Conclusions: Although study methodologies varied widely, evidence consistently suggested that treatment of OSA was associated with favorable economic outcomes, including QALYs, within accepted ranges of cost-effectiveness, reduced HCU, and reduced monetized costs.
Economic growth is often assumed to improve happiness for people in low income countries, although the association between monetary income and subjective well-being has been a subject of debate. We test this assumption by comparing three different measures of subjective well-being in very low-income communities with different levels of monetization. Contrary to expectations, all three measures of subjective well-being were very high in the least-monetized sites and comparable to those found among citizens of wealthy nations. The reported drivers of happiness shifted with increasing monetization: from enjoying experiential activities in contact with nature at the less monetized sites, to social and economic factors at the more monetized sites. Our results suggest that high levels of subjective well-being can be achieved with minimal monetization, challenging the perception that economic growth will raise life satisfaction among low income populations.
Citation: Miñarro S, Reyes-García V, Aswani S, Selim S, Barrington-Leigh CP, Galbraith ED (2021) Happy without money: Minimally monetized societies can exhibit high subjective well-being. PLoS ONE 16(1): e0244569.
Many studies have explored the possible role of monetary income in raising SWB. A consistent trend has been noted between SWB and the logarithm of the per capita gross domestic product (GDP) , which implies that the strongest effect of income on SWB occurs among low-income countries (Fig 1). Household income has also been correlated with the life satisfaction of individuals within communities [6, 17], a finding that has been echoed in some low income, non-Western settings . The income-SWB association is consistent with a priori expectations, given that income in monetized societies provides for essential human needs and access to services and amenities.
However, there are reasons to question a fundamental role of monetary income in determining SWB. A large body of literature has explored the observation that many countries do not appear to become happier as they grow richer, a finding known as the Easterlin Paradox . The Easterlin Paradox throws doubt on the strength of the causal relationship between income and SWB. In addition, most of the work on driving factors of SWB has its origins in Western, educated, industrialized, rich and democratic (WEIRD) societies , which may not be representative of SWB drivers in other contexts. Furthermore, because income is quantified with money-denominated market exchange values, studies of the income-SWB relationship necessarily exclude non-monetized, subsistence-based societies.
While it can be argued that purely non-monetized societies no longer exist, a number of minimally-monetized societies do persist. In such societies people produce enough to satisfy their own needs, with only minor trade or barter for non-essential goods and services . According to the widespread understanding that income matters more for the SWB of people at low income levels, one would expect that people in minimally-monetized economies would show low SWB. Yet, the fact that happiness is a universal feeling [24, 25] suggests that income may be just a substitute for other sources of happiness, an assumption that is easier to notice in settings where money has little or no use. Here we examine how SWB varies in societies with different degrees of monetization through the use of multiple SWB measures.
Despite the complex nature of SWB, the three measures showed a decreasing trend with increasing monetization (Fig 2). Mean SWL generally decreased from Roviana to Chittagong, which had the lowest SWL (Fig 2A and S3 Table) and the highest index of monetization. Mean SWL in Roviana and Gizo, the less monetized sites, was not significantly different but very high (8.14 2.11, S6 Table). Affect balance showed high dispersion but was also higher in the Solomon Islands (0.71 0.41) than in Bangladesh (0.36 0.54), did not differ between Roviana and Gizo, and was different between Nijhum Dwip and Chittagong. Nijhum Dwip had the lowest overall affect balance, the only discrepant measure in the study. Since affect tends to show higher sensitivity to short-term circumstances, we attribute this discrepancy to the frequent hurdles reported by participants in Nijhum Dwip, including exposure to extreme weather events, lack of hospital infrastructure, and frequent harassment by pirates . Momentary affect was remarkably similar between sites in the same country. Nearly all ESM responses in the Solomon Islands (N = 163) reported positive emotional states while only < 10% reported negative emotional states (Fig 2C). In Bangladesh, 52% of responses (N = 1075) reported positive emotional states and 31% reported negative emotional states (S3 Table). Thus, despite the inherent variability in primary data, all three measures show the highest levels of SWB at the least monetized sites.
Despite the complication of within-country variation, the pattern between the study sites holds and is consistent across the three independent SWB measures: SWB decreases with the degree of monetization in our study sites. Thus, not only may income be insufficient to measure what matters for well-being [1, 3], but the relationship can be reversed when applied to lesser-monetized societies.
As with the SWB measures, the most frequently reported factors showed consistent differences between study sites (Fig 3). Pleasant activities such as listening to music, relaxing, or going for a walk by the seaside were frequently cited at the less-monetized sites, and the frequency of these factors decreased with monetization. Family factors, such as seeing parents happy or spending time with relatives, were common at all sites, but their frequency increased markedly with increasing monetization, as did the frequency of answers related to economic aspects, such as having a high income or selling their fishing catch. Fishing and subsistence activities were more important in the rural sites, while social factors, like playing games with friends or going to parties, were more common at urban sites.
The cluster analysis indicates a consistent trend in the perceived drivers of SWB along the gradient of increasing monetization. More than half of the answers at the least monetized site were contained in Cluster B, reflecting simple pleasures and contact with nature, but the frequency of this cluster decreased steadily with monetization (Fig 4B). In contrast, the more monetized sites were dominated by answers belonging to Cluster A and Cluster C, reflecting social and economic factors. This shift could reflect cultural differences between the less monetized Solomon Islands and more monetized Bangladesh, but the observed trend is consistent with the monetization gradient. Although monetization itself is unlikely to be the only driver of this trend, we hypothesize that it may reflect a tendency for how perceptions of happiness change when societies transition from subsistence to monetized economies.
Having a supportive and cohesive social network, or high social capital, is also widely recognized as a universal driver of SWB . It might therefore appear curious that the frequency of social factors was low at subsistence sites, almost doubling across our gradient of monetization. However, because our question asked for perceived drivers of happiness, respondents were unlikely to report factors for which they had not experienced a large variation. Thus, if respondents rarely felt a significant lack of social support, they would be less likely to list social factors as important sources of happiness. Consistent with this, traditional subsistence practices have been shown to increase kin and kith solidarity as the entire community contributes to these activities, and connect contemporary communities to cultural traditions and their elders . In contrast, with increased monetization people often spend more time working, away from their close relatives, and engage in uncertain social interactions with strangers rather than in their small, close-knit subsistence communities [48, 49]. In the same way, economic factors may barely appear in the lesser-monetized site because people do not depend on money to fulfil their basic needs, and money does not play a central role in determining self-worth. The identified happiness drivers are therefore likely to reflect both fulfillment of perceived deficiencies and enriching experiences, dependent on learned expectations.
Our findings from minimally monetized societies challenge the prevailing view that economic growth is a reliable pathway to increase subjective well-being. While the data presented here were collected only in two countries, and must therefore be extrapolated with caution, this is the first study to our knowledge that systematically compares standardized SWB measures in minimally-monetized, very low-income societies. Culture plays a major role on how happiness is perceived and conceptualized [15, 23], and likely has complex influences on our measures of SWB. Nevertheless, among the populations studied here, our findings are highly consistent across the three independent SWB metrics, which are unlikely to share the same cultural effects or measurement problems. The highest SWL occurred with the least degree of monetization and was comparable to the SWL reported from high income countries. The results provide an unusually clear substantiation of the often-discussed importance of non-material and non-market determinants of SWB and raises reasonable doubts to the income-happiness debate as a whole, suggesting that this debate could be missing a part of the picture when it comes to subjective well-being. 153554b96e