PART IX

CULTURE AND
PHYSICAL HEALTH

Algerian college students receive stress counselling.

As a student, you probably work to maintain good grades, have

an active social life, and to stay healthy but there is a popular
joke about what it’s like to be in college -You can only pick
two of these things. The busy life of a college student doesn’t
always allow you to maintain and balance all three areas of your
life, especially around midterm and finals. Researchers found
that students taking exams were more stressed, smoked more,
drank more caffeine, had less physical activity, and had worse
sleep habits (Oaten & Chang, 2005), all of which could have

Culture and Physical Health | 211

detrimental effects on their health. Positive health practices
are especially important during times of stress, but how have
habits you have been enculturated into shaped those
practices? What are the similarities and differences in staying
healthy as a college student in the United States compared to
other countries?
Globally, human beings are living longer than ever but living
a longer life does not necessarily mean we are living healthier.
Researchers in the field of health want to improve our
understanding of how social and technological advances in
medicine and lifestyle are being undermined by increasing
rates of obesity, unhealthy behaviors and widening gaps in
access to health care. For centuries of human history, life
expectancy has slowly and steadily risen for each generation;
however, current unhealthy habits (smoking, substance abuse,
obesity) may potentially threaten this trend. The New England
Journal of Medicine reported that the average youth of today
may live less healthy, and even shorter, lives than their parents
(Olshansky, et. al., 2005). If that is the case, today’s youth would
be the first generation in modern, recorded history to NOT
automatically be expected to outlive the generation that raised
them.

212 | Culture and Physical Health

What Does it Mean to
be Healthy?
The meaning of health has evolved over time but early
definitions of health focused on the theme of the body’s ability
to function. Originally health was seen as a state of normal
function that could be disrupted from time to time by disease.
Disease is a broad reference to any condition that impairs
normal functioning of the body. Most Western countries focus
on the physical processes – pathology, biochemistry and
physiology of a disease – as primary contributors to health.
This is known as the biomedical model. According to the
biomedical model, health means freedom from disease, pain,
or defect but does consider the role of social factors or
individual subjectivity. There is a contrasting model of health
that takes a more holistic approach, often referred to as
traditional medicine.
The World Health Organization (WHO) defines traditional
medicine as “the sum total of the knowledge, skills, and
practices based on the theories, beliefs, and experiences
indigenous to different cultures” (WHO, 2019). In 1977, American
psychiatrist George Engel developed an interdisciplinary
model that looked at the interconnection between biology,
psychology, and socio-environmental factors. With his
biopsychosocial approach, Engel strived for a more holistic
approach to health by recognizing that each patient has his or
her own thoughts, feelings, and history.
Engel’s biopsychosocial model views the development of
illness through the complex interaction of biological factors
(genetic, biochemical), psychological factors (mood,
personality, behavior) and social factors (cultural, familial,
socioeconomic, medical). For example, a person may have a

What Does it Mean to be

Healthy? | 213
genetic predisposition for depression, but he or she may have
social factors such as extreme stress at work and family life, and
psychological factors such as a perfectionistic tendency, which
when combined can trigger this genetic code for depression.

214 | What Does it Mean to be Healthy?

Global Definition of
Health
Health, as defined by the World Health Organization (WHO),
is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity (WHO, 2019).
This definition has been subject to controversy, as it may have
limited value for implementation. Generally, the context in
which we live our lives is critical for our health and quality of
life. It is increasingly recognized that health is maintained and
improved not only through the advancement and application
of health science, but also through intelligent lifestyle choices
and efforts of the individual, as well as larger society.
According to the World Health Organization the main
determinants of health include:

• Social environment
• Economic environment
• Physical environment
• Individual characteristics and behavior
• Global Indicators of Health

Health indicators are quantifiable characteristics of a

population which researchers use for describing the health of a
population. Adopting a standard system with reliable measures
for defining health is important for global monitoring of
changes in health (see Chapter 3 for more about reliability).
Researchers using data collected from around the world look
for patterns in identifying, preventing, and treating disease.
There are three common global health indicators identified
by The World Health Organization (WHO) that directly and
indirectly measure and monitor global health:

Global Definition of Health | 215

 1. Life expectancy
2. Infant mortality
3. Subjective well-being

These three indicators serve as standard measures to assist

health professionals working in both developed and
developing countries. Each indicator is discussed in greater
detail.

