How does health affect happiness?

 An Economist’s Lessons on Happiness

The Easterlin paradox is a finding in happiness economics formulated in 1974 by Richard Easterlin, then professor of economics at the University of Pennsylvania, and the first economist to study happiness data. The paradox states that at a point in time happiness varies directly with income both among and within nations, but over time happiness does not trend upward as income continues to grow. It is the contradiction between the point-of-time and time series findings that is the root of the paradox.

Does money make you happy? This is one of the questions addressed in the book. 

Richard Easterlin says :

In considering the effect on happiness of increasing income, we saw that because of interpersonal comparison, the reference level for income (the incomes of others) tends to increase along with one’s actual income, and happiness remains unchanged. By contrast, when intrapersonal comparison chiefly determines the reference level, as it does for health, the happiness outcome is different. The reference level for health is rooted in past experience and usually changes much less than the reference level for income

And on the Happiness Revolution, 

 Here it is: The Happiness Revolution. Whereas the two prior revolutions, the Industrial Revolution and the Demographic Revolution, led to a transformation in people’s objective circumstances, as indexed by the multiplication of real GDP per capita and life expectancy, the principal concern of the Happiness Revolution is different and calls for a different kind of measure. Which is? “What people have to say about themselves,” Andy offers. “Specifically, people’s feelings about their lives as a whole.” Yes! This revolution centers on people’s feelings—how happy they are and how satisfied with their lives. It becomes a revolution, the Happiness Revolution, when the findings show a marked improvement in people’s feelings of well-being, i.e., their subjective well-being. And this is what’s happening now!

A controversial view. You may agree or not, anyway, a recommended reading. 

 

Què ens fa feliços?

World Happiness Report 2023

L'informe mundial de la felicitat ens explica en sis variables quin són els països on els seus habitants són més feliços. Aquestes variables són: PIB per càpita, suport social, esperança de vida en bona salut, llibertat per escollir a la vida, generositat, i inexistència de corrupció. I el resultat és aquest:

Malauradament, no hi sortim en aquest informe. Però fa temps vaig explicar com ho calcula l'OCDE i allà si que hi sortim.

Per una nova societat d'obligacions recíproques

Can We Be Happier? Evidence and Ethics

La pregunta de si podem ser més feliços, motiu del comentari del llibre d'avui, hauria de ser posterior a la de saber si som feliços ara. I com sempre anem a petar al problema de la mesura. L'economista Richard Layard porta molts anys explicant que podem mesurar la felicitat, i que hi ha dos components, la satisfacció amb la vida que té cadascun de nosaltres (felicitat experimentada) i la felicitat creada, fruit de la interacció social amb els altres. I diu:

We need to replace the harsh culture in which we judge our lives by our success compared with others. That is a zero-sum game – the total of relative success can never be changed, however hard each person tries to improve their own position. Instead, we need a goal for each of us which can lead to progress for all. That goal has to be the positive-sum activity of contributing to a happier society.

If we want a happier society, we have to aim at it explicitly. We will never achieve a happier society as a by-product. And it is a single overarching concept that we need if we are to displace the false idol of GDP. A dashboard of wellbeing indicators is certainly better than nothing, but it has been tried for half a century by the ‘social indicators’ movement with relatively little success.

Més endavant recupera els 10 factors que contribueixen a la felicitat:

Curiosament, tant que parlem de desigualtat, la referida a la renda diu que només explica menys del 2% de les diferències en la felicitat. És el que diu, jo no ho puc contrastar. En canvi el més important a tenir en compte són les privacions, allò al que no es pot accedir. I es carrega plenament la jerarquia de necessitats de Maslow.

Entre països, allò que explica la variació en el nivell de felicitat són bàsicament sis factors que expliquen el 76%:

• trust (the proportion of people who think ‘most people can be trusted’)
• generosity (the proportion who have donated money to a charity in the present month)
• social support (the proportion who have relatives or friends they can count on to help them whenever they need them)
• freedom (the proportion who are satisfied with their freedom to choose what they want to do with their life)
• health (years of healthy life expectancy)
• income (GDP per head)

És el que diu. A la majoria de països la felicitat va augmentar entre 1980 i 2007, després hi ha hagut recorreguts diversos i el creixement econòmic no és garantia de més felicitat.

