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Measuring people’s well-being:the BCFN Index

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Contact Details

Barilla Center for Food & Nutrition

Via Mantova, 166

43122 Parma ITALY

[email protected]

www.barillacfn.com

Photo by

www.barillacfn.com

[email protected]

Advisory Board:

Barbara Buchner, Claude Fischler, Jean-Paul Fitoussi, Mario Monti,

Gabriele Riccardi, Camillo Ricordi, Joseph Sassoon, Umberto Veronesi.

In collaboration with:

The European House-Ambrosetti

Graphics, paging, editing:

Burson-Marsteller

Photo by:

National Geographic Image Collection

Cover image: David Cupp/National Geographic Image Collection

Contents - 1

1. WELL-BEING AND HOW TO MEASURE IT 4

2. THE BCFN APPROACH TO THIS ISSUE 10

3. BCFN INDEX 22

3.1 Methodology 26

3.2 Lifestyle sub-index 30 3.2.1Psycho-physicalwell-being 30 3.2.2Behavioralwell-being 41 3.2.3SummaryresultsoftheLifestylesub-index 53

3.3 Other components of the BCFN index 54 3.3.1WealthandSustainabilitysub-index 55 Materialwell-being 55 Environmentalwell-being 58 SummaryresultsoftheWealthandSustainabilitysub-index 62 3.3.2SocialandInterpersonalsub-index 63 Educationalwell-being 63 Socialwell-being 68 Politicalwell-being 72 SummaryresultsoftheSocialandInterpersonalsub-index 75

3.4 The BCFN Index: main evidence 75 3.4.1SensitivityanalysisontheBCFNIndex 77

4. CONCLUSIONS AND NEXT STEPS 80

BIBLIOGRAPHY 86

STATISTICAL APPENDIX 90

Contents

2 -Measuring people’s well-being: the BCFN Index 3

DearReader,

In these first two years of its work, the Barilla Center for Food and Nutrition (BCFN)has tackled a series of issues linked to diet and nutrition which, by their very nature,whetherdirectlyorindirectly,haveatangibleeffectonthewell-beingofpeople.Atthesametime,wehavealsodelvedfullyintotheeffectsthatlifestylesanddietcanhaveontheenvironmentsurroundingus,whichareresponsiblefortheabsorptionanddepletionof natural resources (from the emission of greenhouse gases to soil depletion and theusage and pollution of water). Not to mention those aspects linked to food which aremorecloselyconnectedtothesocialsphereandinterpersonalrelationships(conviviality,socializing,etc.).

FromtheexperienceoftheBCFNAdvisoryBoard,theresultsobtainedfromtheworkthathasbeendoneandpositivereactionsto itfrompolicymakers,opinionleadersandthescientificcommunity,itwasdecidedtotakepartinthecurrentdebateonindicatorsformeasuringwell-beingbyofferinganinnovativeandspecificcontributionfocusedonfoodchoicesandlifestyles.

The future of foodis growing with us .

Thedebateregardingtheneedtoexpandtherangeofindicatorsforgoverningsocietyandtheeconomy,inparticularformeasuringtheGrossDomesticProduct(GDP),hasbeenongoing for some time now and has triggered a broad-ranging series of considerations.It isawell-establishedfactthateconomicanalysesbasedexclusivelyonGDPareoftenmisleading.Forexample,intheyearsimmediatelyprecedingtherecenteconomiccrisis,GDPwasunabletodifferentiatebetween“healthy”and“artificial”growth.

Withinthiscontext,there is increasingly-growingawarenessthatall-roundpersonalwell-beingdependsonanumberofvariables—includingsomeaspectslinkedtolifestyle,food choices, healthcare and environmental protection, etc.—which are not basedexclusively on economic and material aspects generally taken into consideration whenmakingpolicychoices.

Although there is now a widely-held belief that indicators of an exclusively materialnatureareunsuitable for offering “all-round” measurement of the real situationofacountryoragivenarea,thedifficultiesinvolvedindevisingameasurementsystemaresuchthatto-dateithasnotyetprovenpossibletofindasatisfactorysolutiontothevariousmethodologicalneedsunderlyingitsconstruction.

The goal of the work undertaken in this context by the Barilla Center for Food andNutritionhasbeen,therefore,toinsertthecomponent tied to diet and lifestyleintoamulti-dimensionalindexthatmeasuresandcomparesthelevelofwell-beingofpeopleinaselectedgroupofdevelopedcountries.

Inpresentingthisdocument,wewishtoannouncethatweareembarkingonaprocessfocusedonthedesiretomakeacontributiontothisambitiousgoal,inlinewithourownparticular perspective which starts first and foremost from the study and knowledgeof dietary issues. Along the way, this process will involve the professionalism, skills,intelligence and willingness of all those who feel they can provide a constructivecontribution.

Theformweneedtogivetoourworkisthatoftheopen “platform”,whichwillcombinetheworkofanalysisandstudybythetechnicalgroupsmadeupofexpertsandmembersof institutions with the willingness to take the suggestions of all those interested inbeinginvolvedinthistask.

Werealizethatitwillbealonganddifficultundertaking,butweareconvincedthattheroadtowardsafairerworldalsoinvolveshavingthetoolstounderstandsituationsthatarebettersuitedtorecordingphenomena.Toolsmoreappropriatetothesituationsweallencounterinourdailylives.

Enjoy!

GuidoBarilla

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1. Well-being and how to measure it

The Gross National Product does not allow for the health of our families, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our family values, the intelligence of our public debate or the integrity of our public officials.

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Defining and measuring the well-being of man in a way that is as inclusive, widely-shared and relevant as possible, is not just a fascinating challenge for social scientists, but also a fundamental step towards defining better political and economic choices and therefore, what should be a better world.

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There is no one single dimension of well-being, but rather a number of pos-sibledimensions,whichtogethercontributetodefiningtheoverallmeaning.Itinvolves economic as well as more social aspects, environmental and politicalaspectsandsignificantpersonalelementslinkedtohealthandthewayoflifeofsocietiesandindividuals.Howeverlong,adetailedlistofthepossiblefactorsabletoaffectanydimensionofindividualwell-beingwouldofcoursebeincom-plete,astherearesomanyaspects—evenjusttheoreticalones—thatgotomakeupacompletedefinition.

Briefly put, there does not exist a single definition of well-being. Thecomplexityofthephenomenonissuchthat,strictlyspeaking,itdoesnotseempossible to arrive at a “definitive” measurement. Nonetheless, it is possible tomakearoughcalculation,ashasoftenbeenattemptedthroughoutthecourseofhistorywiththehelpofinstrumentsmadeavailablethroughprogress.

Thisevidenceleadstothefirstmethodologicalchoicewemade,alsobasedonthemostadvancedexperienceinthisfield:thatofattemptingtoconsiderthelargest number of factors, avoiding definitions which emphasize one par-ticular aspect or element to the detriment of others. Well-being is, therefore,primarilytheresultofanobjectivesituationinwhichthereisabalancedoccur-renceofaverybroadsetofpositive—oratleastnotnegative—phenomena.

Notonlyisitdifficulttoofferacompleteframeworkforthe“well-being”phe-nomenon:wemustalsoindicatetheresearchapproach.Choosingtoadopttheindividual as the focal point of study poses a further, fundamental problemlinked to the logic for choosing, measuring and weighting the various factorsthathelpdefineindividualwell-being.Infact,whentheperspectiveisthatofahumanbeing,thereareasmanyobjective factorsastherearesubjective well-being factors.Ononehand,theapproachusedisthatofmeasuringthefactualelementsoftheexistenceofpeople,whicharegatheredandassessedobjectivelybecausetheyaredisassociatedfromapartial,personalview.Ontheother, the logic is that of the assessment individuals make of their own lives,the census of the interpretation of objective phenomena formulated subjec-tivelybyeachperson.Itisthegreat,irresolvabledistancebetweenwhatexistsandwhatisperceived.

How then can we fill the gap between objective measurement and sub-jective perception?Onewayistoaskindividualstoevaluatethelatter.Thiswouldmakequantifyingindividualwell-beingmorecomplete,andbringitclosertotrulyassessingthequalityoflifeofpeople.Nonetheless,thisprocesswouldinvolve highly subjective elements in measuring well-being, making compari-sonsbetweenindividualsanddifferentcountriesverycomplex.Theotherwayistoremainwithintheframeworkofobjectivemeasurements,expandingthe

1.Well-being and how to measure it

rangeofphenomenadeemedtoco-determinewell-being.Theaimhereistoar-riveasymptoticallyatameasurementofwell-beingwhichisascloseaspossibletothe“real”one.

This second course, however is not totally without pitfalls. Firstly, al-though statistical measuring techniques provide the foundation, their meth-odologyinvolvesmajorsimplificationsandasetofnecessaryconventions.Sec-ondly,theyinvolveabasictrade-off.Ononeside,asmallernumberofvariablesobservedandestimatedhastheadvantageoffocusingandlimitingthepoten-tialdistortionsinvolvedinthemultiplecalculationoftheendeffectonthephe-nomenonbeinganalyzedinthesurvey.Thiscanbecausedbytheinclusionofdifferentinterpretationsandvariableswithinthemodelitself,eveniftheyarelinkedbythefactthattheypartlyregisterthesamephenomenonneededforthepurposeofthesurvey.Ontheotherhand,thechoiceofa limitednumberof variables necessarily pays the price with a very “approximate” descriptionofthescenario.Itcreatestheriskofnotconsideringasetofelementsthatcanplayatrulysignificantrole,ariskthatincreasesaswegetclosertophenomenawhereitistheindividualthatisthefocusofinterest.

Inanycase,theversionoftheindexpresentedinthisdocumentisofanob-jective nature.Despitethis,weareawareoftheneedtointroduce subjec-tive measuring elements, linked at least to the definition of the weightingsystemwhichconstitutesitsframework.

Ascanbeseen,measuringindividualwell-beingiscomplexand, insomere-spects, does not provide a definitive solution. Despite all the difficulties, how-ever,aseffectivelyrecalledbyFitoussi,SenandStiglitzinthefinalreportoftheCommissionontheMeasurementofEconomicPerformanceandSocialProgress,“What we measure influences what we do”, defining and measuring the well-being of man in a way that is as inclusive, widely-shared and relevant to thecomplexities of the situation in question as possible, is not just a fascinatingchallenge for social scientists, but also a fundamental step towards definingbetter political and economic choicesandtherefore,whatshouldbeabet-ter world.

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2. The BCFN approach to this issue

However long, a detailed list of the possible factors able to affect any dimension of individual well-being would of course be incomplete, as there are so many aspects—even just theoretical ones—that go to make up a complete definition.

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It is a well-established fact that economic analyses based exclusively on GDP are often misleading.

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Thedebateregardingtheneedtoexpandtherangeofindicatorsforgoverningsocietyandtheeconomy,inparticularformeasuringtheGrossDomesticProduct(GDP),1hasbeenongoingforsometimenow,andrecently,bothabroadandinItaly,ithastriggeredaseriesofconsiderations.

Itisawell-establishedfactthateconomicanalysesbasedexclusivelyonGDPareoftenmisleading.Forexample,intheyearsimmediatelyprecedingtherecenteconomiccrisis,GDPwasunabletodifferentiatebetween“healthy”and“artificial”growth”;orthatintheeventofanaturalcatastrophe,theGDPincreasesthankstoreconstructionexpenditure,while the cost of the catastrophe itself is not accounted for, and social well-being cer-tainlydoesnotimprove.AlthoughGDPremainsagoodindexofeconomicgrowth,itisnotsuitedtograspingthoseaspects tied to the advancement and well-being of people.Infact,itdoesnottakeintoaccountgoodsthatdonothaveamarket.Itdoesnotconsidernegativeexternalfactors—i.e.,costsgeneratedbymanufacturing(pollution,unsustain-ableexploitationofresources,lossofbiodiversity,etc.),thequalityofpublicexpenditure,andsoforth.

RobertF.Kennedy’scommentontheinadequacyofGDP,deliveredattheUniversityofKansasonMarch18,1968,isstillrelevant:

Asearlyas1934,the“father”ofGDP,SimonKuznets,2declaredbeforetheCongressoftheUnitedStatesthatwell-beingandGDParetwoseparatethings:“Thewell-beingofanation[…]cannoteasilybededucedfromanationalincomeindex.”

In economic literature, it is possible to find many examples of descriptive multi-dimensional indicators created for the purpose of measuring the well-being and quality of lifeforagivennation,region,city,etc.Thismeasurementismadebycombin-inganumberofindicatorswhichfocusoncrucialaspects;whetherdirectlyorindirectly,theseinfluencethequalityoflifeofindividualsandcommunities,andindeeddeterminethem.Bywayofexample,theycanincludeeducationandtrainingindicators,orothers

1 TheGDPisthesumcalculatedwiththemarketvalueofallgoodsandservicesproducedinacountrywithinagivenperiodoftime,whichisgenerallyoneyear.Whenexaminedintermsofpopulation(percapitaGDP),itmakesitpos-sibletocomparedifferentcountries,regionsorothersub-nationalunitsovertimeandspace.Generallyspeaking,itisthefirstindicatorusedfordiagnosingtheeconomicandsocialsituationandmakingcomparisonsbetweendifferentcontexts.Asagrowthrate,itrepresentsthemainindicatorforassessingthelong-termperformanceofacountryorregion.

2 AmericaneconomistandNobeleconomicsprizewinner.

2.The BCFN approach to this issue

“We will find neither national purpose nor personal satisfaction in a mere continuation of economic progress, in an endless amassing of worldly goods. We cannot measure national spirit by the Dow Jones Average, nor national achievement by the Gross National Product. For the Gross National Product includes air pollution and advertising for cigarettes, and ambulances to clear our weekend highway carnage. It counts special locks for our doors, and jails for the people who break them. It in-cludes television programmes that glorify violence to sell violent goods to our children. It increases with the production of napalm, missiles and nuclear warheads, and it also includes research for improving dissemination of the bubonic plague. It increases with the equipment the police uses to put down riots, and does nothing but increase when slums are built on their ashes. The Gross National Product does not allow for the health of our families, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our family values, the intelligence of our public debate or the integrity of our public officials. It fails to take account of justice in our courts, nor fairness in relations between us. The gross national product measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country. It measures everything, in short, except that which makes life worth-while; and it can tell us everything about America except whether we are proud to be Americans”.

regardingemployment,theenvironment,energy,health,humanrights,availableincome,infrastructure,publicandprivatesafety,recreationalandculturalactivities,andsoforth.What follows is a brief list (for illustrative purposes only and should not be consideredcomplete) with a short description of some of the main contributions recently made tothistopic,elaboratedbyeconomistsandleadingnationalandinternationalinstitutions.

Index of Sustainable Economic Welfare AnalternativeeconomicindextoGDP,theIndexofSustainableEconomicWelfare(ISEW)

wasdevelopedbyeconomistsWilliamNordhausandJamesTobinandwaspresented inthe 1990s in their study, Measure of Economic Welfare. The method for calculating this“economicwelfare”indexproposestheintroductionofanumberofcorrectionstotradi-tional national accounting measurements in order to take into consideration a number

offactorswhich,althoughwithoutdirectimpact on measuring GDP, do influenceeconomicwell-being.Thisinvolves,forex-ample,thedepletionofnaturalresources,the economic “cost” associated with thedegradationoftheenvironmentor,froma

positive standpoint, the economic value of individual leisure time (in terms of personalwell-being),theeconomicandsocialvalueofhomemaking(althoughunpaid,notextrane-oustothewell-beingofpeopleandnations).

The innovation proposed by Tobin and Nordhaus regarding the measurement of eco-nomicwelfaregeneratedbynationaleconomiesrepresentedanimportantpointofreflec-tionformanysubsequentstudies,includingsomeofthosepresentedinthecourseofthispaper.

Genuine Progress Indicator (GPI)TheGenuineProgressIndicator(GPI) isoneofthemainresultsofthedevelopmentof

thetheoreticalandmethodologicalapproachoftheSustainableEconomicWelfareIndextowards“improving”therepresentativenessofGDPthroughtheintegrationofadditionalindicators which take into account social-economic phenomena that GDP is not able toreflect.

Thisindicator(alsoknownastheGenuineProgressIndicator),wasdevelopedtohigh-lighttheneteffectonthewelfareofpeoplelivinginagivencountry,comparedwithanincreaseintheproductionofgoodsandservices,whiletakingintoaccountthatsomeele-mentswithanetpositiveeffectonGDPactuallyhaveanegativeimpactonpersonalwell-being(forexample,theeconomiccostofcrime).

According to this approach, GPI is calculated in a similar way as occurs in companieswhich, starting from profits, calculate net real profits by subtracting costs. From thisstandpoint,therefore,GPIwillbezeroif,everythingelsebeingequal,thefinancialcostsofcrime,pollution,post-earthquakereconstruction,etc.,areequaltothefinancialbenefitsfromtheproductionofgoodsandservices.

ThemethodforcalculatingtheGenuineProgressIndicatorcallsfortheidentification,onthelevelofnationalaccounts,ofanumberof“positive”expenditures(whichincreasewell-being)andanumberofnegativeexpenditures(withanegativeimpactonthewell-beingofindividuals,suchasthecostofcrime,pollution,roadaccidents,etc.).

GPI is therefore calculated as the difference, the balance between “positive” and“negative”expenditures(thusgoingbeyondtheGDPapproachthatincludesallexpenditureas positive and does not take into consideration those activities which, although theygeneratemonetaryflowsandcreatewealth,donotcontributetoincreasingthewelfare

it is necessary to have long-term indicators ofthe sustainability of well-being, which chieflyinvolveproblemslinkedtotheenvironment.


of a society). In addition, among the expenditures and activities classified as “positive”is also included an evaluation of services not transacted on the market (e.g., volunteerservicesorhomemakingactivity).Onceagain,anaspectnot“intercepted”byGDP..

Human Development Index (HDI) The Human Development Index (HDI) is a macroeconomic development indicator cre-

ated by Pakistani economist Mahbub ulHaq in 1990. Today, this indicator is regu-larlyutilizedandpublishedbytheUnitedNations as a supplement to GDP, in orderto evaluate the quality of life of membercountries.This indicator isasummary in-dex created for each country by takinginto consideration aspects such as crime,promotion of human rights, improvementofpubliceducation,environmentalprotec-tion,sustainabledevelopmentofnationalresources, weakening of the social fabric,

pollution,spreadofcertaintypesofdiseases(suchasHIV/AIDS),etc.

Theindexisexpressedinthousandthsandcanrangefrom0(minimum)to1(maximum).Onthebasisofthisindicator,theUnitedNationssubdividesmembercountriesinto:n HighHumanDevelopment(HDIbetween0.800and1.000);n MediumHumanDevelopment(HDIbetween0.500and0.799);n LowHumanDevelopment(HDIbetween0and0.499).

The20threport,HumanDevelopmentReport2010,wasreleasedonNovember4,2010.

Contribution of the New Economics FoundationThe New Economics Foundation (NEF) is an independent organization based in the

UnitedKingdomwhosemissionistoinvestigateintotheactualnatureofindividualwell-being,asopposedtoeconomicwell-being.ThegoaloftheNEFistoimprovethequalityoflifeofindividualsthroughthepromotionofinnovativesolutionsinevaluatingwell-beingwhich go beyond traditional, mainstream economic thought to introduce analysis andevaluationofenvironmentalandsocialaspectsthatimpactonthewell-beingofpeople.NEFwasfoundedin1986byanumberofleadersofTheOtherEconomicSummit(TOES).Inadditiontobeinganinstitutionofreferenceonaninternationallevelandworkingtoguideformulationofpoliciesthatarethemostsuitablepossibleforimprovingindividualwell-being,theNEFconstantlyworksondevelopinginnovativemethodstomeasurede-velopmentthroughanalyzingimpactsonwell-beingandfromthestandpointofenviron-mentalsustainability.

Thefoundation’sworkintermsofmeasuringwell-beingisfocusedonidentifyingwhatshouldbedefinedas“socialvalue”andassuch,measured.Towardsthis,theNEFhascre-atedaconceptualframeworkforthedevelopmentofa“NationalAccountsofWell-being”thatmakesitpossibletogenerate:n aninnovativemethodforevaluatingthemeasurementofsociety’sprogressthrougha

subjective surveyofthelevelofwell-beingthatindividualsincountriesaroundtheworldperceiveintermsoftheirownlives;

n anacross-the-boardapproachtothevariouscomponentsofwell-beingandsocialde-velopmenttoallowamoreaccuratedefinitionofpoliciesofnationalgovernmentsthatgobeyondthelogicofmaximizationofeconomicefficiencyinordertoalsoofferdeci-sion-makersmoreappropriatetoolsforevaluatingtheactualimpactoftheirdecisionsonthelivesofindividuals;

n improvementintherelationshipbetweengovernmentsandtheirpopulationsbygivinggovernmentstheopportunitytoimprovetheirrelationswiththeircitizensthroughof-feringmoredirectinvolvementintheprocessofformulatingstrategiesforthecountry,thuscontributingtoreducethe“democraticdeficit”whichmanyEuropeancountriesarefacingtoday.

TheNEFalsopreparesanindicatortomeasurethelevelofwell-beingoftheworld’spop-ulations.Itiscalled“The Happy Planet Index (HPI)”andwascreatedtodiscover,ononehand,whatindividualsconsidertobeimportantforlivingalong,happyandmeaningfullife,andontheother,whatisimportantforourplanetintermsofresourceconsumption.

FEEM Sustainability IndexFromthestandpointofItaly,amajorscientificcontributionintermsofinnovativemeth-

odsinthemeasurementofwell-being,canbefoundintheworkoftheFondazioneENIEn-ricoMatteiwhichthisyearpublishedits15thFEEMIndex(www.feemsi.org),constructedonthebasisofanaggregateofvariableswiththegoalofexaminingandmeasuringtheenvironmentalandsocialsustainabilityofeconomicdevelopment.

Thisindicatoriscreatedthroughtheaggregationofaseriesofvariablesthatmeasuredevelopment sustainability and is elaborated using specially-defined weightings as-signedtothevariablesandcombinationsofvariables.ThisprovidesaunifiedsummaryindexofperformancecalledtheFEEMSustainabilityIndex(SI).

Inadditiontothesignificantstructureofquantitativeanalysisonwhichthe indexiscalculated,thespecialaspectofthemethodologicalapproachadoptedforcalculatingtheFEEMSustainabilityIndex(SI)liesintheabilitytodevelopforecastsforthefutureandtomakeinternationalcomparisonsonthebasisofthisindicator.

“Il Sole 24 Ore” Quality of Life IndexOnceagainfromthestandpointofItaly,itshouldbenotedthatforthelastfifteenyears,

IlSole24Ore,thecountry’sleadingeconomicandfinancialnewspaper,hasbeenpublish-inganannualclassificationofthe“livability”ofthe103Italianprovinces.

Italy’s position reflects some decidedlypositive performances, such as for averagelife expectancy and average life expectancyin good health, second only to the figures forJapan,andagenerally“high”levelofwell-beingconnected to the psychological sphere of thepopulation.

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This classification is prepared on the basis of an aggregation of a set of 36 indicatorsgroupedaccordingtothefollowingdimensions:n Publicorder(reportedthefts,robberies,etc.);n Population(percentagewithcollegedegrees,immigration,etc.);n Leisuretime(numberoftheaterandconcertevents,indexofbooksread,etc.);n Standardofliving(bankdepositsperresident,avg.costperm2ofhousing);n Businessandemployment(registeredcompanies,unemployment,etc.);n Services,environmentandhealthcare(indexofavailableinfrastructure,technicalad-

vanceonanannualbasis).

