出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2018/08/17 04:26:56」(JST)
クオリティ・オブ・ライフ（英: quality of life、QOL）とは、一般に、ひとりひとりの人生の内容の質や社会的にみた生活の質のことを指し、つまりある人がどれだけ人間らしい生活や自分らしい生活を送り、人生に幸福を見出しているか、ということを尺度としてとらえる概念である。QOLの「幸福」とは、身心の健康、良好な人間関係、やりがいのある仕事、快適な住環境、十分な教育、レクリエーション活動、レジャーなど様々な観点から計られる。
またQOLには国家の発展、個人の人権・自由が保障されている度合い、居住の快適さとの関連性も指摘される。
したがってクオリティ・オブ・ライフは、個人の収入や財産を基に算出される生活水準（英: standard of living）とは分けて考えられるべきものである。
クオリティ・オブ・ライフと対比される概念として、クオリティ・オブ・デス（英: quality of death、QOD、死の質）がある[1]。
なお以下においては「医療上におけるクオリティ・オブ・ライフ」について述べる。
QOL に対する取り組みは医療の歴史とともに発展してきた。医療は人を診るものであり医学は病気を診るものだとする考え方があったが、医療も科学的側面が強くなり、「病気は治ったが患者は死んだ」という状態が問題となった。
現状、長期療養を要する疾患、ならびに消耗の激しい疾患や進行性の疾患では、いたずらな延命治療、患者への侵襲が激しい治療を継続することによって、患者が自らの理想とする生き方、もしくは社会的にみて「人間らしい生活」と考える生活が実現できないことが提唱された。このような状況を「QOL （生活の質）が低下する」と呼んでいる。
これに対して、患者が自身の尊厳をより保ち得る生活の実現を目的とした援助が重要であるという考え方が生じたのである。これを「QOL（生活の質）を維持する、向上させる」などという。
疾患は病名により医学的に定義されるが、障害もしくは合併症状の生活面の影響は、医学的には充分考慮されていない。
たとえば治療行為に伴い生じた運動・視力・食事・排泄などの障害には、それぞれに何らかの合併症名が与えられるが、障害の程度には総じて「QOL の低下」と表現される。また医学的検査で原因が不明瞭な感覚的障害（痛み、痺れ、倦怠感など）では、課題として軽視する傾向がある。障害（合併症状）の影響は患者の生活にとって重要であり、これを QOL として認識し指標化する医療上の課題がある。
癌などの治療選択や治療評価においては、生存率や縮小率などを指標とする場合が多いが、予後の QOL を考慮していない場合もある。
患者の立場からは、QOL も考慮されることが望ましいが、医療機関や医師、患者本人との価値観の差異などもあり、具体的に言及されることが少ない。最近は、インフォームド・コンセントの普及に伴い QOL の概念が重要視される傾向にある。
疾病の増悪や治療において生じた障害の生活支援として、公的な障害年金制度がある。
健康関連の QOL の評価法は、一般的に患者に聞き取るか、評価者自身が評価する。評価項目は、その文化圏で一般的な汎用評価法と、特定の疾患や病態の患者を対象とした疾患特異的評価法、QOL の構成概念の各領域ごとの評価法などがある。
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Quality of life (QOL) is the general well-being of individuals and societies, outlining negative and positive features of life. It observes life satisfaction, including everything from physical health, family, education, employment, wealth, safety, security to freedom, religious beliefs, and the environment.[1] QOL has a wide range of contexts, including the fields of international development, healthcare, politics and employment. It is important not to mix up the concept of QOL with a more recent growing area of health related QOL (HRQOL[2]). An assessment of HRQOL is effectively an evaluation of QOL and its relationship with health.
Quality of life should not be confused with the concept of standard of living, which is based primarily on income.
Standard indicators of the quality of life include not only wealth and employment but also the built environment, physical and mental health, education, recreation and leisure time, and social belonging.[3][4] According to the World Health Organization (WHO), quality of life is defined as “the individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals.” In comparison to WHO’s definitions, the Wang-Baker Faces scale defines quality of life as “life quality (in this case, physical pain) at a precise moment in time.”[5]
According to ecological economist Robert Costanza:
While Quality of Life (QOL) has long been an explicit or implicit policy goal, adequate definition and measurement have been elusive. Diverse "objective" and "subjective" indicators across a range of disciplines and scales, and recent work on subjective well-being (SWB) surveys and the psychology of happiness have spurred renewed interest.[6]
One approach, called engaged theory, outlined in the journal of Applied Research in the Quality of Life, posits four domains in assessing quality of life: ecology, economics, politics and culture.[7] In the domain of culture, for example, it includes the following subdomains of quality of life:
Also frequently related are concepts such as freedom, human rights, and happiness. However, since happiness is subjective and difficult to measure, other measures are generally given priority. It has also been shown that happiness, as much as it can be measured, does not necessarily increase correspondingly with the comfort that results from increasing income. As a result, standard of living should not be taken to be a measure of happiness.[3][8] Also sometimes considered related is the concept of human security, though the latter may be considered at a more basic level and for all people.
