The well-being of Australian adolescents and young adults with self-reported long-term health conditions, impairments or disabilities: 2001 and 2006.
Abstract: As noted in the preamble to the 2007 UN Convention on the Rights of Persons with Disabilities, 'persons with disabilities continue to face barriers in their participation as equal members of society and violations of their human rights in all parts of the world'. In this paper we present nationally representative data on the nature and level of disadvantage faced by young Australians with a long-term health condition, impairment or disability in 2001 and 2006. The results suggest that: (1) when compared with their non-disabled peers, young Australians with a long-term health condition, impairment or disability face pervasive social and material hardship and have lower subjective well-being; (2) no progress was made between 2001 and 2006 in equalising the opportunities of young Australians with a long-term health condition, impairment or disability; (3) lower subjective well-being is not inherently associated with disability, but is contingent on the experience of social exclusion and material hardship.

Keywords: disability, quality of life, discrimination
Article Type: Report
Subject: Disabled youth (Social aspects)
Quality of life (Analysis)
Authors: Emerson, Eric
Honey, Anne
Madden, Ros
Llewellyn, Gwynnyth
Pub Date: 09/22/2009
Publication: Name: Australian Journal of Social Issues Publisher: Australian Council of Social Service Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2009 Australian Council of Social Service ISSN: 0157-6321
Issue: Date: Autumn, 2009 Source Volume: 44 Source Issue: 1
Topic: Event Code: 290 Public affairs
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 203535846
Full Text: Introduction

Indicators of 'well-being' are increasingly employed to monitor social progress, including progress to reduce socially determined inequalities in the life chances or opportunities of disadvantaged or vulnerable groups. As such, they are central to evaluating the impact of social policies that seek to support the equalisation of opportunities for people with disabilities. As noted in the preamble to the 2007 UN Convention on the Rights of Persons with Disabilities, 'persons with disabilities continue to face barriers in their participation as equal members of society and violations of their human rights in all parts of the world'. There exists ample evidence to support such an assertion (Australian Institute of Health and Welfare, 2004; Elwan, 1999; Emerson, Fujiura, & Hatton, 2007; Groce, 2003; UNICEF, 2007b).

Contemporary approaches to the measurement of well-being reflect two distinct traditions: (1) social indicators of the conditions under which people live their lives; and (2) subjective indicators of peoples' appraisal of their living situation (including overall measures of subjective well-being or happiness) (Sirgy, et al., 2006).

The value of social indicators is dependent on there being some consensus on: (1) what constitutes a 'good life' or a 'good society'; and (2) which are the most important resources and conditions that enable people to pursue a 'good life'(Diener & Suh, 1997; Grasso & Canova, 2008). Increasing attention has been paid over recent years to the conceptual frameworks used to guide the selection and development of social indicators. These frameworks have included the capabilities framework of Sen and Nussbaum, (Anand, Hunter, & Smth, 2005; Burchardt, 2008; Headey, 2006a; The Equalities Review, 2007), the Scandinavian level of living approach, (Grasso & Canova, 2008) and, more recently, the use of normative frameworks based on human rights instruments to define the social conditions that constitute a good society (Australian Research Alliance for Children and Youth, 2008; Bradshaw, Hoelscher, & Richardson, 2007; Emerson, Honey, & Llewellyn, 2008; UNICEF, 2007a). For example, Emerson and colleagues selected social indicators based on the UN Convention on the Rights of Persons with Disabilities to characterise the well-being of Australian adolescents and young adults with long-term health conditions, impairments or disabilities (Emerson, et al., 2008). Alternative frameworks for monitoring social progress generally and more specifically in relation to welfare have been developed by the Australian Bureau of Statistics (Australian Bureau of Statistics, 2006) and the Australian Institute for Health and Welfare (Australian Institute of Health and Welfare, 2005).

The use of subjective indicators of well-being to measure social progress is also gaining prominence (Cummins, Walter, & Woerner, 2007; Cummins, Woerner, et al., 2007; Edwards & Imrie, 2008). Indeed, it has been argued that subjective well-being (SWB) or happiness should be the yardstick with which to measure social progress (Layard, 2005). Unfortunately, the association between social indicators of living conditions and SWB is neither simple nor strong. As such, choice of approach will have profound implications for the conclusions that may be drawn regarding the equalisation of opportunity for disadvantaged or vulnerable groups.

Early research suggested that, within the general population, there was only a weak association between social indicators and SWB (Argyle, 1999; Diener, Suh, Lucas, & Smith, 1999; Easterlin, 2003; Kahneman, Diener, & Schwarz, 1999; Ryan & Deci, 2001; Sirgy, et al., 2006). It also drew attention to the 'paradoxically high' SWB of what may be considered to be particularly disadvantaged groups, including people with significant disabilities (Albrecht & Devlieger, 1999). These (and other) observations led to the development of 'set point' models of SWB that placed primary emphasis on the role of genetic, personality and cognitive variables in establishing a set point for SWB with adaptive or homeostatic processes ensuring that, unless overwhelmed by external events, SWB remains close to that set point (Brickman & Campbell, 1971; Carver & Scheier, 1990; Cummins, 2003; Frederick & Loewenstein, 1999; Headey & Wearing, 1989; Lykken & Tellegen, 1996).