“Beyond GDP” initiativeOver the last few years, the European Parliament, European Commission, OECD and

theClubofRomehavebeeninvolvedinaprojectentitled“Beyond GDP”3incollaborationwiththeWWF.

InNovember2007,theEuropeanCommission,togetherwiththejointtaskforcecom-prisedoftheEuropeanParliament,ClubofRome, OECD and the WWF, organized andhostedatop-levelconferenceentitled“Be-yondGDP”,heldinBrussels,withtheprin-cipalobjectiveofdiscussingandclarifyingwhatthemostappropriateindicescouldbetomeasuretheprogressandwell-beingof

nationsandhowthese indicescouldbebetter integrated intoprocessesofformulatingeconomicandsocialpoliciesandbeproperlytakenintoaccountinpublicdebateonmajorstrategicissues.

Theconvictionunderlyingthisconferenceis—inlightofwhathasbeensaidprevious-ly—thateconomicindicatorssuchasGDParenotdesignedtorepresentacross-the-boardmeasurementofpersonalwell-being.Thisgivesrisetotheneedtodevelopcomplemen-taryindicatorswhich,althoughwiththesameclarityasseeninGDP,areabletobroadenthefieldofmeasurementtootheraspectsofwell-beingthatgobeyondtheeconomicdi-mensionofthisaspect(particularlyintermsofenvironmentalandsocialproblems).

WhatarerequiredtodayareindicatorsmoresuitablethanGrossDomesticProductiontotakeonsomeofthemostdemandingglobalchallengesfacinghumanity,suchasclimatechange,poverty,resourcedepletionandhealth,tonamejustsome.

The“BeyondGDP”conferencebroughttogetherover650people,includingpoliticians,expertsanddecision-makerswho,together,undertookacriticalandtask-orientedexami-nationoftheissuesupfordiscussion.Evenbeforethemainconferenceitself,aseminarforanumberofselectedexpertswasheldinwhichthecurrentavailabilityandutilizationofindicatorsinthemeasurementofprogressandwell-beingwasdiscussed.

Asafollow-uptothe2007conference,in2009theEuropeanCommissionannouncedtheprogressthathadbeenmadeintheworksurroundingthe“BeyondGDP”theme,out-liningadetailedroadmapinfivemajorareasofstudyand/orkeyinitiativestoguidethecontinuationofworkinthisarea.ThefivekeyinitiativesidentifiedbytheEuropeanCom-missionare,briefly:n TheCommissionundertakestoproposeintheshort-termamethodologyforcalculat-

ing a “pilot” index for measuring the progress of nations in the area of environmen-talpolicy(thisindexshouldinclude,forexample,CO2emissionsintotheatmosphere,protectionofareasofnaturalbeauty,airquality,pollution,waterconsumption,wastedisposal,etc.).

3 Foradditionalinformation,consultthewebsite:www.beyond-gdp.eu

n The Commission undertakes to intensify efforts in the construction and diffusion ofdatatobeusedinmeasuringenvironmentalandsocialaspectsofindividualwell-be-ing.To-date,infact,thisdataisreleasedfromEuropeanbodieswithaseveral-yearde-lay(while“traditional”,purelyeconomicindicatorsarereleasedjustweeksaftertheyarecompiled).Thegoalistomakeavailabletopolicymakers,inrealtime,asetofinfor-mationtobeusedtonurturethedecision-makingprocessinformulationofpolicyonissuesthatgobeyondeconomicdevelopment.

n The European Commission will work towards preparing a set of indicators involvingincomedistributionandinequities,inordertofacilitatethedrawingupofpoliciesin-volvingeconomicandsocialcohesion.

n TheEuropeanCommissionwillcreateabalancedscore-cardconstructedonthebasisofalready-existingsustainabledevelopmentindicatorswhichwillbepublishedinordertopermitanalysisandcomparisoninmeasuringwell-beingbetweenEuropeancoun-triesandon-goingmonitoringofbestpracticesonaninternationallevel.

n TheCommissionwillworktowardsintegrationofnationalaccountingindicators(GDP,investment,consumption,publicspending,etc.)withindicatorsconstructedontheba-sisofwhatwillbedefinedas“environmentalandsocialaccounting”.

Theprocessinitiatedin2007andcontinuedin2009isstillunderwayandrepresentsoneofthemostsignificantcontributionsinthestudyofsystemsofmeasuringthewell-beingofpopulationsthatgo“beyondGDP”.

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The psycho-physical well-being of individualsmay be influenced in large part by personalbehavior and lifestyles (diet, lifestyle, sportsactivity,etc.).


hastackledaseriesofissues linked to diet and nutritionwhich,bytheirverynaturehaveadirectorindirecttangible effect on the well-being of people.Firstandfore-most,theeffectsthatdietarychoiceshaveonthehealthofchildrenandadults,whetherinnegative(directcauseorriskfactorsintheonsetofcertainseriousillnesses)orpositiveterms(protectiveeffectagainstcertainillnesses).Ithasalsodelvedfullyintotheeffectsthatlifestylesanddietcanhaveontheenvironmentsurroundingus,whicharerespon-siblefortheabsorptionanddepletionofnaturalresources(fromtheemissionofgreen-housegasestosoildepletionandwateruseandpollution).Nottomentionthoseaspectslinked to food which are more closely linked to the social sphere and interpersonal relationships(conviviality,socializing,timespentinpreparingandeatingfood,etc.).

The considerations formulated by the Advisory Board of the BCFN and the evidencecollatedinthestudiesithaspublished—bringingtogetherthemostinterestingpointstocomeoutofthescientificdebateregardingtheneedfornewinstrumentstomeasurethewealthandwell-beingofnations,firstandforemostamongthesetheStiglitz-Sen-Fitoussireportmentionedabove—haveresultedintheconvictionthata sizeable amount of the overall well-being of individuals is linked to the diet and lifestyles they adopt,firstandforemostbecauseofthespin-offeffectstheyhaveonhumanhealthandenvi-ronmentalsustainability.

FromtheexperienceoftheBCFNAdvisoryBoard,theresultsobtainedfromtheworkthathasbeendoneandpositivereactionstoitfrompolicymakers,opinionleadersandthescientificcommunity,it was decided to take part in the current debate on indica-tors for measuring well-being by offering an innovative and specific contribu-tionfocusedonfoodchoicesandlifestyles.

Thegoalhasbeen,therefore,toinsertthecomponent tied to diet and lifestyle into a multi-dimensional index that measures and compares the level of well-being of people in a selected group of developed countries.

Theaimofthisstudyistoprovideaproposal that contributes to the scientific de-bate currently underway,introducingan original standpointwhichwehaveyet to come across in other similar experiences. Indeed, the innovative nature of our ap-proachconsistsofgaugingfactors linked to diet and lifestyles of peoplealongwiththeelementsthataretakenintoaccount;assaidbefore,thesehaveasizeableeffectonthewell-beingofpeople.

Thisdocumentoutlinesthefirstdraftofwork still in progress,whichinthecomingmonths will benefit from further technical and scientific contributions, as well as addi-tional material resulting from work to perfect proprietary survey instruments (inter-viewsandquestionnaires).Theseresultswillbecombinedwiththeofficialinstitutionalstatisticsusedto-date(obtainedfromdatabasesoforganizationssuchastheOECD,WHO,IMF,IEA,WorldBank,etc.).In this way the objective factors for measuring well-be-ing will be combined with more subjective elements for gauging the way people perceive well-being.Thelatterrepresentsapivotalpoint,aspeople’sperceptionoftendifferssignificantlyfromdatafoundinofficialstatistics.

Toconclude,inordertoensurethescientificcredibilityofthisstudy,wehavetriedtocomplywithtwofundamentalcriteria:n topayparticularattentiontotheauthoritativeness of the sources,selectingexclu-

sivelydataproducedbyinstitutionsandindividualsknownforthequalityoftheirdataprocessing;

n toensurethemaximumtransparencyinourmethodsandcalculations,furnishingalltheinformationnecessaryforclearcomprehensionoftheworkdoneandtheresultsobtained.Ourcommitmenttotransparencywilltaketheformofpublishingthisdocu-mentwhichcontainsallthestatisticaldetailsrequiredindefiningtheindex.

Stiglitz-Sen-Fitoussi CommissionInadditiontothenationalandinternationalexamplesofferedabove(towhichcouldbe

addedothersthathavenotbeenincludedforspacereasons4),thesignificantcontributiontothedebateonmeasuringwell-beingprovidedrecentlybyacommissioncomprisedofaround thirty international economists5 must also be mentioned. The commission waspresidedoverbyNobelprizewinnersJosephStiglitzandAmartyaSenandFrenchecon-omistJean-PaulFitoussi6andwaschargedbyFrenchpresidentNicolasSarkozytostudyandproposealternativestoGDP.

Thecommissiondidnot identifyanewsummaryindicator,but itdiddraftaseriesofrecommendations7 which are summarized below. They are useful for understandingthemanyfacetsofsocialwell-being:n Materialwell-beingshouldbeassessedintermsoffamily nucleus,takingintoconsid-

erationincomeandconsumptionratherthanproduction.Moreover,greaterempha-sisshouldbeplacedonthedistribution of income,consumptionandwealth:anaver-ageincreaseinincomedoesnotnecessarilycorrespondtoanincreaseforeveryone;

n It isalsonecessarytodevelopmeasurementsandstatisticsfornon-market activi-ties,aswell-beingalsodependsonactivitiesthatdonotgiverisetomarketexchanges,suchasservicesprovideddirectlybetweenindividuals(forexampleactivitiesandser-vicesprovidedwithinthefamily,lookingafterthesickandtheelderly,etc.);

n Itisnecessarytotakeintoconsiderationthemulti-dimensional nature of the mea-surement of well-being,whichnotonlytouchesoneconomicconditions,butalsooneducation,health,thequalityofdemocracy,social networks,theenvironmentandsecurity;

n Attentionshouldbededicatedtoenvironmental sustainabilityinordertomeasuregrowthincludingthedestructionofresourcesandtherisksofclimatechange;

n Theservices offered by the Stateshouldnotbemeasuredaccordingtotheircosts,as currently occurs with the GDP, but based on their impact on the well-being of citizens.

Moreover, regarding the non-material dimension of well-being, it is necessary to re-membertheimportanceofleisuretimeandtheneedtomeasuresocialrelations,political“voice”andthesecurityorvulnerabilityofindividuals.

Finallyandmoregenerally,itnotesthatboth objective and subjective measuresshouldbetakenintoconsideration,andthatitisnecessarytohavelong-termindicatorsof the sustainability of well-being, which chiefly involve problems linked to theenvironment.

Approach of the Barilla Center for Food and NutritionInthesefirsttwoyearsofitswork,theBarilla Center for Food and Nutrition(BCFN)

4 Amongtheseare:-theIndexofEconomicWell-Being(IEWB)definedbytheCentrefortheStudyofLivingStandards;-theIndexofSocialHealth(ISH)definedbyFordhamUniversity;-theIndexofLivingStandards(ILS)definedbytheFraserInstitute;-theCanadianIndexofWellbeing(CIW)definedbytheInstituteofWellbeing;-theQualityofLifeIndex(QOL)draftedbyEdDieneroftheUniversityofIllinois;-theIndexofSocialProgress(ISP)draftedbyRichardEstesoftheUniversityofPennsylvania;-theBCStatsIndexofRegionalIndicators;-theOregonBenchmarkscreatedbytheOregonProgressBoard.-theUrbanEcosystemreportpreparedbyLegambienteinconjunctionwithAmbienteItaliaandIl Sole 24 Ore.

5 ForItaly,thecommissionincludedtheparticipationofEnricoGiovannini,ChairmanofISTAT,theNationalInstituteofStatistics.

6 ProfessorofEconomicsandPresidentoftheScientificCommitteeoftheInstitutd’EtudesPolitiquesdeParis;Presi-dentoftheObservatoireFrançaisdesConjoncturesEconomiques.ProfessorFitoussiisalsoamemberoftheAdvisoryBoardoftheBarillaCenterforFoodandNutrition.

7 ProfessorJosephE.Stiglitz,Chair,ColumbiaUniversity;ProfessorAmartyaSen,ChairAdviser,HarvardUniversity;ProfessorJean-PaulFitoussi,CoordinatoroftheCommission,IEP,“ReportbytheCommissionontheMeasurementofEconomicPerformanceandSocialProgress”.

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3. BCFN Index

What are required today are indicators more suitable than GDP to take on some of the most demanding global challenges facing humanity, such as climate change, poverty, resource depletion and health.

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A sizeable amount of the overall well-being of individuals is linked to the diet and lifestyles they adopt, first and foremost because of the spin-off effects they have on human health and environmental sustainability.

26 -Measuring people’s well-being: the BCFN Index 3. BCFN Index - 27

Figure1–Summaryofthe41KPIsusedforcalculatingtheBCFNIndexforthe10countriesexamined

Relativeweighting

Psycho-physicalwell-being

1 Lifeexpectancy 10%

2 Healthylifeexpectancy 30%

3 Mortalityrateforcirculatorydiseases 15%

4 Mortalityrateformalignantneoplasms 15%

5 Mortalityratefordiabetesmellitus 10%

6 Mortalityrateforsuicides 10%

7 Consumerexpenditureonanti-depressants 10%

Behaviouralwell-being

8 Obeseandoverweightadultpopulation 20%

9 Obeseandoverweightyouthpopulation 10%

10 Physicalactivity 20%

11 Consumerexpenditureonfruitandvegetables 10%

12 Adultpopulationsmokingdaily 20%

13 Alcoholconsumption 5%

14 Averageconsumptionofcalories 10%

15 Eatingtimeonaverageday 5%

Materialwell-being

16 Realmedianincome 50%

17 Netwealthofhouseholds 30%

18 Grossfixedcapitalformation 20%

Environmentalwell-being

19 AdjustedNetSaving 25%

20 EcologicalFootprint 5%

21 WaterFootprint 5%

22 Contributionofrenewablestoenergysupply 15%

23 CO2emissionsfromfuelcombustion 20%

24 PM10countrylevels 15%

25 Municipalwaste 15%

Educationalwell-being

26 P.I.S.A.score 20%

27 Averageannualnumberofnewgraduates 35%

28 Foreignstudentsenrolledintheuniversitysystem 15%

29 Unemploymentrateofuniversitygraduates 10%

30 Annualnumberofdailynewspaperspublished 10%

31 Fixedbroadbandsubscribers 10%

Socialwell-being

32 Atriskofpovertyrate 25%

33 Inequalityofincomedistribution 10%

34 Numberofweeklyhoursofchildrencare 5%

35 Unemploymentrate 25%

36 Unemploymentrateamongyoungpeople 10%

37 Old-agedependencyratio 5%

38 NationalInstitutionIndex 10%

39 InterpersonalTrustIndex 10%

Politicalwell-being

40 TheEconomistIntelligenceUnit’sIndexofDemocracy 75%

41 CorruptionPerceptionsIndex 25%

Source:TheEuropeanHouse-Ambrosetti,2010

Asalreadymentioned inthesectionabove,analysisofthescientificreference litera-ture,suggestionsmadebytheAdvisoryBoardoftheBarillaCenterforFoodandNutritionandresearchcarriedoutbytheworkinggroupofTheEuropeanHouse-Ambrosettihaveguidedthedevelopmentofanad hoc methodologyforquantitative measurementofthecomparativelevelofwell-beingstartingfromasamplingofreference countries.

The methodological process adopted has made it possible to construct a multidimen-sionalsummaryindexforthequantitativemeasurementofthewell-beingofcountries.ThisindicatorhasbeennamedtheBCFN Index.

Whatfollowsisadescriptionofthemethodadoptedinconstructingtheindexandthemainevidencegatheredthroughitsapplication(subsequentsections).

Inordertoguaranteemaximumcoherenceandscientific rigorforthemethodologi-calsystemoftheBCFNIndex,thestartingpointusedwastheworkdonebyStiglitz,SenandFitoussi.Thisinvolvesanalyzinga wide range of differing variables(suchasin-come,health,education,extentofsocialnetworksandqualityofdemocracy,etc.)inordertoassessavarietyofaspects(dimensions)of well-beingcontemporaneously.

Fortheinternationalcomparison,10 benchmark countrieswerechosen:n ThreecountriesrepresentingMediterranean Europe:Italy,SpainandGreece;n TwocountriesrepresentingContinental Europe:FranceandGermany;n TwocountriesrepresentingScandinavia:DenmarkandSweden;n theUnited Kingdom;n theUnited States;n andJapan.

The identifiedboundaryofanalysisdoesnot includeanyoftheso-called“emerging countries” (Brazil, India, Russia, China, etc.) as it was felt that the differences still existant inthesocial-economicdevelopmentstagecomparedwithdevelopedcountrieswould render the construction of an index to measure well-being conceivedin this manner and the formulation of relevant policy indications somewhat insignificant.

ThecalculationoftheBCFNindexisbasedon41 KPIs(KeyPerformanceIndicators)formeasuringthenationalperformanceoftheseven dimensions considered.Theseare:n “Psycho-physical well-being”;n “Behavioral well-being”;n “Material well-being”;n “Environmental well-being”;n “Educational well-being”;n “Social well-being”;n “Political well-being”.

EachKPIwasselectedwiththespecificgoalofmeasuringoneormoreaspectsprovidedforinthemethodologyutilizedforeachofthereferencecountries.Insomecases,asitisnotpossibletotakeprecisemeasurementsofthephenomenontobegaugedowingtoalackofavailablefiguresand/orowingtothenatureofthephenomenonitself,approxima-tions(proxies)wereusedtoensurethephenomenonwasmeasurednonetheless.

3.1Methodology


(throughasimpleweightedaverage)tocalculatethepartialsummaryindicatorsforeachofthesevenwell-beingaspects,alongwiththethreesub-indicesconsideredandthefinalsummaryindicator,calledtheBCFN Index(whichcombinestheresultsofthethreesub-indices).

Wherenecessary,theKPIswererelativizedusingaspecificdenominator,inordertoin-creasetheirsignificancewithinthecontextofthenationalcomparison.Thedataregard-ingconsumptionrates,forexample,seemmoresignificant(inthiscontext) ifcomparedand expressed in percentage of the available national income with equal purchasingpower.Bythesametoken,dataregardingobesityorthepropensityofapopulationtodoregularexercisecanonlybecomparedifexpressedinpercentageoftheoverallpopula-tion,andsoforth.

Thesectionswhichfollowoutlinetheresultsthatemergedfromthecomparisonsbe-tweenthetencountriesexamined,thesevendimensionsofwell-being,thethreesub-indices(Lifestylesub-index,Wealthandsustainabilitysub-indexandSocialandinterper-sonalsub-index)andtheBCFNIndex.Forsummarypurposes,detaileddataforeachofthe41KPIswillnotbeprovided,althoughtheyhavebeenincludedinthepartialindicesandfinalindex.

In turn, the seven dimensions of well-being were aggregated into three reference clusters,forwhichthree sub-indiceswerecalculated:n Lifestyle sub-index (15 KPIs):

-“Psycho-physicalwell-being”(7KPIs)-“Behavioralwell-being”(8KPIs)

n Wealth and Sustainability sub-index (10 KPIs):-“Materialwell-being”(3KPIs)-“Environmentalwell-being”(7KPIs)

n Social and Interpersonal sub-index (16 KPIs):-“Educationalwell-being”(6KPIs)-“Socialwell-being”(8KPIs)-“Politicalwell-being”(2KPIs)

Figure2–Schemaofthemethodologicalsystemused:theBCFNIndexanditscomponents

BCFN Index Relativeweighting

35%Lifestyle sub-index

“Psycho-physical” well-being(Health) 20%

“Behavioral” well-being(Dietandlifestyles) 15%

35%Wealth

and Sustainabilitysub-index

“Material” well-being(Income,investmentsandassets) 20%“Environmental” well-being

(Environmentalsustainabilityandquality) 15%

30%Social

and Interpersonalsub-index

“Educational” well-being(Instructionandculture) 10%

“Social” well-being(Welfare,family,societyandinstitutions) 10%

“Political” well-being(Democracyandindividualfreedom) 10%


The performances of the countries in the various KPIs were rendered homogeneousthrough the use of a point system. For each KPI, points were assigned as follows: 10 points tothecountrywiththebest performanceand1 pointtothecountrywiththeworst performanceamongthoseexamined.Theremainingcountrieswereassignedascore between 1 and 10 proportionate to the absolute value of the indicator, on a scaleobtainedusingthefollowingformula:

SCALE=(maximumvalue–minimumvalue)/(maximumscore–minimumscore)

Afterdeterminingthescale,thescoresforeachcountrywerecalculatedasfollows:

SCORE=[(countryvalue–minimumvalue)/scale]+1

Thismethodmadeitpossibletoobtainuniformscoresbetween1and10foreachoftheKPIs;thesescorescanbecomparedandcombinedinsummaryindicators.

Inaddition,theattributionofa“relative weighting”foreachKPI,eachaspectofwell-beingandeachofthethreesub-indices(asshowninthepreviousfigure)madeitpossible Co

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30 -Measuring people’s well-being: the BCFN Index

Life expectancy at birthLifeexpectancyisthestatisticallyexpected number of years of life remaining at

a given age, inthiscase,atbirth.Here,thelifeexpectancyatbirthforeachofthetencountriesunderexaminationwasconsidered.

LifeexpectancywasincludedamongtheindicatorsselectedforcreatingtheLifestylesub-index and BCFN index because it represents a summary parameter directly con-nected tothewell-beingofpopulationsfromapsycho-physicalstandpoint.Lifeexpec-tancyis influenced, infact,byanumberofenvironmentalfactors,whethercontext-orlifestyle-related(includingdiet,health,availabilityandqualityofmedicalcare,criminali-ty,climate,etc.),thataredirectlyconnectedtothestateof“well-being”(frommanypointsofview)inwhichpeoplelive.

Figure4–Averagelifeexpectancyatbirthin2008,expressedinnumberofyears

Source:TheEuropeanHouse-Ambrosettire-elaborationofdatafromtheWorldHealthOrganizationandOECD,2010

Observingtheresultsobtainedthroughcreatingtheindicatorinquestion,itcanbeseenthatlifeexpectancyatbirthvariesbetweenthetencountriesexamined.Althoughtheyrepresentaselectionofcountriesthatareamongthe“richest”intheworldandallhighlysociallyandeconomicallydeveloped,averagelifeexpectancyfortheresidentsofthesecountriesvaries,uptoasmuchasfiveyearsifthedifferencebetweenthe“bestperform-er”country(Japan)andthelowest-rankedcountry(theUnitedStates)isconsidered.Thevariation inthisparameter evenbetweennationsthataresubstantiallyhomogeneousfromthestandpointofwealthandeconomicdevelopment,representsfurtherconfirma-tionoftheimpactofbehavioralandpsycho-physicalfactors(suchasthoseconsideredintheBCFNIndexmethodology)onthewell-beingofpeopleandunquestionablytiedtothelengthofthelivesoftheseindividuals.

Intermsofthisindicator,Italyistheno.2nationamongthoseconsidered,withanav-erage life expectancy of 81.5 years, followed by Sweden, Spain, France, Germany andGreece,whichalsohadaveragelifeexpectancyofover80years.

