What is quality of life? II Quality of life

 Introduction to Quality of life 

Literally, quality means a measure of excellence or a state of being free from defects and problems. Life is the experience of being alive. When we live without any problems and hazards in life, there lies quality of life. 

Quality of life is a collection of interacting objective and subjective dimensions. Quality of life is also a dynamic concept; values and self-evaluations of life may change over time in response to life and health events and experiences. Each area of quality of life can also have knock-on effects on others. For example, retaining independence and social participation may promote feelings of emotional independence and social participation may promote feelings of emotional well-being, but are partly dependent on retaining health and adequate finances. These can also be influenced by local transport facilities, type of housing, community resources and social relationships. Quality of life is multidimensional and its parts affect each other as well as the sum. It poses inevitable challenges for measurement. Therefore, there are many non-identical techniques existing for the measurement of quality of life. Satisfaction and happiness in one's life are the key requirements of quality of life. In order to be satisfied with existing needs and aspirations, we need to have the ability to take proper decisions regarding the determination of needs. 

The basic aspects of human needs, which are to be fulfilled for maintaining the quality of life, are described below: 

a) Physical aspects 

Human needs including food, housing, clothing and such other things of physical existence, that fulfill human's aspirations for the addition of quality in life are called physical aspects of quality of life. It includes those factors which have physical or material existence. The materials which can be seen, touched and are needed for our survival are included under this aspect. Drinking water, transportation, communication, security, sanitation, income, health services, etc. are some other examples of the physical aspects of quality life. 

b) Psychological and emotional aspects 

Human needs, including love, satisfaction, entertainment and such other abstract factors that do not have nay material existence but are associated with psychological and emotional satisfaction for the addition of quality in life, are called psychological and emotional aspects of quality of life. This aspect includes abstract factors, which are non-materials but needed for a happy life. Recreation, entertainment, cooperation etc. are also included in this aspect. 

c) Spiritual aspects 

Human needs including freedom to practice one's culture, freedom to trust in God, honor, social prestige, fundamental rights and such other high-ranked abstract factors, which are regarded as the products of advanced thoughts of human beings, are called spiritual aspects of quality of life. Spiritual aspects encompass abstract or non-material elements. These are ranked higher than psychological and emotional aspects. 

The above mentioned aspects include various human needs. These needs are to be fulfilled in order to get satisfaction in one's life. Besides, various social, political, aesthetic and other contextual needs play a vital role in determining the quality of life of people. The fulfillment of the needs and degree of satisfaction may differ from person to person. For example, a hungry beggar can get high satisfaction by getting a single piece of bread, whereas a child of a rich family ignores a smaller piece of bread and demands pizza. One can be very happy by getting a bicycle but another person may be unhappy even with motorcycle and tries further to get a car. We cannot say that a similar sort of fulfillment of need will create a similar degree of satisfaction. It depends upon the status, background and extent of desire for something that an individual has. But, everybody agrees that basic needs are a must for all because they are the needs for survival. Without having the basic needs fulfilled, no one can have more advanced desires. Quality of life, to some context, is regarded as life style with a process of promoting satisfaction and happiness by fulfilling every sort of needs which arise in life. United Nation's Educational Scientific and Cultural Organization (UNESCO) gave a definition of quality of life in 1976. It states: " The quality of life is a sense of being pleased or satisfied with those life elements that are most important to a person." This definition has given more emphasis to the sense of being pleased or satisfied. Quality of life is complex and abstract. Therefore, it should be understood in a broader sense. ln such context, we can define quality of life as the degree of satisfaction achieved in one's life by the fulfillment of basic needs as well as physical, mental, emotional, spiritual, socio-cultural, biological, psychological and other aspects of human needs that arise in human life with a desire to fulfill them. 

