Different theories of well-being offer a number of competing conceptions of well-being. We have described five different theories of well-being, which present competing views on what it means for a life to go well (see Figure 1 for an overview).
We can usefully distinguish in theory between:
i. Complete theories of well-being that identify what it is to lead a good life such as preference fulfilment, hedonism and life satisfaction.
ii. Partial theories of well-being which state that something is an important aspect of well-being but do not aim to give a complete explanation of well-being.
iii. Descriptions of inputs or basic functionings (either physical or psychological) which are not setting out to describe well-being per se, but rather to establish whether conditions exist that would enable well-being (however defined) to occur. Achieving these basic functionings would be a necessary but not sufficient condition for high well-being. The justification for their importance may be based on theory (as in the case of Ryan and Deci’s Self-Determination theory), social agreement, or on a statistical relationship.
A clear distinction between outcomes (non-instrumental) and determinants (instrumental) is not always easy in practice. The same attribute may be taken as important for different reasons. For example, ‘relatedness’ may be seen as part of what it is for life to go well (as it is in Ryff’s Psychological Well-Being theory), a universal psychological need required for health and well-being (as it is in Ryan and Deci’s Self-Determination theory), or a characteristic which, on average, predicts higher life satisfaction (as is often found to be the case in empirical data).[Dolan et al, 2008] As a consequence, measurement instruments drawn from different theoretical backgrounds may share similar content.
From a policy perspective, and particularly from the perspective of conducting economic evaluation, it clearly does matter if the well-being measure is to be taken as a complete measure of well-being, part of well-being or an important input to well-being. Whilst inputs to well-being are important for policy, for evaluation purposes, considering both inputs and outputs runs the risk of double counting potential benefits.
Our six instruments draw from a number of competing conceptual theories somewhat ‘pick and mix’ style, taking some aspects from a hedonist theory, some from evaluative theory, some from preference satisfaction. If a number of possible ways of thinking about well-being are attractive, but
there is no commitment to a single theory which explains what well-being is, then it becomes even more difficult to conceive of a way of constructing a single index of overall well-being.
We have considered a number of ways in which our six instruments differ:
They are measuring different overall constructs: health-related quality of life (EQ-5D), mental health (GHQ-12, WEMWBS), social-care needs (ASCOT), capabilities (ICECAP-A), SWB including evaluative, affect and flourishing (ONS-4).
Those that measure mental health or psychological well-being break down the construct into different dimensions (GHQ has positive and negative items, WEMWBS has only positive items).
They have a different potential for accuracy of measuring dimensions due to different number of items (for example EQ-5D and ONS-4 have one item on negative affect, GHQ-12 has 6).
They are likely to have a different degree of sensitivity at different levels of the construct (for example the WEMWBS may be sensitive to a change in a good mental health state but not in a very poor mental health state), hence subject to potential ceiling or floor effects.
With these potential theoretical and measurement differences in mind, the key question is whether or not these differences are also evident empirically. The measures are used to judge whether or not a good life is being lived. It is relatively easy to think of examples in which judgment would collide (a happy paraplegic, for example). However, a more relevant question is whether well-being measures drawn broadly from these different approaches present levels of well-being for individuals or groups which substantively differ empirically in ways which are policy relevant. Furthermore, it may be the case that some measures/questions are redundant given other measures/questions already included. For example, there may be redundancy across the measures included within the ONS well- being battery, particularly in relation to the WEMWBS and GHQ-12. Is it necessary to include feeling ‘relaxed’ (WEMWBS), and feeling ‘anxious’ (ONS-4), and feeling ‘constantly under strain’ (GHQ-12)? The next step will be to compare the measures empirically using existing datasets.
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