The relative insensitivity of SWB to living conditions does present major problems for the use of SWB in evaluating the impact of social policies that seek to support the equalisation of opportunities for marginalised groups. As the Nobel Laureate Amartya Sen has argued 'Concentrating exclusively on mental characteristics (such as pleasure, happiness or desires) can be particularly restrictive when making interpersonal comparisons of well-being ... Our desires and pleasure-taking abilities adjust to circumstances, especially to make life bearable to adverse situations ... deprived people tend to come to terms with their deprivation because of the sheer necessity of survival, [as such] ... the deprivation of the persistently deprived may look muffled and muted" (Sen, 2001).

However, more recent evidence has forced a re-evaluation of these models. Specifically, research using longitudinal data suggesting that SWB may be more sensitive to objective life conditions than was originally thought, that long-term levels of SWB do change and that adaptation to changing situations is not inevitable (Diener, Lucas, & Scollon, 2006; Headey, 2006b, 2008; Headey, Muffels, & Wooden, 2008; Lucas, 2007a, 2007b). For example, recent data suggests that the onset of disability in adulthood is associated with marked declines in SWB with no evidence of adaptation over a follow-up period of up to seven years (Krause, 1997; Lucas, 2007a, 2007b), although the impact of the onset of disability in later life may be buffered (moderated) by wealth (Smith, Langa, Kabeto, & Ubel, 2005).

In addition, there is increasing evidence that people with disabilities do have lower SWB than their non-disabled peers although the effect is often not large (Albrecht & Devlieger, 1999; Dijkers, 1997; Emerson & Hatton, 2008; Lucas, 2007b; Mehnert, Krauss, Nadler, & Boyd, 1990), and that variation in SWB among people with disabilities is related to such factors as age, severity, timing and nature of disability, employment status, the experience of poverty and material hardship, immigration status, social support, spirituality, personality factors (e.g., having a sense of control) and psychological coping styles (Albrecht & Devlieger, 1999; Della Fave & Massimini, 2005; Emerson & Hatton, 2008; Livneh, Lott, & Antonak, 2004; Mehnert, et al., 1990; Uppal, 2006; Ville, Ravaud, & Tetragap Group, 2001).

The aims of the present paper are: (1) to extend the work of Emerson and colleagues by using indicators of well-being based on the UN Convention on the Rights of Persons with Disabilities to characterise change in the well-being of Australian adolescents and young adults with long-term health conditions, impairments or disabilities between 2001 and 2006; (2) to explore the interactions between disability status, living conditions and SWB among Australian adolescents and young adults in 2006. The later analyses will be informed by the general theoretical framework arising from the study of resilience (Luthar, 2003), which suggests that the impact of a potential adversity (in this case disability) will be moderated by the personal, social and community resources available to the person (Smith, et al., 2005). As such, our analyses will specifically explore the extent to which SWB is predicted by the interaction between disability status and indicators of living conditions.

Method

Our results are based on a secondary analysis of data extracted from Waves 1 (2001) and 6 (2006) of the survey of Household Income and Labour Dynamics in Australia (HILDA: http://melbourneinstitute.com/hilda/). Full details of HILDA are available in a series of technical reports and annual reports (Headey, Warren, & Harding, 2006; HILDA, 2006; Watson, 2008). Briefly, HILDA is a panel survey originating from a national probability sample of approximately 7,500 Australian households in 2001 (Wave 1). Continuing panel members include all panel members of Wave 1 households, any children subsequently born to or adopted by panel members and all new entrants to a household who have a child with an existing panel member. In addition, information is collected on temporary panel members (people who share a household with a continuing panel member in wave 2 or later) as long as they share a household with a continuing panel member. All household members aged 15 or above are invited to participate in a personal interview.

Identification of Participants with a Self-Reported Long-term Health Condition, Impairment or Disability

Participants were identified as having a long-term health condition, impairment or disability if they answered in the positive to a question 'Do you have any impairment, long-term health condition or disability such as these [shown list] that restricts you in your everyday activities and has lasted or is likely to last for 6 months or more?'

Wave 1 data include interviews with 3,465 people in the age range 15-29. Of these, 528 (weighted prevalence 14.8%) identified themselves as having a long-term health condition, impairment or disability. Wave 6 data include interviews with 3,392 people in the age range 15-29. Of these, 509 (weighted prevalence 14.0%) identified themselves as having a long-term health condition, impairment or disability. The difference between the prevalence rates in 2001 and 2006 is not statistically significant.

Basic demographic characteristics of the sub-samples of participants are presented in Table 1.

Indicators

We used the UN Convention on the Rights of Persons with Disabilities to identify potential domains of well-being and then identified items contained within HILDA that could be employed as indicators of well-being within these domains in both 2001 and 2006. A list of the indicators and information on their derivation is presented in Table 2. In identifying indicators of well-being we followed contemporary practice by identifying living conditions, experiences or behaviours that may plausibly related to low well-being in that specific domain (Australian Research Alliance for Children and Youth, 2008; Bradshaw, et al., 2007; Emerson, et al., 2008; UNICEF, 2007a). Thus, for example, daily use of tobacco was included as an indicator of poorer well-being in the domain of health due to the extensive evidence of health risks associated with regular tobacco use.