216 | Global Definition of Health

Life Expectancy
Life expectancy (LE) is a statistical measure of the average
time an organism (in our case human) is expected to live, based
on the year of its birth, its current age and other demographic
factors including gender. There are great variations in life
expectancy between different parts of the world, mostly
caused by differences in public health, medical care, and diet.
Comparing life expectancies from birth across countries can be
problematic. There are differing definitions of live birth versus
stillbirth even among more developed countries, and less
developed countries often have poor reporting.
Worldwide, the average life expectancy at birth was 71.5
years, 68.4 years for males and 72.8 years for females over the
period 2010–2015 according to United Nations World
Population Prospects (UN Population Prospects, Revised 2015).
In the United States, African-American people have shorter
life expectancies than their European-American counterparts.
For example, white Americans born in 2010 are expected to
live until age 78.9, but black Americans only until age 75.1. In
contrast, Asian-American women live the longest of all ethnic
groups in the United States, with a life expectancy of 85.8 years.
The life expectancy of Hispanic Americans is 81.2 years (Center
for Disease Control, CDC, 2019).
Overall, the United States ranks 49 globally in LE. The highest
life expectancy is found in Monaco (Europe) and the lowest
life expectancy is found in Angola (Africa) (“Life Expectancy”,
2019). Ranking 49 in the world in life expectancy doesn’t sound
so bad when you consider over 200 countries contribute data
but it is problematic and concerning given the comparative
abundance of resources of the United States. Some argue that
the United States, with access to health sciences, technology,

Life Expectancy | 217

and supported innovation should be a global leader in life
expectancy rates with a much higher global ranking.

218 | Life Expectancy

Health in American
Culture
Given that the United States spends more on health care than
most (if not all) industrialized nations in the world, one could
reasonably expect the American people to be some of the
healthiest citizens in the world. How is it then that modern
Americans are significantly less healthy than other societies
and, may even be expected to live shorter lives than previous
generations? In previous chapters, westernized ideals of
control, choice, short-term time orientation, and capitalism
were explored as influencing how young people are
enculturated in the United States.
In this chapter, aspects of western culture will be viewed
through the lens of their impact on our physical health
including our perceptions of health, desire to be health and
access to health education and resources. In this chapter we
will explore the impact of American culture on four aspects of
health in United States society:

• American diet
• Sleep hygiene
• Socio-economic status
• Ethnic and racial disparity

Health in American Culture | 219

Diet
The history of United States Department of Agriculture (USDA)
nutrition guides includes over 100 years of American nutrition
advice. The guides have been updated over time to adopt new
scientific findings and new public health marketing
techniques. The current guidelines are the Dietary Guidelines
for Americans 2015 – 2020. What the government promotes
as a healthy diet has not only changed over the course of
generations but is often heavily influenced be societal values at
that time.
These guidelines have been criticized over time as not
accurately representing scientific information about optimal
nutrition, and as being overly influenced by profit, personal
interest, and the agricultural industries the USDA promotes.
The introduction of the USDA’s food guide pyramid in 1992
attempted to express the recommended servings of each food
group into the American diet.
MyPlate is the current nutrition guide published by the
United States Department of Agriculture, consisting of a
diagram of a plate and glass divided into five food groups.
It replaced the USDA’s MyPyramid diagram in 2011, ending 19
years of food pyramid iconography (USDA, 2019).
Diet is the sum of food consumed by an organism or group,
and should not be confused with dieting, which refers to food
restriction with the goal of weight control. Numerous studies
have attempted to identify contributing factors for poor health
habits in the United States that have contributed to rising rates
of obesity and diseases related to obesity. These studies have
resulted in numerous hypotheses as to what those key factors
are. A common theme is that of too much food, too little
exercise, and a sedentary schedule; however, these themes are
increasingly viewed as overly simplistic and lacking in

