Whose Quality of Life is it anyway: the collective health experience and quality of life. Paper presented to the 2011 Aging and Society: An Interdisciplinary Conference, University of California, Berkeley, CA . Paper recipient of the 2011 Graduate Scholar Award.

1. “Whose Quality of Life is it anyway: The
Collective Experience and Quality of Life”
Michele Battle-Fisher, MPH, MA
Doctoral student, The Ohio State
University
Instructor, Wright State University
Aging & Society Conference
Graduate Scholar Award Recipient
University of California, Berkeley
November 8- 9, 2011

2. Overview
• Quality of Life
• Influence of social networks on QOL
• Objectivity & Subjectivity in QOL
• Introduction of “Collective QOL” and
Concentric Model of Health-Bound
Networks
• Introduction of “Pass Back Benefit”
through social networks
• Ethical implications
• Future directions

3. Quality of Life
• Health- personal experience with physical and
mental domains (Muldoon et al., 1998)
• QOL- functional status versus subjective
wellbeing (Muldoon et al., 1998)
• Gill & Feinstein (1994)- QOL “perceived
perception”
• QOL framed as something “should have” &
not as dynamic
• No solution for altering a person’s QOL and
what is happening in someone’s head.
(Gurland, personal communication)

4. Social Networks and QOL
• House et al. (1988)- social support fails to
account for the social network dynamics
• Smith & Christakis (2008)- embeddedness of
social support next step
• Cornwell & Waite (2009)- social isolation
linked to lower self-rated health
• Lin (2000)- social resources “embedded in
ties”
• Steinhauer et al. (2000)- clinical staff focus on
physical, patients on mental domain during
end of life

5. Objective & Subjective QOL
Conventional Objective
QOL Subjective QOL
•Measurement of personal •“Happiness
function requirements” necessary
•QOL as individual conditions for happiness
in a given society (McCall,1975)
•Measurement across life
• Bramston et al. (2002) Intimacy,
domains (e.g. physical, community involvement and
interpersonal, occupational) emotional well-being domains
•Health status, functional •Individual level- loneliness
status, quality of life used •Systems level- “sense of
interchangeably community”
(Muldoon et al.,1998)

6. A step forward- Collective QOL
• Proposed by Battle-Fisher (2011)
• Patient embedded in social network(s)
• Subjective linked to involvement with patient’s
functional status
• Caring others (surrogates) affected by life
state of patient
• QOL originated by illness experience of
patient
• Decreased physical and mental functionalities
across networks
• Surrogates serve different purposes to patient

7. Collective QOL
• Not same as “subjective wellbeing” as
surrogates’ lives are also affected by patient’s
disease state
• Particularly salient due to increased longevity
and chronicity of older patients
• Calls for unit of analysis to be at network level,
not patient level (though patient is ego for social
network analysis)
•Not a replacement of personal QOL measure,
but a necessary collective view of QOL not
attended to presently

8. A possible application of collective QOL
“Concentric Model of Health-Bound
Networks” ©
(Battle-Fisher & Mawasha, 2011)

9. Pass back benefit (Battle-Fisher, 2011)

10. Ethical implications
• Is it ethical to accept a patient’s “low” QOL
objective score and a high, subjective ranking
of personal or collective QOL?
• Does maintaining patient autonomy lead us to
a false reality of chronic illness management?
• Should nominalization of benefit seek
personal QOL benefit (bottom up) or collective
QOL to trickle down to patient (top-down)?
(Gusmano, personal communication)
• What of discordance in collective QOL as
valued among surrogates? (Gusmano,
personal communication)

11. Future directions
• To what extent should the surrogates be
responsible for the patient’s QOL (guilt,
power, self-imposed responsibility at play)?
• Nested QOL networks (overlap of illness
narratives within network)
• How might utility as conceived by surrogates
work?
• Does the difficult/ noncompliant patient or
network affect the cycle?

12. Future directions
• Is there a ripple effect of influence
within networks (homophily) under
pass back benefit?
• How might end of life decisions be
influenced by pass back?
• How might pass back fit within
Concentric Model of Health-Bound
Networks?(Battle-Fisher &
Mawasha, 2011)

13. Thank you to
 Dr. Barry Gurland, Columbia University, Director of
the Morris W. Stroud III Center for the Study of
Quality of Life
 Dr. Michael Gusmano, The Hastings Center, NY
 Joann Mawasha, Psy.D., Wright State MPH student
 Faculty, staff and students of the Ohio State and
Wright State Master of Public Health Programs
 My family
 Mary Anne Benner for graphics assistance
 University of Illinois Common Ground Publishing

14. References
• Battle-Fisher, M. (2011). Whose (Quality of) Life is it anyway?
Unpublished manuscript.
• Battle-Fisher, M. & Mawasha, J. (2011). Development of the
Concentric Model of Health- Bound Networks: Understanding
Quality of Life through the ecological model and social network
theory. Unpublished manuscript.
• Bramston, P., Pretty, G. & Chipuer, H. (2002). Unravelling
subjective quality of life- an investigation of individual and
community determinants. Social Indicators Research. 59, 261-
74.
• Cornwell, E. & Waite, L. (2009). Social disconnectiveness,
perceived isolation, and health among older adults. Journal of
Health and Social Behavior. 50(1), 31-48.
• Gill, T. & Feinstein, A. (1994). A critical appraisal of the quality of
quality of life measurements. JAMA. 272, 619-25.

15. References
• House, J., Umberson, D. & Landis, K. (1988). Structures and
Processes of Social Support. Annual Review of Sociology. 14,
293-318.
• Lin, N. (2000). Inequality of social capital. Contemporary
Sociology. 29, 785-795.
• McCall, S. (1975). Quality of Life. Social Indicators Research. 2,
229-248.
• Muldoon, M., Barger, S., Flory, J., & Manuck, S. (1998). What
are the quality of life measurements measuring? BMJ. 316, 542-
5.
• Smith, K. & Christakis, N. (2008). Social networks and health.
Annual Review of Sociology. 34, 405-29.
• Steinhauser, N., Christakis, N.,…& Tulsky, J. (2000). Factors
considered important at the end of life by patients, family,
physicians and other care providers. JAMA. 284, 2476-82.

16. The science of medicine. The art of healing.