Catholic Church. SWS did so many opinion polls, up to the 1990s, showing the non-existence of a Catholic vote at either national or local level. With these polls, family planning advocates hoped to weaken the resistance of politicians to reforms allowing government institutions to provide family planning services to the people; this is still an on-going battle.

7.1.4 Case 4: How Can Policymakers Use Indicators of Multidimensional COVID-19-Related Risk Factors to Inform Emergency Interventions in Highly Unequal Urban Areas? by Jhonatan Clausen and Nicolas Barrantes

Peru is currently one of the most severely affected countries by the COVID-19 pandemic at the global level (Ritchie et al., 2020). It is the country with the largest cumulative confirmed COVID-19 deaths per million people according to the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University COVID-19 (JHU CCSE n.d.). Lima, Peru’s capital city, concentrates the 29.8% of the entire Peruvian population (INEI, 2020) as well as the 41.1% of deaths caused by the pandemic in the country (CDC, 2021). As in most Latin American large cities, the living conditions of Lima’s population reflect significant spatial inequalities not only in a number of basic dimensions of quality of life, but also in the way in which the pandemic has hit different areas of the city.

Emergency policymaking in low- and middle-income countries (LMICs) is a significantly challenging endeavor. This is not only because of budget constraints but because of a lack of updated and detailed data, as well as low governmental capacity. In these contexts, it is crucially important to develop policy-relevant tools that, while not perfect, provide initial insights to direct certain specific interventions adopting a territorial perspective. Our research focused on Lima and Callao Provinces can inspire other efforts that build bridges between academia and policymaking in highly unequal cities, which is a characteristic of a range of urban areas in Latin American countries.

Following the hypothesis proposed by Alkire et al. (2020), the aim of our study was to empirically explore to what extent four COVID-risk indicators: (1) living in an overcrowded dwelling; (2) lacking access to safe water; (3) not owning a refrigerator; and (4) cooking with polluting fuels, were associated with higher levels of mortality caused by the COVID-19 in the context of a densely populated and highly unequal middle-income country capital city such as Lima and its main port, the Province of Callao. We conducted this analysis using district-level information from 4 sources: (1) the Peruvian National System of Deaths (SINADEF) of the Ministry of Health (MINSA, 2021); (2) the 2017 Peruvian National Censuses, gathered by the National Institute of Statistics (INEI, 2017); (3) the 2018 district-level monetary poverty map, elaborated by INEI (2020); and (4) the district-level Human Development Index (HDI) estimates for Peru, calculated by the United Nations Development Programme (2019).

Table 7.2 shows the four COVID-risk indicators we estimated, as well as the criteria we applied to identify whether a person suffered a deprivation in each one of them or not. We calculated two out of the four indicators (“Water source” and “Cooking fuel”) following the proposal of Alkire and Jahan (2018). In addition, we opted to identify a person to be living in COVID-related multidimensional risk if she suffered deprivation in at least two out of the four indicators of risk shown in Table 5.1.

Table 7.2 COVID-risk indicators and deprivation criteria

First, we calculated the incidence of people living in COVID-related multidimensional risk which corresponds to the proportion of people in a district that suffered deprivation in at least two out of the four COVID-related risk indicators. Second, we measure COVID-related mortality at the district level using the percentage increases in non-violent deaths occurred over the March–December period between 2019 and 2020 in each district. Third, we used this information to explore the association between district-level COVID-related multidimensional risk and mortality. In addition, we also explored the association between mortality at the district level and other indicators of quality of life such as the incidence of monetary poverty, as well as with district-level information on the HDI

Table 7.3 shows the values of Spearman, Kendall and Pearson coefficients that reflect the association between the percentage increase in non-violent deaths and different quality of life measures, including the incidence of COVID-related multidimensional risk. Our results showed that there is a positive association between COVID mortality, and our measure of COVID-related multidimensional risk based on the joint distribution of risk factor deprivations. Similarly, COVID mortality is also positively associated with income poverty, and non-income deprivation in the four risk factor indicators that form our COVID-related multidimensional risk measure. In addition, our findings revealed that districts with higher values of the HDI present lower COVID mortality rates.

Table 7.3 Correlation between the percentage increase in non-violent deaths (March–December 2019/March–December 2020) and different quality of life measures; districts of Lima and Callao Provinces

The above-mentioned association between COVID mortality and non-income multidimensional risk follows a spatial pattern of overlapping. Panels A and B in Fig. 3.1 show that the districts with higher levels of COVID mortality are among the districts with higher incidence of multidimensional risk. While these results should not be taken as evidence of a causal relationship between both variables, it provides policymakers with relevant information to implement rapid-response policies aimed at mitigating the potential effects that these deprivations could have on the population. For instance, this data might be useful to identify areas of the city in which to implement temporary stations of hand washing or emergency clean water provision systems. What is more, this information could be used to geographically target interventions oriented to inform people on the importance of opening doors and windows to improve indoor ventilation, as well as on the convenience of using on open spaces (such as communal football pitches) to hold activities maintaining social distance (Fig. 7.3).

