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Abstract

Is happiness good for your health? This common notion is tested in a
synthetic analysis of 30 follow-up studies on happiness and longevity. It appears that
happiness does not predict longevity in sick populations, but that it does predict
longevity among healthy populations So, happiness does not cure illness but it doe

s

protect against becoming ill. The effect of happiness on longevity in healthy popu-
lations is remarkably strong. The size of the effect is comparable to that of smoking
or not

.

If so, public health can also be promoted by policies that aim at greater happiness
of a greater number. That can be done by strengthening individual life-abilities and
by improving the livability of the social environment. Some policies are proposed.
Both ways of promoting health through happiness require more research on con-
ditions for happiness.

Keywords Happiness Æ Life satisfaction Æ Longevity Æ Public health Æ
Social policy Æ Research synthesis

1 The issu

e

It is widely acknowledged that mental factors may influence physical functioning and
that psychological well-being works positively on physical health. This idea does not

This study was done for ZonMw, the Netherlands’ organization for health research and development
and reported in Dutch in Veenhoven 2006a.
Earlier versions of this paper were presented at the 3rd European Conference on Positive Psy-
chology in Braga, Portugal, July 3–6, 2006 and the 7th conference of the International Society fo

r

Quality of Life Studies, in Grahamstown, South Africa, July 16–2

0

R. Veenhoven (&

)

Department of Social Sciences, Erasmus University Rotterdam, Postbus 1738, Rotterdam 3000
DR, Netherlands
e-mail: veenhoven@fsw.eur.n

l

123

J Happiness Stud (2008) 9:449–469
DOI 10.1007/s10902-006-9042-

1

R E S E A R C H P A P E R

Healthy happiness: effects of happiness on physical
health and the consequences for preventive health care

R. Veenhove

n

Published online: 28 February 2007
� Springer Science+Business Media B.V. 2007

only live among adherents of holistic medicine, it also has a firm root in academic
psychology. There is good evidence for the negative effects of mental distress on
physical health, e.g. of depression, anxiety and hostility and there are also indications
for the beneficial effects of positive mental states, such as positive affect (Zautra,
2003).

In this context it is commonly assumed that happiness is conducive to physical
health. It is believed that happiness helps to heal the sick and that it protects people
in good healthy against getting ill. In this view, health-care should not only be
concerned with illness, it should also be concerned with wider quality-of-life. This
view is reflected in broad definitions of health, such as the World Health Organi-
zation’s definition of health as a state of general physical, mental and social well-
being and not only the absence of illness and defect (Seedhouse, 1996, p. 41). In this
line it is also asserted that current health education may be counter productive
because it puts a damper on enjoyable things such as smoking and drinking (War-
burton, 1994, 1996).

Yet there are also different notes. For instance, VanDam (1989) argues that
positive attitudes cannot stop serious illness and that the idea of ‘fighting cancer’
with happiness is a mere illusion that blames the victim. Several studies have indeed
failed to find longer survival times among happy cancer patients and some studies
even report shorter survival times (e.g. Derogatis, Abeloff, & Melisaratos, 1979).
There is also doubt about the protective effect of happiness and even reports of
greater mortality among cheerful people as a result to their more risky lifestyles
(Friedman et al., 1993). In this view healthcare is better limited to physical health in
the strict sense with too buoyant living being discouraged.

In this paper I address this issue in two ways: First I take stock of the empirical
research on effects of happiness on physical health. I focus on longevity and assess
whether happy people live longer. This appears to be the case, though happiness
does not cure serious illness, it does appear to protect against falling ill in some way.
Having established that happiness adds to health, I next explore the consequences of
this finding for public health policy.

2

Effects of happiness on physical health: A review of the research literature

Assessing the effect of happiness on health requires first of all that we clearly define
these concepts. The terms ‘happiness’ and ‘health’ are both used with different
meanings, some of which overlap. Evidently we can assess meaningful effects only if
we deal with different things. A second requirement is selection of appropriate
measures of these concepts.

Happiness is defined, as the overall appreciation of one’s life-as-a-whole, in short,
how much one likes the life one lives. Elsewhere I have delineated that concept in
more detail (Veenhoven, 1984, chapter 2). Thus defined, happiness is a state of mind
and can therefore be measured using questioning techniques, among which single,
direct questions. Self-reports of happiness appear to be fairly valid, though not ver

y

precise (Veenhoven, 1984, chapter 3).