Unlike per capita GDP or standard of living, both of which can be measured in financial terms, it is harder to make objective or long-term measurements of the quality of life experienced by nations or other groups of people. Researchers have begun in recent times to distinguish two aspects of personal well-being: Emotional well-being, in which respondents are asked about the quality of their everyday emotional experiences—the frequency and intensity of their experiences of, for example, joy, stress, sadness, anger, and affection— and life evaluation, in which respondents are asked to think about their life in general and evaluate it against a scale.[9] Such and other systems and scales of measurement have been in use for some time. Research has attempted to examine the relationship between quality of life and productivity.[10] There are many different methods of measuring quality of life in terms of health care, wealth and materialistic goods. However, it is much more difficult to measure meaningful expression of one's desires. One way to do so is to evaluate the scope of how individuals have fulfilled their own ideals. Quality of life can simply mean happiness, the subjective state of mind. By using that mentality, citizens of a developing country appreciate more since they are content with the basic necessities of health care, education and child protection.[11]
Perhaps the most commonly used international measure of development is the Human Development Index (HDI), which combines measures of life expectancy, education, and standard of living, in an attempt to quantify the options available to individuals within a given society. The HDI is used by the United Nations Development Programme in their Human Development Report.
The World Happiness Report is a landmark survey on the state of global happiness. It ranks 156 countries by their happiness levels, reflecting growing global interest in using happiness and substantial well-being as an indicator of the quality of human development. Its growing purpose has allowed governments, communities and organizations to use appropriate data to record happiness in order to enable policies to provide better lives. The reports review the state of happiness in the world today and show how the science of happiness explains personal and national variations in happiness.[12] Also developed by the United Nations and published recently along with the HDI, this report combines both objective and subjective measures to rank countries by happiness, which is deemed as the ultimate outcome of a high quality of life. It uses surveys from Gallup, real GDP per capita, healthy life expectancy, having someone to count on, perceived freedom to make life choices, freedom from corruption, and generosity to derive the final score. Happiness is already recognised as an important concept in global public policy. The World Happiness Report indicates that some regions have in recent years have been experiencing progressive inequality of happiness. Without life, there is no happiness to be realised.[13]
The Physical Quality of Life Index (PQLI) is a measure developed by sociologist Morris David Morris in the 1970s, based on basic literacy, infant mortality, and life expectancy. Although not as complex as other measures, and now essentially replaced by the Human Development Index, the PQLI is notable for Morris's attempt to show a "less fatalistic pessimistic picture" by focusing on three areas where global quality of life was generally improving at the time and ignoring gross national product and other possible indicators that were not improving.[14]
The Happy Planet Index, introduced in 2006, is unique among quality of life measures in that, in addition to standard determinants of well-being, it uses each country's ecological footprint as an indicator. As a result, European and North American nations do not dominate this measure. The 2012 list is instead topped by Costa Rica, Vietnam and Colombia.[15]
Gallup researchers trying to find the world's happiest countries found Denmark to be at the top of the list.[16] uSwitch publishes an annual quality of life index for European countries. France has topped the list for the last three years.[17]
A 2010 study by two Princeton University professors looked at 1,000 randomly selected U.S. residents over an extended period. It concludes that their life evaluations – that is, their considered evaluations of their life against a stated scale of one to ten – rise steadily with income. On the other hand, their reported quality of emotional daily experiences (their reported experiences of joy, affection, stress, sadness, or anger) levels off after a certain income level (approximately $75,000 per year); income above $75,000 does not lead to more experiences of happiness nor to further relief of unhappiness or stress. Below this income level, respondents reported decreasing happiness and increasing sadness and stress, implying the pain of life’s misfortunes, including disease, divorce, and being alone, is exacerbated by poverty.[18]
Gross national happiness and other subjective measures of happiness are being used by the governments of Bhutan and the United Kingdom.[19] The World Happiness report, issued by Columbia University[20] is a meta-analysis of happiness globally and provides an overview of countries and grassroots activists using GNH. The OECD issued a guide for the use of subjective well-being metrics in 2013.[21] In the U.S., cities and communities are using a GNH metric at a grassroots level.[22]
The Social Progress Index measures the extent to which countries provide for the social and environmental needs of their citizens. Fifty-two indicators in the areas of basic human needs, foundations of wellbeing, and opportunity show the relative performance of nations. The index uses outcome measures when there is sufficient data available or the closest possible proxies.
