Creating an Index to Measure Wellbeing and Predict Life Satisfaction in Athens, Georgia Series 1: January 2018

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1 Creating an Index to Measure Wellbeing and Predict Life Satisfaction in Athens, Georgia Series 1: January 2018 Ashley Bradford Anneliese Hermann Aishah Khan Under the direction of Dr. Grace Bagwell Adams

2 EXECUTIVE SUMMARY Context Wellbeing is a broad and important concept that encapsulates many facets of mental, physical, emotional, developmental, spiritual, and social welfare. It is intentionally subjective and captures not only empirical reality, but also people s innate perceptions and feelings. Although it is difficult to measure, it has significant consequences both to the individual and to society as a whole. Higher levels of wellbeing are associated with more positive health outcomes, higher levels of productivity, and greater civic engagement (Rath and Harter, 2010a). Not only is wellbeing naturally associated with a variety of health and social outcomes, it can be used by policy makers to explore areas of their communities that require attention and intervention. Other cities have started to measure wellbeing as one metric for success. The city of Santa Monica created its own wellbeing index in order to identify both areas of strength and areas of opportunity for policy intervention, as well as track the success and failure of ongoing programs (City of Santa Monica, 2017). Accessing this information allows the city to target policy interventions towards areas of opportunity. The Gallup-Sharecare Wellbeing Index collects data on health, happiness, and life satisfaction across the globe along the six dimensions that comprise their index: purpose, social, financial, community, and physical wellbeing (Gallup, 2017). The ability to measure multiple different countries and states with the same methodology yields important insights, such as the fact that Georgia ranked 29th in the nation for wellbeing relative to the other states in 2016 (Healthways, 2017). It is evident that there is room for improvement in wellbeing within the state and therefore opportunities for disease prevention, economic growth, and greater community engagement. Due to these motivating factors, we have designed a wellbeing index that is specific to Athens-Clarke County (ACC) and can be implemented by the community to get a snapshot of how different populations within Athens are either struggling or thriving. There are many policy interventions that could be implemented in the hopes of increasing overall life satisfaction in ACC. If ACC is able to effectively reach the people who systematically fall through the cracks and encourage all residents to participate actively in the resources and shared life at the core of the community, then we can move towards a healthier, more productive, and more satisfied ACC for everyone. Research Aims In this study we use data from the Athens Wellbeing Project (AWP) survey to: 1) Create an index that measures wellbeing in our community. 2) Use the wellbeing index to predict overall life satisfaction for residents of Athens-Clarke County, Georgia.

Creating an Index to Measure Wellbeing Maslow s Hierarchy of Needs is a widely accepted theory in the field of psychology that attempts to explain human motivation.

3 Creating an Index to Measure Wellbeing Maslow s Hierarchy of Needs is a widely accepted theory in the field of psychology that attempts to explain human motivation. Maslow hypothesized that human beings must have their basic needs met in order to feel motivated. These needs arranged in a pyramid with five tiers, and include: physiological needs, safety needs, love and belonging needs, self-esteem needs, and self-actualization (Gratton, 1980). We created an index using five proxies, one for each tier on the hierarchy. The index includes: self-reported health status, how safe a respondent feels to walk or exercise in their neighborhood, frequency of social gathering, highest level of education, and whether a respondent engages in a hobby. Key Findings We find that our wellbeing index is a strong predictor of self-reported life satisfaction. A one unit increase in the wellbeing index (moving from being unhealthy, feeling unsafe in one s neighborhood, gathering socially infrequently, having no college degree, and not having a hobby to being healthy to feeling safe in one s neighborhood, having frequent social gathering, having a college degree, and having a hobby) is associated with a 35.0% increase in the likelihood that a respondent indicates that they are satisfied with their life. We also found several other significant relationships. Positive predictors of the likelihood that a respondent is satisfied with their lives include having health insurance (+7.3%), putting effort into the Athens community (+2.4%). Negative predictors of life satisfaction include the imminent chance of being evicted from their home (-14%), and having contact with the police in the past year (-9.7%).