220 | Diet
awareness to the complex approaches that are needed to
improve healthy living for all Americans. For example, while
dieting, people tend to consume more low-fat or fat-free
products, even though those items can be just as damaging
to the body as the items with fat. Currently, less than 20%
of all Americans meet the recommended minimum dietary
guidelines for optimal health (“Health Diet”, n.d).
Other factors not directly related to caloric intake and activity
levels are also believed to contribute to lowered physical fitness
and higher body-mass index (BMI) rates. These include careers
that involve long hours of sitting, decreased ability to delay
gratification, and heavy marketing to promote unhealthy
foods. Genetics are also believed to be a factor that contributes
to higher BMI. In a 2018 study, researchers stated that the
presence of the human gene APOA2 could result in a higher
BMI in individuals. Also, the probability of obesity can even
start before birth due to things that the mother does such as
smoking and gaining a lot of weight.
Among the complex factors impacting eating habits in
American culture are two key enculturated trends:

• Consumer culture
• Mixed media messaging

Consumer culture focuses on the spending of the customer’s

money on material goods to attain a lifestyle in a capitalist
economy. Over the years, people of different age groups are
employed by marketing companies to help understand the
beliefs, attitudes, values, and past behaviors of the targeted
consumers. As consumers grow increasingly removed from
food production, the role of product creation, advertising, and
publicity become the primary vehicles for information about
food. With processed food as the dominant category,
marketers have almost infinite possibilities in developing their
products for mass appeal.

Diet | 221
 Today’s American citizens are inundated with marketed
messages that food choices should be fast, bring us pleasure,
and meet our emotional needs over physiological needs. Of
the food advertised to children on television, 73% is fast or
convenience foods (“Consumer Culture”, 2019). Additionally,
Americans are often enculturated to pursue personal
satisfaction while also adhering to unrealistic standards of
fitness and attractiveness. Our consumer culture promotes
these conflicting standards with mixed messaging in various
media formats.
Mixed messaging can refer to any communication that is
contradictory, inconsistent, or unclear, especially in its motive
or intent. Media advertisements, athletic and entertainer role-
models, and character storylines are often embedded (subtly,
or at times, overtly) with the message that Americans “deserve”
to feel good but must also look good in the process.
With 1 out of 3 adults and 1 out of 6 children in the United
States categorized as excessively overweight by the Centers for
Disease Control (CDC) it is imperative to examine the factors
affecting this damaging trend (Obesity, 2019). We will talk in
Chapter 10 about the cultural relationship Americans have with
diet and appearance, which contributes to the formation of
eating disorders, further damaging overall health and well-
being.

222 | Diet
Sleep Hygiene
Sleep hygiene is the recommended behavioral and
environmental practice that is intended to promote better
quality sleep. Sleep hygiene recommendations include
establishing a regular sleep schedule, using naps (with care),
avoiding physical or mental exercise too close to bedtime,
limiting worry, limiting exposure to light in the hours before
sleep, getting out of bed if sleep does not come, not using
bed for anything but sleep and sex, avoiding alcohol, nicotine,
caffeine, and other stimulants in the hours before bedtime, and
having a peaceful, comfortable and dark sleep environment.
One set of recommendations relates to the timing of sleep.
For adults, getting less than 7–8 hours of sleep is associated
with a number of physical and mental health deficits. A top
sleep hygiene recommendation is allowing enough time for
sleep. There is also focus on the importance of waking up each
around the same time every morning and generally having a
regular sleep schedule
Human sleep needs vary by age and among individuals.
Sleep is considered to be adequate when there is no daytime
sleepiness or dysfunction. Researchers have found that
sleeping 7–8 hours each night correlates with longevity and
cardiac health in humans, though many underlying factors
may be involved in the causality behind this relationship.
Research also suggests that sleep patterns vary significantly
across cultures (“Sleep”, 2019). Sleep deprivation, also known
as insufficient sleep or sleeplessness, is the condition of not
having enough sleep. According to the Centers for Disease
Control and Prevention (CDC), 79% of Americans are currently
getting less than the recommended 7-hour minimum of
quality sleep per night. The United States experiences some of
the highest rates of sleep deprivation and sleep disorder rates