Life expectancy in good healthThehighlevelsofaveragelifeexpectancypresentedaboveareprimarilyduetothepro-

gressivereductioninrecentyearsinthenationsexaminedofdeathratesoftheelderly.Intermsofgaugingindividualwell-being,theincreaseinlifeexpectancyforpeopletoan

Scorefrom1to10 Numberofyears,atbirth

UnitedStates 1.0 77.9

Denmark 2.7 78.8

U.K. 4.4 79.7

Greece 4.9 80.0

Germany 5.3 80.2

France 6.0 81.0

Spain 7.2 81.2

Sweden 7.2 81.2

Italy 7.7 81.5

Japan 10.0 82.7

3. BCFN Index - 31

TheLifestylesub-indexisthefirsttakenintoconsiderationintheconstructionoftheBCFNIndex.Itreferstotwospecificdimensionsofindividualwell-being:thefirstinvolveshealth (referred to as “Psycho-physical well-being”) while the other involves diet andlifestyles(called“Behavioralwell-being”).

Figure3–TheLifestylesub-Indexwithinthemethodologicalsystemutilized,withitstwodimensionshighlighted





35%Wealth




30%Social






Analysis of the Lifestyle sub-index is based on a total of 15 KPIs. Specifically, sevenKPIswereconsideredfor“Psycho-physicalwell-being”,andeightKPIsformeasuring“Be-havioralwell-being”.

3.2.1 Psycho-physical well-being“Psycho-physicalwell-being”isthefirstofthetwodimensionscomprisingtheLifestyle

sub-index.Theindicatorstakenintoconsiderationare:n Life expectancyatbirth(numberofyears);n Life expectancy in good healthatbirth(numberofyears);n Standardized mortality rate from heart disease, measured as the number of

deathsper100,000people;n Standardized mortality ratefromtumors,measuredasthenumberofdeathsper

100,000people;n Standardized mortality ratefromdiabetes mellitus,measuredasthenumberof

deathsper100,000people;n Standardized mortality ratefromsuicides,measuredasthenumberofdeathsper

100,000people;n Expenditure on antidepressantsandmoodstabilizers,measuredastotalsalesper

personperyear.

Inaccordancewiththemethodologyillustratedabove,foreachoftheaforementionedindicators,arankingwascreated,givingeachcountryascorefrom1(relative“worst”per-formance)to10(relative“best”performance).

3.2Lifestyle sub-index


theLifestylesub-index).

DatafromtheWorldHealthOrganization2indicatethatin2005,worldwide,therewere17.5 million deaths due to cardiovascular disease, 30% of all deaths.Ofthese,7.6millionwereduetocoronaryproblemsand5.7milliontostroke.By2015,itiscalculatedthatthenumberofdeathscausedbycardiovasculardiseaseonagloballevelwillriseto20 million individuals,becomingtheno.1causeofdeathintheworld.

Fortheyear2006intheUnitedStates,itisestimatedthat80millionpeoplewereaf-fectedbyoneormorecardiovascularpathologies.Deathsfortheyear2005indicate,how-ever,thatover864,000peoplediedfollowingcardiovasculardisease(35.3%ofthetotal,i.e.,oneoutofevery2.8deaths),withcoronarypathologiesbeingtheprimarycauseofdeathoverall(445,000deaths).IntheUnitedStates,thenumberofdeathscausedbycar-diovasculardiseaseismuchhigherthanthesumofdeathsduetocancer(559,000),ac-cidents(117,000)andHIV/AIDS(12,000).3

FortheEuropeancontinent,ontheotherhand,cardiovascularpathologiesarerespon-siblefor4.3milliondeathseachyear(2millionwithintheEuropeanUnion).4Coronarypa-thologiesrepresentthediseaseresponsibleforthelargestnumberofdeaths(1.9milliondeathsinallEuropeandmorethan741,000inmemberstatesoftheEuropeanUnion).

The following chart offers the results of the indicator selected for the standardizedmortalityrateforheartdisease.

2 Source:“Cardiovasculardiseases”,Factsheetno.317,February2007,WorldHealthOrganization3 Source:“HeartDisease&StrokeStatistics.2009Updateat-a-glance”,AmericanHeartAssociation,20094 Source:“Europeancardiovasculardiseasestatistics2008”,BritishHeartFoundation;HealthPromotionResearch

Group,DepartmentofPublicHealth,UniversityofOxford;HealthEconomicsResearchCentre,DepartmentofPublicHealth,UniversityofOxford,2009

agewhichonlyfiftyorahundredyearsagowouldhavebeeninconceivable,sparksdebateaboutthequalityoflifeofindividualsintheirlateryears.Forthisreason,analysiswasextendedtoincludedataforlifeexpectancyingoodheathandthis,atleasttoacertainextent,resolvesthisquestion.TheWorldHealthOrganization(WHO)gatherstheparam-eterofaveragelifeexpectancyingoodhealthforthepopulationsofmanynationsintheworld,anddefinesthisvariableas“theaveragenumberofyearsapersoncanexpecttolivein ‘fullhealth’,takingintoaccountallperiodsaffectedbydiseasesand/orconvales-cencefrombodilyinjury”.Itisaparameterstronglytiedtothepsycho-physicalwell-beingofindividualsand,forthisreason,therelativeweightassignedtoitis30%,thehighestamongthesevenindicatorsconsideredformeasuringpsycho-physicalwell-being.

Figure5–Averagelifeexpectancyingoodhealthatbirthin2007,expressedinnumberofyears

Source:TheEuropeanHouse-Ambrosettire-elaborationofdatafromtheWorldHealthOrganization,2010

Observingthedatainthefigureabove,itcanbeseenthat,forallcountries,valuesarelowerthanforoverall lifeexpectancy(infact, inthiscase,onlytheaveragenumberofyearsthecitizensofthecountriesexaminedcanliveinfullhealtharetakenintoconsid-eration).However,thereisnosignificantchangeintherankingofeachcountrycomparedwiththepreviousindicator(averagelifeexpectancy).

Onaverage,theJapanesepopulationcan“count”onenjoying76yearsofgoodhealth,whileAmericanslive,onaverage,for70yearsoftheirlivesingoodhealth.Italy,SpainandSwedenareequal,withanaveragelifeexpectancyingoodhealthof74years,whilethisdropsto73forSpainandGermany.GreeceandDenmarkshareavalueof72years.

Mortality rate from heart diseaseDiseasesofthecardiovascularsystem1aretheno. 1 cause of death in all developed

countries;thesepathologiesareoftendisablingandtheirspreadisdestinedtogrowbe-causeofthecontinuedriseinlifeexpectancy(asseenabove).Themainprovenrisk fac-torsaretiedabovealltoimproper lifestyles,however,sinceitinvolvesproblemslinkedtothepsycho-physicalsphereofindividualsandtheirwell-being,fromamethodologicalstandpoint,theindicatorforthesediseaseswasconsideredaspartofthecalculationofpsycho-physical well-being. Behavioral factors (such as lifestyles) which impact on thewell-beingofpeopleweremeasuredthroughtheKPIsetselectedtocalculatethebehav-ioral aspect of well-being (which, together with psycho-physical well-being, comprises

1 Forexample,heartattack,hypertension,thrombosis,aneurism,stroke,etc.



Denmark 4.0 72.0

Greece 4.0 72.0

U.K. 4.0 72.0

Francia 5.5 73.0

Germany 5.5 73.0

Italy 7.0 74.0

Spain 7.0 74.0

Sweden 7.0 74.0

Japan 10.0 76.0

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Figure7–Standardizedmortalityratefromtumors,measuredasthenumberofdeathsper100,000people,2006

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECDdata,2010

Asclearlyseeninthechart,thecountrywiththelowestrateofdeathsfromtumorsper100,000peopleisJapan(aswasalsoseeninrelationtodeathsfromheartdisease).Itisfol-lowedbyGreeceandSweden(withthesamerate),SpainandGermany.Italy,withanan-nualaverageof158deathsper100,000people,isfifthoutofthetencountriesconsidered,followedbytheUnitedStates,France,theUnitedKingdomandDenmark.

Aside from the direct impact on individual psycho-physical well-being, the incidenceof tumors is directly connected to the lifestyle behavior (diet, physical activity, etc.) ofpeople. Also for this reason, as will be seen below, in measuring behavioral well-being,includedwereanumberof indicatorsrelatedtothosebehavioralmodelsthatcanhavegreatestinfluenceonthedevelopmentoftumorsor,ontheotherhand,makeitpossibletolowertheriskfactorsforthistypeofdisease.Itisestimated,infact,thatapprox.40%oftumordeathscouldbepreventedbyworkingonriskfactorsofthispathologythatcanbemodified.Firstonthelistissmoking,farandawaythemostsignificantrisk(21%),alcohol abuse(5%)andlow consumption of fruit and vegetables(5%).

Mortality rate from diabetesDiabetesisoneofthemost common chronic pathologies throughout the world,

especiallyinhighly-industrializedcountriesandisoneofthemostsignificantandcostlysocialdiseasesofourday.Especiallybecause it isachronicdiseaseandtendstocreatecomplicationsoverthelong-term,thispathologycanhaveamajorimpactonthepsycho-physicalwell-beingofpeople.Inadditiontoproblemsthediseaseitselfgeneratesforthehealthandwell-beingofanindividual(forexample,complicationsrelatedtothisdiseasecause cardiovascular and kidney ailments, as well as vision problems), it is estimatedthatdiabetesreducesaveragelifeexpectancyinpatientsfrom5to7years.Inaddition,althoughdiabetesisapathologythatappearsaboveallinlateryears,itisexpectedthattherewillbeagradualincreaseinthespreadofthisdiseaseamongrelativelyyoungindi-viduals.

Onceagaininthecaseofdiabetes,thecausesoftheonsetofthediseasecanbefoundinanumberofbehavioralfactors(whichwillbediscussedfurtheron),includingtheprolif-erationofimpropereatinghabits,growthinthenumberofoverweight/obeseindividuals,spreadofincreasingly-sedentarylifestyles,etc.

Scorefrom1to10 Numberofdeathsper100,000people

Denmark 1.0 199

U.K. 5.1 172

France 6.6 163

UnitedStates 7.3 158

Italy 7.3 158

Germany 7.5 157

Spain 8.3 151

Sweden 8.9 147

Greece 9.0 147

Japan 10.0 140

Figure6–Standardizedmortalityratefromheartdisease,measuredasthenumberofdeathsper100,000people,2006


Ascanbeseeninthechart,withinthecomparisonoftheboundaryofanalysisunderconsideration,thenationwiththehighestmortalityrateduetoheartdiseaseisGreece,followed by Germany and the United States. Japan, on the other hand, has the lowestheartdiseasemortalityrate,withanaverageof118deathsannuallyper100,000people.Italy,with171deathsper100,000people,hasanincidenceofheartdiseasethatishigherthanonlythoseofSpain,FranceandJapan.

Mortality rate from tumorsTumorsarethesecondcauseofdeathintheworld,inEuropeandinItaly.Inaddition,itis

apathology which continues to riseandwithastrongnegativeimpactonthepsycho-physicalconditionoftheindividualduringthecourseofthedisease(generallyprolonged,evenintheeventofpositivetreatmentresults).Becauseitisapathologywhichgenerallyaffectspeoplelateroninyears,asalreadynotedinrelationtoincidenceofheartdisease,the lengthening of average life span is an important factor in their growing spread. In2007,itwasestimatedthattherewere12millionnewcasesoftumorsintheworld.5

Thetypesoftumorsthatcausethegreatestnumberofdeathsonaworldlevelarelungtumors(1.3milliondeathsperyear),stomachtumors(803,000deathsperyear),colon-rec-taltumors(639,000deathsperyears),livertumors(610,000deathsperyear)andbreasttumors(519,000deathsperyear).Estimatesforthefutureindicateagrowthworldwideindeathscausedbytumors,uptoalevelof9 million in 2015and11.4 million in 2030,thenetmajorityofwhichwillbeinmedium-to-lowincomecountries.

Giventhemajorimpactthistypeofdisease,unfortunately,hasonindividualwell-be-ing,themortalityratefortumorsexpressedasthenumberofdeathsper100,000peopleaccountsforarelativeweightof15%inpsycho-physicalwell-being,equaltotheweightassignedforthemortalityrateduetoheartdisease.

5 Source:“GlobalCancerFacts&Figures2007”,AmericanCancerSociety


Greece 1.0 263

Germany 3.4 224


Sweden 5.3 194

U.K. 5.7 187

Denmark 6.0 183

Italy 6.8 171

Spain 7.3 162

France 9.6 124

Japan 10.0 118


Usingtheyear2007asapointofreference,amongpeoplebetween20and79yearsofage,itisestimatedthattheprevalence6ofthisdiseaseworldwideis5.9%,7whichis246millionpatientsforanincreaseofapprox.27%over2003(whenitwasestimatedthat194millionpeoplewereaffectedbythisdisease).Eachyeararoundtheglobemorethan7mil-lionnewcasesofdiabetesarereported(oneevery5seconds).8Forecastsfor2025indicateasignificantincreaseinprevalencewhichwillreach7.1%ofthepopulation,involving380millionpeoplethroughouttheworld,foranincreaseof54.5%over2007.IntermsofItaly,ISTAThasestimatedthatin2008,therewasaprevalenceofdiabetesinthepopulationof4.8%9(higherforwomen,5.2%,comparedwithmen,4.4%).Onthebasisofthisdata,thenumberofpeopleinItalywithdiabetesisapproximately2.8million.

Figure8–Standardizedmortalityratefromdiabetesmellitus,measuredasthenumberofdeathsper100,000people,2006


Ascanbeseenfromtheanalysisoftheresultsofthisindicator(seechart),theUSpopu-lationhasthehighestincidenceofdeathsfromdiabetes(approx.20deathsperyearper100,000people),althoughitcouldbenotedthatinabsoluteterms,thismortalityrateissignificantlylowerthanvaluesforheartdiseaseortumors.AlsoforItaly,mortalityratesduetodiabetesareamongthehighestforthetencountriesexaminedinthisstudy.Onceagain,Japanisthemost“virtuous”countryfromthisstandpoint(infact,ashasbeenseen,Japanhasthebestperformanceinallindicatorspresentedabove).

Mortality rate from suicideMeasurementofthepsychologicalsphereofindividualwell-being,partofthepsycho-

physicalwell-beingindicator,wascarriedoutthroughtheuseoftwoindicators,oneofwhichwasthestandardizedmortalityratefromsuicideexpressedastheaveragenumberofdeathsfromsuicideperyearper100,000people.

Suicideasaphenomenonrepresentstheextrememanifestationofserioussituationsofpsychologicalmalaisethatcanbetheresultofaseriesofexternalandinternalfactors(cultural,environmental,social,familial,etc.).

6 Prevalencemeasuresthenumberofindividuals(inapopulation)affectedbyaparticulardiseaseatthatgivenmoment.

7 Thevastmajorityofcases(85-95%)involvetype2mellitusdiabetes,ornon-insulindependentdiabetes.8 Source:“DiabetesAtlas”,InternationalDiabetesFederation,2009(http://www.eatlas.idf.org/)9 AccordingtotheInternationalDiabetesFederation,thelevelis5.8%



Italy 3.6 16.0

Denmark 3.9 15.5

Germany 4.6 14.4

Spain 5.3 13.3

Sweden 6.4 11.4

France 7.1 10.2

Greece 9.1 7.0

U.K. 9.5 6.4

Japan 10.0 5.5

TheWorldHealthOrganizationestimatesthattherearenearlyonemillionsuicidesperyearthroughouttheworld,witha“global”mortalityrateof16deathsper100,000people(whichtranslatesintoonedeathevery40seconds).Inthelast45years,suiciderateshaveincreased60%onaworldwidelevel.Insomecountries,suicideisamongthemaincausesofdeathforindividualsbetween15and44yearsofage,andthesecondcauseofdeathforthosebetween10and24.Addedtothesefiguresshouldalsobethoseforattemptedsuicidewhichitisestimatedcouldbe20timesmorefrequentthansuccessfulsuicides.

Mentaldisorders(inparticulardepressionanddisturbancesrelatedtoalcoholabuse)aretheprimaryriskfactorforsuicideinEuropeandNorthAmerica,whileinAsiancountries(againaccordingtotheWHO),culturalfactorsandimpulseseemtoplayaveryimportantrole.

Thedatagatheredforthetencountriesexaminedaregiveninthechartbelow.

Figure9–Standardizedmortalityratefromsuicide,measuredasthenumberofdeathsper100,000people,most

recentyearavailableforeachcountry



Japan 1.0 24.8

France 4.2 17.3

Sweden 5.9 13.2

Denmark 6.4 12.0

Germany 6.5 11.9


Spain 8.2 7.9

U.K. 8.8 6.5

Italy 8.8 6.4

Greece 10.0 3.6

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Ifthefigurefor Japaniscomparedtotheresultsfortheindicatorforsuicidemortalityrates,thetwodatacouldseemtocontradicteachother.Nonetheless,itispossiblethat,inthiscase,itcouldreflectculturaldifferencesbetweenthecountries,onthebasisofwhichindividualsinJapancouldbedriventosuicideforculturalreasonsunderspecificsituations,withoutnecessarilybeingdepressedorsubjecttootherformsofpsychologicalmalaise.

Psycho-physical well-being summary indicator“Psycho-physical well-being” is an innovative, distinctive contribution of the

BCFNIndexcomparedtootherexistingindicesformeasuringwell-being.Fromtheanaly-sis of international scientific literature and on the basis of suggestions which emergedduringthemeetingsoftheAdvisoryBoard,weightingswereassignedtoeverycompo-nentanalyzed.

Thespecificweightingsutilizedformeasuringarethefollowing:n Life expectancyatbirth(numberofyears)–Relativeweighting: 10%;n Life expectancy in good health at birth (number of years) – Relative weighting:

30%;n Standardized mortality rate from heart disease, measured as the number of

deathsper100,000people–Relativeweighting:15%;n Standardized mortality ratefromtumors,measuredasthenumberofdeathsper

100,000people–Relativeweighting:15%;n Standardized mortality ratefromdiabetes mellitus,measuredasthenumberof

deathsper100,000people–Relativeweighting:10%;n Standardized mortality ratefromsuicides,measuredasthenumberofdeathsper

100,000people–Relativeweighting:10%;n Expenditure on antidepressants andmoodstabilizers,measuredastotalsalesper

personperyear–Relativeweighting:10%.

Ascanbeseen,ahigherweightingwasassignedtheKPIsrelatedtolifeexpectancyingoodhealthandmortalityratesforchronicdiseases.

Inaccordancewiththemethodologyillustratedpreviously,foreachoftheaforemen-tioned indicators, a ranking was created, giving each country a score from 1 (relative“worst”performance)to10(relative“best”performance).

As can be seen from the chart, the statistics show that, in some cases, psychologicalwell-beingandphysicalwell-beingmaybediametricallyopposed.Forexample,Greeceisthecountrywiththelowestrateofsuicideamongthoseexamined,fromwhichitcouldbededucedthatthereisgreaterpsychologicalwell-beingamongthepopulation,despitethefactthattheindicatorsusedtoquantifyphysicalwell-beingoftenputthiscountrylowintherankings.Onthecontrary,Japan,whichwasno.1inalltheindicatorsinvolvingphysicalwell-beingexamined,wouldappearinthiscasetobethecountrywiththehigh-estmortalityratefromsuicide.

Intermsoftheothercountriesstudied,Italyhasarelativelylowsuiciderate(althoughalmost double that of Greece), followed by the United Kingdom, Spain and the UnitedStates.InadditiontoJapan,theothercountrieswiththehighestsuicidemortalityratesareFrance,SwedenandDenmark.

Intermsofsuicideprevention,theWorldHealthOrganizationmaintainsthatastrategyoflimitingaccesstocommonmethodsofsuicide,suchasfirearmsandtoxicsubstances,hashadsomeefficacy.Nonetheless,theWHOadamantlystressesthatactiontoreducesuicideratesmustbecarriedoutonanumberoffrontsusingarangeoflevelsandmodesofintervention.Forexample,thereisconvincingevidencethatpreventionandtreatmentofdepressionandalcoholabusecanreducesuicideratesinapopulation,ascanlong-termpsychologicalassistanceforthosewhohaveattemptedsuicide.

Expenditure on antidepressants and mood stabilizersThesecondindicatorutilizedtomeasurethe“psychological”aspectofpsycho-physical

well-beingofindividualsisaverageannualpercapitaexpenditureforthepurchaseofan-tidepressantandmoodstabilizingdrugs.This indicatorwasselectedbecauseit isfairlyrepresentativeoftheoveralllevelof“psychologicalmalaise”ofapopulation.

Thechartbelowprovidesasummaryoftheanalysisresultsforthisindicator.

Figure10–Annualpercapitaexpenditureonantidepressantandmoodstabilizingdrugs,eurosperinhabitant,2010

Source:TheEuropeanHouse-Ambrosettire-elaborationofIMSHealthSpadata

Fromtheresultspresentedinthechart,itcanbeseenthatthepopulationsoftheUnitedStatesandScandinaviancountriesinEuropeconsumesignificantlyhigheramountsofan-tidepressantsandmoodstabilizersthanothercountriesexamined.TheUnitedKingdom,ItalyandJapan,ontheotherhand,arethecountrieswiththelowestpercapitaexpendi-tureonantidepressantscomparedwiththeothercountriesinthestudy.

Scorefrom1to10 Eurosperresident


Sweden 2.4 31.7

Denmark 3.1 29.5

Greece 6.6 18.1

Spain 7.6 14.9

France 8.7 11.3

Germany 9.3 9.5

Japan 9.6 8.4

Italy 9.8 7.7

U.K. 10.0 7.2

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3.2.2 Behavioral well-beingMeasurementof“Behavioralwell-being”istheinnovativeanddistinctive aspectof

theBCFNIndexcomparedtootherexistingindicesformeasuringwell-being.

Thiscomponenthasbeenincludedinthemodelbecause,basedontheresultsofBCFNresearch, the comments of the BCFN Advisory Board and the scientific debate on thethemeofmeasuringwell-beingofcountries,theconvictionemergedthatapartofindi-vidual well-being also depends on lifestyle and dietary choices and, as a result, theoverallstateofhealth.

Accordingly,theterm“Behavioralwell-being”referstotheanalysisofthosevariablesrelatingtodietandlifestylewhich,onthebasisoftheleadingscientificstudiesanalyzedbytheBCFN,10haveasignificantinfluenceonthegeneralwell-beingofindividuals.

Specifically,theindicatorsusedformeasurementare:n Obese and overweight adult population(IMC>25kg/m2),measuredasapercentage

oftheadultpopulation;n Obese and overweight youth population (11-15 years) (IMC>25Kg/m2), measured

asapercentageofthepopulationagedbetween11and15years;n Physical activity,measuredastheportionofthepopulationdeclaringtobeinvolved

inregularphysicalactivity;n Expenditure on fruit and vegetables in terms of the percentage of available in-

come:n Percentage of adult smokers,measuredagainstthetotaladultpopulation;n Average alcohol consumption,measuredastheaveragenumberoflitersconsumed

peradult;n Average daily calorie intake per person;n Average time spent on meals.

Inouropinion,these8 KPIs,seemtoprovidegoodproxies regarding the adequacy of the diet and lifestyle adopted.Givenbelowisadetailedexplanationoftheirinclu-sioninthe“behavioralwell-being”indicator.

Obese and overweight members of the adult populationThepercentageoftheadultpopulationwhichisobeseandoverweightisanaspectcor-

relatedtothelifestyleanddietadopted.Infact,numerousstudiesshowthatoverweight and obesity have a positive correlation with the risk of contracting chronic dis-eases (heartdisease,diabetesandtumors).

