Exploring perceptions of National wellbeing: links between inequalities, health, and wellbeing in Ghana
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We live in a world currently faced by unprecedented social and environmental changes (WEF, 2017). In the face of such rapid change, it is becoming difficult to understand what population wellbeing might mean as well as the indicators that capture its essence. Since the post-war era, Gross Domestic Product (GDP) has been widely used as an indicator of population wellbeing (Potter et al. 2012). However, in recent times, population wellbeing or how people are doing and their progress is increasingly seen as more than merely the value of economic activity undertaken within a given period of time. In response to the growing discontent with the use of economic measures to reflect societal progress and population wellbeing, there has been a global momentum to develop and encourage the use of community-level indicators of wellbeing (Michalos, 2011; Davern et al., 2017). These initiatives aim to increase public understanding of wellbeing and ideas of the ‘good life’ beyond traditional economic measures. Despite the relevance of these alternative measures for practical and policy purposes, their application remains limited in low to middle-income countries (LMICs), especially sub-Saharan Africa (SSA). The limited usage is due to the narrow focus of current measures and their inability to adequately capture what wellbeing means in the SSA context. Also of critical importance is whether the constituents of these ‘Beyond GDP’ measures represent what really matters to people in their specific contexts and captures the collective, contextual and compositional attributes that shape wellbeing of places in low to middle-income countries. This thesis explores the meaning of wellbeing, with emphasis on the role of inequality as a key contributor to the wellbeing of places in low to middle-income countries (LMICs), using Ghana as a case study. The research focused on three broad objectives: first, to develop an integrated framework for understanding links between inequality and wellbeing in LMICs; second, to explore lived experiences, perceptions and understanding of wellbeing and its indicators in LMICs and finally, to explore the potential pathways that link inequalities, and wellbeing in the context of LMICs. A mixed-method approach involving a conceptual review, key informants interviews, focus group discussions and a survey were used in the research. The conceptual review suggests that the role of place and inequality in wellbeing research is inadequately conceptualized and inequality as a key attribute of the wellbeing of places in LMICs is not given adequate attention. The review thus suggested that an integrated framework will enable researchers to adequately conceptualize inequality and wellbeing. It further shows that inequality affects wellbeing through multiple pathways. First, inequality may lead to poor wellbeing through status anxiety- the psychosocial response of individuals or societies to the perception of their place in the status ladder. Secondly, the ‘social facts’ of communities and societies like inequalities may have long-lasting impacts on social cohesion and community vitality. This is especially important in the context of LMICs where communities, and not individuals, mostly serve as the units of identification and development. Thirdly, inequality is detrimental to population wellbeing in LMICs through the differential accumulation of exposures and experiences that have their sources in the material world, which weakens societies’ willingness to make investments that promote the common good. Results from the key informants and focus group discussions revealed similarities as well as context-specific descriptions or definitions of wellbeing across Ghana. Description of wellbeing consists of an embodiment of both material and non-material circumstances. The descriptions or definitions that people ascribe to wellbeing were complex and context dependent. Perceptions of the relative importance of indicators differed depending on sex, gender, and location. Further, findings from the survey (n=1036) reveal that inequalities affect wellbeing by constraining access to basic amenities like water, food, and housing and also through its effects on community social capital and cohesion. This research makes important contributions to knowledge, policy, and practice. Theoretically, the research links capability framework with an ecosocial theory to demonstrate the multidimensional nature of wellbeing by revealing the contextual influences that simultaneously facilitate and constrain optimum experience of wellbeing. The framework outlined is a useful tool for exploring how structural forces at different scales interact to shape population patterns of wellbeing in low to middle-income countries. The framework is beneficial as it enables researchers to connect interactions between environmental risks and (re)actions with broader socio-economic factors to understand wellbeing inequalities and how populations literally embody inequalities. Moreover, the framework can be applied to the embodiment of other risks (e.g., water/air pollution) within similar (or different) contexts. Methodologically, the research contributes to the conceptualization and measurement of wellbeing in a cross-cultural context and expands health geographers’ substantive focus to include population wellbeing. The research also provides an effective example of an embedded mixed-method design by highlighting the strengths of mixing quantitative methods with other research methods such as focus group discussions and key informants interviews in order to gain a nuanced understanding of wellbeing. In terms of policy, the research highlights to adopt wellbeing as the central focus of policy interventions. It also highlights the need for policies to respect community perspectives and experiences in identifying what matters to forge a common understanding not only of wellbeing but also what is fair and just.
Cite this version of the work
Joseph Kangmennaang (2019). Exploring perceptions of National wellbeing: links between inequalities, health, and wellbeing in Ghana. UWSpace. http://hdl.handle.net/10012/14640