As for the concept of health, I restrict to physical health, which I define in the
narrow sense of absence of illness or defect. I do so to avoid conceptual overlap wit

h

happiness or related attitudinal matters. Physical health can be measured objectively

450 R. Veenhoven

12

3

using medical assessments or subjectively using self-reports. The most objective
measure of physical health is longevity1.

2.1

Correlational studies

There is a wealth of cross-sectional studies on happiness and physical health, much
of which is summarized in the World Database of Happiness, section Correlational
findings on happiness and Physical Health (Veenhoven, 2006b). This research shows
consistent positive relationships.

Correlations vary between +.10 and +.40 and appear to be largely independent of
age, gender, socio-economic status and personality. The correlations tend to be
higher in patient populations than among the general public. The correlations of
happiness with self-rated health are somewhat stronger than the correlations be-
tween happiness and heath ratings based on medical examinations, but that does not
necessarily mean that the relation with ‘real health’ is weaker, since objective
indicators do not capture several relevant aspects of health (Benyamini, Leventhal,
& Leventhal, 1999). A recent cross national survey found highly similar correlations
in 46 nations, a one point difference on the 5-step self-rating of health corresponding
to a 0.6 point difference in happiness (Helliwel, 2002, p. 339).

These studies clearly show that there is a statistical relationship, but they do not
inform us about cause and effect. The correlations can be caused by the effect of
health on happiness rather than by effects of happiness of health. To disentangle
cause and effect we need follow-up studies.

2.2

Follow-up studies on effect of health on happiness

Only four studies have been done to assess the effect of earlier physical health on
later happiness. One of these estimated physical health in the first year of life, using
the medical records of a maternity clinic, and found no statistical relation with
happiness at age 33 (Ventegodt, 1997, p. 300). Likewise, a 12-year follow-up of adults
did not find a correlation between doctor’s visits at baseline and later happiness
(Chiriboga, 1982, p. 23). Another 12-year follow-up of middle aged Americans did
find some relation between baseline self-rated health and later happiness, but no
effect of change in physical health over this period (Palmore, 1977, p. 315). Still
another 12-year follow-up among married couples in the USA found a small cor-
relation between baseline self-rated health and later happiness (r = +.13 p < .001). Interestingly, this study also observed a stronger effect of baseline happiness on later health (r = +.37 p < .001, Hawkins & Booth, 2005, p. 456). These results suggest that the observed correlation between happiness and health will be largely due to a causal effect of happiness, and as we will see, that is the case.

2.3

Follow-up studies on effect of happiness on health, in particular longevity

Physical health can be measured objectively using medical assessments or subjec-
tively using self-reports. For the purpose of this study I opted for the most objective
measure possible, that is, longevity. The reason was to avoid contamination. If we

1
No measure of health is perfect. Longevity does not capture the good health of people who dye

prematurely as a result of an accident.

Healthy happiness 451

123

measure health using self-reports, there would be a fair chance that happiness colors
self-appraisals of health and this could even be the case with medical assessments
that are at least partly based on reports of symptoms.

Studies There is a lot of research on predictors of longevity. Studies at the indi-
vidual level have documented effects of various genetic factors, physical func-
tioning, personality traits, life style variables, social support and socio-economic
status. For a recent review see Lyyra (2006). Only some of these studies have
involved indicators of happiness and because happiness is typically a side issue it is
difficult to trace the findings bibliographically. Most references were found in the
Bibliography of the World Database of Happiness (Veenhoven, 2006b) and in a
recent monograph on the consequences of subjective wellbeing by Lyubomirsky,
Diener, and King (2005)

Selection I used three criteria for selecting studies: first that the investigation involved
follow-up over time, second that longevity was assessed and third that this was related
to earlier happiness. In the context of the latter criterion I inspected whether the
indicators of happiness used fit the above definition of happiness. Some studies claim
to assess happiness, but measured something else. This was for instance the case with
the above-mentioned study that observed greater mortality among cheerful people,
the word ‘cheerfulness’ being used for a happy-go-lucky attitude (Friedman et al.,
1993).

Altogether, I found 30 studies, which gave a rather mixed bag. The studies were
all done among different populations and used different methodologies. A main
methodological difference was found in the control variables. Some of the studies
did not assess baseline physical health and could therefore not rule out the possi-
bility that greater longevity of the initially most happy is due to their better initial
physical health. Most studies did control baseline physical health, but assessed this in
different ways, some using self-reports and others medical screening. Another
noteworthy difference was in the statistics used for quantifying the effect of happi-
ness on longevity. Some studies expressed the difference in a regression coefficient
and others in Odds Ratio’s of different kinds. On the basis of the published research
reports I could not transform the findings to obtain a common effect size and a full
blown meta-analysis is therefore not possible.