4 Recommendations As a result of this study, we recommend focusing on the following: v Building social capital. One way ACC could increase feelings of self-actualization, and therefore increase overall wellbeing, is to create opportunities for hobbies in ACC such as lectures on gardening, art lessons, or craft fairs. Creating additional educational outreach programs for adults or helping to connect people to outreach programs that are already in place in Athens could increase social capital. Facilitating more social activities in Athens, such as trivia games, singles nights, or film festivals, could increase feelings of belonging. The Osher Lifelong Learning Institute is a program that is already in place in ACC for people over the age of 50. OLLI holds almost daily meetings and/or classes in topics such as history, health and fitness, writing, and the arts. This program already implements many of the ideas that the index attempts to encapsulate. It fosters feelings of self-actualization, provides educational opportunities, facilitates social interaction, and motivates health and wellness. This program, if expanded to populations other than just those over the age of 50, could likely make significant strides in improving overall life-satisfaction in ACC. v Improved neighborhood safety. Residents need to feel safe enough to walk or exercise in their neighborhood. This could be improved by working to repair existing infrastructure including sidewalks and streetlights in neighborhoods across the community. From this study, we observe that families who face housing volatility (imminent danger of eviction <2 months) and families that had contact with the police in the last 12 months have lower levels of life satisfaction. Concerted efforts to improve neighborhood safety and stability among these groups in particular could improve community wellbeing.

5 INTRODUCTION In the fall of 2017, a series of policy analysis papers were produced as partial fulfillment of course requirements for the Health Policy Analysis course taught by Dr. Grace Bagwell Adams in the Department of Health Policy and Management, College of Public Health at the University of Georgia. Each of these papers utilized the Athens Wellbeing Project (AWP) household survey data collected in the fall of 2016 through the winter of 2017, in addition to secondary data sources from the U.S. Census Bureau and other state and national databases. The intent of these analyses is to inform policy making at the local level in the Athens-Clarke County Community. Four policy papers were produced from the graduate seminar, covering the following topics: access to mental health services, housing quality and asthma prevalence, the underutilization of food assistance for women and children, and creation of an index to measure wellbeing. This study investigates the extent to which wellbeing is associated with life satisfaction in Athens-Clarke County. Wellbeing is a broad and important concept that encapsulates many facets of mental, physical, emotional, developmental, spiritual, and social welfare. It is intentionally subjective and captures not only empirical reality, but also people s innate perceptions and feelings. Although it is difficult to measure, it has significant consequences both to the individual and to society as a whole. Higher levels of wellbeing are associated with more positive health outcomes, higher levels of productivity, and greater civic engagement (Rath and Harter, 2010a). Not only is wellbeing naturally associated with a variety of health and social outcomes, it can be used by policy makers to explore areas of their communities that require attention and intervention. We introduce a comprehensive index for wellbeing in Athens-Clarke County (ACC), a concept which brings together global judgments of life satisfaction and feelings ranging from depression to joy, integrates mental health, and physical health, resulting in more holistic approaches to disease prevention and health promotion (Center for Disease Control, 2016). We then predict life satisfaction as a function of the wellbeing index and find the two to be positively associated as a respondent s wellbeing increases, the likelihood of reporting life satisfaction increases significantly. MOTIVATION AND RESEARCH AIMS Using the household-level survey data from the Athens Wellbeing Project (AWP), we developed two primary aims to address in the context of Athens-Clarke County: 1) Create an index that measures wellbeing in our community. 2) Use the wellbeing index to predict overall life satisfaction for residents of Athens-Clarke County, Georgia.

6 AWP DATA ANALYSIS Household survey data from the Athens Wellbeing Project (AWP) was used in this cross-sectional study. The AWP is a collaboration among the Athens-Clarke County Unified Government, Clarke County School District, Athens Area Community Foundation, Family Connection-Communities in Schools, United Way of Northeast Georgia, the Athens Housing Authority, and the University of Georgia. A community-based household survey was designed to collect information about important public health issues in Athens- Clarke county, as well as provide key stakeholders with a snapshot of resource utilization relating to education, public safety, civic vitality, and housing. 1 Survey data were collected in the fall of 2016 through the winter of 2017 using a stratified random sample of all Athens-Clarke County residents, with the 16 Clarke County School District elementary school attendance zones representing individual strata. Four additional strata were created to represent low income and vulnerable populations, including seniors and homeless or transitional families, which might otherwise be under represented in the household sample. In total, 1,354 households completed the survey. The AWP household survey is representative of the total population at the county level. To account for variation in non-response, a sample weight was created to increase the level of representativeness of the survey. AIM 1: CREATING AN INDEX TO MEASURE WELLBEING Several different governments have started to measure wellbeing as a metric for policy success. The city of Santa Monica created an index for their Wellbeing Project, which is comprised of six aspects of interest: outlook, community, health, economic opportunity, place and planet, and learning (City of Santa Monica, 2017). Taking a holistic approach to community health has yielded important findings concerning groups at risk. For example, the most recent report found that nearly one in three 11th graders reported a significant period of extreme sadness last year (City of Santa Monica, 2017). Accessing that information allows the city to target policy interventions towards areas of opportunity. The Gallup-Sharecare Wellbeing Index collects global data on health, happiness, and life satisfaction at the country and state level along the six dimensions that comprise their index: purpose, social, financial, community, and physical wellbeing (Gallup, 2017). The scope of the Gallup-Sharecare data collection is valuable in terms of generalizability and comparison of findings, as opposed to a local project such as the Santa Monica wellbeing index. The ability to measure multiple different countries and states with the same methodology yields important insights, such as the fact that Georgia ranked 29th in the nation for wellbeing relative to the other states in 2016 (Healthways, 2017). It is evident that there is room for improvement in wellbeing within the state and therefore opportunities for disease prevention, economic growth, and greater community engagement. To create our index, we referred to Maslow s Hierarchy of Needs, which is a widely accepted theory of human motivation. Maslow s Hierarchy includes five tiers: 1) physiological needs such as food and shelter, 2) safety needs such as physical and financial security, 3) belongingness needs that refer to social acceptance and fulfillment, 4) esteem needs that incorporate feelings of accomplishment, and 5) 1 The study protocol was approved by the University of Georgia Institutional Review Board and was deemed exempt from further review meeting non-research criteria (IRB Study ID # ).

