Social determinants of health (SDOH) and happiness of older adults is a pivotal area in healthy ageing. The past decades have received noteworthy consideration of the concept of happiness in the field of public health [1]. However, the relationship between the SDOH and happiness concerning older adults is yet to be accorded adequate attention. Therefore, an evidential understanding of the correlation between these two vital concepts as far as older adults are concerned is appropriate and timely. This study drove on the premise that environments in which older adults are born, live, learn, work, play, worship, and age affect a wide range of health, functioning, and quality-of-life outcomes as well as happiness of older adults [2, 3]. In the conceptualization of Health People [2], SDOH comprised five indicators including economic stability, education access and quality, healthcare access and quality, neighbourhood and built environment, and social and community context [2]. It is worth noting that these indicators of SDOH have enormous consequences on livelihoods linked with material affluence, physical safety and subjective life satisfaction which may affect one’s level of happiness [4–7], in this case older adults.
Earlier studies have shown the relationships between the specific indicators of SDOH and happiness [8–11]. There is positive relationship between economic stability and happiness [10, 11]. Many people struggle to have or keep a job but those with the opportunity to have a steady employment are very less likely to live in poverty and very likely to be healthy and happy. Also, working full or part time and earning higher income help people including vulnerable groups like older adults to pay for food, housing, healthcare etc. This enhances happiness among older adults in low- and middle-income countries [10–12] indicating that older adults who are working and receive better income are happier than their counterparts who do not have the opportunity of working to earn for basic living [13, 1, 14].
Besides, access to high quality healthcare services contributes positively towards healthy living and happiness [15]. Thus, availability and access to the needed healthcare services and the satisfaction with health care delivery timely and of high quality are regarded to improve health and brings happiness [16–19]. The implications are that access to healthcare without satisfaction of the care services delivered negatively affect patients’ happiness. For instance, health workers’ intermittent late reporting to work, conclusive diagnosis without listening to patients’ concerns, improper examination of patients, not explaining the diagnosis, shortage of medicines, and medical equipment are negatively associated with happiness of patients [20]. Also, older adults without health insurance could have less access to primary care provider which could also limit their ability to pay for healthcare services and the medications they need. This could negatively impact their wellbeing and happiness.
Furthermore, the neighbourhood and built environment [NPE] or living in a healthy and safer location is linked to health and wellbeing [21–24]. Living in a neighbourhood that has high rates of violence, unsafe water and air alongside other social health and safety risks has adverse effect on healthy living and happiness of older adults [25]. On the other hand, healthy and happy people are found in a safer environment where there is good interactions among the people [23]. Also, the place of residence is reported to play a significant role in a happy life [21]. Living in a rural or urban area impacts happiness [21]. Access to safe, open, natural, and green spaces, which are designed features for allowing social interaction is associated with happiness [24].
Evidence shows that educational attainment increases the level of happiness through independence and freedom of choice [26]. Highly educated people build better self-esteem and have confidence when compared with those with lower level of educational attainment, which result in higher levels of happiness [27, 28]. Also, higher educational achievement is accompanied by decent occupation, and higher income which impact individual happiness [29, 30].
Imperatively, close relationships and interactions with family, friends, colleagues at work, and community members have key impact on people’s happiness. Access to safer open social spaces for recreational purposes like the community centers, aged friendly drinking spots, church places, and places where older adults can gather to play games are very important characteristics of the social and community context that are directly related to happiness [31]. These enhance interpersonal relationships among older adults [31] and the sense of community which significantly influence happiness [32]. Older adults who have positive relationships at home, at work, and in the community have less to worry about in life. Further, spending time with friends and good neighbours, community participation, and trust in people in the neighbourhood including the local police have significant relationship with happiness of older adults [33]. Also, religiosity and attending religious activities (social integration and engagement) have positive relationship with happiness [34, 35]. An indication that the community serves as social environment that has profound effects on the kind of social support one could get [36, 37]. Aged people are happier when they are socially integrated and engaged into the community where they live[38].
Studies in Ghana have shown that family social capital, including family sense of belonging, autonomy support, control, and social support, vary with self-reported happiness [39]. Happiness among Ghanaians is influenced by several factors such as economic, cultural, social capital and health factors [40]. A wide range of scholarly work have contributed to the debate on SDOH and happiness. Yet these studies do not primarily target older adults. Also, the categorization of the SDOH by the Healthy People [2] as applied in this study does not include access to healthy food or diet which has been shown to have influence on happiness. Lastly, none of the available studies have investigated the direct, indirect and covariance effect of the indicators of SDOH on happiness of older adults in Ghana, as far as our search revealed. Premised on the foregoing, this study examined the relationship between the SDOH and happiness of older adults in Ghana. This is because the conditions in which they are born, live, learn, work, play, worship, and age could affect their happiness as previous studies have shown from different contexts.
Theoretical perspective
The Objective List Theory (OLT) strengthened the premise of this study. The theory holds that happiness consists of a human life that achieves certain things from a list of worthwhile pursuits which may include career accomplishments, friendship, freedom from disease and pain, material comforts, civic spirit, beauty, education, love, knowledge, and good conscience [41, 42]. The OLT best explains relationship between happiness and the SDOH as the main aim of this study. Aspects that have applied the OLT include the argument that people’s objectivist judgments would recognise knowledge as an element of happiness because it involves appropriately justified beliefs about meaningful truths [43]. Parker [44] asserts that the most worthwhile lives are those high in various objective goods which principally include happiness and meaning. Although these studies somewhat justify the tenets of the OLT, they apply the theory either making detail explanations of the theory itself or scarcely apply it to older adults in terms of their happiness. Therefore, the relationships between happiness and the SDOH concerning older adults is left of out. The study theorised that happiness of older adults is influenced by the SDoH as categorised by Healthy People [2]. In addition to the five indicators by Healthy People, access to healthy food was included and tested in this study. Figure 1 presents details of the theoretical framework.