I el llibre parla dels mestres, dels metges, dels polítics, funcionaris, científics, economistes i tots aquells que poden contribuir a la felicitat i els ofereix una agenda per a l'acció.

There is no objective reason why so many lives in the West should be so stressful. We ourselves have created the stress by our goals, and the way our institutions respond to them. If we change our goals, we really can produce a happier society.

Future generations will be shocked by many of the unthinking and unskilful features of life today. They will be shocked at the neglect of mental illness, at the stresses imposed on our children, and at the common assumption that everyone is an egotist.

So the world happiness movement can indeed bring in a better, gentler culture and do it fast. But what happens will ultimately depend on each one of us. We can all be heroes in the happiness revolution

Llibre recomanable, amb alguns biaixos que es poden descomptar des de l'inici (com una èmfasi excessiva en la salut mental i el mindfulness). En Martin Wolf deia que no li agrada massa això de que la felicitat estigui al capdamunt de l'agenda política. Jo crec que el que cal és afavorir les condicions per a un alt nivell de satisfacció amb la vida, i no sé si la paraula felicitat ajuda o distreu, potser més el segon. Estic convençut que una societat amb menor stress és possible. Totes aquelles decisions i accions individuals i col·lectives que hi contribueixin seran benvingudes en una nova societat d'obligacions recíproques.

PS. Malauradament no hi surt Catalunya als rankings de felicitat que publica Layard. Miraré de trobar material si és que n'hi ha.

PS. Sobre les diferències de renda i la felicitat: "There have been thousands of surveys in hundreds of countries and they typically find that, holding all else constant, a person with double your income will be 0.2 points happier than you are. Similarly, a person whose income is one half of yours will be 0.2 points less happy"

PS. El concepte de societat d'obligacions recíproques és de Collier.

An active life ruled by reason

The humble economist

The works by Tony Culyer are so familiar for every health economist that we couldn't live without them. Those that have arrived a little bit late, now have the opportunity to read all his contributions in one book. My impression is that any university professor could create a syllabus following only this reader: Social Scientists and Social Science, Extra-Welfarism, Ethics, Need and Equity,Health Policy,Health Technology Assessment.
The introduction highlights his academic life, 250 articles, more than two dozens of books and a strong public impact of his works.
I still remember the first time I was reading about the extra-welfarist approach. In those days, the individual utility paradigm was the basis for any article you could read. I was feeling uncomfortable on the assumptions, Culyer gave the opportunity to open the windows for fresh air. Unfortunately his message has not always been understood and applied. Let me reproduce some paragraphs from the introduction:

Culyer’s concept of “extra-welfarism” helps to liberate health economists from the confines of the traditional “Paretian” or “welfarist” approach to evaluating alternative policies and institutions that dominated economic thinking in the nineteenth and twentieth centuries. Traditional “welfarist” economic analysis assumes that subjective individual preferences or “utilities” (understood either as the desires that motivate individual decisions or the feelings of happiness that may or may not follow those decisions) are the be all and end all of the social good when it comes to doing “economic” analysis properly. Culyer’s “extrawelfarist” approach allows economists to use additional sources of information about individual wellbeing or lourishing – i.e. additional to subjective desires and feelings – for evaluating alternative policies and institutions. In keeping with his professional humility, of course, he does not endorse any specific view of what constitutes a flourishing life: “Flourishing may mean different things to different people; all I require is that it be a high goal whose accomplishment gives a deep satisfaction to the one living it, and perhaps others too, as when it is said of someone who has died ‘that was a life well-lived’.

The concept of “extra-welfarism” builds upon the work of Amartya Sen, who first coined the term “welfarism” and wrote of the need to use “non-welfare” or “non-utility” information when assessing individual wellbeing. Culyer developed and refined this idea in the specific context of health care, showing in particular how non-welfare information about people’s health – and not merely people’s health-related preferences or desires – could be fruitfully used in the health care field. The three essays in turn set out the basic idea; develop and refine the distinction between “welfarist” and “extra-welfarist” approaches to health economics, in a multiauthor essay originally lead authored by the eminent Dutch health economist, Werner Brouwer; and then explore a range of different practical applications of both “welfarist” and “extra-welfarist” approaches in the health sector, showing how both can be fruitful in different contexts.