Day-Reconstruction Method was another way of measuring happiness, in which researchers asked their subjects to recall various things they did on the previous day and describe their mood during each activity. Being simple and approachable, this method required memory and the experiments have confirmed that the answers that people give are similar to those who repeatedly recalled each subject. The method eventually declined as it called for more effort and thoughtful responses, which often included interpretations and outcomes that do not occur to people who are asked to record every action in their daily lives.[23]
The term quality of life is also used by politicians and economists to measure the livability of a given city or nation. Two widely known measures of livability are the Economist Intelligence Unit's Where-to-be-born Index and Mercer's Quality of Living Reports. These two measures calculate the livability of countries and cities around the world, respectively, through a combination of subjective life-satisfaction surveys and objective determinants of quality of life such as divorce rates, safety, and infrastructure. Such measures relate more broadly to the population of a city, state, or country, not to individual quality of life. Livability has a long history and tradition in urban design, and neighborhoods design standards such as LEED-ND are often used in an attempt to influence livability.[24]
Some crimes against property (e.g., graffiti and vandalism) and some "victimless crimes" have been referred to as "quality-of-life crimes." American sociologist James Q. Wilson encapsulated this argument as the Broken Window Theory, which asserts that relatively minor problems left unattended (such as litter, graffiti, or public urination by homeless individuals) send a subliminal message that disorder in general is being tolerated, and as a result, more serious crimes will end up being committed (the analogy being that a broken window left broken shows an image of general dilapidation).
Wilson's theories have been used to justify the implementation of zero tolerance policies by many prominent American mayors, most notably Oscar Goodman in Las Vegas, Richard Riordan in Los Angeles, Rudolph Giuliani in New York City and Gavin Newsom in San Francisco. Such policies refuse to tolerate even minor crimes; proponents argue that this will improve the quality of life of local residents. However, critics of zero tolerance policies believe that such policies neglect investigation on a case-by-case basis and may lead to unreasonably harsh penalties for crimes.
The Popsicle Index is a quality of life measurement coined by Catherine Austin Fitts as the percentage of people in a community who believe that a child in their community can safely leave their home, walk to the nearest possible location to buy a Popsicle, and walk back home.[25][26][27]
Within the field of healthcare, quality of life is often regarded in terms of how a certain ailment affects a patient on an individual level. This may be a debilitating weakness that is not life-threatening; life-threatening illness that is not terminal; terminal illness; the predictable, natural decline in the health of an elder; an unforeseen mental/physical decline of a loved one; or chronic, end-stage disease processes. Researchers at the University of Toronto's Quality of Life Research Unit define quality of life as "The degree to which a person enjoys the important possibilities of his or her life" (UofT). Their Quality of Life Model is based on the categories "being", "belonging", and "becoming"; respectively who one is, how one is not connected to one's environment, and whether one achieves one's personal goals, hopes, and aspirations.[28][29]
Experience sampling studies show substantial between-person variability in within-person associations between somatic symptoms and quality of life.[30] Hecht and Shiel measure quality of life as “the patient’s ability to enjoy normal life activities” since life quality is strongly related to wellbeing without suffering from sickness and treatment.[5] There are multiple assessments available that measure Health-Related Quality of Life, e.g., AQoL-8D, EQ5D - Euroqol, 15D, SF-36, SF-6D, HUI.
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Quality of life is an important concept in the field of international development since it allows development to be analyzed on a measure broader than standard of living. Within development theory, however, there are varying ideas concerning what constitutes desirable change for a particular society, and the different ways that quality of life is defined by institutions therefore shapes how these organizations work for its improvement as a whole.
Organisations such as the World Bank, for example, declare a goal of "working for a world free of poverty",[31] with poverty defined as a lack of basic human needs, such as food, water, shelter, freedom, access to education, healthcare, or employment.[32] In other words, poverty is defined as a low quality of life. Using this definition, the World Bank works towards improving quality of life through the stated goal of lowering poverty and helping people afford a better quality of life.
Other organizations, however, may also work towards improved global quality of life using a slightly different definition and substantially different methods. Many NGOs do not focus at all on reducing poverty on a national or international scale, but rather attempt to improve quality of life for individuals or communities. One example would be sponsorship programs that provide material aid for specific individuals. Although many organizations of this type may still talk about fighting poverty, the methods are significantly different.
Improving quality of life involves action not only by NGOs but also by governments. Global health has the potential to achieve greater political presence if governments were to incorporate aspects of human security into foreign policy. Stressing individuals’ basic rights to health, food, shelter, and freedom addresses prominent inter-sectoral problems negatively impacting today’s society and may lead to greater action and resources. Integration of global health concerns into foreign policy may be hampered by approaches that are shaped by the overarching roles of defense and diplomacy.[33]
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| 国試過去問 | 「110G017」「104G026」「099D001」「103H008」「104G005」 |
| リンク元 | 「生活の質」「quality of life」「健康関連」「クオリティーオブライフ」 |
| 拡張検索 | 「QOL質問票」「健康関連QOL」 |
| 関連記事 | 「Q」 |
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