Results Together, researchers in these 30 studies observed 38 effects, with some
researchers looking at subgroups separately. In 53% of the cases the observed effect
was positive, meaning that the initially happiest people lived longer. In 13% the
effect of happiness appeared to be negative, happy people living shorter lives. In
34% of the cases the difference was not statistically significant.

At first glance this does not denote a robust effect. Yet a more consistent picture
emerges when we make a difference between studies among ailing people and
studies among healthy populations. There is also a difference to be found in the
results of short-term and long-term follow-up studies.

2.3.1

Happiness and longevity in sick people

Eleven follow-up studies have been done among ailing people, partly among frail
elderly and partly among patients suffering serious diseases. Given the poor health
of these people, the follow-up period was typically no longer than a few years. These
studies are presented in Table 1 in order of follow-up length; the shortest follow-up
period was 1 year, the longest 11 years.

452 R. Veenhoven

123

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Healthy happiness 453

123

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.9
9

454 R. Veenhoven

123

Researchers in these 11 studies observed 14 effects, of which only four appear to
be positive and five negative, while in another five cases no significant effect was
found. The positive effects were observed in studies with relatively healthy samples,
that is, veterans in an old age home (not a nursing home), heart patients of all ages
and people with spinal cord injuries. An exception to this pattern was the positive
effect found for cancer patients that had a relapse. The negative effects were
observed among incurably ill patients and the very old frail elderly.

Together these results do not suggest that happiness ‘heals’, at least not that
happiness can restore health in the case of serious illness. In other words: happiness
does not appear to prolong the deathbed.

2.3.2

Happiness and longevity in healthy populations

Nineteen follow-up studies in healthy populations are summarized in Table 2,
mainly non-institutionalized elderly persons and a few studies among younger age
categories. A special case is the study carried out among nuns, summarized at the
bottom of Table 2. The studies are again presented in order of length of the follow-
up period, which vary from 1 year to more than 60 years. Five of the studies cover
20 years or more.

Researchers in these 19 follow-up studies assessed 24 effects, of which 16 were
positive, while in eight cases an observed (positive) effect did not reach statistical
significance. In the case of the study done in Japan by Kawamoto and Doi (2002) the
non-significance is possibly due to control for activity and social contacts, which is
likely to have removed variance in happiness. None of the studies in Table 2 resulted
in a negative effect.

The observed positive effects of happiness on longevity are quite sizable and
amount to 7.5 years and 10 years. The strongest effect was observed in the longest
follow-up, the study among American nuns, which covered their entire adult life-
time. In this study, happiness in young adulthood was measured using autobio-
graphies written by the nuns on entering the convent. Unfortunately baseline health
could not be controlled in that study. In the study by Levy et al. among over 50 aged
in Ohio USA, the researchers did control baseline health and still found that the
happy lived 7.5 years longer.

It is not possible to generalize these finding to a simple statement such as: happy
people live so many years longer. This is partly due to technical problems such as the
use of incomparable statistics and different cut-off points between more and less
happy people. Another problem is that the size of the effect may differ across
subgroups of a population, such as among age categories. Still it clear that the effect
of happiness on longevity is large. It involves several years and as such is comparable
to the effect of smoking or not.

Since we have seen that happiness does not cure serious illness, this outcome
means probably that happiness ‘protects’ one against falling ill. That interpretation
fits well with the fact that the effects manifest most strongly in the long-term
studies.

2.4

How could happiness protect physical health?

This begs the question of how happiness might protect against illness. Several pos-
sible mechanisms are mentioned in the literature.

Healthy happiness 455

123

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1
0

456 R. Veenhoven

123

T
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Healthy happiness 457

123

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458 R. Veenhoven

123

The most commonly mentioned direct effect is that chronic unhappiness activates
the fight-flight response, which is known to involve harmful effects in the long run,
such as higher blood pressure and a lower immune response. The effect of negative
mental states is well documented in psychosomatic medicine. There are also indi-
cations that positive mental states protect against illness, e.g. better immune re-
sponse when in good mood (Cohen et al., 1995).