In this post I made some reviews of his recent work and here you'll find an interesting article that it is pending to be read and commented in this blog. 
Right now I only would like to share with all of you the opportunity to read the whole book again, some articles are not easy to find. Definitely, it is a reference book for any person interested in Health, Health Care and Social Decision Making, as it says the subtitle.
Congratulations!

PS. Check the extra-welfarist approach in p.59 of this excellent book of Vicente Ortún.

Risk-adjusted cost-effectiveness

 Health Technology Assessment With Diminishing Returns to Health: The Generalized Risk-Adjusted Cost-Effectiveness (GRACE) Approach

Cost-effectiveness analysis (CEA) embeds an assumption at odds with most economic analysis–that of constant returns to health in the creation of happiness (utility). We aim to reconcile it with the bulk of economic theory.

Therefore, 

 As health payers increasingly turn to CEA for value assessment, it becomes even more important to assure that it reflect the preferences of real people. Current models run an important risk by not considering the consequences of diminishing returns and risk aversion over health. Continuing to assume that the  incremental value of health is invariant to severity of illness endangers the foundations of CEA. The combination of the diminishing returns and severity of illness adjustments suggests that we are probably overvaluing treatments of low-severity illnesses (possibly by a factor of 2 or more) and undervaluing  treatments of very high-severity conditions (possibly by a factor of 5 or more).

This is solved by the GRACE framework that shows how to generalize traditional CEA models to incorporate the effects of diminishing returns to health improvements as severity of illness increases. This creates cost-effectiveness thresholds (stated as multipliers of consumption) that incorporate risk preferences both in consumption and in QoL and that increase with severity of illness.

 

Reordering our society is possible

 What We Owe Each Other.A New Social Contract for a Better Society

A thought -provoking book. Chapter 5 is devoted to Health:

Being healthy is the most important determinant of our wellbeing. Physical and mental health (subjective well-being as it is called in the academic research) rank at the top of every major study of happiness across the world. Ultimately, this is why every society aspires to provide health care for its population. And because the costs of providing health care are reduced when a large population pools its resources, and because a healthy labour force is also good for the economy, the social contract in every society includes health care in some form or another.

The great issues:

• Defining a Minimum for Universal Health Care
•  How Should Health Care Be Provided?
• Health Spending Is Only Going Up
• A More Digital Future for Health
• Individual and Social Responsibilities – Where Is the Balance?

The message:

We owe each other more. A more generous and inclusive social contract would recognise our interdependencies, provide minimum protections to all, share some risks collectively and ask everyone to contribute as much as they can for as long as they can. This is not about increasing the welfare state, but about investing in people and building a new system of risk sharing to increase overall well-being. Change will come inevitably because the forces of technology, demography and environmental pressures will drive it. The question is whether we prepare for that change or continue to allow our societies to be buffeted by these powerful forces, as we have in recent decades. This book lays out the challenges we face and provides a menu of alternatives for a better social contract around families, education, health, work, old age and between the generations. It is not a blueprint, but it provides a direction of travel that is economically feasible. Nor is it a fixed menu – countries may choose to  implement some elements and not others depending on their values and preferences.

Podem reimaginar-nos un nou capitalisme? (6)

The crisis of democratic capitalism 

En aquest blog he escrit anteriorment sobre reimaginar el capitalisme i realment fa molts anys que se'n parla però qui dia passa any empeny. Ara en Martin Wolf, cap d'opinió de FT acaba de publicar un llibre il·lustrador. Ho és perquè explica amb tot detall com hem arribat fins aquí, i què caldria fer per avançar en les institucions democràtiques i econòmiques, i evitar així més d'un ensurt.

Aquest llibre argumenta que quan la gent no veu cap esperança i perd la confiança en les institucions democràtiques, tant la democràcia com els mercats poden fallar i fallaran. En resum, cal una reforma radical i valenta de l'economia capitalista i hem d'enfortir els vincles econòmics de la ciutadania alhora que s'aprofundeix la cooperació internacional.