Asshowninrecentstudies,includingthatofFranzetal.(2002),11overweightandobesi-tyinthepopulationissodetrimentalthatanaveragereductionofbodyweightbyaround7%canhaveapositiveandsignificantimpactonreducingthepossibilityofdevelopingtype2diabetes.

Inaddition,theInternationalAgencyforResearchonCancer12hasindicatedoverweightandobesityasfactorsthataugmenttheriskofcolorectalcancer.Onaworldwidelevel,theratesofcolorectalcanceraretentimeshigherindevelopedcountriesthanindevelopingcountries, and this is due, in large part, to obesity and overweight. Only in the UnitedStateswherethepercentageofobeseandoverweightpeopleisveryhighdoescolorectal

10 Formoreinformation,pleaserefertothe“AlimentazioneeSalute”PositionPaperpublishedbytheBarillaCenterforFood&Nutritionin2009

11 FranzMJ,BantleJP,BeebeCA,BrunzellJD,ChiassonJL,GargA,HolzmeisterLA,HoogwerfB,Mayer-DavisE,Moo-radianAD,PurnellJQ,WheelerM:Evidence-basednutritionprinciplesandrecommendationsforthetreatmentandpreventionofdiabetesandrelatedcomplications.DiabetesCare25:148-198,2002

12 Overweightandlackofexerciselinkedtoincreasedcancerrisk.In:Weightcontrolandphysicalactivity.Lyon,Interna-tionalAgencyforResearchonCancer,(IARCHandbooksofCancerPrevention,Vol.6),2002

Assigningascoretoeachofthecountriesforthe7KPIsandtheirweightingbasedontheassignedweightings,madeitpossibletoobtainaprovisionalsummaryindexregard-ingthedimensionof“psycho-physicalwell-being”.

Figure11–Rankingfor“Psycho-physicalwell-being”


Asisclearfromthechart,Japanisthecountrywiththehighestpsycho-physicalwell-beingindexwithinthebenchmarkperimetertakenintoconsideration,obtaininganover-allscoreof8.1pointsonascaleof1(minimum)to10(maximum).Japan’spositionatthetopoftherankingistheresultofthecountry’shighperformanceinindicatorsrelatedtophysicalwell-being,includingthehighestaveragelifeexpectancyandlowestmortalityrates(withinthetencountriesexamined)forchronicdiseases(heartdisease,tumorsanddiabetes),whichcompensateforitsveryhighmortalityratefromsuicide.

Italyisrankedthirdforpsycho-physicalwell-being,withascoresimilartothatofSpain(secondinthepsycho-physicalwell-beingindex)andFrance(infourthplace).Italy’sposi-tionreflectssomedecidedlypositiveperformances,suchasforaveragelifeexpectancyandaverage lifeexpectancy ingoodhealth,secondonlytothefigures for Japan, andagenerally“high”levelofwell-beingconnectedtothepsychologicalsphereofthepopula-tionasseenfromalowrateofsuicideandaveragelowannualpercapitaexpenditureforantidepressantsandmoodstabilizers.

Sweden,theUnitedKingdom,GermanyandGreece,withrelativescoresbetween5.3and5.7, are mid-way in the ranking, while Denmark and the United States are the countrieswiththelowestpsycho-physicalwell-beingindexamongthoseexamined.TheUS,inpar-ticular,isthecountrywiththelowestaveragelifeexpectancy,aboutfiveyearslessthanJapan(andthisincreasestosixiflifeexpectancyingoodhealthistakenintoconsideration).Inaddition,theUnitedStateshasaveryhighlevelofconsumptionofantidepressantsandmoodstabilizerscomparedwiththeothercountriesinthisstudy,aswellasasignificantincidenceofchronicdiseasesamongthemaincausesofdeathofthepopulation.

Asmentionedpreviously,thepsycho-physicalwell-beingof individualsmaybe influ-encedinlargepartbypersonalbehaviorandlifestyles(diet,lifestyle,sportsactivity,etc.).Forthisreason,analysisoftheso-called“Lifestylesub-index”(withaweightedimpactof35%withintheBCFNIndexoverall)wassupplementedbyasetof8KPIsselectedtomea-surebehavioralwell-being.Thesearepresentedinthesectionwhichfollows.

Scorefrom1to10

UnitedStates 3.0

Denmark 3.6

Greece 5.3

Germany 5.3

U.K. 5.6

Sweden 5.7

France 6.1

Italy 6.4

Spain 6.5

Japan 8.1


ducethe lifestyles anddiets adopted bythepopulationsexamined: theseresultsshowthat,onaverage,theAmericanandEnglishdietisless-balancedthanthatincontinentalEuropeorJapan.

Obese and overweight members of the youth populationFortheparticularlynegativeconsequences insocial,healthcareandeconomicterms,

notonlywasthepercentageoftheadultobeseandoverweightpopulationanalyzed,butattention was also focused on the percentage of the youth population that is obese oroverweight.

For a child, overweight and obesity can cause a series of physical and psycho-logical consequences that can be so seriousthattheymanifestthemselvesinchild-hood (precocious consequences), as well as (often more serious) problems that may bemoreeasilyencounteredinadulthood(lateconsequences).Themostfrequentprecociousconsequencesofchildhoodobesityarebothmetabolic(insulinresistance,dyslipidemia,glucose intolerance, high blood pressure) and non-metabolic in nature, such as osteoar-ticular (valgis of the lower limbs, articular pain, reduced mobility, flat feet), cutaneous(stretchmarks,Acanthosisnigricans),hepatic(fattyliver),respiratory(desaturationandnocturnalapnea)andpsychologicalpathologies (poorbody image,eatingdisorders,de-pression).

In addition, obesity involves emotional, social and psycho-social consequenc-es that are significant for children and adolescents.22Amongthesearebullyingatschool,associatedinturnwiththeriskofdepressionandanxiety.Ingeneral,overweightchildren have lower self-esteem and are more likely to be excluded by playmates andclassmates (a critical aspect for their social and psychological development). And final-ly,giventheirlowerself-esteem,theyaremoresusceptibletobehaviorwithanegativehealthimpact,suchasdrinkingandsmoking.23

22 CorteseS,etal.,“Therelationshipbetweenbodysizeanddepressionsymptomsinadolescents”,JPediatr.200923 LobsteinT.,BaurL.,UauyR.,“Obesityinchildrenandyoungpeople:acrisisinpublichealth”,ObesityReviews,2004

cancer represent the second most prevalent cause of cancer deaths.13 Overweight andobesity also increase the risk of adenocarcinoma of the esophagus,14 as well as riskfactors for pancreatic tumors,15 especially if coupled with high consumption of meatand lowpercentageofvegetables inthediet.Radimer,16Trentham-Dietz,17Carmichael18and Stephenson19 have noted that overweight, especially in adulthood, represents anincreasedfactorofriskindevelopingbreastcancer,whileAmant20andBergstrom21haveshownthattheriskofuterinecancerisapproximatelythreetimeshigherinobesewomenasopposedtothoseofnormalweight.

Figure12–Obeseandoverweightadultpopulation(IMC>25kg/m2),measuredasapercentageoftheadultpopulation

Source:TheEuropeanHouse-Ambrosettire-elaborationofEuromonitor,WHO,Eurostatdata,2010

Onagenerallevel,asnotedbytheWHO,obesityisthecauseofnearly3milliondeathseach year. The most recent estimates indicate that in Western Europe and the UnitedStates,approximatelyhalfamillionpeopledieeachyearfordiseasestiedtoobesity.WHOforecastsfor2020indicateasignificantincreaseinthenumberofdeathsduetoobesitywhichareexpectedtoreach5milliondeathsperyearintheabsenceofcorrectiveactiontochangedietandlifestyle.

StatisticsregardingobesityandoverweightintheUnitedStates—aswellasinWesternEurope—arealarming.Over8USadultsoutof10areoverweightorobese,intheUnitedKingdom approx. 6.4 out of 10 and the average in continental Europe is around 5 over-weightorobeseadultsoutof10.Japanisthecountrywiththelowestincidenceofadultoverweightandobesity,withapercentageunder25%.Thisdatamakesitpossibletode-

13 JemalA,SiegelR,WardE,Cancerstatistics,CACancerJClin2006;56:106-130,200614 BrownLM,Adenocarcinomaoftheesophagus:roleofobesityanddiet.JournaloftheNationalCancerInstitute,

87:104—109,1995.Adenocarcinomaisamaligntumordevelopedfromepithelialcellsorganizedintogland-likestruc-tures

15 MichaudDS,Physicalactivity,obesity,height,andtheriskofpancreaticcancer.JournaloftheAmericanMedicalAs-sociation,286:921-1632,2001

16 RadimerKL,Ballard-BarbashR,MillerJS,Weightchangeandtheriskoflate-onsetbreastcancerintheoriginalFram-inghamcohort.NutrCancer,49:7-13,2004

17 Trentham-DietzA,NewcombPA,EganKM,Weightchangeandriskofpostmenopausalbreastcancer(UnitedStates).CancerCausesControl,11:533-542,2000

18 CarmichaelAR,BatesT.Obesityandbreastcancer:areviewoftheliterature.Breast,13,200419 StephensonGD,RoseDP.Breastcancerandobesity:anupdate.NutrCancer,45:1-16,200320 AmantF,MoermanP,NevenP,Endometrialcancer.Lancet,366:491-505,200521 BergstromA,OverweightasanavoidablecauseofcancerinEurope.InternationalJournalofCancer,91:421-430,

2001

Scorefrom1to10 Overage15,%


U.K. 3.9 63.4

Greece 4.7 58.3

Germany 5.6 52.7

Spain 5.7 52.4

Italy 6.4 47.5

Denmark 6.7 45.5

Sweden 6.8 45.1

France 8.0 37.8

Japan 10.0 24.9

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Analysisoftheoverallquestionofobesity,includingbothyouthandadults,showsthattherelativestandingsofthecountriesaremoreorlessthesame.Japanisthecountrywiththeleastnumberofobeseandoverweightpeopleinbothagebrackets,whiletheUnitedStateshasthegreatestnumberofobeseandoverweightindividualsinbothgroups.

ForItaly,adisturbingfactisthatthecountryisinsixthplaceintherankingofobeseand overweight adults, while it is in third place—just behind Greece in second place—inthe ranking of percentage of obese and overweight youth. Given the close connectionbetweenobesity inchildhoodandwhenadult,thiscouldhighlightthefactthat, inthefutureinItaly,thepercentageofobeseoroverweightindividualsisdestinedtoincrease.

Physical activityStudiesshowthatregular physical activity,normally30minutesperdayalmostev-

erydayoftheweek,isone of the most important factors, if not the most important one, in preventing chronic disease.

Adoptingalifestylewithadequatephysicalactivityiscorrelatedtoaninverseriskofcardiovascular disease, especially coronary disease. Studies by Manson et al. (1992),26Kriska et al. (1993),27 Helmrich et al. (1991),28 and McAuley et al. (2002)29 showed thatphysicalactivityhaspositiveeffectsontheriskoftheonsetoftype2diabetes.

And finally, the International Agency for Research on Cancer30 has indicated over-weightandphysicalinactivityasthefactorswhichaccountforbetween20%and35%ofcasesintheonsetofbreast,colon,renalandesophagealcancer.

Generally,worldwide,itisestimatedthat1.9milliondeathseachyearcanbelinkedtophysicalinactivity.31Thereismanifoldscientificevidencethatdemonstrateshowregularphysicalactivitypromoteshealthylivingwithnoteworthybenefitsforoverallindividualhealth. Among the positive aspects is the possibility of reducing the risk of developingcardiacdisease,canceranddiabetesbyupto50%.

Theimportanceofengaging inregularphysicalactivity isalsoconfirmedbynationalhealthprograms. IntheUnitedStates,forexample,the“HealthyPeople2010”programindicatesphysicalactivityasoneofthemaingoalsforthecountry.

Through its “Public Health Programme (2003-2008)”, the European Union proposesprojectstosupportandpromotephysicalactivity.InItaly,theNationalHealthPlan2003-2005stressedtheimportancetohealthofphysicalactivityandthesubsequentNationalHealth Plan 2006-2008 took on the issue of a sedentary lifestyle, especially from thepointofviewofthecausesofdiabetes.Theimportanceofengaginginregularphysicalactivityisalsoconfirmedbynationalhealthprograms.IntheUnitedStates,forexample,the“HealthyPeople2010”programindicatesphysicalactivityasoneofthemaingoalsforthecountry.

26 MansonJEetal.AprospectivestudyofexerciseandincidenceofdiabetesamongUSmalephysicians.JournaloftheAmericanMedicalAssociation,1992,268:63-67

27 KriskaAMetal.Theassociationofphysicalactivitywithobesity,fatdistributionandglucoseintoleranceinPimaIndians.Diabetologia,1993,36:863-869

28 HelmrichSPetal.Physicalactivityandreducedoccurrenceofnon-insulindependentdiabetesmellitus.NewEnglandJournalofMedicine,1991,325:147-152

29 McAuleyK.A.,WilliamsS.M.,MannJ.I.,etal.:Intensivelifestylechangesarenecessarytoimproveinsulinsensitivity:arandomisedinterventiontrial.DiabetesCare25:445,2002.

30 Weightcontrolandphysicalactivity.Lyon,InternationalAgencyfoResearchonCancer,(IARCHandbooksofCancerPrevention,Vol.6),2002

31 Source:WorldHealthOrganization,“Dietandphysicalactivity: apublichealthpriority”

Themostcommonoftheconsequencesofchildhoodobesityiscontinuation of obe-sity into adulthood:approx.70% of obese adolescents remain so even as adults.24

Asaresult,informationanddataregardingthepercentageoftheyouthpopulationthatisoverweightorobeseprovideinformationaboutwhetherandinwhatwayobesityper-sistsinadulthoodand,therefore,whetherandinwhatwayimproperlifestyleandunbal-anced dietary choices persist, aspects with a direct correlation to increased risk of theonsetofchronicdiseases.

Individualswhohavebeenoverweight/obesewhenyoungaremoresusceptibletocar-dio-circulatory(highbloodpressure,heartdisease),muscular-skeletal(earlydevelopmentof arthritis due to static-dynamic stress on spine and lower limb joints most subject tosupportingweight)andmetabolicpathologies(mellitusdiabetes,hypercholesterolemia,hypertriglyceridemia,etc.).

Figure13–Obeseandoverweightyouthpopulation(11-15years)(IMC>25Kg/m2),measuredasapercentageofthe

populationagedbetween11and15years

Source: The European House-Ambrosetti re-elaboration of OECD, Eurostat and Japan Statistic Bureau and Statistic

Center,2010

A study published in the New England Journal of Medicine25 which monitored nearly5,000Americanchildrenbornbetween1945and1984,concludesthatchildhood obe-sity involvesamore than double probability of death by the age of 55duetotheincreased risk of developing metabolism-related pathologies, heart disease, high bloodpressure,etc.

Aswiththepreviousindicator,evenintermsofyoungpeople,theUnitedStatesisthecountrywiththehighestlevelofoverweightandobeseindividuals.Almost3childrenoutof10intheUSareobeseoroverweight,whilethisvalueisnearly2outof10inGreeceandItaly,1.8outof10inSpainand1.2outof10intheUnitedKingdomandGermany.Japan,withlessthan9%,isonceagainthecountrywithfewerobeseandoverweightyouthintermsofthetotalpopulation.

24 WhitakerR.C.,etal.,“Predictingobesityinyoungadulthoodfromchildhoodandparentalobesity”,NewEnglandJournalofMedicine,1997

25 FranksP.W.etal.,“ChildhoodObesity,OtherCardiovascularRiskFactors,andPrematureDeath”,TheNewEnglandJournalofMedicine,Volume362:485-493,February11,2010

Scorefrom1to10 age11-15,%


Greece 5.7 18.8

Italy 5.9 18.3

Spain 6.6 16.7

U.K. 8.6 12.0

Germany 8.6 12.0

Sweden 9.2 10.5

France 9.2 10.5

Denmark 9.6 9.7

Japan 10.0 8.7


Cancer37approximately60%oftumorsoftheoralcavityarelikelytobecorrelatedwithalackofmicronutrients,duetoadietwithalowfruitandvegetablecontent.Moreover,theresultsofmedical/scientificstudiesindicatethattheconsumptionoffruitandvegetablesalso reduces the onset of colorectal cancer. Analyzing risk factors for stomach tumors,Gonzalez38,discoveredthattheconsumptionoffruitandvegetablesisaprotectivefac-toragainststomachcancer,whileBandera39provedthatadietcontaininghighquantitiesoffruitandvegetablesreducestheriskofendometrialcancer.Manystudies40havealsodemonstratedthatfruitandvegetablesalsoplayaprotectiveroleagainstlungcancer.

Generallyspeaking,itisestimatedthatasmanyas2.7milliondeathsayearareattrib-utabletoalowintakeoffruitandvegetables41. Ithasbeenprovedthat, inordertopre-servehealthasmuchaspossible,certainvitaminsandnutritionalsubstancescontainedinfruitandvegetablesshouldbeanintegralpartofthehumandiet.

Figure15–Expenditureonfruitandvegetablesasapercentageofavailableincome

Source:Re-elaborationsofTheEuropeanHouse-AmbrosettiusingEurobarometerdata,aswellasestimatesondata

fromtheUnitedStateDepartmentofAgricultureandtheJapanStatisticBureauandStatisticCenter,2010

The graph above shows that, in this particular case the Mediterranean countries, i.e.Greece,SpainandItaly,arethosewiththehighestexpenditureonfruitandvegetablesoutoftotalavailableincome.Alsointhiscase,theUnitedStatescomeslast,asitdoesintherankingforadultandyouthobesity,withanexpenditureforfruitandvegetablesofaround0.7%,therebydistinguishingitselfastheonlycountryintheworldwithavaluebelow1%.

37 Cancer:causes,occurrenceandcontrol.Lyon,InternationalAgencyforResearchonCancer,IARC,1996;Food,nutri-tionandthepreventionofcancer:aglobalperspective.Washington,DC,WorldCancerResearchFund/AmericanInstituteforCancerResearch,1997.

38 GonzalezCA.Vegetable,fruitandcerealconsumptionandgastriccancerrisk.IARCSciPubl,156:79–83,2002.39 BanderaEV,KushiLH,ConsidineDM,Theassociationbetweenfood,nutrition,physicalactivityandtheriskofendo-

metrialcancerandunderlyingmechanisms.InsupportoftheSecondWCRF/AICRReportonFood,Nutrition,PhysicalActivityandthePreventionofCancer,2007.

40 AmericanCancerAssociation,AmericanCancerSocietyGuidelinesonNutritionandPhysicalActivityforCancerPrevention:ReducingtheRiskofCancerWithHealthyFoodChoicesandPhysicalActivity,2006.

41 Source:WorldHealthOrganization,“Dietandphysicalactivity:apublichealthpriority”

Scorefrom1to10 %ofavailableincome


Sweden 3.3 1.05

Germany 3.8 1.13

U.K. 3.8 1.14

Denmark 4.9 1.31

France 6.4 1.56

Japan 7.3 1.72

Italy 8.1 1.86

Spain 8.2 1.87

Greece 10.0 2.17

Inconformitywiththesefindings,inordertomeasurephysicalactivity,adhocsurveyswereutilized,theobjectiveofwhichwastoprofilethelevelofaveragephysicalactivityofpeopleofthecountriesexamined.

Figure14–Physicalactivity,measuredastheportionofthepopulationdeclaringtobeinvolvedinregularphysical

activity

Source: The European House-Ambrosetti re-elaboration of Eurobarometro, American Time Use Survey and Japan

StatisticBureauandStatisticCenterdata,2010

Fromthedata,itcanbeseenthatGreece,with18%whodeclaretheyengageinregularphysicalactivity,hasasignificantlylowerlevelthanothercountries. Italyisinpenulti-mateplacewithlessthan30%ofthepopulationdeclaringitengagesinregularphysicalactivity,whileSpainisrankedfourthfromthebottom.Ingeneral,residentsofScandina-viancountriesdeclareonaveragetoengageinregularphysicalactivityinapercentagemorethandoublethatofMediterraneancountries(Greece,ItalyandSpain).

Expenditure on fruit and vegetablesAs demonstrated by numerous studies, there is an inverse relationship between

the consumption of fruit and vegetables and the onset of chronic diseases32.Intheabsenceofstatisticsontheconsumptionoffruitandvegetables,expenditure for fruit and vegetables was used as a proxy for their consumption.Moreinparticular,expenditureforfruitandvegetableswascalculatedasapercentageofavailableincome,inordertonormalizethedatawithrespecttotheincomeearned.

Morespecifically,Ness33,Liu34,Joshipura35andGilman36havediscoveredthatthereisaverystrongprotectiverelationshipbetweentheconsumptionoffruitandvegetablesandtheriskofcardiovasculardisease.AccordingtotheInternationalAgencyforResearchon

32 NessAR,PowlesJW.Fruitandvegetables,andcardiovasculardisease:areview.InternationalJournalofEpidemiology,26:1—13,1997.

33 NessAR,PowlesJW.Fruitandvegetables,andcardiovasculardisease:areview.InternationalJournalofEpidemiology,26:1—13,1997.

34 LiuS,Fruitandvegetableintakeandriskofcardiovasculardisease:theWomen’sHealthStudy.AmericanJournalofClinicalNutrition,72:922—928,2000.

35 JoshipuraKJ,Fruitandvegetableintakeinrelationtoriskofischemicstroke.JournaloftheAmericanMedicalAssocia-tion,282:1233—1239,1999.

36 GilmanMWetal.Protectiveeffectoffruitsandvegetablesondevelopmentofstrokeinmen.JournaloftheAmericanMedicalAssociation,273:1113—1117,1995.

Scorefrom1to10

Greece 1.0 18.0

Italy 2.8 29.0


Spain 4.5 39.0

Japan 5.5 45.0

U.K. 5.7 46.0

France 6.0 48.0

Germany 6.2 49.0

Denmark 8.7 64.0

Sweden 10.0 72.0


Average consumption of alcohol and alcoholic drinksExcessiveconsumptionofalcoholisassociatedwithanincreaseincardiovasculardis-

easesandis,therefore,notrecommended.Somestudieshave,nonetheless,highlightedthatmoderateconsumptionofalcoholcanreducetheonsetofcoronarydisease,althoughagreementtothiseffectisnotunanimous.Withreferencetocardiovasculardiseases,thescientificevidenceproduceduntilnowdoesnotseemtoofferconclusivedataonthecon-sumptionofalcohol46.

Inthiscontextandinthefaceofsuchevidence,negativeforexcessiveconsumptionofalcoholandconflictingforitsconsumptioninmoderatequantities,therecommendationsofferedbyalltheleadinginternationalscientificassociationsistoavoidconsumptionofalcoholandalcoholicdrinks.

Proceedingtotherelationshipbetweentumorsandalcohol,ontheotherhand,there-sultsappearclearerandmoresignificant.McKillop47,forexample,demonstratedthatal-coholconsumptionisariskfactorfortheonsetofhepaticcancer,probablythroughthedevelopment of cirrhosis of the liver. Smith-Warner48 demonstrated how an increase inthe daily consumption of alcohol increases the risk of breast cancer. Last but not least,Giovannucci49,inanumberofstudiesonalcoholfoundthattheconsumptionofalcoholicdrinksisassociatedwithagreaterriskofcolorectalcancer.