Another commonly mentioned mechanism is better health behavior. Happy
people are more inclined to watch their weight (Schulz, 1985, p. 52), are more
perceptive of symptoms of illness (Ormel, 1980, p. 350) and cope better with
threatening information (Aspingwall & Brunhart, 1996). Happy people also live
healthier, they engage more often in sports (Schulz, 1985) and they tend to be more
moderate with smoking and drinking (Ventegodt, 1997, pp. 180–184).

Happiness could also further health through its wider activating effects, which
keep the body fit and resilient. The reverse is seen in depression that typically slows
down functioning and probably for that reason makes people more susceptible to
illness. This mechanism fits Frederickson’s (1998) theory that positive affect
‘broadens’ the action repertoire. According to Frederickson, positive affect helps
also to ‘build’ resources and this is likely to create healthier living conditions. One
notable mechanism in this context is that happiness facilitates the creation and
maintenance of supportive social networks.

Another mechanism may be that happy people make better choices in life, be-
cause they are more open to the world and more self-confident. Happy people are
also less likely to fall victim to the pattern of one-dimensional thinking in distress,
which might hamper choice (Zautra, 2003).

There is piece-meal evidence for each of these causal mechanisms, but as yet little
overview on their relative importance and interactions. For the time being we know
that happiness fosters physical health, but not precisely how.

3

Implications for preventive health care: An exploration

This finding that happiness adds to health opens new ways for health promotion,
preventive public health care in particular. It implies that we can make people
healthier by making them happier. This not only broadens the practical options for
interventions, but also widens the ideological basis for health promotion, the goal of
‘Health for all’ coinciding with the utilitarian aim of ‘Greater happiness for a greater
number’.

What innovations could this approach lead to? To answer this question I will first
summarize the commonly used ways to promote public health. Next I consider to
what extend these policies also add to happiness; in other words, I look how much
synergy there is between current health promotion and the requirements for greater
happiness. Using this as a basis, I then identify in section ‘‘Furthering health through
happiness’’ some ways that can be used to further happiness that are not yet part of
public health policy.

3.1

Spearheads of preventive health care

Preventive health care operates at different levels, at the micro-level of individual
citizens, at the meso-level of social institutions and at the macro-level of nations.

Healthy happiness 459

123

At the level of individuals, illness is prevented by means of inoculation programs
and by providing periodical health checks for categories such as new-borns and
school children. Next there are attempts to raise awareness of health treads via
health education, common themes of which today are that we should take more
physical exercise, stop smoking, drink moderately, eat healthy and have safe sex.

At the level of institutions health policy is aimed at reducing disease-producing
conditions in the work and living environment. The emphasis is on regulations, for
instance rules for safety in working places, hygiene in restaurants and sewage sys-
tems in cities. The observance of such rules is enforced by controls, i.e. fines for non-
compliance or the closing down of building sites. Adherence is also encouraged by
providing information.

At the level of nations public health is also protected in several ways, such as by
keeping people with infectious diseases out of the country, preventing pollution with
noxious chemicals and mandatory safety controls of food and consumer commodi-
ties. Health protection is also an issue in wider policies. For instance one of the
objectives of social security schemes is to prevent health damage resulting from
(child) poverty.

It is hard to say how effective each of these policies is, but together they seem to
contribute substantially to public health. Life expectancy doubled in the last century
and is still rising and this gain is at least partly due to public health policies (Van-
derMaas, 1989).

3.2

Fit with pursuit of greater happiness for a greater number

These improvements in physical health are likely to contribute to happiness, though
as we have seen above, the effects of health on happiness are typically small. Does
preventive health care otherwise add to happiness? Let us consider the possible
effects at each of the levels discussed here.

3.2.1

Healthy lifestyle and happiness

It is not likely that inoculation programs and health screenings will have an inde-
pendent effect on happiness. However, it is possible that life-style education has. It
could be that a healthy life-style is more enjoyable irrespective of its add-on physical
health, e.g. that taking regular exercise makes life more satisfying anyway. However
it is also possible that healthy living is not particularly enjoyable and that health
educators typically try to make us do things that we do not like. What do the
available data tell us?