In addition, we extracted data on a general indicator of subjective

well-being; self-reported life satisfaction (a single item 11 point rating scale). From this we derived two indicators of SWB: (1) a normalised SWB score; (2) a binary indicator of low SWB (score < 7 on 11 point rating scale) (Cummins, 2003).

Approach to Analysis

All analyses were undertaken on data weighted to correct for cross sectional unit non response. Analyses of the relationships between hardship, social support and SWB were undertaken on 2006 data.

Results

Detailed results are presented in Table 2. In summary, there were statistically significant differences between adolescents and young adults who reported having a long-term health condition, impairment or disability and their peers on 23/29 (79%) of indicators in 2001 and 21/29 (72%) indicators in 2006. The difference between these proportions is not statistically significant. In no instance was the difference on a specific indicator statistically significant between 2001 and 2006.

When statistically significant differences were found, adolescents and young adults who reported having a long-term health condition, impairment or disability were more disadvantaged than their peers with one exception. In 2006, adolescents and young adults who reported having a long-term health condition were more likely to have and be looking after children than their peers.

Non-significant change in a positive direction (less inequality over time between the two groups) occurred for 14/24 (58%) of the indicators in which there were significant between-group differences in at least one point in time. The difference between positive (58%) and negative (42%) change is not statistically significant.

There were, however, some interesting and potentially important trends within these results. First, while both groups reported higher levels of satisfaction in belonging to their local community in 2006, this change was more marked for participants who reported having a long-term health condition, impairment or disability. The between-group differences, while highly statistically significant in 2001 (p<0.001), were no longer statistically significant in 2006. At the same time, actual participation in community-based organizations declined among both groups (and more markedly among participants who reported having a long-term health condition, impairment or disability). Second, both groups experienced improvements in the quality of the neighbourhoods in which they were living (as measured by both the Socio-Economic Indexes for Areas for Australia (SEIFA) (Pink, 2008) and self-reported problems with hostility, crime and safety). However, the improvements in reported neighbourhood safety were more marked among participants who did not report having a long-term health condition, impairment or disability.

The Association between Disability, Hardship, Social Support and Subjective Well-Being

We explored the relationship between disability, hardship, social support and our two indicators of SWB; normalised scale score and scoring within the 'low' range for SWB. The results of our analysis of normalised SWB score (Table 3) indicated that SWB was significantly lower for people with a self-reported long-term health condition, illness or disability (p<0.001), people living in hardship (p<0.001) and people with lower levels of social support (p<0.001). The results also indicated that there were significant interaction effects between disability status and social support (p=0.001) and between disability status and hardship (p<0.001). In order to understand these interaction effects, we plotted the average normalised SWB scores for all relevant groups (figure 1). Inspection of these data indicates that: (1) under conditions of low hardship and high social support there are no differences in the mean SWB of participants with/without disability; (2) under conditions of either low hardship and low support or high hardship and high support there are moderate differences in the mean SWB of participants with/without disability; (3) under conditions of high hardship and low support there are very marked difference in the mean SWB of participants with/without disability.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

The results of our analysis of low SWB (Table 4) also indicated that low SWB was significantly more likely among people with a self-reported long-term health condition, illness or disability (p<0.001), people living in hardship (p<0.001) and people with lower levels of social support (p<0.001). Again, the analysis (using logistic regression with backward stepwise conditional variable removal from an initial model including disability status, hardship, social support and all two and three way interaction terms) indicated a significant interaction between disability status and hardship (p--0.006). Inspection of group percentages (figure 2) indicates that: (1) under conditions of low hardship and high social support there are no differences in the percentage of participants with low SWB by disability status (OR = 1.36, 95%CL 0.63-2.93, n.s.); (2) under conditions of low hardship and low support there are moderate effect sizes and statistically significant differences in the percentage of participants with low SWB by disability status (OR = 1.81, 95%CL 1.05-3.12, p=0.041); (3) under conditions of high hardship and high support there are also moderate effect sizes for the differences in the percentage of participants with low SWB by disability status, although the difference is not statistically significant (OR = 2.00, 95%CL 0.98-4.01, p=0.059); (4) under conditions of high hardship and low support there are large and statistically significant differences in the percentage of participants with low SWB by disability status (OR = 3.17, 95%CL 1.96-5.13, p<0.001).

Conclusions

The results of these simple comparisons attest to the level of disadvantage currently faced by Australian adolescents and young adults with a self-reported long term health condition, disability or impairment. Overall they are significantly more likely than their peers to be socially isolated, excluded from the labour force, have fewer educational qualifications, experience poverty and hardship, live in poorer neighbourhoods, have poorer health and be less satisfied with their lives. While the link between long-term health condition, disability or impairment and health may not be surprising, it would be wrong to view this association simply in terms of it being an inevitable consequence of peoples' impairments. Low standard of living, unemployment, poor education and social isolation have all been identified as important social determinants of health (Marmot, 2005; Marmot & Wilkinson, 2006; Wilkinson, 2005; World Health Organisation, 2008). As such, young Australians with a long term health conditions, disability or impairment are much more likely than their peers to live under conditions that are known to place peoples' health and well-being in jeopardy.