Figure17–Consumptionofalcoholmeasuredastheaveragenumberoflitersconsumedperadult

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECD2010data

Asthegraphshows,France,with12.5liters,comesfirstintherankingfortheaverageconsumptionofalcoholperpersonperyear.Japan,oncemore,provesitselftobeoneofthebestcountriesasregards“behavioralwell-being”.

46 KerrD.,MacdonaldI.A.,HellerS.R.,TattersallR.B.:AlcoholcauseshypoglycaemicunawarenessinhealthyvolunteersandpatientswithType1(insulindependent)diabetes.Diabetologia33:216,1990.

47 McKillopI,SchrumL.,AlcoholandLiverCancer,DepartmentofBiology,UniversityofNorthCarolinaatCharlotte,Charlotte,2005

48 Smith-WarnerSA,Alcoholandbreastcancerinwomen:apooledanalysisofcohortstudies.JournaloftheAmericanMedicalAssociation,279:535—540,1998..

49 GiovannucciE,Alcohol,low-methionine,low-folatediets,andriskofcoloncancerinmen.JournaloftheNationalCancerInstitute,87:265—273,1995.

Scorefrom1to10 Averagenumberoflitersperadult

France 1.0 12.6

Spain 2.4 11.7

Denmark 3.7 10.9

U.K. 3.8 10.8

Germany 5.3 9.9

Greece 6.7 9.0


Italy 8.1 8.1

Japan 9.1 7.5

Sweden 10.0 6.9

Percentage of adult smokersThestudiesconductedhaverevealedthatapprox.30-32%oftheresponsibilityforcan-

cercanbeattributedtotobaccoconsumption42.Inotherwords,almostone-thirdofalltu-morsiscausedbytobaccosmoke.

Medical/scientificresearchhasdemonstratedthatsmokersare30timesmorelikelytocontracttumor-relatedlungdiseases43andthattobaccosmokeis,in80%ofcases,theele-mentresponsibleforlungtumorsindevelopedcountries44.Itisalsooneofthemainriskfactorsforcancerofthemouth,larynxandesophagus.Thecombinationoftobaccosmokewithhighbloodpressureandhighcholesterollevelstriggersmorethanthree-quartersofthecardiovasculardiseasesthroughouttheworldwhichare,inturn,theworld’sprimarycauseofdeath45.

Figure16–Percentageofadultsmokersoutofthetotaladultpopulation

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECDdataandJapanStatisticBureauandStatisticCenter

data,2010

Nowadays,tobaccosmokeaccountsforapprox.5milliondeathsworldwideandthees-timatesfor2020forecastanincreaseto9milliondeaths,ifcorrectiveactionisnottaken.

Overall, the studies conducted show how tobacco causes or contributes to the onsetofcancerinthemouth,throatandlungs,damagetotheskin,psoriasis,cardiacdisease,gastriculcers,wrinkles,osteoporosis,cataracts,diabetes,Alzheimer’sdisease,leukemia,sexualdysfunction,infertilityandgumdisease.

Theresultsobtainedshowthat,inGreece,40%(maximumvalue)ofadultcitizensaresmokers, while in Sweden only 14.5% are smokers (minimum value). Italy ranks fourthwithapprox.22%ofsmokersamongitscitizens,ascorethatislower–albeitonlymargin-ally–thanthatofGermany,FranceandSpain.

42 DollR,PetoR,“The causes of cancer”,OxfordMedicalPublications,198143 BiesalskiHK,BuenodeMesquitaB,ChessonA,EurConsensusStatementonLungCancer:riskfactorsandpreven-

tion.LungCancerPanel.CACancerJClin,48:167–176,1998.44 ReducingTobaccoUse:AReportoftheSurgeonGeneral.USDepartmentofHealthandHumanServices,Centers

forDiseaseControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,OfficeonSmokingandHealth,2000

45 Source:WorldHealthOrganization,“TheWorldHealthReport2002-Reducingrisks,PromotingHealthyLife”

Scorefrom1to10 %ofadultpopulation

Greece 1.0 40.0

Spain 5.8 26.4

Japan 5.9 26.0

France 6.3 25.0

Denmark 6.3 25.0

Germany 6.9 23.2

Italy 7.2 22.4

U.K. 7.7 21.0


Sweden 10.0 14.5


Figure18–Averagedailycalorieintake

Source:TheEuropeanHouse-Ambrosettire-elaborationoftheUNFoodandAgricultureOrganisation,FAOSTAT,2010data

The United States ranks first for daily calorie intake with an average value of over3,800.DespitebeingthemothercountriesoftheMediterraneandiet,ItalyandGreeceholdsecondandthirdplace.TheyarefollowedbyGermanyandFrance. Japanisthecountrywiththelowestdailycalorieintake:over1,000lessthatthoseconsumedbytheAmeri-canswhichcorrespondstoapprox.25%less.Inotherwords,thedailycalorieintakeoftheJapanesetodayissimilartothatoftheAmericansinthe1980s.

Average time spent on mealsTheaveragetimespentonmealsisaveryimportantfactorasregardssocializationand

theconvivialityofsharingmealswithfamilyandwithfriends52,butevenmorefromthehealthperspective.

AccordingtoarecentstudyconductedbytheLaikoGeneralHospitalinAthens,rushingmealspreventsthereleaseofanumberofintestinalhormonesthattriggerthefeelingofsatiety.Sothefasterapersoneats,themorehungrytheyfeel,sinceeatingquicklyleadstoareductioninthereleaseofthesatietyhormoneswhichwouldfunctioncorrectlyifthepersonweretoeatslowly53.

Theresultisthatthebodydoesnotreceivethesignalthatitistimetostopeating,andthiscanleadtoovereating.Additionally,thestudyexplainsthatittakes12minutesforsatietysignalstoreachthebrainofthinpeopleandatleast20minutesforthemtoreachthebrainofobesepeople.

Inadditiontothisresult,thestudyhasalsodemonstratedthateatingslowlycanbeawayofeatinghealthyportions.

52 BCFN,FoodForCulture,2009.53 KokkinosA.,EatingQuicklyIsAssociatedwithOvereating,JournalofClinicalEndocrinology&Metabolism(JCEM),

2009.

Scorefrom1to10

UnitedStates 1,0 3.820

Italy 2,0 3.699

Greece 2,3 3.655

Germany 2,8 3.605

France 2,9 3.587

U.K. 3,9 3.469

Spain 4,0 3.455

Denmark 4,5 3.392

Sweden 5,8 3.231

Japan 10,0 2.716

Average daily calorie intake per personAwareofthedifferencesthatcanexistbetweenindividualsfromthesamecountry,or

betweencitizensfromdifferentcountries,intermsofbuildandphysicalactivity,ahighcalorieintakecanproducenegativeeffectsonbodyweightandisthereforepositivelycor-relatedwithincreasedriskofcardiovasculardisease.

The combination of foods and nutrients consumed must also be taken into consider-ation.Anindividualcould,forexample,haveacorrectcalorieintakewhileconsumingun-healthyfoodsorproductswithhighsugarandsaltconcentrations.So,inadditiontothequantity,thecaloriecombinationisalsoextremelyimportantforhumanhealth.

Havingsaidthis,somestudies50havedemonstratedthata5-7%reductionincaloriesperdayinanadultcanconsiderablyreduce(60%)theriskoftype2diabetes.

Thegeneralgoal,forahealthydiet,istoconsume,atmost,10%ofdailycalorieintakeinsaturatedfats;transfattyacids(hydrogenatedfats)shouldbelimitedtolessthan1%of a person’s daily calorie intake, while polyunsaturated fatty acids should account forbetween6%and10%ofthedailycalorierequirement.Ingeneral,fatsshouldaccountforbetween15%and30%ofthetotaldailycalorieintake.Carbohydratesshouldaccountforbetween45%and60%,andproteinsbetween10%and20%ofthedailycalorieintake.

Currenttrends,particularlyintheWesternworld,pointtoacontinualandconstantin-creaseindailycalorieintaketogetherwithatendencytoconsumefoodsthatarerichincalories.

For example, over the past 30 years the calories consumed per day by the averageAmericanhaverisenby25%,andthisincreasehasbeenaccompaniedbyanincreaseinthe consumption of foods with a high sugar and fat content. As a consequence of thischange in dietary habits, around 65% of Americans are now overweight, a percentagethat is substantially higher than that recorded in the Eighties, which was 46% of thepopulation51.

Inconclusion,giventhedifferencesintermsofphysicalbuild,physicalactivityandthecombination of foods consumed, the indicator for the average quantity of calories con-sumedbythepopulationmaybeusedasaproxyforthelevelofovereatingthathas–andwillhaveinthefuture–animpactonbodyweightand,hence,alsoontheincidenceofcardiovasculardisease.

50 RamachandranA,SnehalathaC,MaryS,MukeshB,BhaskarAD,VijayV.TheIndianDiabetesPreventionshowsthatlifestylemodificationandmetforminpreventtype2diabetesinAsianIndianwithImpairedGlucoseTolerance(IDPP-1).Diabetologia2006;49:289-97

51 NationalInstituteofHealth,StrategicPlanforNIHobesityresearch,2004

3. BCFN Index - 51


aretheworst.Italyrankssixth,asitwashamperedbytheresultsonphysicalactivityandontheincidenceofobesityandoverweightinyoungpeople.

Figure20–Rankingfor“Behavioralwell-being”


3.2.3 Summary results of the Lifestyle sub-index Aftercalculatingthesummaryindicatorfor“Psycho-physicalwell-being”andfor“Be-

havioral well-being”, the table below shows the ranking of the Lifestyle sub-index ob-tained, as already indicated, from the weighted average of the two previous summaryindicators.

Figure21–RankingoftheLifestylesub-index


Asthegraphshows,Japangainsfirstplacewithascoreof7.97,followed,atacertaindis-tance,bySwedenandFrance.Italyranks4thtogetherwithSpain,withanaveragescoreof6.10,whiletheUnitedStatescomeslastwithascoreof3.24.

Scorefrom1to10

UnitedStates 3.6

Greece 3.8

U.K. 5.4

Spain 5.5

Italy 5.7

Germany 5.8

France 6.4

Denmark 6.6

Japan 7.8

Sweden 7.9

Scorefrom1to10

UnitedStates 3.24

Greece 4.65

Denmark 4.88

U.K. 5.53

Germany 5.54

Spain 6.10

Italy 6.10

France 6.24

Sweden 6.64

Japan 7.97

Figure19–Averagetimespentonmeals,inminutes


The United States come last fromthisperspective too,while France gainsfirst place,dedicatingtwoandaquarterhoursadaytomeals.Japan,Italy,Greece,SpainandGermanyspendaroundtwohoursperdayonmeals.

Asalreadymentioned,theBCFNIndexdistinguishesitselffromotheralreadyexistingwell-being indices through the innovative contribution offered by “Behavioral well-being”.Fromananalysisofinternationalscientificliteratureandincompliancewiththeguidelines developed in the course of the Advisory Board meetings, weightings havebeenattributedtoeachcomponentanalyzed.

Thespecificweightingvaluesusedinmeasuringarethefollowing:n Obese and overweight adult population (BMI>25kg/m2), measured as a per-

centage of the adult population–Relativeweighting:20%;n Obese and overweight youth population (11-15 years) (BMI>25Kg/m2), mea-

sured as a percentage of the population aged between 11 and 15 years–Rela-tiveweighting:10%;

n Physical activity, measured as the portion of the population declaring to be involved in regular physical activity–Relativeweighting:20%;

n Expenditure for fruit and vegetablesasapercentageofavailableincome–Relativeweighting:10%;

n Percentage of adult smokers, measured against the total adult population–Relativeweighting:20%;

n Average alcohol consumption,measuredastheaveragenumberoflitersconsumedperadult–Relativeweighting:5%;

n Average daily calorie intake per person–Relativeweighting:10%;n Average time spent on meals,inminutes–Relativeweighting:5%.

Clearly, greater weighting has been attributed to the KPIs for physical activity, over-weight/obesityandsmoking,incompliancewiththeresultsemergingfromkeymedicalandscientificstudies.

TheresultsshowthatSwedenandJapanarethetwocountrieswiththebestperfor-mancefromthe“behavioralwell-being”perspective,whiletheUnitedStatesandGreece

Scorefrom1to10 Minutes

UnitedStates 1.0 76

U.K. 1.9 82

Denmark 3.4 92

Sweden 3.9 95

Germany 6.6 113

Spain 6.7 114

Greece 6.9 115

Italy 7.2 117

Japan 7.3 118

France 10.0 136


Theresultsshowthatasregardsbehaviorconnectedwithhealth,nutritionand,moreingeneral,lifestyle,theJapanesearethecitizenswhoadoptthemostvirtuouschoicesamongthecountriesconsidered.Incontrast,thecitizens of the United Statesareattheoppositeextreme.Allthingsconsidered,theItaliansareinafairlygoodposition,withascorethat ispractically doublethatoftheUnitedStatesandnottoofarfromthetoppositions.

The Wealth and Sustainability sub-index is the second sub-index considered for theconstructionoftheBCFNIndex.Thisindicatorreferstotwoparticulardimensionsofthewell-beingofindividuals:thefirstconcernsthesphereofwealthandeconomicresources(defined“Materialwell-being”),whilethesecondconcernsthequalityoftheenvironmentandtheecologicalimpactandenvironmentalsustainabilityofthesocio-economicmodeladopted(“Environmentalwell-being”).

Figure22–TheWealthandSustainabilitysub-indexwithinthemethodologicalsystemadopted,showingthetwo

dimensionsofwhichitisformed





35%Wealth




30%Social






The analysis relative to the Wealth and Sustainability sub-index considered thecountries’performancein10 KPIs,utilizingthelatestfiguresavailablefromthestatisti-calsourcesused.Threeandsevenperformanceindicatorswereemployedforcalculating“Materialwell-being”and“Environmentalwell-being”,respectively.

3.3Other components of the BCFN Index

3.3.1 Wealth and Sustainability sub-index

Material well-being“Materialwell-being”isthefirstofthetwodimensionsmakinguptheWealthandSus-

tainabilitysub-index.Theindicatorstakenintoconsiderationandtheweightingvaluesusedinmeasuringarethefollowing:n Level of available average per capita income, measured in euros at purchasing

powerparity;n Net household wealth54,measuredasapercentageoffamilies’availablenetincome;n Per capita gross fixed investments, measured as the overall sum of the invest-

mentsmadeinthecountryinproportionwiththepopulation.

Followingthemethoddescribedearlier,foreachoftheaforementionedindicatorsapar-tialclassificationwascreated,attributingtoeachcountryascoreofbetween1(“worst”relativeperformance)and10(“best”relativeperformance).

Bywayofexample,theanalysesrelativetothetwoindicatorsattributedthegreatestweightingwithin“Materialwell-being”dimensionarereportedindetail.

Level of available median per capita income Percapitaincomeisoftenusedtomeasurethedegreeofwell-beingofthepopulation

ofacountrycomparedtoothercountries.Generallyspeaking,itisoneofthemostwidelyemployedindicatorsforanalyzingthematerialwealthofapopulationoracountry,percapita.

Inordertocomparethevariouslevelsofincomerecordedinthevariouscountries,theincomemustbeexpressedinaleadinginternationalcurrency:theEuroortheDollar.

Inanycase,sincethepercapitaincomedoesnotrevealthedistributionoftheincomewithinacountry,asmallgroupofverywealthypeoplecouldincreasetheaverageincomeoftheentirepopulation.So,inordertogainaclearerpictureoftheaveragewealthofacountry,insteadofusingtheaveragepercapita income,theavailablemedianpercapitaincome was used, i.e. the income positioned exactly at the center of the distribution ofwealth,inotherwordstheincomethatdividesthesampleinhalf.

Lastly,sincethedifferentcurrenciesofthevariouscountriesconvertedintoaninter-nationallyrecognizedcurrency(EuroorDollar)donotalwaysaccuratelyreflecttherealpurchasingpowerofthecurrencies,thedataweretakenfromaseriesalreadynormalizedforpurchasingpower.

54 Alsoforthisindicator,aswaspossibleforthepreviousone,itwouldhavebeenmorecorrecttousethemedianvalueratherthantheaverageone.Inanycase,datadonotexistforallofthecountriesunderexamination.


Figure24–Nethouseholdwealth,calculatedasapercentageofthefamilies’availablenetincome

Source:TheEuropeanHouse-AmbrosettiusingOECDdata,2010

From the data analyzed, Italy emerges as the number one country for net householdwealth, while the United States – which ranks second for median per capita income –comeslast.

ItisinterestingtonotethatItaly,notwithstandingthedifficultiesofthelasttenyearsinincreasingproductionlevels–andhence,income–isacountrythatisbecomingincreas-inglywealthierintermsofstockofaccumulatedincome.

Aninterestingaspectwhichdeservesreflectionisthatoverthelasttenyears–aperiodjudgedtobeextremelycriticalfortheItalianeconomy–thegrowthrateofwealthinItaly(determinedbytheflowsofsavingsplustheincreaseinthenetvalueoftheactivities)hasshownanincreaseincurrentvalueofover6%peryear.

AccordingtoananalysisoftheBankofItaly,ifeveryItalianfamilyweretoinvest(likeaFoundation)itsassetsinaseriesofpropertyandfinanceactivities,receivinginthelongtermarealinterestratecorrespondingtotheaveragegrowthrateoftheworldeconomy,itcouldcountonanaveragecapitalincomeof18,000Eurosperyear,equivalentto1,500Eurospermonthfortwelvemonths.Clearly,inordertocalculatewealth,anindicatorofthistypeisabsolutelyindispensable.

Fromananalysisoftheindicesforcalculatingwell-beingataninternationallevelandincompliancewiththeguidelinesdevelopedinthecourseoftheAdvisoryBoardmeetings,weightingshavebeenattributedtoeachcomponentanalyzed

Thespecificweightingvaluesusedinmeasuringarethefollowing:n Average per capita income level available,measuredineurosatpurchasingpower

parity–Relativeweighting:50%;n Net household wealth55,measuredasapercentageofthefamilies’availablenetin-

come–Relativeweighting:30%;n Per capita gross fixed investments,measuredastheoverallsumoftheinvestments

madeinthecountryinproportionwiththepopulation-Relativeweighting:20%.

55 Alsoforthisindicator,aswaspossibleforthepreviousone,itwouldhavebeenmorecorrecttousethemedianvalueratherthantheaverageone.Inanycase,completedatadonotexistforallofthecountriesunderexamination.

Scorefrom1to10 %familynetavailablewealth


Greece 2.9 547

Spain 3.6 573

Germany 5.0 629

Japan 6.8 697

Denmark 6.9 700

Sweden 7.0 702

France 8.3 752

U.K. 8.7 768

Italy 10.0 818

Figure23–Levelofavailablemedianpercapitaincome,calculatedineurosatpurchasingpowerparity


As the graph shows, the first three positions are occupied by Denmark, the UnitedStates and the United Kingdom, the only countries with an available median per capitaincomegreaterthan20,000Eurosperyear.France,Germany,JapanandSwedenarepo-sitionedinthebracketrangingfromapprox.17,000to19,200Euros.Italyranksthird-lastwithavalueofapprox.13,700Euros,agapofalmost3,300EurosfromFrance,whichisequivalentto20%lessthantheFrenchavailablemedianpercapitaincome.Greece,inlastplace,withlittlemorethan11,000euros,hasanavailablemedianpercapitaincomethatislessthanhalfthatofDenmark.

Net household wealthNethouseholdwealthisaveryimportantindicatorforassessingthe“Materialwealth”

ofacountry.

Inadditiontothetraditionalincomeindicators,itisusefulalsotoconsidertheindicatorsofthestockofwealthexistinginacountry,since“materialwell-being”isobtainedfromthesumofthetwocomponents.

Income,infact,correspondstotheeconomicvalueofthegoodsandservicesproducedinayearbythecitizensofacountryanddistributedamongthemintheformofsalariesandwages.Wealth,ontheotherhand,isthestockofactivitiesrelatingtoproperty(hous-esandland)andfinance(shares,bondsandcash)accumulatedovertimebythecitizensresidentinacountry.

Intangibleterms,thecalculationofwealthintheformofstockisanaspecttobecon-sideredineconomicanalyses,asittouchesuponanissuethatisfarfrombeingmarginal.afamilyisrichnotonlybecauseitcurrentlyearnsacertainincomebutbecauseithasahistoryofaccumulation,i.e.judiciousmanagementoftheassetspasseddownfromgen-erationtogeneration.

Thegreaterafamily’swealthbase,themoreitswell-beingwillbedeterminedbycapitalgain,asopposedtoincome.

Scorefrom1to10 Euros,equalpurchasingpower

Greece 1.0 10,925

Spain 1.8 12,276

Italy 2.8 13,735

France 4.9 17,085

Germany 5.3 17,869

Japan 6.2 19,223

Sweden 6.2 19,266

U.K. 7.0 20,574

UnitedStates 7.7 21,707

Denmark 10.0 25,321


n CO2 emissions deriving from the use of fossil fuels, measured in Kg per person;n Levels of PM10 generated, measured in micrograms per cubic meter;n Urban waste produced, measured in Kg per person.

The first four indicators refer, in particular, to the environmental sustainabilitydimension,andthenextthreetothecurrentquality of the environment.

Adjusted net savingAdjusted net saving isaneconomicsustainabilityindicatorcalculatedbytheWorld

Bank which measures saving in an economy, considering as negative elements the(negative)externalitiesderivingfromtheconsumptionofnaturalresourcesandpollution.

Externalitiesarisewhentheactionofapartyoranactivitycreates(positiveornegative)third party spill over effects for which no compensation is paid in monetary terms, i.e.withoutadefinedpricebeingpaidthroughfreemarketnegotiation.

A typical example of negative externalities are those linked to pollution. If theproductionprocessofaneconomicactivityreleasesharmfulorpollutingsubstancesintotheatmosphere,thisvalueisnotcalculatedinthesellingpriceofthegoodproducedfromthisactivity.So,forcorporateaccountingpurposesandatanationallevel,theincomeandthewealthproducedbytheactivity isconsidered,butnotthedamagewreakedontheenvironment.

Figure26–AdjustedNetSaving

Source:TheEuropeanHouse-AmbrosettiusingWorldBankdata,2010.

Swedenisatthetopofthelist,followedbyJapanandDenmark.Italyranksfourthbe-foretheUnitedKingdomandtheUnitedStates,thelatterscoringpracticallyzero.Greece,inlastplace,istheonlycountrywithanegativeadjustednetsaving(netofnegativeex-ternalities). In other words, the sum of the negative externalities produced are greaterthanthesavinggenerated.

CO2 emissions deriving from the use of fossil fuelsCO2emissionsrepresentaveryimportantstatisticintheassessmentofenvironmental

well-being,asthecarbondioxide(CO2),naturallypresentintheecosystemsasafunda-

Scorefrom1to10 Percentageofgrossnationalincome

Greece 1.0 -4.8


U.K. 4.1 3.9

Italy 5.7 8.5

France 6.2 9.8

Spain 6.3 10.1

Germany 6.7 11.3

Denmark 7.6 13.7

Japan 8.2 15.3

Sweden 10.0 20.5


Theawardingofascoretoeachcountryforeachofthe3KPIsanalyzedandtheweight-ing of the results obtained with the percentages shown above enabled the calculationofanintermediatesummaryindexforthe“Materialwell-being”dimension.Therankingthusobtainedisrepresentedinthefigurebelow.