Physical exercise Sportive people tend to be somewhat happier than non-sportive
people, and the difference appears to be independent of age, marital status and
physical health (Schulz, 1985). There are indications of a causal effect, in particular
the effects of jogging on mood (Biddle, 2000). In this case there is synergy between
the promotion of health and happiness

Smoking Moderate smokers appear to be no less happy than non-smokers, but heavy
smokers are. There are indications for a causal effect of happiness on smoking, a
follow-up among American adolescents showing that earlier unhappiness predicts
later smoking (Bachman, O’ Malley, & Johnson, 1978), but in a recent follow-up in
Russia, happiness appeared not to predict starting or stopping smoking (Graham,
Eggers, & Sukhatankar, 2004, p. 18). The available data do not tell us whether

460 R. Veenhoven

123

smoking cuts back on happiness irrespective of health. So, for the time being, we
cannot rule out the possibility that smoking affect health negatively but happiness
positively, hence we are not sure that synergy exists on this point.

Drinking Moderate drinkers appear to be happier than teetotallers, the optimum
being one or two units of alcohol a day (Ventegodt, 1995, pp. 180–184). As in the
case of smoking, heavy drinkers are less happy, that is people who drink five or more
units of alcohol per day. The only indication of causality is found in a five-year
follow-up in Russia, in which an increase in drinking appeared to be associated with
a decline of happiness. Unfortunately the amounts of alcohol involved are not re-
ported (Graham et al., 2004). As in the foregoing case we cannot rule out that heavy
drinking may be worse for your health than for your happiness. Only in the case
problem drinking is there a clear synergy.

Eating There is a lot of research into the effects of nutrition on physical health, but
hardly any research into the effects of diet on happiness. Analysis of a health-survey
in the Netherlands showed no relationship between intake of unhealthy food-stuffs
(sugar, fats) and happiness, nor with healthy food (fruit), while consumption of meat
and dairy-products was slightly positively correlated with happiness (Aakster, 1972).
In a study carried out in Denmark the researcher observed that people who often eat
fast foods tend to be somewhat less happy (Ventegodt, 1995). In both cases the
correlations could be spurious or be due to a causal effect of happiness on food
preference rather than the converse. There is not much research either on the effects
of how much one eats on happiness. The available data suggest that being slightly
overweight does not depress happiness, people with Body Mass Index between 25
and 30 being happiest (Ventegodt, 1995, pp. 232–234). Yet again we lack data on
cause and effect. All in all, no clear synergy has been found as yet.

3.2.2

Healthy living environment and happiness

At the institutional level preventive healthcare deals primarily with physical aspects
of the living environment, such as proper sewage, removal treatment, providing
clean air and standards that must be met for electrical appliances or that detail what
constitutes safe stairways. Does this also add to happiness? There is a correlation
between quality of housing and happiness, independent of marital state and social
class (World Database of Happiness, Correlational findings on Happiness and Living
environment, Veenhoven, 2006b). Causality is probable, but not proven as yet. The
same holds for working conditions, though we know a lot about the effects of
working conditions on health, we are still largely in the dark about the effects of
working conditions on happiness.

3.2.3

Sane society and happiness

At the societal level an important spearhead of preventive health care is the control
of infectious diseases in the country. This will certainly add to public health, but is
unlikely to involve an independent effect on happiness. Another aim is to reduce of
accidents in road traffic and workplaces. In this case synergy is more likely, since
comparative research has shown a strong negative correlation between mortality
from accidents and average happiness (Veenhoven, 1996, p. 34). Causality is likely,
but not proven as yet; the correlation can also be due to a greater degree of accident
proneness in unhappy countries.

Healthy happiness 461

123

As noted above, considerations of health also play a role in wider social policies
such as social security arrangements. Contrary to common expectation, there
appears to be no relationship between spending on social security and health out-
comes in nations, nor a relationship with happiness (Veenhoven, 2000a). So in this
case there is again no synergy.

All in all, it is clear that not all health promotions are likely to further happiness as
well. As yet this seems to be the case only for policies that aim at promoting exercise
and preventing problem drinking and accidents. This applies to policies that aim at
physical health. Synergy may be greater for preventive mental health care.

4

Furthering health through happiness

Because happiness adds to physical health, health can also be furthered by policies
that make people happier in the first place. What policies can we think of? Below are
some proposals for each of the three levels discussed above.

4.1

Helping individuals to live happier

Happiness can be furthered at the individual level by (1) information (2) training
and (3) guidance. This approach is particularly useful in modern nations, where the
environmental conditions are typically so good that most of the variance in happi-
ness is due to individual differences.