Elements of Quality of life 

Elements of quality of life mean the factors that are responsible for determining the quality of life. Some of the elements of quality of life are discussed below: 

a) Nutritious food 

Food is one of the basic needs since without having this need fulfilled, no one can survive. There must be supply of nutritious food and a balanced diet for quality life. We can get immunity power to be safe against many infectious as well as non-infectious diseases from a balanced diet, which includes the basic elements of nutrition values like carbohydrates, proteins, vitamins and minerals. Nutritious food adds happiness and satisfaction in life by fulfilling hunger, strengthening the immunity power, saving us from health hazards and problems, and this way adding quality to our life. Junk foods, stale foods and an balanced diet may satisfy instant hunger but cannot contribute to quality of life. 

b) Small family size 

Family size plays a vital role in determining the quality of life. A small family has less number of family members. Where there are less family members, there is less demand for basic and additional needs. These needs can be fulfilled easily with limited resources. Fulfillments of needs increases the happiness and satisfaction in life, ultimately increasing the quality of life. 

c) Health 

We have a saying; 'Health is wealth'. If we are health, we can go ahead wherever we want. IF we are unhealthy, we cannot work, study and even entertain ourselves in desired way. Without having the sound health, family members suffer from different diseases, become handicapped and disabled. Such a condition becomes a burden for the healthy members, too and they cannot involve themselves in other income generating activities. Without sufficient income, there is further problem of fulfilling the needs that arise in the family. Therefore, health is regarded as an important element for gaining quality of life. 

 The status of health can be promoted by the following given points: 

1. Managing a balanced diet in the family. 
2. Maintaining personal hygiene and cleanliness among family members. 
3. Making community members aware and involve them actively in community cleanliness. 
4. Managing safe drinking water. 
5. Managing regular health check-ups and appropriate treatment in case of any disease. 
6. Providing the basic health education for all. 
7. Making people aware about a healthy life style with good habits and proper exercise and rest. 

d) Sanitation 

Sanitation is the process of maintaining cleanliness. The cleanliness clears the dwelling place of micro-organisms, which cause diseases. Sanitation promotes a healthy life. Healthy life further assures quality of life. 

e) Education 

Education brings many changes in human beings. One can have skills and knowledge for employment, know about a healthy life style, can have techniques to tackle against many problems which arise in life, and can acquire much happiness and satisfaction in life. In this way, education is considered a vital factor in acquiring quality of life. 

f) Income of the family 

Income is regarded as the primary tool in fulfilling the basic as well as additional needs in life. Fulfillment of one's needs determines the quality in life. Family income becomes more if there are more active members in the family. Active members go for job to earn money. They can manage their profitable business and other income generating activities. More income in a family assures fulfilment of the needs in the family and maintains the quality of life. 

g) Security 

Security can be categorized into three groups: physical, economical and emotional security. The family is an institution where members can get all sorts of security. When one member is in problem other members share the problem and use their collective effort to solve this. With the support of family members, one can get security. This adds satisfaction to life and uplifts the quality of life. 

h) Saving 

Saving is considered as a wise move to be ready for any certain or uncertain event in the future. Allocation of total income must have a portion of saving. Saved amount can be utilized against a sudden attack of disease, to have assurance for a safe future and to grab beneficial opportunities in the future. Such advantages become more helpful in gaining more satisfaction and improving the quality of life. 

i) Housing 

Housing is one of the basic needs. Houses are made and managed to live in. A house provides physical security against environmental factors like sunlight, wind, storm, rainfall, dust, and so on. A good house gives a degree of satisfaction to the persons who live in it and adds to quality of life. 

j) Socio-cultural needs 

Socio-cultural values and norms affect the degree of quality of life. Discrimination among people in the name of caste, ethnicity,  poverty and gender, etc. creates a feeling of humiliation in the suppressed group. Such a feeling declines the quality of life. Socio-cultural values support some superstitious beliefs and practices, too. witch doctors, dowry systems, isolation of girls in menarche, similar isolation of mothers in pregnancy, use of alcohol in social rites, rituals, feasts, and festivals, etc. degrade the quality of life of the concerned group of people. Some socio-cultural practices are beneficial for improving the health status of people. Taking a bath everyday in the morning, eating nutritious foods, and fasting at times help in improving the health status of the people. In this way, the socio-cultural values influence human health positively or negatively. 