El llibre es llegeix magníficament, està molt ben escrit. Destaco alguns paràgrafs clau:

A market economy that operates under trustworthy rules, rather than the whims of the powerful, underpins prosperity and lowers the stakes of politics. In turn, a competitive democracy induces politicians to offer policies that will improve the performance of the economy and so the welfare of the people. Beyond these practical reasons for the marriage of liberal democracy and market economy, there is also a moral one: both are founded on a belief in the value of human agency—people have a right to do the best they can for themselves; people have a similar right to exercise a voice in public decisions. At bottom, both are complementary aspects of human freedom and dignity.

Els objectius de reforma del capitalisme democràtic haurien de ser:

• Un nivell de vida creixent, àmpliament compartit i sostenible
• Bona feina per a aquells que poden treballar i estan preparats per fer-ho
• Igualtat d'oportunitats
• Seguretat per a qui ho necessiti
• Acabar amb privilegis especials per a uns pocs

Removing harms, not universal happiness, is the objective. The approach to reform is that of “piecemeal social engineering,” as recommended by Karl Popper, not the revolutionary overreach that has so often brought calamity.

Behind these specific proposals is a wider perspective. A universal suffrage democracy will insist on a citizenship that is both economic and political. This means that business cannot be free to do whatever it wishes. It means that taxes must be paid, including by the economically powerful. It means that the state must be competent and active, yet also law-governed and accountable. All of this was the clear lesson of the twentieth century.

I sobre el concepte de ciutadania, el que no és i el que és:

Here are things this does not mean.

It does not mean that democratic states should have no concern for the welfare of noncitizens. Nor does it mean that it sees the success of its own citizens as a mirror image of the failures of others. On the contrary, it must seek mutually beneficial relations with other states.

It does not mean that states should cut themselves off from free and fruitful exchange with outsiders. Trade, movement of ideas, movement of people, and movement of capital, properly regulated, can be highly beneficial.

It does not mean that states should avoid cooperating closely with one another to achieve shared goals. This applies above all to actions designed to protect the global environment.

Yet there are things it clearly does mean.

It means that the first concern of democratic states is the welfare of their citizens. If this is to be real, certain things must follow.

Every citizen should have the reasonable possibility of acquiring an education that would allow them to participate as fully as possible in the life of a high-skilled modern economy.

Every citizen should also have the security needed to thrive, even if burdened by the ill luck of illness, disability, and other misfortunes.

Every citizen should have the protections needed to be free from abuse, physical and mental.

Every citizen should be able to cooperate with other workers in order to protect their collective rights.

Every citizen, and especially successful ones, should expect to pay taxes sufficient to sustain such a society.

Those who manage corporations should understand that they have obligations to the societies that make their existence possible.

Citizens are entitled to decide who is allowed to come and work in their countries and who is entitled to share the obligations and rights of citizenship with them.

Politics must be susceptible to the influence of all citizens, not just the wealthiest.

Policy should seek to create and sustain a vigorous middle class, while ensuring a safety net for everybody.

All citizens, whatever their race, ethnicity, religion, or gender are entitled to equality of treatment by the state and the law.

The West cannot go back to the 1960s. It cannot go back to a world of mass industrialization, where most educated women did not work, where there were clear ethnic and racial hierarchies, and where the Western countries still dominated the globe.

Missatge contundent pels qui el vulguin sentir, no podem tornar als 60s, i de vegades penso que hi anem de camí.

I per aquells que no els agrada el capitalisme i el voldrien fer desaparèixer, unes paraules de recordança: 

There are, it is true, alternative ways to seek power under democratic capitalism. All will fail. One extreme is to offer a fully socialized economy. But the economy will founder, and the rulers will be forced out of power or seize it undemocratically, as happened most recently in Venezuela. An opposite extreme is to marry laissez-faire economics to a populism founded on anti-intellectualism, racism, and cultural conservatism. Such pluto-populism is also likely to end in an autocracy in which even plutocrats are insecure. A still faster route to autocracy is via a blending of the two extremes in nationalist socialism (or national socialism). This combines a welfare state with arbitrary rule by demagogues. This, too, will ultimately ruin both the economy and democracy, as the unaccountable gangster in charge rewards cronies and punishes opponents.