Sleep Hygiene | 223

in the industrialized world; it is worth examining aspects of
American culture that contribute to this trend.
Researchers examining health trends in the United States
have highlighted our time-sensitive culture, emphasis on
technology, and general attitudes toward sleep as contributing
factors to our sleep hygiene. In 2000, the average American
worked 1,978 hours per year, 500 hours more than the average
German but 100 hours less than the average Czechoslovakian
(“Sleep”, 2019). Overall the United States labor force is one of
the most productive in the world, largely due to its workers
working more than those in any other post-industrial country
(excluding South Korea). Americans generally hold working
and being productive in high regard. Being busy and working
extensively is a source of pride for many and, as they say in
America, “time is money.” Additionally, while there is little
dispute that technology has enhanced our daily lives, studies
show it is also negatively impacting our sleep habits. The
increased stimulation of our devices can make it more difficult
to unwind at the end of the night, while the unique light put off
by these devices also block key sleep hormones. According to
the National Sleep Foundation (2019), children (ages 6-17) who
slept in the same room as an electronic device reduced the
amount of quality sleep by one-hour each night.
Overall health is correlated with the quantity and quality of
our sleep. Studies have shown that those who engaged in
protective habits (e.g., getting 7–8 hours of sleep regularly, not
smoking or drinking excessively, exercising) had fewer illnesses,
felt better, and were less likely to die over a 9–12-year follow-
up period (Belloc & Breslow 1972; Breslow & Enstrom 1980).
For college students, health behaviors can even influence
academic performance. Poor sleep quality and quantity are
related to weaker learning capacity and academic
performance (Curcio, Ferrara, & De Gennaro, 2006). Overall,
people with sleep less are more likely to be obese, report higher
levels of stress, and/or report symptoms of a mood disorder

224 | Sleep Hygiene

than those who obtain optimal levels of sleep each night (CDC,
2014).

Sleep Hygiene | 225

Socioeconomic Status
(SES)
Socioeconomic status (SES) is an economic and social
combined total measure of a person’s economic and social
position in relation to others, based on income, education, and
occupation; however, SES is more commonly used to depict
an economic difference in society as a whole. Socioeconomic
status is typically broken into three levels (high, middle, and
low) to describe the three places a family or an individual may
fall in relation to others. Recently, there has been increasing
interest from researchers on the subject of economic
inequality and its relation to the health of populations.
Socioeconomic status is an important source of health
inequity, as there is a very robust positive correlation between
socioeconomic status and health. Socioeconomic status in the
United States is related to health outcomes. Individuals higher
in the social hierarchy, typically, enjoy better health than do
those lower in the hierarchy. Low income and education levels
have been shown to be strong predictors of a range of physical
and mental health problems. These health problems may be
due to environmental conditions in living and workspaces,
increased levels of stress, lack of access to healthcare, food
scarcity or poor nutrition. This correlation suggests that it is
not only the poor who tend to be sick when everyone else is
healthy, but that there is a continual gradient, from the top
to the bottom of the socio-economic ladder, relating status to
health.
Education in higher socioeconomic families is typically
stressed as more important, both within the household, as well
as the local community. In poorer areas, where food, shelter
and safety are priority, education often takes a backseat –

226 | Socioeconomic Status (SES)

becomes less of a priority. American youth are particularly at
risk for many health and social problems in the United States.
Overall, lower socioeconomic status has been linked to chronic
stress, heart disease, ulcers, type 2 diabetes, rheumatoid
arthritis, certain types of cancer, and premature aging.
Social class in the United States is a controversial issue,
having many competing definitions, models, and even
disagreements over its very existence. Many Americans believe
that in the country there are just three classes: the American
rich; the American middle class; the American poor. Most
definitions of the social classes in the United States entirely
ignore the existence of parallel Black, Hispanic and minorities
communities. SES differences in health have long been
associated by many Americans as related to poor impulse
control, unhealthy habits, and an overall lack of motivation
(Braveman, et al, 2010). One difficulty with this
oversimplification is that these attitudes reduce poverty (and
related problems associated with lower SES) as a problem with
the individual rather than a reflection of complex societal
components that contribute to poor health and lower life
expectancy. The assumption that individual choices and
internal control are enough to overcome the impact of poverty
further adds to the difficulty impoverished people have in
overcoming economic hardships. Educational, economic, and
health care inequity within lower SES groups have each been
shown to correlate with poor health must be addressed in
order to create meaningful change in the health of Americans
(Braveman, et al, 2010). Given the ranking of the United States
across global indicators, we might do well to address poor
health of Americans as a social problem and not a personal
problem.