4.1.1 Evidence-based happiness advice
Happiness depends to some extent on the choices we make in life, in particular in
modern ‘multiple-choice societies’. Life-choices are for the most part based on ex-
pected happiness, for instance we typically choose a profession we think we will like.
Economists call this ‘expected utility’, or ‘decision utility’, and acknowledge that this
may differ from later ‘experienced utility’, because decisions are mostly made on the
basis of incomplete information. An example of mal-informed choice is the decision
to accept a higher paying job that requires more commuting. People typically accept
such jobs in the expectation that the extra money will compensate for the travel
time, but follow-up research has shown that they are mostly wrong, and that hap-
piness tends to go down in such cases (Frey, 2004).

Research of this kind can help people to make more informed choices. Though
there is no guarantee that things will pan out in the same way for you, it is still useful
to know how it has worked out for other people in the recent past. Such research is
particularly useful if it concerns similar people.

This policy does not involve paternalism; it does not push people into a particular
way of life, but it provides them with information for making a well-informed
autonomous decision. Paternalism would only be involved if research is manipulated
or its results communicated selectively. For instance if the observed negative effect
of parenthood on happiness is disguised (World Database of Happiness, Correla-
tional findings on happiness and Having Children, Veenhoven, 2006b).

This approach to the furthering of happiness is similar to current evidence based
health-education. As in the case of happiness, we are often not sure about the
consequences of life-style choices on our health. How much drinking is too much? Is

462 R. Veenhoven

123

eating raw vegetables really good for your health? We cannot answer such question
on the basis of our own experience and common wisdom is often wrong. Hence we
increasingly look to the results of scientific studies that provide us with ever more
information.

As yet, the information basis for such a way of furthering happiness is still small.
Although there is a considerable body of research on happiness, this research is
typically cross-sectional and does not inform us about cause and effect. What we
need is panel data that allow us to follow the effects of life-choices over time. Still
another problem is that current happiness research deals mainly with things over
which we have little control, such as personality and social background. What we
need is research on things we can choose, for example, working part-time or fulltime
or raising a family or not.

Once such information becomes available, it will quickly be disseminated to the
public, though the lifestyle press and the self-help literature. It can also be included
in organized health-education, broadened to become education for ‘living well’. The
problem is not in the dissemination of knowledge, but in the production of it.

4.1.2

Training techniques for art-of-living

Happiness depends heavily on various skills for living, such as realism, determina-
tion, social competence and having some resilience. Consequently, improving such
skills can further an individual’s happiness.

As yet, such attempts focus typically on repairing skill-deficits, for instance psy-
chotherapy in case of unrealistic beliefs and empowerment trainings for sub-asser-
tive individuals. Many of the interventions are provided in the context of mental
health care and are often paid for by health insurers. This supply caters to the
unhappiest part of the population. Recently there has also been a rise in techniques
that aim at to strengthen the life-skills of people without problems, in particular the
‘Positive Psychology’ movement (Seligman & Csikszentmihalyi, 2000). There is less
institutional support for such ‘positive training’, but the potential audience is much
greater.

In this context it would be worthwhile to invest in the development of training
that focus on the art of living. ‘Art-of-living’ is the knack of leading a satisfying life,
and in particular, the ability to develop a rewarding life-style (Veenhoven, 2003).
This involves various aptitudes, some of which seems to be susceptible to
improvement using training techniques. Four of these aptitudes are: (1) the ability to
enjoy, (2) the ability to choose, (3) the ability to keep developing and (4) the ability
to see meaning.

Learning to enjoy The ability to take pleasure from life is partly in-born (trait
negativity–positivity), but can to some extent be cultivated. Learning to take plea-
sure from life was part of traditional leisure-class education, which emphasized
prestigious pleasures, such as the tasting of exquisite wines and the appreciation of
difficult music. Yet it is also possible to develop an enjoyment of the common things
in life, such as breakfast or watching the sunset. Training in savoring simple plea-
sures is part of some religious practices.

Hedonistic enjoyment is valued in present day modern society and figures
prominently in advertisements. Yet techniques that help us to gain the ability to
enjoy are underdeveloped. There are no professional enjoyment trainers, at least no
trainers aiming at improving our general level of enjoyment. There is professional

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123

guidance for specific types of pleasures, such as how to appreciate fine arts and often
the main goal is to sell a particular product.