 Human beings must act collectively as well as individually. Acting together, within a democracy, means acting and thinking as citizens.

If we do not do so, democracy will fail, and our freedoms will evaporate.

It is our generation’s duty to ensure it does not. It took too long to see the danger. Now it is a moment of great fear and faint hope. We must recognize the danger and fight now if we are to turn the hope into reality. If we fail, the light of political and personal freedom might once again disappear from the world.

L'alerta és clara per qui la vulgui sentir, és el deure de la nostra generació, ens hi juguem la llibertat. Ho diu ben clar. Actuar depèn de cadascú de nosaltres i de tots nosaltres col·lectivament. 

Per tant, si que és possible reimaginar el capitalisme i en Martin Wolf dona algunes pistes. Molt recomanable la lectura i relectura pausada. Malauradament em temo que a molts dirigents els passarà per alt i ni se'n adonaran que s'ha publicat.

 

Economic science needs humanities

 Bettering Humanomics. A New, and Old, Approach to Economic Science

The discoveries I have made by responding critically, yet as amiably as I could manage, are two:

1. There seems to be emerging a new and I think more serious and sensible way of doing economic science—quantitatively serious, philosophically serious, historically serious, and ethically serious, too, as I argue in this volume. The economist Bart Wilson and a few others nowadays call it the “humanomics,” as in the title here.4

2. But, I argue in the other volume, neoinstitutionalism, from Douglass North and Daron Acemoglu and many other economists and political scientists, is not the way forward. Scientifically speaking, its factual claims, like those of the other recent neobehaviorist fashions, such as neuroeconomics and behavioral finance and happiness studies, are dubious—or, at best, questionably founded and argued. The neoinstitutionalists, like the others, do not listen, really listen, to the evidence of humans, or to their friends’ scientific questions and objections. Substantively, they treat creative adults like a flock of little children, terrible twos, to whom we need not listen. We need, they say, merely to “observe their behavior,” omitting for some reason linguistic behavior. And then we record the behavior in questionable metrics. The children-citizens will be pushed around with “incentives,” beloved of Samuelsonian economists and econowannabes. From a great height of fatherly expertise in discerning and designing Max U institutions, the neoinstitutionalist looks down with contempt on the merely human actions and interactions of free adults.

A key book by controversial Deirdre McCloskey, this is the outline:

Part I. The Proposal

Chapter 1. Humanomics and Liberty Promise Better Economic Science

Chapter 2. Adam Smith Practiced Humanomics, and So Should We

Chapter 3. Economic History Illustrates the Problems with Nonhumanomics

Chapter 4. An Economic Science Needs the Humanities

Chapter 5. It’s Merely a Matter of Common Sense and Intellectual Free Trade

Chapter 6. After All, Sweet Talk Rules a Free Economy

Chapter 7. Therefore We Should Walk on Both Feet, Like Ludwig Lachmann

Chapter 8. That Is, Economics Needs Theories of Human Minds beyond Behaviorism

Part II. The Killer App

Chapter 9. The Killer App of Humanomics Is the Evidence That the Great Enrichment Came from Ethics and Rhetoric

Chapter 10. The Dignity of Liberalism Did It

Chapter 11. Ideas, Not Incentives, Underlie It

Chapter 12. Even as to Time and Location

Chapter 13. The Word’s the Thing

Part III. The Doubts

Chapter 14. Doubts by Analytic Philosophers about the Killer App Are Not Persuasive

Chapter 15. Nor by Sociologists or Political Philosophers

Chapter 16. Nor Even by Economic Historians

Wellbeing as a top priority

Wellbeing. Alternative Policy Perspectives

Open access book by Tim Besley et al.

Why not focus directly on increasing measured human happiness? Why not try to improve people’s overall quality of life, as it is subjectively seen by citizens themselves?