The data reported here provide no evidence to suggest that the extent of disadvantage faced by Australian adolescents and young adults with a self-reported long term health condition, disability or impairment diminished over the five year period between 2001 and 2006. These data are consistent with previous analyses of ABS population survey data from 1998 and 2003 (Australian Institute of Health and Welfare, 2007a). This lack of progress must be of concern given that the Disability Discrimination Act 1992 makes discrimination on the grounds of disability unlawful, provides a mechanism for investigating and resolving individual complaints and provides a framework for setting standards in areas such as transport, building access, education, insurance and banking. The lack of progress may reflect the phased introduction of these standards. For example, education standards, which include requirements for the provision of 'reasonable adjustments' to enable a student with a disability to participate on the same basis as a student without disability, only came into effect in 2005.

Nevertheless, the data do suggest that, at a time of significant economic prosperity, existing Commonwealth, State and Territory government policies and services relating to disability, which typically use the language of rights and participation, failed in the first half decade of the 21st Century to redress the pervasive social and material disadvantage faced by Australian adolescents and young adults with a self-reported long term health condition, disability or impairment.

More recently, Australia has ratified the UN Convention on the Rights of Persons with Disabilities. Australian governments have also expressed their commitment to a National Disability Strategy. The commitment to ratification of the UN Convention and any evaluation of the impact of the proposed National Strategy will require the development of robust procedures for monitoring progress toward the equalisation of opportunities for people with disabilities. While existing data sources may need improvement, the present analysis nevertheless provides an example of the possibility of using them to contribute to this process.

The results relating to the relationship between disability status, social/emotional support, hardship and SWB add to the existing literature in two main ways. First, they support literature indicating that, overall, people with disabilities do have lower SWB than their non-disabled peers (Albrecht & Devlieger, 1999; Dijkers, 1997; Emerson & Hatton, 2008; Lucas, 2007b; Mehnert, et al., 1990). Second, and more importantly, they suggest that this difference may be contingent on the social and material conditions under which young people with disabilities are living. Under more advantageous living conditions (lower hardship combined with higher social support), there were no discernable difference in the SWB of young people with or without disabilities. As level of disadvantage increased, so did the strength of effects associated with disability status. While caution must be exercised in drawing causal inferences from such cross-sectional analyses, the data do suggest that low SWB is not inherently associated with disability and are consistent with approaches to social policy that focus on the environment of people with disabilities, and specifically address their experience of hardship and social support.

As always, the data and analyses reported in this paper do need to be treated with a degree of caution. As noted above, causal inferences cannot be derived from cross sectional data. Thus, for example, it is possible that the observed association between SWB and social support could reflect a general response bias (people who are less satisfied with their lives overall being less satisfied with their social support). In addition, while the sampling frame of the HILDA survey is certainly robust, the level of information available on impairment, functioning and disability is much less so. Indeed, the identification of disabled people within generic household surveys is problematic (Tossebro & Kittelsaa, 2004), with different question structures and formats producing quite divergent estimates of the prevalence of disability in working age populations (Bajekal, Harries, Breman, & Woodfield, 2004). As a result, different approaches to defining disability would have resulted in a different partitioning of the used sample. It is notable in the present analyses that the ascertained prevalence of 'disability' is greater than other Australian estimates (Australian Institute of Health and Welfare, 2007b). It is likely that this difference reflects the inclusion of self-reported long-term health conditions and impairments in the present analyses. It is notable, however, that these estimates are lower than some estimates from other high income countries (Bajekal, et al., 2004). Future research will be required to determine whether: (1) the substantive results of the present paper can be replicated in other samples; (2) more recent changes in policy and practice have an impact in reducing the level of social exclusion and material disadvantage faced by young Australians with a long-term health condition, impairment or disability.

Acknowledgment

'This paper uses unit record data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) and is managed by the Melbourne Institute of Applied Economic and Social Research (MIAESR). The findings and views reported in this paper, however, are those of the author and should not be attributed to either FaHCSIA or the MIAESR.'

References

Albrecht, G. L., & Devlieger, P. J. (1999). The disability paradox: high quality of life against all odds. Social Science & Medicine, 48, 977-988.

Anand, P., Hunter, G., & Smth, R. (2005). Capabilities and well-being: Evidence based on the Sen-Nussbaum approach to welfare Social Indicators Research, 74, 9-55.

Argyle, M. (1999). Causes and correlates of happiness. In D. Kahneman, E. Deiner & N. Schwarz (Eds.), Well-Being: The Foundations of Hedonic Psychology (pp. 353-373). New York: Russell Sage Foundation.

Australian Bureau of Statistics (2006). Measures of Australia's Progress 2006. Canberra: Australian Bureau of Statistics.

Australian Institute of Health and Welfare (2004). Children with Disabilities in Australia. Canberra: Australian Institute of Health and Welfare.

Australian Institute of Health and Welfare (2005). Australia's Welfare 2005. Canberra: Australian Institute of Health and Welfare.

Australian Institute of Health and Welfare (2007a). Australia's Welfare 2007. Canberra: Australian Institute of Health and Welfare.

Australian Institute of Health and Welfare (2007b). Young Australians: Their Health and Well-Being 2007. Canberra: Australian Institute of Health and Welfare.