Socioeconomic Status (SES) | 227

Race and Ethnicity
The United States is a racially diverse country. Race and
ethnicity in the United States is a complex topic both because
the United States has a racially and ethnically diverse
population and because of a history of racism involving slavery
and segregation that persists to present day. At the federal
level, race and ethnicity have been categorized separately.
Race refers to a classification of humans into groups based
on physical traits, ancestry, genetics or social relations, while
ethnicity refers to a category of people who identify with each
other based on similarities such as common ancestry,
language, history, society, culture or nation. Race and health
refers to how being identified with a specific race influences
health.
Race and ethnicity often remain undifferentiated in health
research. Differences in health status, health outcomes, life
expectancy, and many other indicators of health in different
racial and ethnic groups are well documented. Some
individuals in certain racial groups receive less care, have less
access to resources, and live shorter lives in general.
Epidemiological data indicates that racial groups are unequally
affected by diseases, in terms or morbidity and mortality. These
health differences between racial groups create racial health
disparities.
Health disparities are defined as preventable differences in
the burden of disease, injury, violence, or opportunities to
achieve optimal health that are experienced by socially
disadvantaged populations. Health disparities are intrinsically
related to the historical and current unequal distribution of
social, political, economic and environmental resources
(“Health Equity”, 2019). The relation between race and health
has been studied from a multidisciplinary perspective, paying

228 | Race and Ethnicity

attention to how racism influences health disparities and how
environmental factors and physiological factors respond to
each other and to genetics.
Current evidence supports the notion that these racially
centered disparities continue to exist and are a significant
social health issue. A current report from the Centers for
Disease Control (CDC, 2019) found that 700 women died from
preventable complications of pregnancy in the United States, a
rate higher than any other developed country, but the rate of
death was higher for Black and Native American women. The
death rate for Black mothers was over 3 times higher than for
white mothers and the rate for Native American mothers was
over 2 times higher than for white mothers. A majority of these
deaths are largely preventable and some relate to implicit racial
bias that is unrelated to social status, income or education.
Minority populations have increased exposure to
environmental hazards that include lack of neighborhood
resources, structural and community factors as well as
residential segregation that result in a cycle of disease and
stress (Gee, 2004). Racial segregation is another environmental
factor that occurs through the discriminatory action of those
organizations and working individuals within the real estate
industry, whether in the housing markets or rentals. Even
though residential segregation is noted in all minority groups,
blacks tend to be segregated regardless of income level when
compared to Latinos and Asians. Thus, segregation results in
minorities clustering in poor neighborhoods that have limited
employment, medical care, and educational resources, which
is associated with high rates of criminal behavior (Williams,
2005). In addition, segregation affects the health of individual
residents because the environment is not conducive to
physical exercise due to unsafe neighborhoods that lack
recreational facilities and have nonexistent recreational space.
Racial and ethnic discrimination adds an additional element
to the environment that individuals have to interact with daily.

Race and Ethnicity | 229

Individuals that report discrimination have been shown to have
an increased risk of hypertension in addition to other
physiological stress-related affects (Mujahid, 2011). The high
magnitude of environmental, structural, socioeconomic
stressors leads to further compromise on the psychological and
physical being, which leads to poor health and disease (Gee,
2004).

230 | Race and Ethnicity

Global Health
Cross-Cultural
Comparisons
Many of the factors explored in American health also relate to
global health such as:

• Access to health education and care

• Socioeconomic and racial disparities
• Food or housing scarcity

Health disparities are also due in part to cultural factors that

involve practices based not only on sex, but also gender status.
For example, in China, health disparities have distinguished
medical treatment for men and women due to the cultural
phenomenon of preference for male children. Additionally, a
girl’s chances of survival are impacted by the presence of a
male sibling. Girls do have the same chance of survival as boys
if they are the oldest girl – they have a higher probability of
being aborted or dying young if they have an older sister.
In India, SES and gender-based health inequities are
apparent in early childhood. Many families provide better
nutrition for boys in the interest of maximizing future
productivity given that boys are generally seen as
breadwinners. In addition, boys receive better care than girls
and are hospitalized at a greater rate. The magnitude of these
disparities increases with the severity of poverty in a given
population.
Additionally, the cultural practice of female genital
mutilation (FGM) is known to impact women’s health, though
is difficult to know the worldwide extent of this practice.