We chose to weight each tier in this index equally due to the broad and subjective nature of wellbeing.

7 self-actualization, which refers to the pursuit of a creative or intellectual outlet for self-expression (Gratton, 1980). We created an index using five proxies from the Athens Wellbeing Project survey data, one for each tier of the hierarchy. We chose to weight each tier in this index equally due to the broad and subjective nature of wellbeing. The index includes: self-reported health status, how safe a respondent feels to walk or exercise in their neighborhood, frequency of social gathering, highest level of education, and whether a respondent engages in a hobby. Figure 1: Maslow s Hierarchy of Needs.

8 Figure 2: Wellbeing Index for Athens-Clarke County. AIM 2: PREDICTING LIFE SATISFACTION IN ATHENS CLARKE COUNTY The index was then tested for its power in predicting life satisfaction using a multivariate logistic regression that controlled for influencing variables such as health insurance status, level of community engagement, likelihood of eviction, and contact with the ACC police. The marginal effects can be directly interpreted as the probability that a respondent indicates that they are satisfied with their life that is associated with a one-unit increase of the variable in question. Thus, a one unit increase in the wellbeing index (moving from being unhealthy, feeling unsafe in one s neighborhood, gathering socially infrequently, having no college degree, and not having a hobby to being healthy to feeling safe in one s neighborhood, having frequent social gathering, having a college degree, and having a hobby) is associated with a 35.0% increase in the likelihood that a respondent indicates that they are satisfied with their life. Health insurance status, putting effort into being a part of the Athens community, likely eviction, and contact with police were also significant in our model. Moving from being uninsured to being insured is associated with a 7.3% increase in the likelihood that a respondent indicates that they are satisfied with their life. Putting effort into being part of the Athens-Clarke community is associated with a 2.4% increase in the likelihood that a respondent is satisfied. Each increase in the likelihood that a person will be evicted in the next two months is associated with a decrease in the likelihood that they respond with satisfaction by 14.0%. And finally, having contact with the police in the past year is associated with about a 9.7% decrease in the chances that a respondent is satisfied with their life.

9 Table 1. Marginal Effects of Relevant Factors on Overall Wellbeing with T-Statistics. Variable Marginal Effect on Wellbeing (T-Statistics) Index score 0.35*** (6.45) Health insurance status 0.073*** (2.65) Respondent puts effort into being part of Athens community 0.024** (2.19) Likelihood of eviction in next two months -0.14*** (-4.15) Any contact with police in last 12 months *** (-4.47) Note: * p<0.10, ** p<0.05, *** p<0.01. All data weighted using probability weights. RECOMMENDATIONS As a result of this study, we recommend focusing on the following: v Building social capital. One way ACC could increase feelings of self-actualization, and therefore increase overall wellbeing, is to create opportunities for hobbies in ACC such as lectures on gardening, art lessons, or craft fairs. Creating additional educational outreach programs for adults or helping to connect people to outreach programs that are already in place in Athens could increase social capital. Facilitating more social activities in Athens, such as trivia games, singles nights, or film festivals, could increase feelings of belonging. The Osher Lifelong Learning Institute is a program that is already in place in ACC for people over the age of 50 (OLLI, 2018). OLLI holds almost daily meetings and/or classes in topics such as history, health and fitness, writing, and the arts. This program already implements many of the ideas that the index attempts to encapsulate. It fosters feelings of self-actualization, provides educational opportunities, facilitates social interaction, and motivates health and wellness. This program, if expanded to populations other than just those over the age of 50, could likely make significant strides in improving overall life-satisfaction in ACC. v Improved neighborhood safety. Residents need to feel safe enough to walk or exercise in their neighborhood. This could be improved by working to repair existing infrastructure including sidewalks and streetlights in neighborhoods across the community. From this study, we observe that families who face housing volatility (imminent danger of eviction <2 months) and families that had contact with the police in the last 12 months have lower levels of life satisfaction. Concerted efforts to improve neighborhood safety and stability among these groups in particular could improve community wellbeing.