Figure25–Rankingfor“Materialwell-being”


Inthefinalandsummaryclassification,Denmarkgainsfirstplace,followedbyagroupof countries in joint second place composed of the United Kingdom, Sweden, Japan andFrance. Italy, Germany and the United States all have the same score, while Spain andGreeceranksecond-lastandlast,respectively.

Environmental well-beingTheseconddimensionoftheWealthandSustainabilitysub-index isentitled“Environ-

mentalwell-being”.Thiscomponenthasbeenincludedwithaviewtoassessingthecur-rent “environmental health” status of a country, together with the environmental sus-tainabilityofthesocio-economicmodelofreference.

Theindicatorstakenintoconsiderationandweightingvaluesusedinmeasuring”Envi-ronmentalwell-being”arethefollowing:n Adjusted Net Saving, i.e. net saving rate, the sustainability indicator calculated by

theWorldBankwhichmeasurestherealsavinginaneconomy,whilealsotakingintoaccountthenegativeexternalitiesderivingfromtheconsumptionofnaturalresourcesandpollution;

n Ecological Footprintpercapita,i.e.theareaoftheearth’ssurfacerequiredtoabsorbthepollutiongeneratedbythecountry,measuredinequivalentglobalhectares;

n Water Footprintpercapita,i.e.thequantityofwaterabsorbedtosustainthenationalsocio-economic model (production of goods and services and personal consumption),measuredincubicmeters(virtual);

n Contribution of renewable sources to the national energy supply, measured as a percentage of the total primary energy supply;

Scorefrom1to10

Greece 1.6

Spain 3.1

Italy 5.2

UnitedStates 5.2

Germany 5.2

France 6.3

Japan 6.3

Sweden 6.3

U.K. 6.5

Denmark 9.1


Forthesereasons,thequantitiesofPM10,calculatedinmicrogramsperm3,werecalcu-latedinthecountriesunderexamination.

Figure28–LevelsofPM10generated,measuredinmicrogramspercubicmeter

Source:TheEuropeanHouse-AmbrosettiusingWorldBankdata,2010

Alsointhiscase,Swedenranksfirstwith11.6microgramsofPM10perm3,whileGreecerankslastwith36microgramsofPM10perm3,300%morethantheformercountry.Italy,with 26.7 micrograms of PM10 per m3, is fourth-last, after the United States, Denmark,Germany,theUnitedKingdomandFrance.

Fromananalysisoftheindicesforcalculatingwell-beingataninternationallevelandincompliancewiththeguidelinesdevelopedinthecourseoftheAdvisoryBoardmeetings,weightingshavebeenattributedtoeachcomponentanalyzed.

Thespecificweightingvaluesusedinmeasuringarethefollowing:n Adjusted Net Saving,i.e.thenetsavingrate,thesustainabilityindicatorcalculated

bytheWorldBankwhichmeasurestherealsavinginaneconomy,alsoconsideringthenegativeexternalitiesderivingfromtheconsumptionofnaturalresourcesandpollu-tion–Relativeweighting:25%;

n Ecological Footprintpercapita,i.e.theareaoftheearth’ssurfacerequiredtoabsorbthepollutiongeneratedbythecountry,measuredinequivalentglobalhectares–Rel-ativeweighting:5%;

n Water Footprintpercapita,i.e.thequantityofwaterabsorbedtosustainthenationalsocio-economic model (production of goods and services and personal consumption),measuredincubicmeters(virtual)–Relativeweighting:5%;

n Contribution of renewable sources to the national energysupply,measuredasapercentageofthetotalprimaryenergysupply–Relativeweighting:15%;

n CO2 emissions deriving from the use of fossil fuels, measured in Kg per person–Relativeweighting:20%;

n Levels of PM10 generated, measured in micrograms per cubic meter–Relativeweighting:15%;

n Urban waste produced, measured in Kg per person–Relativeweighting:15%.


Scorefrom1to10 Microgramsperm3

Greece 1.0 36.0

Spain 2.6 31.6

Japan 3.3 29.6

Italy 4.4 26.7


Denmark 7.4 18.7

Germany 7.4 18.6

U.K. 8.6 15.5

France 9.3 13.5

Sweden 10.0 11.6

mentalsubstanceinthevitalprocessesofplantsandanimals, isdeemed- inexcessivequantities-tobeoneofthechiefcausesforthegreenhouseeffectontheplanet.

Theglobalwarmingtheoryisbasedontheincreaseinthequantityofcarbondioxideintheatmospherewhich,generatingthegreenhouseeffect,contributestoanincreaseintheaveragetemperatureoftheplanet,towhichtheecosystemsdonothavetheneces-sarytimetoadapt.

Theextentofthiseffectisstillunderdiscussion,butthewidespreadconvictionthattheEarth’sclimateisundergoingageneralizedwarmingprocesshasledtothesigningoftheKyotoprotocolbymanycountriesthroughouttheworld.Thisprotocolisanagreementinwhichthecountriesundertaketolimitingandreducingcarbondioxideemissions,sothatitsconcentrationsremainbelowestablishedacceptablethresholdlevels.

Figure27–CO2 emissionsderivingfromtheuseoffossilfuels,measuredinKgperperson


Normalizingthisdatapernumberofpersons,theUnitedStateshasthehighestcarbondioxideemissionsinkilogramsperpersonofallthecountriesconsidered,andthereforeitoccupiesthelastplace.TheaveragequantityofCO2emittedbyanAmericanis20tons,againstthe5tons(approx.)emittedbyaSwede.

Germany(second-last)andJapan(third-last)emitanaveragequantityof9.7tonsofCO2

perperson,halftheamountoftheUnitedStates;Italyranksthirdwithemissionsofap-prox.7.4tons,behindFrance,whichgainssecondplacewithalmost6tonsofCO2emis-sionsperperson.

Levels of PM10In recent years, among the main atmospheric pollutants, special attention has been

dedicatedtothePM10concentrationintheatmosphere,asevidencehasemergeddemon-stratingtheextenttowhichtheseparticlesarehazardoustohumanhealth.

PM10isanacronymwhichindicatesthedustparticlespresentintheatmospherethathaveanaerodynamicdiameteroflessthan10μm(10thousandthsofamillimeter).Thesedustparticleshavethepowertopenetratethelowerrespiratorytractasfarasthetho-rax (bronchi and lungs), causing irritations of the primary respiratory tract and effectsofvaryinggravitysuchasinflammationsandworseningofchronicrespiratorydiseases.

Scorefrom1to10 Kgperperson


Germany 7.0 9,702

Japan 7.0 9,674

Denmark 7.4 9,163

Greece 7.6 8,755

U.K. 7.7 8,577

Spain 8.3 7,688

Italy 8.5 7,382

France 9.4 5,980

Sweden 10.0 5,028


Asshowninthegraph,Italyranksseventh,withascoreof5.42points,veryclosetoGermany.

TheclassificationisheadedbyDenmark(7.78points),withSwedenonitsheels.Franceand Japan are next, followed, at a slight distance, by the United Kingdom. The rankingcloseswiththeUnited States (hampered, inparticular,bythescoreobtainedfor“En-vironmentalwell-being”)andGreece(hampered,inparticular,bythescoreobtainedfor“Materialwell-being”).

3.3.2 Social and Interpersonal sub-indexTheSocialand Interpersonalsub-index isthethirdsub-indexconsideredforthecon-

structionoftheBCFNIndex.Thisindicatorderivesfromtheintegrationofthethreeper-sonalwell-beingdimensions:onefortheeducation and culture sphere(entitled“Edu-cational well-being”), one for the welfare, family, society and institutions sphere(entitled “Social well-being”) and one for the democracy and individual freedomsphere(entitled“Politicalwell-being”).

Figure31–TheSocialandInterpersonalsub-indexwithinthemethodologicalsystemadopted,showingthethree

dimensionsofwhichitisformed





35%Wealth




30%Social






The analysis relative to the Social and Interpersonal sub-index is based on 16 KPIs.Specifically,6KPIshavebeendevelopedformeasuring“Educationalwell-being”,8KPIsfor“Socialwell-being”and2KPIsfor“Politicalwell-being”,respectively.

Educational well-being“Educational well-being” is one of the three dimensions composing the Social and

Interpersonal sub-index. As already mentioned, educational well-being refers to theeducationalandculturaldimensionsofpersonalwell-being,inlinewiththetheorythatthese aspects represent two fundamental qualifying factors for the happiness of thepopulation.

Theawardingofascoretoeachcountryforeachofthe7KPIsanalyzedandtheweight-ingoftheresultsobtainedwiththepercentagesshownaboveenabledthecalculationofanintermediatesummaryindexforthe“Environmentalwell-being”dimension.Therank-ingthusobtainedisrepresentedinthefigurebelow.

Figure29–Rankingfor“Environmentalwell-being”


Summary results of the Wealth and Sustainability sub-index“Material well-being” and “Environmental well-being” are the two dimensions

composing the Wealth and Sustainability sub-index, obtained from the totaling of thepointsscoredbyeachcountryinthe10KPIsselected.

Figure30–RankingfortheWealthandSustainabilitysub-index


Scorefrom1to10

UnitedStates 2.6

Greece 4.0

Spain 5.4

Italy 5.8

U.K. 5.8

Denmark 6.1

Germany 6.4

Japan 6.6

France 6.9

Sweden 9.4

Scorefrom1to10

Greece 2.61

UnitedStates 4.07

Spain 4.11

Italy 5.42

Germany 5.69

U.K. 6.19

Japan 6.44

France 6.56

Sweden 7.64

Denmark 7.78


andapplysimplemodelsorinquirystrategies.Studentsatthislevelshouldbeabletointerpretandusescientificconceptsfromdifferentdisciplinesandapplythemdirectly.Theyshouldbeabletodevelopshortcommunicationsusingfactsandmakedecisionsbasedonscientificknowledge.

n Level 2.Studentshaveadequatescientificknowledgetoprovidepossibleexplanationsinfamiliarcontextsordrawconclusionsbasedonsimpleinvestigations.Theyshouldbecapableofdirectreasoningandmakingliteralinterpretationsoftheresultsofscientificinquiryortechnologicalproblemsolving.

n Level 1.Studentshavesuchalimitedscientificknowledgethatitcanonlybeappliedtoafewfamiliarsituations.Theyshouldbeabletopresentscientificexplanationsthatareobviousandfollowconcretelyfromgivenevidence.

The results emerging for the countries considered in the P.I.S.A. survey are shownbelow.

Figure32–Percentageofnationalstudentsclassifiedatlevels4,5,6accordingtotheevaluationmethodofthePro-

grammeforInternationalStudentAssessment

Source:TheEuropeanHouse-Ambrosettire-elaborationofP.I.S.A-OECDdata,2010

For the construction of the indicator presented here, the three highest levels (4,5,6)weretakenintoaccount,astheywerejudgedtoberepresentativeofstudentswithhighcultural and analytical skills. This indicator was included among the KPIs selected as itwasconsideredanapproximationofthelevelofcognitiveandintellectualskilldevelopedbyindividualsduringtheireducationalpath(aswellasanindexoftheeffectivenessoftheeducationsystem).

It emerges clearly from the results presented in the figure above, that Italy has oneofthe lowest percentagesworldwideofstudents classified atthehighest levels oftheP.I.S.A.assessment(19.7%)(onlyGreecehasalowerscoreforthisindicator).ThisevidencerevealsacriticalsituationinItalyasregardstheeducationsystem,whichhasanegativeimpactonthecalculationofthedimensionentitled“educationalwell-being”.

ThenationthatgainsthehighestscoreisJapan,whichhasapercentageof42%studentsatthehighestP.I.S.A.scorelevels.ItisfollowedbytheUnitedKingdomandGermanywhichhave similar scores (35.6% and 35.4% respectively), Sweden (29%), France (28.9%), theUnitedStates(27.4%),Denmark(26.3%),Spain(22.8%),Italy(19.7%)andGreece(17.6%).

Scorefrom1to10 ProgrammeforInternationalStudentAssessment

Greece 1.0 17.6

Italy 1.8 19.7

Spain 2.9 22.8

Denmark 4.2 26.3


France 5.2 28.9

Sweden 5.2 29.0

Germany 7.6 35.4

U.K. 7.6 35.6

Japan 10.0 42.0

The 6 KPIs considered for the construction of the summary indicator for educationalwell-beingarethefollowing:n P.I.S.A. score (Programme for International Student Assessment), calculated as the

numberofstudentsassessedatlevels4,5or6;n Average annual number of university graduates and research doctorates

(averageoverthelasttenyears,valuesper100,000people)n Foreign students enrolled in the national university system (per100,000people);n Rate of unemployment among university graduates;n Average number of daily newspapers sold56per day(valuesper100people);n Diffusion of broadband internet connections (number of subscribers per 100

people).

Bywayofexample,theparagraphsbelowlisttheevidenceemergingfromananalysisofsomeofthemostsignificantKPIsthatweremeasuredandthatcontributetothecalcu-lationofthefinalscoreforeachcountrywithinthelimitsoftheinternationalcomparison.Fordetailsoneachoftheindicatorsconsidered,pleaserefertothestatisticalappendix.

Percentage of national students classified at levels 4,5,6 according to the P.I.S.A. (Programme for International Student Assessment) classification

The Programme for International Student Assessment – PISA is an international sur-vey promoted by the OECD to assess the skills of young school-goers. The PISA projectinvolved 57 countries, including all thirty OECD member countries and twenty-sevenpartnercountries.

Eachphaseofthesurveyfocusesonaparticulararea:thefirstphase(PISA2000)dealtwithreading,thesecond(PISA2003)withmathematics,whilethemainareaofinvestiga-tionofPISA2006wasscience.TheP.I.S.A.assessmentawardsstudentsscoresfrom1to6,where6isthemaximumand1istheminimum.ThesixlevelsoftheP.I.S.A.assessment,relativetothelastsurvey(2006),aresummarizedasfollows:n Level 6.Studentsshouldbeabletoconsistentlyidentify,explain,andapplyscientific

knowledgeandknowledgeaboutscienceinavarietyofcomplexlifesituations.Theyshouldbeabletolinkdifferentinformationsourcesandexplanationsanduseevidencefromthosesourcestojustifydecisions.Theyshouldbeabletoclearlyandconsistentlydemonstrate advanced scientific thinking and reasoning, and be willing to use theirscientificunderstandinginsupportofsolutionstounfamiliarscientificandtechnologi-calsituations.Studentsatthislevelshouldbeabletousescientificknowledgeandde-velopargumentsinsupportofrecommendationsanddecisionsthatcenteronpersonal,social,orglobalsituations.

n Level 5.Studentsshouldbeabletoidentifythescientificcomponentsofmanycomplexlifesituations;applybothscientificconceptsandknowledgeaboutsciencetothesesit-uations;andshouldbeabletocompare,select,andevaluateappropriatescientificevi-denceforrespondingtolifesituations.Studentsatthislevelshouldbeabletousewell-developedinquiryabilities,linkknowledgeappropriately,andbringcriticalinsightstothese situations. They should be able to construct evidence-based explanations andargumentsbasedontheircriticalanalysis.

n Level 4.Studentsshouldbeabletoworkeffectivelywithsituationsandissuesthatmayinvolveexplicitphenomenarequiringthemtomakeinferencesabouttheroleofscienceortechnology.Theyshouldbeabletoselectandintegrateexplanationsfromdifferent disciplines of science or technology and link those explanations directly toaspectsoflifesituations.Studentsatthislevelshouldbeabletoreflectontheiractionsandcommunicatedecisionsusingscientificknowledgeandevidence.

n Level 3.Studentsshouldbeabletoidentifyclearlydescribedscientificissuesinarangeofcontexts.Theyshouldbeabletoselectfactsandknowledgetoexplainphenomena

56 Duetothelackofreliabledataforsomeofthecountriesunderexamination,itwasnotpossibletoincludeamongtheKPIsofthisareatheaveragenumberofbooksreadorsold.


newuniversitygraduatesandresearchdoctoratesaregenerated(ISCEDLevel6, inthecaseofItaly)inthenationaltertiaryeducationsystem.Withaviewtopreventingapo-larizationoftheindicatortowardsthemoredenselypopulatedcountries(which,allotherthingsbeingequal,wouldbeabletogenerateahigherabsolutenumberofgraduatesthantheothers),theannualaverageofnewuniversitygraduateswasrelatedtothenationalpopulationandexpressedinunitsper100,000people.

Figure33–Averageannualnumberofnewuniversitygraduatesandresearchdoctorates,1999-2009

Source:TheEuropeanHouse-AmbrosettielaborationofEurostatdata,2010

Theevidenceshowsadispersionoftheresultsrecordedforthe10countrieswhichisquite significant. In fact, the results span from an average of approx. 400 new univer-sitygraduatesper100,000peopleinGermanytoover976newuniversitygraduatesper100,000peopleintheUnitedKingdom(whichscores10forthisindicator).

Italy ranks third-last, ahead of Greece and Germany, with an average of around 500newuniversitygraduatesandresearchdoctoratesinthereferenceperiod.

Summary indicator of Educational well-beingFromananalysisoftheindicesforcalculatingwell-beingataninternationallevelandin

compliancewiththeguidelinesdevelopedinthecourseoftheAdvisoryBoardmeetings,weightingshavebeenattributedtoeachcomponentanalyzed.

Thespecificweightingvaluesusedinmeasuringarethefollowing:n P.I.S.A. score (Programme for International Student Assessment), calculated as the

numberofstudentsassessedatlevels4,5or6–Relativeweighting:20%;n Average annual number of university graduates and research doctorates(av-

erageoverthelasttenyears,valuesper100,000people)–Relativeweighting:35%;n Foreign students enrolled in the national university system (per100,000peo-

ple)–Relativeweighting:15%;n Rate of unemployment among university graduates–Relativeweighting:10%;n Average number of daily newspapers sold58 per day (valuesper100people)–Rel-

ativeweighting:10%;

58 Duetothelackofreliabledataforsomeofthecountriesunderexamination,itwasnotpossibletoincludeamongtheKPIsofthisareatheaveragenumberofbooksreadorsold.

Scorefrom1to10 Averageoverlasttenyears,per100,000people

Germany 1.0 405.8

Greece 1.8 459.0

Italy 2.6 505.9

Sweden 3.6 567.7

Spain 4.4 624.3


Denmark 7.5 816.1

Japan 7.7 827.7

France 8.5 882.2

U.K. 10.0 976.5

Thisindicatorimpactsonthecalculationofthesummaryindicatorforeducationalwell-beingwitharelativeweightingof20%.

Average annual number of university graduates and research doctoratesAnotherindicatorusedformeasuring“educationalwell-being”inthecountriesunder

examinationistheaverageannualnumberofuniversitygraduatesandresearchdoctor-ates,whichimpactsonthesummaryindicatorwithaweightingof35%.

Theindicatorwasconstructedcalculatingtheaverage,inthetimeframeofthelast10years,ofthenumberofstudentsthatfinishtheISCED5and6studycycles.57

ThisindicatorwasincludedinthesetofKPIsselectedasthegenerallevelofdissemina-tionofcultureandeducationinapopulationwasthoughttobelinkedtotherateatwhich

57 TheISCEDstandardwasdevelopedbyUNESCOintheearlyseventiesasaninstrumentsuitableforassembling,compilingandpresentingstatisticsofeducationbothwithinindividualcountriesandinternationally.ApprovedinGenevain1975duringtheInternationalConferenceonEducation,ISCEDwaslatersignedbytheGeneralConferenceofUNESCOfollowingtheadoptionoftherecommendationregardingthestandardizationofeducationalstatistics(Paris,1978).ExperienceandapplicationovertimedemonstratedtheneedforareviewoftheISCEDcriteriainordertofurtherfacilitateacomparativeanalysisofthevariouslevelsofeducationthroughouttheworldandtomorefaithfullyreflectthechangestakingplacewithintheworld’seducationalsystems.ThusinNovember1997,anewstandardnamedISCED97wasadopted,coveringtwocross-classificationvariables:levelandfieldofeducation.Level5referstothefirststageoftertiaryeducation,whilelevel6referstotertiaryeducationprogramsleadingtoanadvancedresearchqualification(inItaly,theResearchDoctorate).

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Onthebasisofthisreflection,theindicatorstakenintoconsideration”Socialwell-being”arethefollowing:n Percentage of people at risk of poverty59;n Income distribution inequality rate, calculatedastheratiobetweenthetotalin-

comeof80%ofthepoorestsegmentofthepopulationandtheoverallincomeofthe20%oftherichestsegment;

n Average number of hours dedicated to child care (weeklyaverage,childrenagedbetween0and12yearsofage);

n Average unemployment rate;n Average unemployment rate among young people;n Rate of dependence of the elderly, calculated as a ratio between the population

agedover65yearsandtheworking-agepopulation(25-64years);n National Institution Index60,calculationoftrustintheinstitutions;n Interpersonal Trust Index61.

Bywayofexample,theparagraphsbelowlisttheevidenceemergingfromananalysisofsomeofthemostsignificantKPIsthatweremeasuredandthatcontributetothecalcu-lationofthefinalscoreforeachcountrywithinthelimitsoftheinternationalcomparison.Fordetailsoneachoftheindicatorsconsidered,pleaserefertothestatisticalappendix.

Percentage of people at risk of povertyThisisanindicatorthatwasconstructedbytheEuropeanCommission(departmentof

statistics,Eurostat)fortheEUcountriesandforanumberofleadingnon-Europeancoun-tries.Thisindicatorwascalculatedasthepercentageofindividualsthathaveanincomeequalto,orlessthan,60%ofthemedianvalueofthenationalpercapitaincome.Accord-ingtothislogic,therefore,iftheannualmedianpercapitaincomeofahypotheticalcoun-trywereequivalentto10,000Euros,thethresholdunderwhichanindividualwouldbeconsideredatriskofpovertywouldbe6,000Euros.

Thepercentageofpeopleatriskofpovertyisconsideredaneffectiveindicatorofthequalityofinteraction,ineconomicterms,betweenindividualsandsociety.Itmay,infact,beconjecturedthatthehighestnumbersofpeopleatriskofpovertyreflecttheleastvir-tuoussocialmechanisms,atleastfromtheperspectiveofthegenerationanddistributionofincomeandofremunerationforworkonthebasisofpurchasingpower.

Withregardtothisindicator,5countriesoutoften(UnitedStates,Greece,Spain,ItalyandtheUnitedKingdom)presentanaveragenumberofpeopleatriskofpoverty(in2008)of between 19% and 20% of the population. For the more virtuous countries, this per-centagedropsto12-15%.ThisisthecaseofSweden(12%),Denmark(12%),France(13%)andGermany(15%).Thefigurebelowshowsasummaryoftheresultsobtainedfromthe10countriesconsideredinrelationtothisindicator.

Thisindicatorhasa25%impactonthecalculationofthesummaryindicatorforsocialwell-being.

59 Thepovertythresholdissetatanincomeequalorlowerthan60%ofthemedianper capitaincome,includingsocialsecuritytransfers.

60 CarriedoutbytheGallupcompanythroughtheInternationalsurveysentitledGallupWordPoll,thisindexmeasurestheleveloftrustthatcitizenshaveinthekeyinstitutionsoftheirowncountry,suchasnationalgovernment,thelawandthecourts,thearmyetc.,andinthecorrectnessofelectionprocedures.

