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Compared to Whom? An Investigation of the Relative Health Comparisons of Well People

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Abstract

Objectives: Responses to the self-reported health (SRH) question, “In general how would you rate your health? Excellent, very good, good, fair or poor”, have been repeatedly demonstrated to predict mortality. Survival curves plotted for each response category show that the likelihood of death increases in a stepped fashion with each progressively negative response category and the relationship persists for up to 12 years following initial measurement. To whom do people compare themselves when answering the self-reported health question?

Methods: Twenty-one interviews with people who selected the better-health response choices (i.e., good, very good, or excellent) were conducted in a Canadian city. Qualitative content analysis was undertaken and the interviews were approached with no pre-conceived ideas about what the participants would say.

Results: Analysis of the interviews suggested that there are three key features in making a health comparison: the type (i.e., with whom), direction (i.e., upward or downward), and magnitude of the comparison (i.e., with a few people or an ideal person vs. many other people). These key features varied in a systematic way with the chosen response.

Discussion: The findings related to the direction of comparison contradict, somewhat, the theories of social psychologists but these differences may have occurred because the participants were well. Healthy people may use different factors than ill people when making social comparisons as they select a self-reported health question response category. The nature of the comparisons are complex and the responses indicate that they are affected by age, gender, and life experience.

Résumé

Objectif: Il a été prouvé à maintes reprises que les réponses déclarées par les intéressés à la question «En général, comment évalueriez-vous votre santé? (excellente, très bonne, bonne, passable ou mauvaise)» peuvent prédire la mortalité. Les courbes de survie tracées pour chaque catégorie de réponse démontrent que la probabilité de décès augmente avec chaque catégorie, et que ce rapport peut persister jusqu’à 12 ans après la mesure initiale. À qui les gens se comparent-ils lorsqu’ils répondent à cette question?

Méthode: Vingt-et-une entrevues avec des personnes ayant déclaré avoir une santé relativement bonne (c.-à-d. bonne, très bonne ou excellente) ont été menées dans une ville canadienne. Nous avons procédé à une analyse qualitative du contenu et abordé les entrevues sans avoir d’idées préconçues de ce que diraient les participants.

Résultats: L’analyse des entrevues donne à penser qu’il faut tenir compte de trois grandes caractéristiques lorsqu’on compare la santé des gens: le genre de comparaison (à qui se compare-t-on?), le sens de la comparaison (vers le haut ou vers le bas?) et l’étendue de la comparaison (par rapport à un petit nombre de personnes ou à une personne idéale, ou par rapport à beaucoup d’autres personnes?). Ces grandes caractéristiques changent systématiquement selon la réponse choisie.

Discussion: Les résultats liés au sens de la comparaison contredisent passablement les théories des psychologues sociaux, mais ces différences ont pu se produire parce que les participants allaient bien. Dans leurs réponses, les personnes en bonne santé peuvent en effet faire appel à des facteurs différents de ceux des personnes malades. La nature des comparaisons sociales est complexe, et les réponses indiquent qu’elles sont influencées par l’âge, le sexe et l’expérience de la vie.

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Authors and Affiliations

  1. Division of Epidemiology and Public Health, Medical School, Queen’s Medical Centre, Nottingham, UK, NG7 2UH

    Shona J. Kelly PhD (Lecturer in Social Epidemiology)

  2. School of Nursing, University of British Columbia, Canada

    Pamela A. Ratner PhD

Authors
  1. Shona J. Kelly PhD
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  2. Pamela A. Ratner PhD
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Corresponding author

Correspondence to Shona J. Kelly PhD.

Additional information

Sources of Funding: Dr. Kelly was supported by a CIHR/NHRDP National Health PhD Fellowship from Health Canada. Dr. Ratner was supported by the Canadian Institutes of Health Research.

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Kelly, S.J., Ratner, P.A. Compared to Whom? An Investigation of the Relative Health Comparisons of Well People. Can J Public Health 96, 462–466 (2005). https://doi.org/10.1007/BF03405191

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  • DOI: https://doi.org/10.1007/BF03405191

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