10 LIMITATIONS There are several limitations to this analysis. First, this analysis stems from a cross-sectional survey. As survey responses were taken at a single point in time, relationships described in this analysis are associative and not causal. Second, survey responses were collected at the household level, not the individual level. Thus, we are unable to make inferences or determine relationships at the individual resident level. Third, these data are self-reported measures that introduce the potential for response bias in the sample. CONCLUSIONS 1. We find that our wellbeing index is a strong predictor of self-reported life satisfaction. Health insurance status and putting effort into being a part of the Athens community were also positive predictors of life satisfaction in our model, and likely eviction and contact with police were negative predictors. 2. There are many ways that different members of the community can utilize these results to help the residents of ACC. Both the structure of the index itself and the control variables offer insight into how different aspects of wellbeing can be improved in order to increase feelings of life satisfaction as well as which groups are most at risk of dissatisfaction within ACC. 3. Increasing access to opportunities for hobbies in ACC such as lectures on gardening or art lessons, and creating additional educational outreach programs for adults or helping to connect people to outreach programs that are already in place in Athens could increase social capital. 4. Concerted efforts to improve neighborhood safety and stability in areas where families face housing insecurity could improve community wellbeing. Repairing existing infrastructure including sidewalks and streetlights could also improve feelings of safety. ATHENS WELLBEING PROJECT The Athens Wellbeing Project (AWP) is made possible through the following community stakeholders: Athens Area Community Foundation (AACF), Clarke County School District, United Way of Northeast Georgia, University of Georgia, Athens Housing Authority, and the Athens-Clarke County Unified Government. For more on the AWP, please visit

11 Appendix 1: Full Results of AWP Analysis Table 1: Variable Means and Standard Deviations, Full Sample, Athens Wellbeing Project Survey. Variable Mean Standard Deviation Count Life Satisfaction Index score Proportion of Black respondents Proportion of Latinx respondents Health insurance status Currently enrolled in college Proportion of female respondents Household monthly income before taxes Proportion of married respondents Age Respondent puts effort into being part of Athens community Respondent is member of a church Likely eviction in next two months Any contact with police in last 12 months Observations 1354 Note: All data weighted using probability weights.

12 Table 2: Marginal Effects of Relevant Factors on Overall Wellbeing, Athens Wellbeing Project Survey. Variable Margin (T-Statistics) Index score 0.35*** (6.45) Proportion of Black respondents (-0.75) Proportion of Latinx respondents (0.98) Health insurance status 0.073*** (2.65) Currently enrolled in college (-0.58) Proportion of female respondents (0.99) Household monthly income before taxes (1.12) Marital status (-0.06) Age (0.56) Respondent puts effort into being part of 0.024** Athens community (2.19) Respondent is member of a church (1.22) Likelihood of eviction in next two months -0.14*** (-4.15) Any contact with police in last 12 months *** (-4.47) Number of Observations 973 Note: * p<0.10, ** p<0.05, *** p<0.01. All data weighted using probability weights.

13 References Barnett, J. C., & Vornovitsky, M. S. (2016). Health insurance coverage in the United States: US Census Bureau, Current Population Reports, Report, (P60-257). Center for Disease Control (2016, May 31). Health-Related Quality of Life. Retrieved from City of Santa Monica. (2017, September) Wellbeing Index Findings Summary. Retrieved from Gallup. (2017). How does the Gallup-Sharecare Well-being Index Work?. Retrieved from Gratton, L. C. (1980). Analysis of Maslow's need hierarchy with three social class groups. Social Indicators Research, 7(1): Harter, J. and Agrawal, S. (2012). Causal Relationships Among Wellbeing Elements and Life, Work, and Health Outcomes. Washington, D.C.: Gallup Press. Healthways. (2017, February 1). Gallup and Healthways Release 2016 State Well-Being Rankings. Retrieved from Osher Lifelong Learning Institute at the University of Georgia (2018). Retrieved from: Peters, J. D. (2017) Logit, Probit & Ordinal Models- Overview and Assumptions. Iowa State University. Retrieved from: Rath, T. and Harter, J. a. (2010).The Economics of Wellbeing. Washington, D.C.: Gallup Press. b. (2010, November 30). Giving and Your Community Wellbeing. Retrieved from

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