Fig. 7.3

Distribution of the percentage increase in non-violent deaths (March–December 2019/March–December 2020) and the COVID-related multidimensional risk incidence; districts of Lima and Callao Province. Panel A. Percentage increase in non-violent deaths (March–December 2019/March–December 2020); districts of Lima and Callao Provinces. Panel B. COVID-related multidimensional risk incidence; districts of Lima and Callao Provinces. Source: Clausen and Barrantes (2021, p. 119) based on MINSA (2021), INEI (2017, 2020), PNUD (2019)

How can policymakers in other LMICs take advantage of this type of applied research? Contexts in these kinds of countries are highly diverse and, in consequence, there is not a unique answer to this question nor a “one size fits all” recipe. Yet, a relatively straightforward conclusion is that national and local governments in urban areas of LMICs can rely on spatial and cartographic information to inform how to allocate their scarce emergency resources. Although this data is subject to limitations, including information on basic quality of life indicators on national censuses and using it to conduct this kind of rapid analysis can emerge as a relatively cost-effective way of producing policy-relevant information that can be further complemented by other sources such as data from administrative records.

7.1.5 Case 5: Communication for Public Policy by Francisco Lavolpe

I remember my first job as a communications consultant for the executive area of a municipality. We conducted surveys to look into the problems and needs of citizens and they revealed a list of priorities that allowed us to develop a program of public policies. We gathered data and prepared a list of priority issues that we handed to the executive office. I submitted the report in person and requested a meeting with those responsible for designing public policies aimed at improving and satisfying the municipality’s living conditions.

The meeting never took place and the report was finally wasted. The person in charge of public policy (public infrastructure) distrusted the technical team that I led just because we didn’t come from the same political group. The executive managers simply did not trust the quality of our technical work and the recommendations that emerged from it. Their perception of needs led them to set arbitrary objectives that were far from the recommendations contained in our report. The only programs they implemented were those that were prepared by their operational collaborators, whose customary knowledge of the territory supposedly gave them enough information to carry them out with good results, even though there were no instruments to evaluate them.

Our team was able to identify a gap between the perception of the executive team and the findings of the report. This evidenced the need to work as a single team in the technical design of the objectives and in the understanding of the challenges posed by those objectives. The result of the work carried out was far from optimal, according to our research.

Organizations are made up of human resources recruited from different political tribes even when they represent the same political party. Party referents are often suspicious of representatives of rival tribes. Tribes account for the frequent disputes over territories in organizations. Each tribe refers to leaders, who often engage in disputes for the occupation of spaces in institutions that are in charge of public policies. Appointments to executive or technical positions are made without following a transparent and legitimate procedure that guarantees the best possible choice.

Later, we learned that the final choice for this public policy action was based on business agreements with private companies that implied a clear collusion of interests with the public administration. Even when corruption is not the rule, the choice of public policies is often based on contracts involving private benefits. In time, these practices play a negative role in public policy choices.

7.1.6 Case 6: The Criteria for a Successful Project by Christopher Wrathall

Over the past 20 years I have no longer been involved in setting up or running European projects, though I have been called on by the European Commission to review projects as an independent expert. In the performance of this task, it has been my privilege to gain some insights into the criteria that underlie a successful research project.

One of the key criteria for securing EU funding for projects is a demonstration of added value resulting from the collaboration of organisations across different European states. Added value could be assessed in terms of the synergy achieved because, for example, an expert in traffic modelling in the UK is able to work with a cognitive scientist in Italy and thus include driver behaviour characteristics within the resulting model, or because a young researcher at a Polish university is enabled to carry out PhD research at a French research institution. Some EU-funded projects have allowed key players, e.g. public transport operators from different countries, to agree on proposals for standardisation. This was the case with projects I had worked on that developed data structures and operational procedures for smartcard-based fare management systems. Projects of this type would aim to develop interoperable components, and thus foster advantages for European suppliers, as well as benefits for European citizens.

Indeed, another key aspect of successful research and development projects was the deployment of practical outcomes that are of demonstrable value for the participant communities, whether such communities could be defined in geographical or political terms, e.g. cities or regions, or in virtual or professional terms, e.g. virtual communities of researchers. As an independent expert I was particularly keen that projects should provide evidence of impact assessments that could convincingly demonstrate the benefits for communities of deploying the results of the projects.

Finally an important criterion of success, in my view, is the ability to communicate the value of the research. I have outlined in answer to question 2 above how predominant populist views in the UK can be seen to threaten the country’s position as a leader in research and development. A robust response to these threats from the research community would have to include a better explanation of how the research can benefit the communities that ultimately will decide on whether or not this research should be allowed to continue. (CW)