61 ThisisanindicatorcalculatedbytheWorldValuesSurvey(WVS),commonlyusedtocomparethelevelofinterper-sonaltrustinthevariouscountries.Thecalculationismadebyaskingintervieweeswhethertheygenerallyfeelthattheycantrusttheirfellowcitizensandcountingthenumberofresponsesofthosewhodeclarethattheytrustmostpeople.

n Diffusionofbroadband internet connections(numberofsubscribersper100peo-ple)–Relativeweighting:10%.

Theawardingofascoretoeachcountryforthe6KPIs,onthebasisoftheweightingsat-tributed,enabledthecalculationofanintermediatesummaryindexforthe“Educationalwell-being”dimension,whichisshowninthefigurebelow.

Figure34–Rankingfor“Educationalwell-being”


AsthegraphrepresentingtheEducationalwell-beingindexforthe10countriesunderexaminationshows,Italyhasafairlylowtotalscoreforthissetofindicators,inwhichtheUnitedKingdom,DenmarkandJapantakethelead.

ThepoorpositioningofItalyismainlydue–inadditiontothelownumbersofnewuni-versitygraduatesandresearchdoctoratesandofstudentsclassifiedatthehighestlevelsoftheP.I.S.A.system-toinsufficientinternationalizationoftheuniversitysystem(almosttentimeslessthantheUnitedKingdom,thenumberonecountryforthisindicator)andtoinsufficientdiffusionofInternettechnologyamongthepopulation(which,nowadays,isachannelforcommunicationanddisseminationofknowledgeandculture).

Social well-being“Socialwell-being”isanotherofthethreedimensionscomposingtheSocialandInter-

personalsub-index.Socialwell-beingreferstothecomponentconcerningtherelationsoftheindividualwithsociety,i.e.thecomponentdefinedas“socialwell-being”isthereforegeneratedbytheattitudeofindividualsinthebuildingoffruitfulandmutuallysupport-iverelationswiththesociety inwhichtheylive(welfare,familyetc.).Socialwell-beingderives,therefore,fromparametersthatareexternaltotheindividual,connectedwiththe type of society (such as for example the possibility to carry out a working activitythatprovidessufficientincometoguaranteeself-sufficiencyandself-realization,orfaithinothermembersofsocietyortowardstheinstitutionsgoverningit),butalsofrompa-rametersthatarewithinthecontroloftheindividual,suchasforexamplethevalueas-cribedtothefamily,asaninstitution,thepropensitytocontributeactivelytothecollec-tivewell-beingetc.

Scorefrom1to10

Greece 1.5

Italy 2.3

Spain 3.2

Germany 4.3

UnitedStates 5.2

Sweden 5.3

France 5.7

Japan 6.4

Denmark 7.0

U.K. 8.5


Spainisthecountrywiththehighestrateofunemploymentamongthecountriesunderexamination,witharound18%ofthecountry’spotentiallyavailableworkforcewithoutjobs.Althoughaninterpretationoftheresultsofthis indicatorcannotbuttakeintoac-countthetremendousimpactthattheeconomicandfinancialcrisisofthelasttwoyearshas generated on the leading world economies, considering the global character of thecrisis itself (whichstruckallofthecountriesunderexamination)theresultspresentedearliershould,inanycase,beconsideredrepresentativeofthephenomenonthatistheobjectofthemeasurements.

ThecountrythathasthelowestrateofunemploymentisJapan,withafigureofaround5%,whiletheothercountriesbelongingtotheEuropeanareaandtheUnitedStatesofAmericahaveunemploymentratesofbetween5%and9.5%.

Summary indicator of Social well-beingFromananalysisoftheindicesforcalculatingwell-beingataninternationallevelandin


Thespecificweightingvaluesusedinmeasuringarethefollowing:n Percentage of people at risk of poverty62–Relativeweighting:25%;n Income distribution inequality rate, calculatedastheratiobetweenthetotalin-

comeof80%ofthepoorestsegmentofthepopulationandtheoverallincomeofthe20%oftherichestsegment–Relativeweighting:10%;

n Average number of hours dedicated to child care (weeklyaverage,childrenagedbetween0and12yearsofage)–Relativeweighting:5%;

n Average rate of unemployment–Relativeweighting:25%;n Averagerateof unemployment among young people–Relativeweighting:10%;n Rate of dependence of the elderly, calculated as a ratio between the population

agedover65yearsandtheworking-agepopulation(25-64years)–Relativeweight-ing:5%;

n National Institution Index63, calculation of trust in the institutions – Relativeweighting10%;

n Interpersonal Trust Index64–Relativeweighting10%.


Theawardingofascoretoeachcountryforthe8KPIs,onthebasisoftheweightingsattributed,enabledthecalculationofanintermediatesummaryindexforthe“Socialwell-being”dimension,whichisshowninthefigurebelow.

62 Thepovertythresholdissetatanincomeequalorlowerthan60%ofthemedianper capitaincome,includingsocialsecuritytransfers.

63 CarriedoutbytheGallupcompanythroughtheInternationalsurveysentitledGallupWordPoll,thisindexmeasurestheleveloftrustthatcitizenshaveinthekeyinstitutionsoftheirowncountry,suchasnationalgovernment,thelawandthecourts,thearmyetc.,andinthecorrectnessofelectionprocedures.

64 ThisisanindicatorcalculatedbytheWorldValuesSurvey(WVS),commonlyusedtocomparethelevelofinterper-sonaltrustinthevariouscountries.Thecalculationismadebyaskingintervieweeswhethertheygenerallyfeelthattheycantrusttheirfellowcitizensandcountingthenumberofresponsesofthosewhodeclarethattheytrustmostpeople.

Figure35–Percentageofpeopleclassifiedasbeing“atriskofpoverty”,2008

Source:TheEuropeanHouse-AmbrosettielaborationofEurostatdata,2010

Average rate of unemploymentThemainmechanismofinteractionbetweentheindividualandsocietyiswork,which

is,initself,afundamentalelementforthesocialstructureofthecountriesthemselves.Onthebasisofthisassumption,theaveragerateofunemploymenthasbeenincludedinthecalculationmethodoftheBCFN-Indexasitisheldtobeavalidexpressionofwhathasbeendefinedasthe“socialwell-being”oftheindividual.Giventheextremepertinenceoftheindicatorwiththeobjectbeingmeasured,thisKPIhasanimpactof25%inthesum-mary indicator for social well-being (the same as the percentage of people classified asbeing“atriskofpoverty”).

Figure36–Averageannualrateofunemployment,2009

Source:re-elaborationsofTheEuropeanHouse-AmbrosettionEurostatdata,2010

Scorefrom1to10 %


Greece 1.1 20.0

Spain 1.1 20.0

Italy 2.2 19.0

U.K. 2.2 19.0

Japan 2.4 18.8

Germany 6.7 15.0

France 8.9 13.0

Denmark 10.0 12.0

Sweden 10.0 12.0

Scorefrom1to10 %

Spain 1.0 18.0

France 6.9 9.5

Greece 6.9 9.5


Sweden 7.8 8.3

Italy 8.1 7.8

U.K. 8.3 7.6

Germany 8.3 7.5

Denmark 9.4 6.0

Japan 10.0 5.1


Figure37–Rankingfor“Socialwell-being”


As the graph shows, Italy – with a total score of 4.7 points – ranks fourth-last out ofthe 10 countries under examination, followed by the United States, Greece and Spain(severelypenalizedbyaveryhighrateofunemployment,notonlyatagenerallevelbutalsoconsideringthatamongyoungpeoplealone).Denmark,ontheotherhand,gainsfirstplace inthis index,particularlyonthestrengthof itsextremely lowrateofunemploy-ment,thesmallnumberoffamiliesconsideredatriskofpoverty,thehighnumberofhoursdedicatedtochildcareandhighscoresintheindicesmeasuringinterpersonaltrustandtrustinpublicinstitutions(calculatedbyGallupWordPollandWorldValuesSurvey-WVS,respectively).

The country with the second-highest score in the Social well-being index is Sweden,also part of Scandinavia, which has gained its position on the basis of performancessimilartothatofDenmark.Germany,FranceandtheUnitedKingdom,ontheotherhand,scorebetween6.4(Germany)and5.3(UnitedKingdom).

Political well-beingLastly,thethirddimensionoftheSocialandInterpersonalsub-indexis“Politicalwell-

being”. This dimension refers to the well-being generated in the interaction betweenthe individual and the political institutions and political-institutional framework of thecountry.

For this area, two indicators have been selected65, constructed by internationalreference institutions on the basis of a series of parameters and then added together.Theseare,specifically:n The Economist Intelligence Unit’s index of democracy66;

65 Athirdindicatorselected,entitledFreedomintheWorldpublishedbyFreedomHouseeachyeareversince1972,whichassesseslevelsofcivillibertiesandpoliticalrights,hasbeenexcludedfromthisanalysisasitanalyses193countriesthroughouttheworld,includingthirdworldanddevelopingcountries,thathavemuchlowerlevelsofcivillibertiesandpoliticalrightscomparedtoWesterncountries.Forthisreason,the10countriesincludedinouranalysis,althoughpresentingdifferencesintermsof“Politicalwell-being”,tendtohavesimilarscoresintheFreedomintheWorldindex.

66 TheEconomistIntelligenceUnitIndexofDemocracy isasummaryindexthatmeasuresthequalityofdemocracyin167countriesthroughouttheworld,onanannualbasis.Itinvolvestheassessmentoffiveelements:electoralprocessandpluralism,civilliberties,functioningofgovernment,politicalparticipationandpoliticalculture.

Scorefrom1to10

Spain 2.5

Greece 4.5

UnitedStates 4.6

Italy 4.7

U.K. 5.3

Japan 5.7

France 5.9

Germany 6.4

Sweden 7.1

Denmark 8.8

n Corruption Perceptions Index67.

Asanexample,thefigurebelowprovidesasummaryoftheevidenceemergingfromananalysisoftheindicatorwhichhadthegreatestimpactonthecalculationofthesummaryindexforthePoliticalwell-beingcomponent(witharelativeweightingof75%),entitled“TheEconomistIntelligenceUnit’sIndexofdemocracy”.Fordetailsonthesecondindicatorconsidered,pleaserefertothestatisticalappendix.

The Economist Intelligence Unit’s index of democracyTheEconomistIntelligenceUnitIndexofDemocracyisasummaryindexdevelopedby

theEconomist,anditisasummaryindicatorthatmeasuresthestateofdemocracyin167countries throughout the world, on an annual basis. Specifically, the Economist Intelli-genceUnitIndexofDemocracycomprises4sub-indices:n electoralprocessandpluralism;n civilliberties;n functioningofgovernment;n politicalparticipationandpoliticalculture.

Thesumtotaloftheaforementionedindicatorscreatesthedemocracyindex(expressedbymeansofabriefjudgmentfrom1to10),theresultsofwhichareshowninthegraphbe-low,forthe10countriesunderexamination.

Figure38–ScoreassignedbytheEconomistIntelligenceUnitIndexofDemocracytothenationssubjectedtointer-

nationalcomparison(onascalefrom1to10),2009


Swedenranksfirstintheglobalclassificationandasaresultalsogainsfirstplaceamongthe countries under consideration. Denmark, in second place, also gains a score of over9points,whiletheremainingcountriesconsidered,withtheexceptionofItaly,allscorebetween8and9points.Italy,ontheotherhand,scoresonly7.98pointsonthisindex,thelowestvalueofthe10countriesunderexamination.

67 TheCorruptionPerceptionsIndexisanindexthathasbeencalculatedeachyearsince1995bytheTransparencyInternationalagency,whichclassifiesnumerouscountriesonthebasisofthedegreeofcorruptionexistinginthepublicandpoliticalsectors,asperceivedbythecountry’sowncitizens.Theterm“corruption”referstoabuseofpowerforpersonalgain.

Scorefrom1to10 Scalefrom1to10

Italy 1.0 7.98

France 1.4 8.07

Greece 1.7 8.13

U.K. 1.8 8.15


Japan 2.3 8.25

Spain 3.2 8.45

Germany 5.0 8.82

Denmark 8.3 9.52

Sweden 10.0 9.88


Summary indicator of Political well-beingFromananalysisoftheindicesforcalculatingwell-beingataninternationallevelandin


Thespecificweightingvaluesusedinmeasuringarethefollowing:n The Economist Intelligence Unit’s index of democracy68 – Relative weighting:

75%;n Corruption Perceptions Index69–Relativeweighting:25%.

Inaccordancewiththemethodexplainedearlier,apartialclassificationhasbeencon-structedforeachoftheaforementionedindicators,attributingtoeachcountryascoreofbetween1(“worst”relativeperformance)and10(“best”relativeperformance).

Theawardingofascoretoeachcountryforthe2KPIs,onthebasisoftheweightingsattributed, enabled the calculation of an intermediate summary index for the “Politicalwell-being”dimension,whichisshowninthefigurebelow.

Figure39–Rankingfor“Politicalwell-being”


SincePoliticalwell-beinghasonlybeenassessedonthebasisof2indicators(whichare,inturn,theexpressionofthesumofaseriesofspecificindicators)withan“unbalanced”weightingtowardsTheEconomistUnitIndexofDemocracy(towhichaweightingof75%has been attributed), the summary index relative to this dimension of well-being sub-stantiallyfollowstheclassificationofKPInumber40.

68 TheEconomistIntelligenceUnitIndexofDemocracy isasummaryindexthatmeasuresthequalityofdemocracyin167countriesthroughouttheworld,onanannualbasis.Itinvolvestheassessmentoffiveelements:electoralprocessandpluralism,civilliberties,functioningofgovernment,politicalparticipationandpoliticalculture.

69 TheCorruptionPerceptionsIndexisanindexthathasbeencalculatedeachyearsince1995bytheTransparencyInternationalagency,whichclassifiesnumerouscountriesonthebasisofthedegreeofcorruptionexistinginthepublicandpoliticalsectors,asperceivedbythecountry’sowncitizens.Theterm“corruption”referstoabuseofpowerforpersonalgain.

Scorefrom1to10

Italy 1.2

Greece 1.5

France 2.6

U.K. 3.2

UnitedStates 3.4

Japan 3.6

Spain 3.6

Germany 5.7

Denmark 8.7

Sweden 10.0

TheScandinavianareaofEuropeclearlytopsthisindicator,withSwedenandDenmarkdominatingtherelativeclassification,whileItalyisthecountrythatscoresthelowestforthisdimension.

Summary results of the Social and Interpersonal sub-indexAfter having calculated the summary indicators for “Educational well-being”, “Social

well-being”and“Politicalwell-being”,itispossibletoobtaintheSocialandInterpersonalsub-index,representedinthefollowingfigure.

Figure40–RankingfortheSocialandInterpersonalsub-index


Asshownbythegraph,Denmarkgainsfirstplaceoncemorewithascoreof8.16,fol-lowedbytheotherScandinaviancountry,Sweden,with7.43.TheUnitedKingdom,Ger-manyandJapan,atasubstantialdistancefromthefirsttwo,formatriowithscoresofbetween 5.2 and 5,7. They are followed by France and the United States with scores ofover4,andthen,afteranothergap,bySpain,ItalyandGreece(inlastplace).

The results show that the socioeconomic model of the Scandinavian countries is theonethatintegratesthedimensionsrelativetoeducation,welfare,thefamilyandso-cialspheres,democracyandpersonal freedominthemostbalancedway.Incontrast,the Mediterranean countries such as Greece, Italy and Spain have difficulty as regardstheseaspectsofnationalwell-being.

Asalreadymentioned,theBCFN Indexisacomparativeanalysistooldevelopedforthepurposeofmakinginternational comparisonsconcerningthelevel of well-being(inthebroadsenseoftheterm)“enjoyed”bytheinhabitantsofeachcountry.

Theinnovativeanddistinctive contributionoftheBCFNIndexliesinthemeasur-ing of the psycho-physical and behavioral well-being of people. These compo-nentshaveanextremelystrongimpactonthewell-beingofcitizens,astheyconcerntwodimensionsrelatedtothespheresofhealth (psycho-physicalwell-being)anddietandlifestyle(behavioralwell-being).Forthisreason,withintheconstructionoftheoverallwell-beingindex,significantweighthasbeenattributedtothesecomponents.

Scorefrom1to10

Greece 2.51

Italy 2.73

Spain 3.11

UnitedStates 4.39

France 4.73

Japan 5.22

Germany 5.46

U.K. 5.68

Sweden 7.43

Denmark 8.16

3.4The BCFN Index: main evidence

3. BCFN Index - 75


TheLifestylesub-index,whichisoneofthethreesub-indicesusedforthecalculationoftheBCFNIndex,asexplainedabove,contributestotheoverallwell-beingofpeoplebyaround35%.Thesameweighting–i.e.35%-hasbeenattributedtomaterialandenvironmentalwell-being,while30%hasbeenattributedtoeducational,socialandpoliticalwell-being.

Obviously,overallwell-beingdependsonmanyfactorssuchas,forexample,perceivedincome,householdwealth,environmentalsustainability,levelofeducation,thewelfaresystemofapopulation,etc.and,incalculatingtheBCFNIndex,thesecomponentshave,ofcourse,beentakenintoaccount.

However,sincethemaingoalwastocontributetothedevelopmentofindicesformea-suringtheoverallwell-beingofpeople,throughthecontributionsuppliedbythepartcon-cerninglifestyleanddiet,theoverallwell-beingindex(theBCFNindex)wascalculated,attributingconsiderableweighttothislattercomponent.

With a view to providing a coherent and wide-ranging view of the work carried out,theanalysiswasnotmerelylimitedtotheinnovativeandspecificpartoftheBCFNIndexalone,but–usingthemainfindingsemergingfromliteratureandanalyzingthesurveysconductedbytheOECDandbyinternationally-recognizedinstitutionswhichpublishindi-cesrelativetothemeasuringofoverallwell-being–italsoconsideredvariablesrelativetootherdimensionsofwell-being(material,environmental,socialandpolitical,etc.).

Byandlarge,thethreesub-indicespresentedintheaboveparagraphsprovidedtheba-sisfortheconstructionoftheBCFNIndex.

Infact,bytotalingthescorescalculatedforthe10countries,inthethreesub-indices,usingasimpleweightedaveragewiththeweightingsshowninFigure2,theBCFNIndex–illustratedinthefigurebelow–isobtained.

Figure41–RankingoftheBCFNIndex


TheclassificationoftheBCFNIndex,whichtotalsthefinalresultsforthe10countries

selectedinrelationtoseventypesof“wellbeing”,isledbySweden,with7.23points,fol-lowedatashortdistancebytheotherScandinaviancountry,Denmark,with6.88points.Japangainsthirdplacewith6.61points.

Scorefrom1to10

Greece 3.29

UnitedStates 3.88

Spain 4.51

Italy 4.85

Germany 5.57

U.K. 5.81

France 5.90

Japan 6.61

Denmark 6.88

Sweden 7.23

Itisfollowedbyatrioofcountrieswithasimilarfinalscore,consistingofFrance(5.90points,theU.K.(5.81points)andGermany(5.57points).

Italyisinseventhplacewith4.85points,somedistancefromGermanybutaheadofSpain,whichiseighthwith4.51points.

Surprisingly,theUnited Statesoccupythenexttolastplaceintheclassificationwithjust3.88points,onlybetterthanGreece(inlastplacewith3.29points).Thisresultisex-plainedbythefactthattheyaregreatlyhamperedincomparisonwiththeothercoun-trieswhenfactorssuchasenvironmentalsustainability,healthandlifestyle-whichhaveaveryimportantroleintheBCFNIndex–areconsidered.

Theimportanceofthistypeofanalysisisnotsomuchtheidentificationoftherelativepositionofeachcountry,whichalsodependsonthehistorical,socialandeconomicfactorspeculiartoeachnation,butrathertheexistenceofamoreor lessbalancedsituationinrelationtothedifferentdimensionsofwell-beingidentifiedandanalyzed,andhencethepossibilitytoidentifyspecificareasforimprovementwithinthevariousareaswithaviewtoincreasingtheoverallwell-beingofpeople.

3.4.1 Sensitivity analysis on the BCFN IndexInlinewiththemethodologyadopted,tocalculatetheBCFNIndexandthethreesub-

indicesofwhichitiscomposed,“relativeweightings”havebeenallocatedtothe7dimen-sionsofwell-beinganalyzed.

The allocation of weighting coefficientslinkedtoeachdimensionbeingmeasuredwas made on the basis of the conclusions reached by The European House-Ambrosettiworkinggroup,underthesupervisionoftheAdvisory BoardoftheBarilla Center for Food & Nutritioninthecourseofthelastyear.

Nonetheless,despitethescientificapproachadopted,aslightly“arbitrary”aspectinevi-tablyremainsintheallocationoftherelativeweightings70.

Inordertoverifythestatisticalsolidity,i.e.lowersensitivityduetothepresenceofdif-ferent/anomalousvaluesinthesample,asensitivityanalysiswascarriedout.This as-sumed equal weightings for all seven dimensions considered, in order to evalu-atetheeffectsintermsofvariationofthe end result.The results of this sensitivity analysis are shown in the figure that follows.

70 Thisproblemispotentiallyresolvable(atleastinpart)bycarryingoutaspecificsurveyonarepresentativesampleofthepopulationinthecountriesconsidered,whichwouldbeaskeddirectlytoexpresstheimportanceofeachdimen-sionofwellbeingwithrespecttooverallindividualwell-being.

3. BCFN Index - 77


Figure42–ResultsofthesensitivityanalysiscarriedoutontheBCFNIndex,assumingequalweightingsforallseven

well-beingdimensionsconsidered


Itiseasytodeducebyobservingthepreviousfigurethattheresults clearly demon-strate the “solidity”ofthemethodologicalsystemadoptedwithregardtoavariationintheweightings.Infactthefinalrankingdoes not present relevant variations, as-suming equal weightings for each dimension of well-being. In fact, the scores obtained by the various countries registered minimum variations and there was only one inversion in the positions of two countries (France and United Kingdom) at the center of the ranking. This confirms the validityofthesetofindicatorsse-lected and reliability of the methodological system used, showing that even when theweightings of certain indicators are changed, the results do not undergo radical varia-tions. The solidity and reliability of the model is, therefore, confirmed inasmuch as theindicationsthatemergearenotmodifiablesimplybychangingtheweightingsofthesetofindicators.

original

Greece United States Spain Italy Germany U.K. France Japan Denmark Sweeden

3.29 3.88 4.51 4.85 5.57 5.81 5.90 6.61 6.88 7.23

3.17 3.93 4.27 4.46 5.59 5.71 5.76 6.35 7.11 7.37

Greece United States Spain Italy Germany France U.K. Japan Denmark Sweeden

Score from 1 to 10

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4. Conclusions and next steps

The socioeconomic model of the Scandinavian countries is the one that integrates the dimensions relative to education, welfare, the family and social spheres, democracy and personal freedom in the most balanced way. In contrast, the Mediterranean countries such as Greece, Italy and Spain have difficulty as regards these aspects of national well-being.

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A part of individual well-being also depends on lifestyle and dietary choices and, as a result, the overall state of health.

84 -Measuring people’s well-being: the BCFN Index 4 . Conclusions and next steps - 85

The process of defining an index for measuring collective well-being that is capableofguidingeconomicandoverallgovernmentdecisionstowardsastateofgreaterwide-spread“happiness”isextremelycomplex.Althoughthereisnowawidely-heldbeliefthatindicatorsofanexclusivelymaterialnatureareunsuitableforoffering“all-round”mea-surementoftherealsituationofacountryoragivenarea,thedifficultiesinvolvedinde-visingameasurementsystemaresuchthatto-dateithasnotyetprovenpossibletofindasatisfactorysolutiontothevariousmethodologicalneedsunderlyingitsconstruction.