Australian Research Alliance for Children and Youth (2008). Report Card: The Well-Being of Young Australians. Canberra: Australian Research Alliance for Children and Youth.

Bajekal, M., Harries, T., Breman, R., & Woodfield, K. (2004). Review of Disability Estimates and Definitions. London: HMSO.

Bradshaw, J., Hoelscher, P., & Richardson, D. (2007). An index of child well-being in the European Union. Social Indicators Research, 80, 133-177.

Brickman, P., & Campbell, D. T. (1971). Hedonic relativism and planning the good society. In M. H. Apley (Ed.), Adaptation-Level Theory: A Symposium (pp. 287-302). New York: Academic Press.

Burchardt, T. (2008). Monitoring inequality: Putting the capability approach to work. In G. Craig, T. Burchardt & D. Gordon (Eds.), Social Justice and Public Policy (pp. 205-229). Bristol: Policy Press.

Carver, C., & Scheier, M. (1990). Origins and functions of positive and negative affect: A control-process view. Psychological Review, 97, 19-35.

Cummins, R. (2003). Normative life satisfaction: Measurement issues and a homeostatic model Social Indicators Research, 64(2), 225-256.

Cummins, R., Walter, J., & Woerner, J. (2007). The Wellbeing of Australians --Groups with the highest and lowest wellbeing in Australia: Australian Unity Wellbeing Index Survey 16.1. Melbourne: Australian Centre on Quality of Life, Deakin University.

Cummins, R., Woerner, J., Tomyn, A., Gibson, A., Lai, L., & Collard, J. (2007). Australian Unity Wellbeing Index Survey 18" The Wellbeing of Australians--Changing conditions to make life better. Melbourne: Australian Centre on Quality of Life, Deakin University.

Della Fave, A., & Massimini, E (2005). The relevance of subjective well-being to social policies: Optimal experience and tailored intervention. In E A. Huppert, N. Baylis & B. Keverne (Eds.), The Science of Well-Being (pp. 379-402). Oxford: Oxford University Press.

Diener, E., Lucas, R. E., & Scollon, C. (2006). Beyond the hedonic treadmill: Revising the adaptation theory of well-being. American Psychologist, 61, 305-314.

Diener, E., & Suh, E. (1997). Measuring quality of life: Economic, social and subjective indicators. Social Indicators Research, 40, 189-216.

Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125, 276-302.

Dijkers, M. P. (1997). Quality of life after spinal cord injury: a meta analysis of the effects of disablement components. Spinal Cord, 35, 829-840.

Easterlin, R. A. (2003). Explaining happiness. Proceedings of the National Academy of Sciences, 100, 11176-11183.

Edwards, C., & Imrie, R. (2008). Disability and the implications of the wellbeing agenda: Some reflections from the United Kingdom. Journal of Social Policy, 37(3), 337-355.

Elwan, A. (1999). Poverty and Disability: A survey of the literature. Washington, DC: World Bank.

Emerson, E., Fujiura, G. T., & Hatton, C. (2007). International perspectives. In S. L. Odom, R. H. Horner, M. Snell & J. Blacher (Eds.), Handbook on Developmental Disabilities. New York: Guilford Press.

Emerson, E., & Hatton, C. (2008). The self-reported well-being of women and men with intellectual disabilities in England. American Journal on Mental Retardation, 113(2), 143-155.

Emerson, E., Honey, A., & Llewellyn, G. (2008). The Well-Being and Aspirations of Australian Adolescents and Young Adults with a Long-term Health Condition, Disability or Impairment Canberra: Australian Research Alliance for Children and Youth.

Frederick, S., & Loewenstein, G. (1999). Hedonic adaptation. In D. Kahneman, E. Deiner & N. Schwartz (Eds.), Well-Being: The Foundations of Hedonic Psychology (pp. 302-329). New York: Sage.

Grasso, M., & Canova, L. (2008). An Assessment of the Quality of Life in the European Union Based on the Social Indicators Approach. Social Indicators Research, 87(1), 1-25.

Groce, N. E. (2003). Adolescents and Youth with Disabilities: Issues & Challenges. Washington: World Bank.

Headey, B. (2006a). A framework for assessing poverty, disadvantage and low capabilities in Australia. Melbourne: Melbourne Institute of Applied Economic and Social Research, University of Melbourne.

Headey, B. (2006b). Subjective well-being: revisions to dynamic equilibrium theory using national panel data and panel regression methods. Social Indicators Research, 79, 369-403.

Headey, B. (2008). The Set-Point Theory of Well-Being: Negative Results and Consequent Revisions. Social Indicators Research, 85, 389-403.

Headey, B., Muffels, R., & Wooden, M. (2008). Money Does not Buy Happiness: Or Does It? A Reassessment Based on the Combined Effects of Wealth, Income and Consumption. Social Indicators Research, 87(1), 65-82.

Headey, B., Warren, D., & Harding, G. (2006). Families, Incomes and Jobs: A Statistical Report of the HILDA Survey. Melbourne: Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.

Headey, B., & Wearing, A. (1989). Personality, life events and subjective well-being: toward a dynamic equilibrium model. Journal of Personality and Social Psychology, 57, 731-739.