Contents:

 Introduction: Making Wellbeing Policies Effective

Timothy Besley & Irene Bucelli

Wellbeing as the Goal of Policy

Richard Layard

Accounting for Consequences and Claims in Policy

Paul Dolan

Weighing the Costs and Benefits of Public Policy: On the Dangers of Single Metric Accounting

Johanna Thoma

Wellbeing in Public Policy: Contributions Based on Sen’s Capability Approach

Paul Anand

Incorporating Wellbeing and Mental Health Research to Improve Pandemic Response

Michael Daly & Liam Delaney

COVID-19 and Mental Health and Wellbeing Research: Informing Targeted, Integrated, and Long-Term Responses to Health Emergencies

Annette Bauer

Health, Wellbeing, and Democratic Citizenship: A Review and Research Agenda

Christopher J. Anderson et al.

Health and Disability Gaps in Political Engagement: A Short Review

Mikko Mattila

The useless prediction of the end of liberalism

Francis Fukuyama predicted 25 years ago the end of history, the triumph of liberal democracy and the arrival of post-ideological world, Now Y. N. Harari predicts the end of liberalism and the arrival of a post-humanism (?). All these efforts are useless in my opinion and the reason is obvious, those that predict the future don't have more information than any other human being. They could devote their time to fruitful initiatives.
If I knew that the second half of Homo Deus was devoted to the end of liberalism and the birth of a post-humanism, I wouldn't have read it. I always try to avoid snake-oil sellers. Reading is an asymmetric information game, the writer knows more than the reader. I would suggest to start a global snake-oil writers lists to reduce asymmetric information.
The New Yorker publishes a sound review of the book,

Harari’s larger contention is that our homocentric creed, devoted to human liberty and happiness, will be destroyed by the approaching post-humanist horizon. Free will and individualism are, he says, illusions. We must reconceive ourselves as mere meat machines running algorithms, soon to be overtaken by metal machines running better ones. By then, we will no longer be able to sustain our comforting creed of “autonomy,” the belief, which he finds in Rousseau, that “I will find deep within myself a clear and single inner voice, which is my authentic self,” and that “my authentic self is completely free.” In reality, Harari maintains, we have merely a self-deluding, “narrating self,” one that recites obviously tendentious stories, shaped by our evolutionary history to help us cope with life. We are—this is his most emphatic point—already machines of a kind, robots unaware of our own programming. Humanism will be replaced by Dataism; and if the humanist revolution made us masters the Dataist revolution will make us pets.

Does this makes any sense? Is it possible to remain as the current best seller with such a message?

Norah Jones. It's a tragedy

TMT syndrome (2)

Some months ago I wrote a post on TMT syndrome. It raised the interest of some followers and I was asked to prepare a larger op-ed for a bulletin (in spanish):

El síndrome TMT ante la destrucción creativa

Hoy en día podemos conocer con precisión las preferencias de lectura en una revista electrónica; podemos identificar cuántos acceden a ella y así nos podemos aproximar a las preocupaciones de los lectores. Health Affairs es una revista de referencia en política y gestión sanitaria y, en el ranking de artículos leídos en 2013, la primera posición la ocupa una revisión sobre una asignatura pendiente: la adopción de las tecnologías de la información en el sector salud [1]. El artículo se pregunta si las tecnologías de la información en Estados Unidos están interconectadas, ampliamente implantadas, utilizadas adecuadamente y si se ha producido el cambio organizativo esperado. La respuesta a cada cuestión es simplemente negativa. Y como todo artículo que desea resumir algo complejo en cinco páginas y recurre a generalizaciones, la conclusión a la que llega es parcial. Porque hay una gran mayoría de tareas pendientes por hacer y también hay otras que ya se han hecho y fueron publicadas en el propio Health Affairs cuatro años antes, como es el caso, por ejemplo, de Kaiser Permanente [2]. La barrera fundamental a la adopción de la tecnología tiene que ver con la organización y los incentivos. Entornos de atención fragmentada y con pago por acto médico tienen todos los ingredientes necesarios para que la adopción de tecnologías de la información se deje para otro día.