Global Health Cross-Cultural

Comparisons | 231
Female genital mutilation (FGM), also known as female genital
cutting and female circumcision, is the ritual cutting or
removal of some or all of the external female genitalia. While
generally thought of as a Sub-Saharan African practice, it may
have roots in the Middle East as well. The estimated 3 million
girls who are subjected to FGM each year potentially suffer
both immediate and lifelong negative effects. Long-term
consequences include urinary tract infections, bacterial
vaginosis, pain during intercourse, and difficulties in childbirth
that include prolonged labor, vaginal tears, and excessive
bleeding (“Female Genital Mutilation”, 2019).
Globally, the poorest countries in the world remain the least
healthy (CDC, 2018). In 2015, the World Health Organization
(WHO) identified the need for multiple countries to unify in
targeting health disparity and basic rights/needs. The
Sustainable Development Goals (SDGs) are a collection of 17
global goals set by the United Nations (UN) General Assembly
in 2015 for the year 2030. According to the United Nations, the
long-term target is to reach the communities farthest behind
and most in need.
There are 169 targets for the 17 goals. Each target has
between 1 and 3 indicators used to measure progress toward
reaching the targets. There are many obstacles to realizing this
global call to end human suffering, improve the environment,
and ensure access to basic needs. Critics of SDG’s highlight the
high cost of achieving even the initial target goals and suggest
the plan is overly complex. Currently, world leaders continue to
work with the United Nations in pursuit of global peace and
prosperity to improve human health and well-being.

232 | Global Health Cross-Cultural Comparisons

Summary
There is considerable cultural variation in what it means to be
healthy. The World Health Organization (WHO) has developed
a widely adopted definition of health to include a
biopsychosocial approach to well-being. For many, the
identification of health versus illness often depends on
subjective labeling of how a person feels in the moment, but
in reality, overall health is determined by a complex set of
variables. There is a great deal of intracultural variability in the
United States when it comes to health and well-being. In
particular, disparity exists in groups based on socioeconomic
status and race/ethnicity when it comes to access to health
resources and care. Additionally, enculturated experiences,
perceptions, and values further influence American health in
regard to diet and sleep hygiene. The future of health in the
United States and globally will be shaped by the ability of
future generations to tackle the complex challenges faced
within each culture.

Summary | 233
Infant Mortality
Infant mortality is the death of young children under the age
of 1 and infant mortality rate (IMR) is the number of deaths
of children under one year of age per 1000 live births. Infant
mortality rate is used to standardize infant deaths for global
comparisons (WHO, 2019). Premature birth is the largest
contributor to the IMR. Other leading causes of infant mortality
are birth asphyxia, pneumonia, congenital malformations,
diseases and malnutrition. Many factors contribute to infant
mortality, such as the mother’s level of education,
environmental conditions, and political and medical
infrastructure. Improving sanitation, access to clean drinking
water, immunization against infectious diseases, and other
public health measures can help reduce high rates of infant
mortality.
The reported IMR provides one statistic which reflects the
standard of living in each nation. However, the method of
calculating IMR often varies widely between countries, based
on how they define a live birth and how many premature
infants are born in the country. For these reasons, reporting
infant mortality rate can be inconsistent and may be
understated. Of the 27 most developed countries, the United
States has the highest IMR, despite spending much more on
health care per capita. In particular, IMR varies greatly by race
and socio-economic status (“Infant Mortality”, 2019). These
numbers are disconcerting given the resources available and
technological advances available for health care in the United
States. The relatively high IMR raises questions about culture
and the impact this racial and socio-economic disparity has on
infant health.