HILDA (2006). HILDA Survey Annual Report 2006. Melbourne: Melbourne Institute of Applied Economic and Social Research, University of Melbourne.

Kahneman, D., Diener, E., & Schwarz, N. (Eds.). (1999). Well-Being: The Foundations of Hedonic Psychology. New York: Russel Sage Foundation.

Krause, J. (1997). Adjustment after spinal cord injury: A 9 year longitudinal study. Archives of Physical Medicine & Rehabilitation, 78, 651-657.

Layard, R. (2005). Happiness: Lessons from a New Science London: Penguin.

Livneh, H., Lott, S. M., & Antonak, R. E (2004). Patterns of psychosocial adaptation to chronic illness and disability: a cluster analytic approach. Psychology, Health & Medicine 9(4), 411-430.

Lucas, R. E. (2007a). Adaptation and the set-point model of subjective well-being. Current Directions in Psychological Science, 16(2), 75-79.

Lucas, R. E. (2007b). Long-Term Disability Is Associated With Lasting Changes in Subjective Well-Being: Evidence From Two Nationally Representative Longitudinal Studies. Journal of Personality and Social Psychology, 92(4), 717-730.

Luthar, S. S. (Ed.). (2003). Resilience and Vulnerability: Adaptation in the Context of Childhood Adversities. Cambridge: Cambridge University Press.

Lykken, D., & Tellegen, A. (1996). Happiness is a stochastic phenomenon. Psychological Science, 7, 186-189.

Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365, 1099-1104.

Marmot, M., & Wilkinson, R. G. (Eds.). (2006). Social Determinants of Health (2nd ed.). Oxford: Oxford University Press.

Mehnert, T., Krauss, H., Nadler, R., & Boyd, M. (1990). Correlates of life satisfaction in those with disabling conditions. Rehabilitation Psychology, 35(1).

Pink, B. (2008). Socio-Economic Indexes for Areas (SEIFA): Technical Paper. Canberra: Australian Bureau of Statistics.

Ryan, R. M., & Deci, E. L. (2001). On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology, 52, 141-166.

Sen, A. (2001). Development as Freedom. Oxford: Oxford University Press.

Sirgy, M. J., Michalos, A. C., Ferriss, A. L., Easterlin, R. A., Patrick, D., & Pavot, W. (2006). The quality of life research movement: Past, present and future Social Indicators Research, 76, 343-466.

Smith, D. M., Langa, K. M., Kabeto, M. U., & Ubel, P. A. (2005). Health, Wealth, and Happiness: Financial Resources Buffer Subjective Well-Being After the Onset of a Disability. Psychological Science, 19(9), 663-666.

The Equalities Review (2007). Fairness and Freedom: The Final Report of the Equalities Review. London: The Equalities Review.

Tossebro, J., & Kittelsaa, A. (2004). Studying the living conditions of disabled people: Approaches and problems. In J. Tossebro & A. Kittelsaa (Eds.), Exploring the Living Conditions of Disabled People (pp. 17-44). Lund, Sweden: Studentlitteratur.

UNICEF (2007a). Child Poverty in Perspective: An overview of child well-being in rich countries. Florence: Unicef Innocenti Research Centre.

UNICEF (2007b). Promoting the Rights of Children with Disabilities. Florence: Unicef Innocenti Research Centre.

Uppal, S. (2006). Impact of the timing, type and severity of disability on the subjective well-being of individuals with disabilities. Social Science & Medicine, 63, 525-539.

Ville, I., Ravaud, J.-F., & Tetragap Group (2001). Subjective well-being and severe motor impairments: the Tetra[R]gap survey on the long-term outcome of tetraplegic spinal cord injured persons. Social Science and Medicine, 52, 369-384.

Watson, N. (Ed.). (2008). HILDA User Manual--Release 6. Melbourne: Melbourne Institute of Applied Economic and Social Research, University of Melbourne.

Wilkinson, R. G. (2005). The Impact of Inequality. New York: The New Press.

World Health Organisation (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the Commission on the Social Determinants of Health. Geneva: World Health Organisation.
Table 1: Characteristics of Participants

                            2001                      2006

                    HC/I/D   Not   OR/p       HC/I/D   Not   OR/p

Age
15-19               33%      35%   n.s.       32%      34%   n.s.
20-29               67%      64%              68%      66%
Sex
Men                 53%      48%   1.23 *     49%      49%   n.s.
Women               47%      52%              51%      51
Born in Australia   90%      79%   2.47 ***   88%      82%   1.72 ***
Aboriginal or
  Torres Straight
  Islander          5%       2%    2.07 **    5%       4%    n.s.