Still it would seem possible to develop wider enjoyment training techniques. One
way could be to provide training in ‘attentiveness’, possibly using meditation tech-
niques. Another option could be the broadening of one’s repertoire of leisure
activities, which could link up with expertise in various stimulation programs. A
third way could be looking at ways to remove inner barriers to enjoy, which could be
linked to clinical treatment of a-hedonie.

Learning to choose As mentioned above, happiness depends also the choices one
makes in life and hence also on one’s ability to choose. The art-of-choosing involves
several skills.

One such skill is getting to know what the options are. This aptitude can be
improved by learning and this is one of the things we do in consumer education.
Expertise in this field can be used for training in the charting of wider life options.

Another requirement is an ability to estimate how well the various options would
fit one’s nature. This requires self knowledge and that is also something that can be
improved, self-insight being a common aim in training and psychotherapy.

Once one knows what to choose, there is often a problem of carrying through. This
phase requires aptitudes such as perseverance, assertiveness and creativity, all of which
can be strengthened and are in fact common objectives in vocational trainings.

The next step in the choice process is assessing the outcomes, in term of the
above-mentioned distinction, assessing whether ‘expected utility’ fits ‘experienced
utility’. This phase calls for openness to one’s feelings and a realistic view on one’s
overall mood pattern. Training in mood monitoring is common practice in psycho-
therapy and could possibly be improved using computed based techniques of
experience sampling.

The problem is not so much to develop such training techniques, but to separate
the chaff from the corn. That will require independent effect studies. Once such
techniques have been proven to be effective a market will develop.

Learning to grow Happiness depends largely on the gratification of basic needs, and
an important class of needs is ‘growth-needs’ (Maslow, 1954), also referred to as
‘functioning needs’ or ‘mastery needs’. These needs are not restricted to higher
mental functions but also concern the use and development of the body and senses. In
animals, the gratification of these needs is largely guided by instinct, but in humans it
requires conscious action. Cultures typically provide standard action-patterns for this
purpose, such as providing for vocational career scripts or artistic interests but people
must also make choices of their own, in particular in multiple-choice societies. Failure
to involve oneself in challenging activities may lead one into diffuse discontent or
even depression, this for example happens regularly after retirement from work. Thus
another art-of-living is to keep oneself going and developing.

Intervention would also seem possible in this case. Mere information will prob-
ably be useful and one can also think of various ways to get people going. Once again
training techniques can build on available experience, in this case experience in
various activation programs. There is already an ample supply of ‘growth trainings’
on the peripheries of psychology but as yet little evidence for the effectiveness of
such interventions and certainly no proof of long term effects on happiness.

464 R. Veenhoven

123

Helping to see meaning Probably, but not certainly, happiness also depends on one
seeing meaning in one’s life. Though it is not sure that we have an innate need for
meaningfulness as such, the idea of it provides at least a sense of coherence. Seeing
meaning in one’s life requires that one develops a view of one’s life and that one can
see worth in it. These mental knacks can also be strengthened and possible one can
also learn to live with the philosophical uncertainties that surround this issue. There
is experience on this matter in existential counseling and in practices such as ‘life-
reviewing’ (Holahan, Holahan, & Wonacott, 1999) and ‘logo-therapy’ (Frankl,
1946). As far as I know, the impact of such interventions on happiness has yet to be
investigated.

4.1.3

Professional life-counseling

If we feel unhealthy we go to a medical general practitioner, who makes a diagnosis
and either prescribes a treatment or refers us to a medical specialist. If we feel
unhappy, there is no such generalist. We have to guess about the possible causes
ourselves and on that basis consult a specialist who may be a psychologist, a mar-
riage counselor or a lawyer. Professional guidance for a happier life is unavailable as
yet. This is a remarkable market failure, given the large number of people who feel
they could be happier.

The size of the demand is reflected in the booming sales of self-help books and the
willingness to pay for things that promise greater happiness, such as cosmetic surgery
and second homes. The main reason is probably that the knowledge basis for such a
profession is still small and that trust in happiness counseling is undermined by the
many quacks operating in this area.

Still there seems to be a future for professional counseling for a happier life and
for related life coaching and trainings. There is demand for such services, but as yet
no proper supply. Much can be gained by developing that supply. One of the ways is
to stimulate the professionalization of current activities in that area, amongst other
things by following people who use such services to establish what interventions add
to happiness or do not. The development of professional life counseling could also
profit from the above-advised research into long-term changes in happiness fol-
lowing major life-choices.