La tecnología está disponible, la organización está llamada a prepararse para adoptarla, pero en muchos casos, los incentivos escasean. De lo mucho que hay escrito al respecto, me sigue interesando el libro que coordinó Louise Liang desde Kaiser Permanente [3]. En él, los protagonistas de la experiencia de implantación de la historia clínica electrónica describen su visión y las perspectivas de futuro. Los últimos capítulos interesan en especial. Cuando el uso de aplicaciones móviles parece que sea el próximo milagro para la salud [4], David Eddy y Louise Liang se olvidan de ello y se concentran en explicar la importancia de las trayectorias en enfermos crónicos y los modelos probabilísticos que hay detrás del “Archimedes Model”. Todo dirigido a un solo objetivo: mejorar la toma de decisiones compartidas entre médico y paciente. De este modo, llegan al núcleo esencial del valor potencial de las tecnologías de la información: mejorar las decisiones y mejorar el proceso de atención.

Estoy convencido que estamos en el sector salud ante el síndrome TMT (too much technology, demasiada tecnología). Las organizaciones son incapaces de digerir la transformación potencial que tiene implicaciones cruciales en el coste y en la calidad. Los requisitos para que esta transformación sea efectiva se han descrito en múltiples ocasiones y ahora, en un contexto económico de límites a la inversión, puede que haya una barrera adicional a la organizativa.

En nuestro entorno próximo, hay casos ejemplares de adopción de historia clínica electrónica. Hay organizaciones que desde hace más de una década disponen de información digitalizada completa de la población que atienden [5], del mismo modo que hay entornos donde escasean ejemplos similares, como sucede en la sanidad privada.

La cuestión emergente es dilucidar hasta qué punto la digitalización generalizada en el sector salud será capaz de modificar ampliamente la “función de producción” de la salud tal como la conocemos hasta ahora. Con ello quiero referirme fundamentalmente a la asistencia sanitaria y a los comportamientos saludables.

Eric Topol ha sido capaz de resumir en un libro lo que está sucediendo y lo que puede suceder [6]. Más allá de confirmar las tendencias conocidas y sus implicaciones, al final, cuando llega al capítulo sobre la necesaria “plasticidad de los médicos”, nos muestra el panorama al que las organizaciones, los profesionales y el regulador han de enfrentarse próximamente.

En el capítulo relativo al “homo digitus”, nos aporta su conclusión: “La especie humana está digitalizando la propia especie, este es el agente último de cambio de la vida. Y esto va más allá de un simple cambio, es la esencia de la destrucción creativa que conceptualizó Schumpeter”. ¿Seguiremos en medio del síndrome TMT o finalmente entraremos en un proceso de destrucción creativa? Si alguien os plantea este dilema, desconfiad del reduccionismo; estoy convencido que estamos en medio del proceso, aunque no podemos dilucidarlo.

Referencias

[1] Kellermann AL, Jones SS (2013). What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Affairs, 32(1):63-8.

[2] Chen C, Garrido T, Chock D, Okawa G, Liang L (2009). The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Affairs, 28(2):323-33.

[3] Liang LL, ed. (2010). Connected for Health: Using Electronic Health Records to Transform Care Delivery. San Francisco CA: Jossey-Bass.

[4] The Economist (2014). Health and happiness. 1st February.

[5] Saigí F (2007). La informatització de la informació sanitària: projectes i experiències d’història clínica compartida. Vol. 1, Cap 4. En: Universitat Oberta de Catalunya, Generalitat de Catalunya. Projecte Internet Catalunya. Modernització tecnològica, canvi organitzatiu i serveis als usuaris en el sistema de salut de Catalunya. Barcelona: UOC.

[6] Topol E (2012). The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books.

Psychological wellbeing and health

Subjective wellbeing, health, and ageing

What is the relationship between wellbeing and age?. This is precisely what this article tries to disentangle considering three types of subjective wellbeing:

• Evaluative wellbeing: evaluations of how satisfied people are with their lives
• Hedonic wellbeing: feelings or moods such as happiness,sadness and anger
• Eudemonic wellbeing: judgments about the meaning and purpose of life

Is it possible that positive subjective wellbeing is a protective factor for health?
Their conclusion:

Research into subjective wellbeing and health at older ages is at an early stage. Nevertheless, the wellbeing of elderly people is important, and evidence suggests that positive hedonic states, life evaluation, and eudemonic wellbeing are relevant to health and quality of life as people age. Health-care systems should be concerned not only with illness and disability, but also with supporting methods to improve positive psychological states.

Do you have any clue of how to do it?