Bases of Quality of Life 

Quality of life is a complex and abstract feature of human life. Therefore, measurement of quality in one's life has been very difficult though we are trying to find ways to measure it. Here are some of the ways, which are found somehow useful to measure quality of life. 

a) Basic needs-oriented approach 

This approach was the first attempt to measure quality of human life. It was brought in practice during the 1970s. In Nepal, the target of fulfilling at least basic needs of people was included in the Sixth Five-year Plan. It was the first attempt at addressing the issue of basic needs formally in the national plan. 

The basic needs oriented approach is a technique of measuring quality of life on the basis of fulfillment of the basic needs of the people of a country in a certain period of time. This approach assumes that if the basic needs are fulfilled in greater extent, there is quality of life and if in lesser extent, there is low quality of life. Basic needs, which are regarded as the major determinants for the quality of life are: food, clothes, shelter, education, health, drinking water and sanitation. 

b) Physical quality of life index (PQLI) 

It is a numeric index representing the quality of people's life determined by their average Child Mortality Rate, life expectancy and literacy rate of a certain place at a given time. PQLI may range from zero to a hundred. In order to get the PQL Index, the following data are taken as its basis: 

1. Child Mortality Rate i.e., mortality rate of children under five years of age.
2. Life Expectancy at birth 
3. Education 

Though PQLI provides important information to understand people's quality of life, it is criticized for the following weakness. 

1. It does not take people's income under consideration. 
2. Mortality rate and life expectancy may have some overlapping features. 
3. It does not measure the spiritual factors of quality of life. 
4. It does not take education under consideration. 

Indicators of Quality of Life 

When there is quality of life, some specific needs are found in people's life. Such features indicate the presence of quality in life. Some of such features, or indicators of quality of life are as follows: 

a) Fulfillment of basic needs 

Basic needs are the most essential needs of human life because these are associated with life and survival. Without fulfilling the basic needs, no one can survive. It includes food, water, clothes, shelter, etc. In order to maintain the quality of life one has to get his/her basic needs fulfilled. A Lifestyle with low quality of life creates difficulties in the ability to fulfill those needs. 

b) Attainment of quality education 

Quality in life assures the possibility of getting quality education. Quality education can be achieved if the basic needs are fulfilled and there is happiness and satisfaction in life. We need time for quality education. In some conditions, quality education is not accessible for poor people. They have to be busy and work very hard for survival. Where there is no quality in life, poverty exists with numerous hazards and obstacles. That creates problems in getting quality education. 

c) Management of health services, facilities and sanitation 

Low quality of life makes people totally centered on fulfilling the basic needs. They have to struggle for food and sustainability of life. Management of health services, facilities and sanitation can get priority in one's life if those basic needs are fulfilled first. When there is quality of life, one can manage health services for his/her family members and live with sanitation, cleanliness and a hygienic life. 

d) Facilities for maternal and child welfare 

In rural and remote areas, where the life standard is low, there in no proper care of mothers and even infants and children. We can still hear from the elderly generation that they had given birth to their children while doing household work inside or outside the home. They delivered when they were working inside the home collecting or when they were away from home harvesting crops and fodder for the cattle. This is because they didn't have knowledge about maternal child health care (MCHC). That's why maternal and infant mortality in the past was observed to be very high. Such conditions stills exist in some underdeveloped country of world. In order to manage proper MCH care for all people, we must try first to increase quality in life by uplifting their life standard. People having quality of life can easily afford the required facilities for maternal and child welfare. They become familiar and well aware regarding the importance of MCH care. So, there is better health of the mother and children in the family. 

e) Opportunities for income generating activities and employment 

Unless there is quality in life, there is no possibility of increasing knowledge and skills needed income generating activities. We have already discussed that we can have quality education and sound health by attaining quality in life first. Without having education, skill and sound health, we cannot get opportunities. 

f) Women empowerment 

The female population occupies more than half the total population of the world. In almost all countries, including Nepal, the population of females is slightly more that that of males. By observation, we can find that gender discrimination and women suppression is found more in those places where people are uneducated, backward and have low quality of life. High quality of life assures gender equality. When there is quality in life, there is access to education, awareness, understanding and a sense of humanity. Such a condition motivates people towards women empowerment against gender discrimination.

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