234 | Infant Mortality

Subjective Well-Being
Subjective well-being (SWB) is the scientific term for
happiness and life satisfaction —thinking and feeling that your
life is going well, rather than badly. Levels of subjective well-
being are influenced by both internal factors, such as
personality and outlook, and external factors, such as the
society in which they live. Some of the major determinants of
SWB are a person’s inborn temperament, the quality of their
social relationships, the societies they live in, and their ability
to meet their basic needs. Although there are additional forms
of SWB, the three in the table below have been studied
extensively. The table also shows that the causes of the
different types of happiness can be somewhat different.
There are different causes of happiness, and that these
causes are not identical for the various types of SWB and high
SWB is achieved by combining several different important
elements (Diener & Biswas-Diener, 2008). People who promise
to know the key to happiness are oversimplifying.
Some people experience all three elements of happiness and
are very satisfied, enjoy life, and have only a few worries or other
unpleasant emotions. Other unfortunate people are missing
all three. For example, imagine an elderly person who is
completely satisfied with her life—she has done most
everything she ever wanted—but is not currently enjoying life
that much because of the infirmities of age. There are others
who show a different pattern who are having fun, but who are
dissatisfied and believe they are wasting their lives.
Importantly, researchers have also studied the outcomes of
SWB and have found that people you report being happier are
more likely to be healthier and live longer, to have better social
relationships, and to be more productive at work (Diener & Tay,
2012; Lyubomirsky, King, & Diener, 2005). In other words, people

Subjective Well-Being | 235

high in SWB seem to be healthier and function more effectively
compared to people who are chronically stressed, depressed,
or angry. Happiness does not just feel good in the moment, but
it is good for people over time and for those around them.

Money and Happiness

A certain level of income is needed to meet our needs, and

very poor people are frequently dissatisfied with life (Diener
& Seligman, 2004); however, having more and more money
has diminishing returns. This means that higher and higher
incomes make less and less difference to happiness. Wealthy
nations tend to have higher average life satisfaction than poor
nations, but the United States has not experienced a rise in
life satisfaction over the past decades, even as income has
doubled. The goal is to find a level of income that you can live
with and earn.
You should not let your aspirations continue to rise so that
you always feel poor, no matter how much money you have.
Research shows that materialistic people often tend to be less
happy, and putting your emphasis on relationships and other
areas of life besides just money is a wise strategy. Money can
help life satisfaction, but when too many other valuable things
are sacrificed to earn a lot of money—such as relationships or
taking a less enjoyable job—the pursuit of money can harm
happiness.

Self – Examination

Although it is beneficial generally to be happy and satisfied,

this does not mean that people should be in a constant state
of euphoria. In fact, it is appropriate and helpful sometimes to
be sad or to worry. At times a bit of worry mixed with positive

236 | Subjective Well-Being

feelings makes people more creative. Most successful people in
the workplace seem to be those who are mostly positive but
sometimes a bit negative. You do not need to be happiness
superstar in order to be a superstar in life. What is not helpful
is to be chronically unhappy. If you feel mostly positive and
satisfied, and yet occasionally worry and feel stressed, this is
probably fine as long as you feel comfortable with this level
of happiness. If you are a person who is chronically unhappy
much of the time, changes are needed, which may include
some professional support.

Subjective Well-Being | 237

Vocabulary
Biopsychosocial model views human health as the result of
reciprocal influences of bodily, psychological, interpersonal,
and cultural influences over time and situations.
Diet is the sum of food consumed by an organism or group.
Disparity results when there is a difference, imbalance, or
inconsistency where one should not otherwise exist.
Drive States are affective experiences that motivate us to
fulfill goals that benefit our survival.
Food scarcity is the result of having limited access to
adequate food and nutrition due to cost, proximity and/or
other resources.
Disease is a broad reference to any condition that impairs
normal functioning of the body.
Illness refers to the individual’s own experience with his/her
disease.
Infant mortality is the death of young children under the age
of 1.
Life expectancy (LE) is a statistical measure of the average
time an organism is expected to live, based on the year of its
birth, its current age and other demographic factors including
gender.
Subjective well-being (SWB) is a self-reported measure of
overall health and wellness. It encompasses general and
subjective areas of one’s own life.
Sleep hygiene is a variety of different practices and habits
that are necessary to have good nighttime sleep quality and
full daytime alertness.
Social determinants are complex social structures and
economic systems that can drive most health inequalities such
as access to health care or education.
Socioeconomic status (SES) is an economic and social

238 | Vocabulary