4.2

Improving the livability of institutions

Happiness depends further on environmental factors, amongst which the residential
conditions in which we live and the organizational context in which we work or get
educated.

There is a lot of research on residential preferences but amazingly little research
into the effects of residential conditions on happiness. Research is driven by the wish
to sell and the focus is therefore on expected utility rather than on experienced
utility. As a result, there is as yet no solid evidence base for promoting happiness at
the local level and decision making is still dominated by mere beliefs.

We find more research in the field of work organization, in particular a consid-
erable body of literature on job-satisfaction. Yet job-satisfaction does not always
coincide with life-satisfaction and this literature leaves us largely in the dark about
cause and effect. There is also a large literature on the negative effects of work-
conditions, such as professional injuries and burnout, but this literature is largely
blind for positive effects. As a result there is as no good evidence base for happiness

Healthy happiness 465

123

promotion in this field either. The same holds for schools. We know a lot about the
exam results produced by educational institutions, but hardly anything about their
impact on long-term happiness.

4.3

Improving the livability of society

Happiness also depends on the macro-social conditions in which one lives and in this
case we can build on a better evidence base. Comparative research has revealed wide
differences in average happiness across nations, scores on a 0–10 step scale ranging
from 8.2 in present day Denmark to 3.2 in Tanzania (Veenhoven, 2005). There is a
clear pattern in these differences. About 83% of the variation in average happiness
can be explained by ‘hard’ country characteristics, such as economic development,
political democracy and rule of law (Veenhoven & Kalmijn, 2005, p. 436). What do
these data tell us about the possibilities to create greater happiness for a greater
number?

Material wealth People live happier in rich countries than in poor countries, the
correlation between average happiness and buying power per head is +.66! The
relationship is not linear, but follows a pattern of diminishing returns. Growth in
material wealth adds little to happiness once the buying power per head is more than
$ 10.000 per year. So, economic development adds most to happiness in poor
countries.

Political democracy People also live happier in democratic countries. The correla-
tion is less strong in this case (r = +.43), but follows a linear pattern, suggesting that
happiness can also be advanced by further democratization in already democratic
countries. This deduction is supported by the fact that in democratic and happy
Switzerland happiness appears to be highest in the cantons where the threshold for
referenda is lowest (Frey & Stutzer, 2000).

Freedom Likewise, people live happier in free countries. This holds for three kinds
of freedom: economic freedom, political freedom and freedom in the private sphere
of life. Economic freedom appears to be most important for happiness in poor
nations and private freedom in rich nations (Veenhoven, 2000b). The relationship is
again linear, suggesting that the saturation point has not yet been reached in the
present day world.

Governance Comparative research has also revealed that happiness prospers in well-
governed countries. There are strong correlations with rule of law (r = +.53) and
government effectiveness (r = +.60). These relationships are largely independent of
economic development and appear in all regions of the world (Ott, 2006).

This all suggests that greater happiness for a greater number can be achieved by
policies that aim at a decent material standard of living, the fostering of freedom and
democracy and good governance.

466 R. Veenhoven

123

5

Conclusions

Happy people live longer, probably because happiness protects physical health. If so,
public health can be furthered by policies that aim at greater happiness of a great
number. Current public health policies seem only to affect happiness marginally.

Happiness can be advanced in several ways: At the individual level happiness
can be furthered by means of (1) providing information about consequences of
life-choices on happiness, (2) training in art-of-living skills, and (3) professional
life-counseling. At the level of society greater happiness for a greater number can be
achieved by policies that aim at a decent material standard of living, the fostering of
freedom and democracy and good governance.

Evidence based happiness engineering requires more research.

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• Healthy happiness: effects of happiness on physical health and the consequences for preventive health care

Abstract

• The issue

Effects of happiness on physical health: A review of the research literature
Correlational studies
Follow-up studies on effect of health on happiness
Follow-up studies on effect of happiness on health, in particular longevity
Happiness and longevity in sick people

• Tab1

Tab1
Happiness and longevity in healthy populations
How could happiness protect physical health?

• Tab2

Tab2
Tab2
Implications for preventive health care: An exploration
Spearheads of preventive health care
Fit with pursuit of greater happiness for a greater number
Healthy lifestyle and happiness
Healthy living environment and happiness
Sane society and happiness
Furthering health through happiness
Helping individuals to live happier

• Evidence-based happiness advice

Training techniques for art-of-living
Professional life-counseling
Improving the livability of institutions
Improving the livability of society
Conclusions
References

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