HC/I/D = Health condition, impairment or disability

OR = Odds ratio

n.s. non-significant difference

* p < 0.05, ** p < 0.01, *** p < 0.001

Table 2: Indicators of Well-Being 2001 and 2006

UN convention       Indicator                  2001
Article
                                               HC/I/D   Not   OR(p)

19: Living          Living independently of    71%      76%   0.74 *
independently and   parents (age 21+)                         0.57-0.97
being included in
the community 29 &  High social/emotional      49%      63%   0.57 ***
1.25 Participation  support                                   0.47-0.70
in Political,
Public, Cultural    Reported weekly contact    77%      81%   0.80 *
Life, Recreation,   with either friends or                    0.63-1.00
Leisure & Sport     relatives

                    Higher satisfaction with   52%      63%   0.65 ***
                    feeling part of the local                 0.54-0.78
                    community (scores above
                    mid-point on single Item
                    11-point rating scale)

                    Member of a community      38%      41%   0.87
                    based organization                        0.71-1.05

23: Respect for     Living with partner        43%      44%   93
home and family     (age 21+)                  --       --    0.73-1.18

                    Has and is caring for      32%      28%   1.17
                    children (age 21+)                        0.91-1.51

24: Education       Studying full time         52%      65%   0.61 **
                    (age 15-20)                               0.45 -0.81

                    Completed Year 12 at       55%      68%   0.57 ***
                    secondary school                          0.45-0.73
                    (age 21+)

                    Has Diploma or higher      24%      36%   0.56 ***
                    academic qualification                    0.43-0.74
                    (age 21+)

25: (Poorer)        Self-reported health       27%      5%    7.55 ***
Health              fair' or 'poor'                           5.77-9.87

                    Low general health         34%      9%    5.51 ***
                    (transformed score of 50                  4.38-6.93
                    or less on SF-36 general
                    health)

                    Low vitality (transformed  43%      26%   2.14 ***
                    score of 50 or less on                    1.76-2.61
                    SF36 vitality scale)

                    Smokes tobacco daily       35%      28%   1.39 **
                                                              1.13-1.70

27: Work and        Employed full time         46%      61%   0.55 **
Employment                                                    0.43-0.69
(age 21+)
                    Employed full or           66%      78%   0.53 ***
                    part-time                                 0.41-0.68

                    Higher job satisfaction    78%      86%   0.59 **
                    (scores above mid-point                   0.41-0.84
                    single item 11 point
                    rating scale)

                    Higher satisfaction with   59%      76%   0.46 ***
                    employment opportunities                  0.36-0.69
                    (scores above mid-point
                    on single Item 11-point
                    rating scale)

28: (Less)          Neighbourhood deprivation  25%      20%   1.36 **
Adequate Standard   (lives in neighbourhood                   1.10-1.69
of Living and       scoring in bottom two
Social Protection   defiles of SEIFAd 2001
                    index of relative
                    socio-economic
                    disadvantage)

                    People being hostile and   10%       9%   1.17
                    aggressive a 'fairly                      0.84-1.62
                    common' or 'common'
                    problem locally

                    Burglary and theft a       26%      24%   1.10
                    fairly common' or                         0.87-1.40
                    common' problem locally

                    Lower satisfaction with    18%      10%   2.07 ***
                    safety (scores at or                      1.62-2.66
                    below mid-point on single
                    item 11-point rating
                    scale)

                    Overcrowded housing        15%      14%   1.09
                    (average of 1.5 or more                   0.84-1.41
                    persons per bedroom)

                    Lower satisfaction with    19%      13%   1.57 ***
                    home (scores at or below                  1.23-199
                    mid point on single item
                    11 point rating scale)

                    Housing tenure (rented)    49%      43%   1.26 *
                                                              1.05-1.51

                    Income poverty (household  24%      17%   1.58 **
                    income equivalised using                  1.27-1.96
                    modified OECD scale less
                    than 60% of sample
                    median)

                    Self-assessed financial    8%       3%    2.58 ***
                    Strain (b)                                1.73-3.85

                    Hardship (c)               55%      40%   1.83 ***
                                                              1.50-2.22

Subjective Well-Being: Higher overall life     75%      88%   0.38 ***
satisfaction (score >6 on 10 point                            0.31-0.48
scale of general life satisfaction)

UN convention       Indicator                  2006
Article
                                               HC/I/D   Not   OR(p)

19: Living          Living independently of    69%      69%   1.01
independently and   parents (age 21+)                         0.77-1.34
being included in
the community 29 &  High social/emotional      51%      64%   0.61 ***
1.25 Participation  support                                   0.48-0.75
in Political,
Public, Cultural    Reported weekly contact    70%      78%   0.66 **
Life, Recreation,   with either friends or                    0.52-0.84
Leisure & Sport     relatives

                    Higher satisfaction with   63%      68%   0.84
                    feeling part of the local                 0.68-1.01
                    community (scores above
                    mid-point on single Item
                    11-point rating scale)

                    Member of a community      31%      37%   0.77 *
                    based organization                        0.61-0.97

23: Respect for     Living with partner        44%      44%   1.02
home and family     (age 21+)                                 0.79-1.32

                    Has and is caring for      32%      23%   1.58 **
                    children (age 21+)                        1.19-2.09

24: Education       Studying full time         54%      62%   0.71 *
                    (age 15-20)                               0.52-0.98

                    Completed Year 12 at       61%      76%   0.49 ***
                    secondary school                          0.38-0.64
                    (age 21+)

                    Has Diploma or higher      22%      38%   0.45 ***
                    academic qualification                    0.33-0.60
                    (age 21+)

25: (Poorer)        Self-reported health       20%      5%    4.56 ***
Health              fair' or 'poor'                           3.34-6.23

                    Low general health         33%      8%    5.27 ***
                    (transformed score of 50                  4.08-6.82
                    or less on SF-36 general
                    health)

                    Low vitality (transformed  45%      25%   2.40 ***
                    score of 50 or less on                    1.93-3.00
                    SF36 vitality scale)

                    Smokes tobacco daily       25%      16%   1.74 ***
                                                              1.35-2.24

27: Work and        Employed full time         43%      63%   0.45 ***
Employment                                                    0.35-0.58
(age 21+)
                    Employed full or           72%      84%   0.49 ***
                    part-time                                 0.36-0.66

                    Higher job satisfaction    84%      87%   0.76
                    (scores above mid-point                   0.50-1.16
                    single item 11 point
                    rating scale)

                    Higher satisfaction with   71%      85%   0.41 ***
                    employment opportunities                  0.30-0.55
                    (scores above mid-point
                    on single Item 11-point
                    rating scale)

28: (Less)          Neighbourhood deprivation  20%      18%   1.09
Adequate Standard   (lives in neighbourhood                   0.84-1.40
of Living and       scoring in bottom two
Social Protection   defiles of SEIFAd 2001
                    index of relative
                    socio-economic
                    disadvantage)

                    People being hostile and   14%      10%   1.43 *
                    aggressive a 'fairly                      1.03-2.00
                    common' or 'common'
                    problem locally

                    Burglary and theft a       18%      15%   1.25
                    fairly common' or                         0.93-1.69
                    common' problem locally

                    Lower satisfaction with    12%      5%    2.34 ***
                    safety (scores at or                      1.68-3.27
                    below mid-point on single
                    item 11-point rating
                    scale)

                    Overcrowded housing        13%      13%   1.09
                    (average of 1.5 or more                   0.81-1.46
                    persons per bedroom)

                    Lower satisfaction with    14%      11%   1.32
                    home (scores at or below                  0.98-1.77
                    mid point on single item
                    11 point rating scale)

                    Housing tenure (rented)    46%      40%   1.27 *
                                                              1.04-1.55

                    Income poverty (household  24%      17%   1.51 **
                    income equivalised using                  1.19-1.92
                    modified OECD scale less
                    than 60% of sample
                    median)

                    Self-assessed financial    4%       2%    2.23 **
                    strain (b)                                2.27-3.95

                    Hardship (c)               38%      26%   1.74 ***
                                                              1.39-2.19

Subjective Well-Being: Higher overall life     76%      90%   034 ***
satisfaction (score >6 on 10 point                            0.26-043
scale of general life satisfaction)

HC/I/D = Health condition, impairment or disability

OR = Odds ratio

n.s. non-significant difference

* p<0.05, ** p<0.01, *** p<0.001

(a.) Scoring above/below median on sum of 10 item scale of satisfaction
with social and emotional support. Each item involves rating on a
7-point scale agreement with such statements as 'I seem to have a lot
of friends' and 'I have no one to lean on in times of trouble'. Scale
internal consistency alpha = .0.82.

(b.) Given existing needs and responsibilities rated the current
financial situation of their family as being 'poor' or 'very poor'

(c.) As a result of shortage of money had (since January 2006) done one
of the following: could not pay electricity, gas or telephone bills on
time: could not pay the mortgage or rent on time; pawned or sold
something, went without meals, was unable to heat home, asked for
financial help from friends or family; asked for help from
welfare/community organisation.

(d.) SEIFA-Socio-Economic Indexes for Areas for Australia (Pink, 2008)

Table 3: Results of Factorial ANOVA Exploring the Association
between Disability Status, Social/Emotional Support, Hardship
and Normalised SWB score (N=2707, R2 =0.132, Adjusted R2 =0.130)

                           Type III    Degrees
                           Sum of      of        Mean
Source                     Squares     Freedom   Square

Social/emotional support   133.22      1         133.22
Hardship                   52.97       1         52.97
Disability status          25.92       1         25.92
Social/emotional
  support x Hardship       .08         1         .08
Social/emotional
  support x Disability
  status                   8.64        1         8.64
Hardship x Disability      10.21       1         10.21
  status
Social/emotional
  Support x Hardship x     .50         1         .50
Disability status
Error                      2276.85     2782      .82
Corrected Total            2624.45     2789

                                    Statistical
Source                     F        Significance

Social/emotional support   162.79   <.001
Hardship                   64.72    <.001
Disability status          31.67    <.001
Social/emotional
  support x Hardship       .10      .756
Social/emotional
  support x Disability
  status                   10.56    .001
Hardship x Disability      12.48    <.001
  status
Social/emotional
  Support x Hardship x     .61      .435
Disability status
Error
Corrected Total

Table 4: Results of Logistic Regression Exploring the Association
between Disability Status, Social/Emotional Support, Hardship
and Low SWB score (N=2790; Model Chi-Sq = 189.3,
df=4, p<0.001; Nagelkerke pseudo r2=0.141)

                                 95.0% Confidence Interval for
                                 Corrected Odds Ratio

                    Corrected                    Statistical
Source              Odds Ratio   Lower   Upper   Significance

Disability status
  x Hardship        .42          .23     .78     .006
Hardship            11.11        3.67    33.64   <.001
Social/emotional
  support           2.95         2.26    3.85    <.001
Disability status   9.22         3.57    23.88   <.001
Constant            .01                          <.001
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