Yettheneedtoguidethepoliciesoftheworld’scountriesandmacro-regionstowardssustainabilityinallitsfacetsisnowmoreurgentthanever.Buttodoso,indicatorsabletopinpointtheinformationthatisreallyrelevantformeasuringphenomenainamulti-dimensionalkeyarerequired.Awarenessofthefactthatthishistoricmovetowardsmoremodernpolicymakingandinstitutionalgovernmentprocessesonaglobalscalecan no longer be postponedmarksthestartingpointofourwork.

Inpresentingthisdocument,wewishtoannouncethatweareembarkingonaprocessfocusedonthedesiretomakeacontributiontothisambitiousgoal,inlinewithourownparticularperspectivewhichstartsfirstandforemostfromthestudyandknowledgeofdietaryissues.Alongtheway,thisprocesswillinvolvetheprofessionalism,skills,intel-ligenceandwillingnessofallthosewhofeeltheycanprovideaconstructivecontribution.Inparticular,wewishtoemphasizetheimportanceofdietaryissuesintermsofimpactonsocialwell-being,healthandtheenvironment.

Tosumup,wearerightbehindthecalltoactionlaunchedbytheFrenchGovernmentwhenitsetupthe“Sen,Stiglitz,Fitoussi”Commission,therebynotonlycontributingtoincreasingawarenessoftheneedtotacklewell-beingissuesfromanewangle,butalsoprovidingapossibleoperationalsolutiontothemanyproblemsthatneedaddressing.Theformweneedtogivetoourworkisthatoftheopen “platform”,whichwillcombinetheworkofanalysisandstudybythetechnicalgroupsmadeupofexpertsandmembersofinstitutionswiththewillingnesstotakethesuggestionsofallthoseinterestedinbeinginvolvedinthistask.

Werealizethatitwillbealonganddifficultundertaking,butweareconvincedthattheroadtowardsafairerworldalsoinvolveshavingthetoolstounderstandsituationsthatarebettersuitedtorecordingphenomena.Toolsmoreappropriatetothesituationsweallencounterinourdailylives.

4.Conclusions and next steps

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Statistical appendix


Psycho-physical well-being

Averagelifeexpectancyatbirthin2008,expressedinnumberofyears

Source:TheEuropeanHouse-Ambrosettire-elaborationofdatafromtheWorldHealthOrganizationandOECD,2010

Averagelifeexpectancyingoodhealthatbirthin2007,expressedinnumberofyears




Denmark 2.7 78.8

U.K. 4.4 79.7

Greece 4.9 80.0

Germany 5.3 80.2

France 6.0 81.0

Spain 7.2 81.2

Sweden 7.2 81.2

Italy 7.7 81.5

Japan 10.0 82.7



Denmark 4.0 72.0

Greece 4.0 72.0

U.K. 4.0 72.0

Francia 5.5 73.0

Germany 5.5 73.0

Italy 7.0 74.0

Spain 7.0 74.0

Sweden 7.0 74.0

Japan 10.0 76.0

Standardizedmortalityratefromheartdisease,measuredasthenumberofdeathsper100,000people,2006


Standardized mortality rate from tumors, measured as the number of deaths per100,000people,2006



Greece 1.0 263

Germany 3.4 224


Sweden 5.3 194

U.K. 5.7 187

Denmark 6.0 183

Italy 6.8 171

Spain 7.3 162

France 9.6 124

Japan 10.0 118


Denmark 1.0 199

U.K. 5.1 172

France 6.6 163


Italy 7.3 158

Germany 7.5 157

Spain 8.3 151

Sweden 8.9 147

Greece 9.0 147

Japan 10.0 140

Statistical appendix - 93


Standardizedmortalityratefromdiabetesmellitus,measuredasthenumberofdeathsper100,000people,2006


Standardized mortality rate from suicide, measured as the number of deaths per100,000people,mostrecentyearavailableforeachcountry




Italy 3.6 16.0

Denmark 3.9 15.5

Germany 4.6 14.4

Spain 5.3 13.3

Sweden 6.4 11.4

France 7.1 10.2

Greece 9.1 7.0

U.K. 9.5 6.4

Japan 10.0 5.5


Japan 1.0 24.8

France 4.2 17.3

Sweden 5.9 13.2

Denmark 6.4 12.0

Germany 6.5 11.9


Spain 8.2 7.9

U.K. 8.8 6.5

Italy 8.8 6.4

Greece 10.0 3.6

Annualpercapitaexpenditureonantidepressantandmoodstabilizingdrugs,eurosperinhabitant,2010

Source:TheEuropeanHouse-Ambrosettire-elaborationofIMSHealthSpadata

Rankingfor“Psycho-physicalwell-being”


Scorefrom1to10 Eurosperresident


Sweden 2.4 31.7

Denmark 3.1 29.5

Greece 6.6 18.1

Spain 7.6 14.9

France 8.7 11.3

Germany 9.3 9.5

Japan 9.6 8.4

Italy 9.8 7.7

U.K. 10.0 7.2

Scorefrom1to10

UnitedStates 3.0

Denmark 3.6

Greece 5.3

Germany 5.3

U.K. 5.6

Sweden 5.7

France 6.1

Italy 6.4

Spain 6.5

Japan 8.1



Behavioral well-being

Obeseandoverweightadultpopulation(IMC>25kg/m2),measuredasapercentageoftheadultpopulation

Source:TheEuropeanHouse-Ambrosettire-elaborationofEuromonitor,WHO,Eurostatdata,2010

Obeseandoverweightyouthpopulation(11-15years)(IMC>25Kg/m2),measuredasapercentageofthepopulationagedbetween11and15years

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECD,EurostatandJapanStatisticBureauandStatisticCen-

ter,2010

Scorefrom1to10 Overage15,%


U.K. 3.9 63.4

Greece 4.7 58.3

Germany 5.6 52.7

Spain 5.7 52.4

Italy 6.4 47.5

Denmark 6.7 45.5

Sweden 6.8 45.1

France 8.0 37.8

Japan 10.0 24.9

Scorefrom1to10 age11-15,%


Greece 5.7 18.8

Italy 5.9 18.3

Spain 6.6 16.7

U.K. 8.6 12.0

Germany 8.6 12.0

Sweden 9.2 10.5

France 9.2 10.5

Denmark 9.6 9.7

Japan 10.0 8.7

Physicalactivity,measuredastheportionofthepopulationdeclaringtobeinvolvedinregularphysicalactivity

Source:TheEuropeanHouse-Ambrosettire-elaborationofEurobarometro,AmericanTimeUseSurveyandJapanSta-

tisticBureauandStatisticCenterdata,2010

Expenditureonfruitandvegetablesasapercentageofavailableincome

Source:Re-elaborationsofTheEuropeanHouse-AmbrosettiusingEurobarometerdata,aswellasestimatesondata

fromtheUnitedStateDepartmentofAgricultureandtheJapanStatisticBureauandStatisticCenter,2010

Scorefrom1to10

Greece 1.0 18.0

Italy 2.8 29.0


Spain 4.5 39.0

Japan 5.5 45.0

U.K. 5.7 46.0

France 6.0 48.0

Germany 6.2 49.0

Denmark 8.7 64.0

Sweden 10.0 72.0

Scorefrom1to10 %ofavailableincome


Sweden 3.3 1.05

Germany 3.8 1.13

U.K. 3.8 1.14

Denmark 4.9 1.31

France 6.4 1.56

Japan 7.3 1.72

Italy 8.1 1.86

Spain 8.2 1.87

Greece 10.0 2.17



Averagedailycalorieintake

Source:TheEuropeanHouse-Ambrosettire-elaborationoftheUNFoodandAgricultureOrganisation,FAOSTAT,2010data

Averagetimespentonmeals,inminutes


Scorefrom1to10


Italy 2,0 3.699

Greece 2,3 3.655

Germany 2,8 3.605

France 2,9 3.587

U.K. 3,9 3.469

Spain 4,0 3.455

Denmark 4,5 3.392

Sweden 5,8 3.231

Japan 10,0 2.716

Scorefrom1to10 Minutes

UnitedStates 1.0 76

U.K. 1.9 82

Denmark 3.4 92

Sweden 3.9 95

Germany 6.6 113

Spain 6.7 114

Greece 6.9 115

Italy 7.2 117

Japan 7.3 118

France 10.0 136

Percentageofadultsmokersoutofthetotaladultpopulation

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECDdataandJapanStatisticBureauandStatisticCenter

data,2010

Consumptionofalcoholmeasuredastheaveragenumberoflitersconsumedperadult


Scorefrom1to10 %ofadultpopulation

Greece 1.0 40.0

Spain 5.8 26.4

Japan 5.9 26.0

France 6.3 25.0

Denmark 6.3 25.0

Germany 6.9 23.2

Italy 7.2 22.4

U.K. 7.7 21.0


Sweden 10.0 14.5

Scorefrom1to10 Averagenumberoflitersperadult

France 1.0 12.6

Spain 2.4 11.7

Denmark 3.7 10.9

U.K. 3.8 10.8

Germany 5.3 9.9

Greece 6.7 9.0


Italy 8.1 8.1

Japan 9.1 7.5

Sweden 10.0 6.9


100 -Measuring people’s well-being: the BCFN Index Statistical appendix - 101

Material well-being

Level of available median per capita income, calculated in euros at purchasing powerparity


Nethouseholdwealth,calculatedasapercentageofthefamilies’availablenetincome


Scorefrom1to10 Euros,equalpurchasingpower

Greece 1.0 10,925

Spain 1.8 12,276

Italy 2.8 13,735

France 4.9 17,085

Germany 5.3 17,869

Japan 6.2 19,223

Sweden 6.2 19,266

U.K. 7.0 20,574


Denmark 10.0 25,321

Scorefrom1to10 %familynetavailablewealth


Greece 2.9 547

Spain 3.6 573

Germany 5.0 629

Japan 6.8 697

Denmark 6.9 700

Sweden 7.0 702

France 8.3 752

U.K. 8.7 768

Italy 10.0 818

Rankingfor“Behavioralwell-being”


Lifestyle sub-index

RankingoftheLifestylesub-index


Scorefrom1to10

UnitedStates 3.6

Greece 3.8

U.K. 5.4

Spain 5.5

Italy 5.7

Germany 5.8

France 6.4

Denmark 6.6

Japan 7.8

Sweden 7.9

Scorefrom1to10

UnitedStates 3.24

Greece 4.65

Denmark 4.88

U.K. 5.53

Germany 5.54

Spain 6.10

Italy 6.10

France 6.24

Sweden 6.64

Japan 7.97


Environmental well-being - Environmental sustainability

AdjustedNetSaving

Source:TheEuropeanHouse-AmbrosettiusingWorldBankdata,2010.

EcologicalFootprint,2005

Source:TheEuropeanHouse-Ambrosettire-elaborationofGlobalFootprintNetwork,2008

Scorefrom1to10 Percentageofgrossnationalincome

Greece 1.0 -4.8


U.K. 4.1 3.9

Italy 5.7 8.5

France 6.2 9.8

Spain 6.3 10.1

Germany 6.7 11.3

Denmark 7.6 13.7

Japan 8.2 15.3

Sweden 10.0 20.5

Scorefrom1to10 Globalhectaresperperson

UnitedStates 1,0 9,4

Denmark 3,4 8,0

Greece 7,1 5,9

Spain 7,4 5,7

U.K. 8,1 5,3

Sweden 8,4 5,1

France 8,8 4,9

Japan 8,8 4,9

Italy 9,0 4,8

Germany 10,0 4,2

Grosspercapitainvestment,2009

Source:TheEuropeanHouse-Ambrosettire-elaborationofEurosat,2009

Rankingfor“Materialwell-being”


Scorefrom1to10 Euros

Greece 1,0 3.500

U.K. 1,7 3.800

Italy 3,9 4.800

Germany 5,1 5.300


Spain 5,7 5.600

Sweeden 5,7 5.600

Japan 6,0 5.700

France 6,9 6.100

Denmark 10,0 7.500

Scorefrom1to10

Greece 1.6

Spain 3.1

Italy 5.2

UnitedStates 5.2

Germany 5.2

France 6.3

Japan 6.3

Sweden 6.3

U.K. 6.5

Denmark 9.1


Environmental well-being - Environmental quality

CO2emissionsfromuseoffossilfuels,2007

Source:TheEuropeanHouse-AmbrosettiofOECDdata,2010

LevelsofPM10,2006

Source:TheEuropeanHouse-AmbrosettireofWorldBankdata,2010



Germany 7.0 9,702

Japan 7.0 9,674

Denmark 7.4 9,163

Greece 7.6 8,755

U.K. 7.7 8,577

Spain 8.3 7,688

Italy 8.5 7,382

France 9.4 5,980

Sweden 10.0 5,028

Scorefrom1to10 Microgramsperm3

Greece 1.0 36.0

Spain 2.6 31.6

Japan 3.3 29.6

Italy 4.4 26.7


Denmark 7.4 18.7

Germany 7.4 18.6

U.K. 8.6 15.5

France 9.3 13.5

Sweden 10.0 11.6

WaterFootprint,media1997-2001

Source:TheEuropeanHouse-Ambrosettire-elaborationofWaterFootprintNetwork,2008

Contributionofrenewablesourcestoenergysupply,2007


Scorefrom1to10 m3perperson


Greece 1.6 2,389

Italy 2.0 2,332

Spain 2.1 2,325

France 5.1 1,875

Sweden 6.8 1,621

Germany 7.3 1,545

Denmark 8.1 1,440

U.K. 9.4 1,245

Japan 10.0 1,153

Scorefrom1to10 %totalprimaryenergysupply

U.K. 1.0 2.3

Japan 1.3 3.1


Greece 1.9 5.2

France 2.5 6.9

Germany 2.6 7.2

Italy 2.6 7.2

Spain 2.6 7.2

Denmark 5.7 16.8

Sweden 10.0 30.0


Wealth and Sustainability sub-index

WealthandSustainabilitysub-indexFigure30–RankingfortheWealthandSustainabilitysub-index


Educational well-being

P.I.S.A.ranking:percentageofstudentsinlevels4,5,6,2009

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECD,PISAdata,2010

Scorefrom1to10

Greece 2.61

UnitedStates 4.07

Spain 4.11

Italy 5.42

Germany 5.69

U.K. 6.19

Japan 6.44

France 6.56

Sweden 7.64

Denmark 7.78

Scorefrom1to10 ProgrammeforInternationalStudentAssessment

Greece 1.0 17.6

Italy 1.8 19.7

Spain 2.9 22.8

Denmark 4.2 26.3


France 5.2 28.9

Sweden 5.2 29.0

Germany 7.6 35.4

U.K. 7.6 35.6

Japan 10.0 42.0

Urbanwaste,2007ormostrecentyearavailable

Source:TheEuropeanHouse-AmbrosettiofOECDdata,2010

Rankingfor“Environmentalwell-being”



Denmark 1.0 800


Germany 6.1 580

Spain 6.1 580

U.K. 6.3 570

Italy 6.8 550

France 7.0 540

Sweden 7.5 520

Greece 9.1 450

Japan 10.0 410

Scorefrom1to10

UnitedStates 2.6

Greece 4.0

Spain 5.4

Italy 5.8

U.K. 5.8

Denmark 6.1

Germany 6.4

Japan 6.6

France 6.9

Sweden 9.4


Unemploymentamonguniversitygraduates,2007

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECDScience,TechnologyandIndustryScoreboarddata,

2009

Averagenumberofnewspaperssolddaily,2009

Source:TheEuropeanHouse-Ambrosettire-elaborationofEuromonitordata,2010

Scorefrom1to10 %

Greece 1.0 5.47

France 1.4 5.34

Spain 3.7 4.51

Italy 4.8 4.10

Germany 5.0 4.03


Sweden 7.1 3.28

Denmark 8.0 2.96

Japan 8.9 2.62

U.K. 10.0 2.23

Scorefrom1to10 Per100people

Greece 1.0 14.2

Italy 1.1 17.1

France 1.4 22.8

Spain 1.8 31.8


Japan 2.7 51.8

U.K. 3.6 70.6

Sweden 3.6 70.9

Germany 6.6 136.7

Denmark 10.0 212.5

Averageannualuniversitygraduates,2009

Source:TheEuropeanHouse-Ambrosettire-elaborationofEurostatdata,2010

Foreignstudentsregisteredinthenationaluniversitysystem,2009


Scorefrom1to10 Averageoverlasttenyears,per100,000people

Germany 1.0 405.8

Greece 1.8 459.0

Italy 2.6 505.9

Sweden 3.6 567.7

Spain 4.4 624.3


Denmark 7.5 816.1

Japan 7.7 827.7

France 8.5 882.2

U.K. 10.0 976.5

Scorefrom1to10 Per100,000people

Italy 1.0 95.4

Japan 1.0 98.6

Spain 1.5 130.5

Greece 2.3 187.9


Germany 4.0 315.3

Denmark 4.9 378.3

France 5.0 383.2

Sweden 7,5 567.7

U.K. 10.0 746.3


Social well-being

Percentageofpeopleonthepovertyline,2008


Levelofincomedistributioninequality,2009


Scorefrom1to10 %


Greece 1.1 20.0

Spain 1.1 20.0

Italy 2.2 19.0

U.K. 2.2 19.0

Japan 2.4 18.8

Germany 6.7 15.0

France 8.9 13.0

Denmark 10.0 12.0

Sweden 10.0 12.0

Scorefrom1to10 %

Sweden 1.0 3.5

Denmark 1.4 3.6


France 3.6 4.2

Germany 5.9 4.8

Japan 6.6 5.0

Italy 7.0 5.1

Spain 8.1 5.4

U.K. 8.9 5.6

Greece 10.0 5.9

Broadbandinternetconnections,2009

Source:TheEuropeanHouse-Ambrosettire-elaborationofOECDBroadbandStatisticsdata,2010

Educationalwell-being

Source:TheEuropeanHouse-Ambrosettire-elaboration,2010

Scorefrom1to10 Numberofsubscribersper100people

Greece 1.0 17.0

Italy 2.5 20.5

Spain 2.9 21.2

Japan 4.5 24.8


U.K. 6.6 29.5

Germany 7.0 30.3

France 7.0 30.4

Sweden 7.9 32.4

Denmark 10.0 37.1

Scorefrom1to10

Greece 1.5

Italy 2.3

Spain 3.2

Germany 4.3

UnitedStates 5.2

Sweden 5.3

France 5.7

Japan 6.4

Denmark 7.0

U.K. 8.5


Averageannualyouthunemploymentrate,2009


Levelofoldagedependency,2009


Scorefrom1to10 %

Spagna 1.0 37.8

Grecia 4.8 25.8

Italia 4.9 25.3

Svezia 5.0 25.0

Francia 5.5 23.3

RegnoUnito 6.9 19.1

StatiUniti 7.3 17.6

Danimarca 9.3 11.2

Germania 9.6 10.4

Giappone 10.0 9.1

Scorefrom1to10

Japan 1.0 0.51

Germany 3.3 0.46

Italy 3.4 0.46

Sweden 4.3 0.44

France 5.7 0.41

Greece 6.0 0.40

U.K. 6.6 0.39

Denmark 7.6 0.37

Spain 7.8 0.37


Averagenumberofhoursdedicatedtolookingafterownchildren


Averageannualunemploymentrate,2009


Scorefrom1to10 Weeklyaverage,childrenage0-12

U.K. 1.0 16.8


Greece 2.8 19.6

Germany 5.0 22.9

Japan 5.2 23.2

Spain 6.0 24.5

France 6.7 25.6

Italy 7.2 26.2

Sweden 8.8 28.7

Denmark 10.0 30.5

Scorefrom1to10 %

Spain 1.0 18.0

France 6.9 9.5

Greece 6.9 9.5


Sweden 7.8 8.3

Italy 8.1 7.8

U.K. 8.3 7.6

Germany 8.3 7.5

Denmark 9.4 6.0

Japan 10.0 5.1

114 -Measuring people’s well-being: the BCFN Index 1.Titolo capitolo - 115

Socialwell-being-Summaryindicator

Fonte:TheEuropeanHouse-Ambrosetti,2010

Political well-being

TheEconomistIntelligenceUnit’sindexofdemocracy,2009

Source:TheEuropeanHouse-Ambrosettire-elaborationofEconomistdata,2010

Scorefrom1to10

Spain 2.5

Greece 4.5

UnitedStates 4.6

Italy 4.7

U.K. 5.3

Japan 5.7

France 5.9

Germany 6.4

Sweden 7.1

Denmark 8.8

Scorefrom1to10 Scalefrom1to10

Italy 1.0 7.98

France 1.4 8.07

Greece 1.7 8.13

U.K. 1.8 8.15


Japan 2.3 8.25

Spain 3.2 8.45

Germany 5.0 8.82

Denmark 8.3 9.52

Sweden 10.0 9.88

NationalInstitutionIndex,2007

Source:TheEuropeanHouse-Ambrosettire-elaborationofGallupWorldPolldata,Year2007

InterpersonalTrustIndex,2008ormostrecentyearavailable

Source:TheEuropeanHouse-Ambrosettire-elaborationofWorldValueSurvey,wavedata,wave2005-2008

Scorefrom1to10 Indexofinstitutionaltrust

Japan 1.0 48

Italy 1.0 48

Germany 1.9 51

Spain 2.6 53

France 2.9 54

Greece 3.2 55

Sweden 3.8 57

UnitedStates 4.1 58

U.K. 4.1 58

Denmark 10.0 77

Scorefrom1to10 Indexoftrustinothers

France 1.0 37.9

Spain 1.3 40.9

Greece 2.6 54.6

Italy 3.1 60.8

U.K. 3.2 61.7

Germany 4.5 75.5


Japan 4.9 79.6

Denmark 9.8 131.9

Sweden 10.0 134.5


Social and Interpersonal sub-index

SocialandInterpersonalsub-index


BCFN Index

BCFNIndex


Scorefrom1to10

Greece 2.51

Italy 2.73

Spain 3.11

UnitedStates 4.39

France 4.73

Japan 5.22

Germany 5.46

U.K. 5.68

Sweden 7.43

Denmark 8.16

Scorefrom1to10

Greece 3.29

UnitedStates 3.88

Spain 4.51

Italy 4.85

Germany 5.57

U.K. 5.81

France 5.90

Japan 6.61

Denmark 6.88

Sweden 7.23

CorruptionPerceptionsIndex,2009

Source:TheEuropeanHouse-Ambrosettire-elaborationofTransparencyInternationaldata,2010

Politicalwell-being-Summaryindicator

Source:TheEuropeanHouse-Ambrosettire-elaboration,2010

Scorefrom1to10

Greece 1.0 3.8

Italy 1.8 4.3

Spain 4.8 6.1

France 6.1 6.9


Japan 7.4 7.7

U.K. 7.4 7.7

Germany 7.9 8.0

Sweden 9.8 9.2

Denmark 10.0 9.3

Scorefrom1to10

Italy 1.2

Greece 1.5

France 2.6

U.K. 3.2

UnitedStates 3.4

Japan 3.6

Spain 3.6

Germany 5.7

Denmark 8.7

Sweden 10.0


BCFNIndexSensitivity


Scorefrom1to10

Greece 3.17

UnitedStates 3.93

Spain 4.27

Italy 4.46

Germany 5.59

France 5.71

U.K. 5.76

Japan 6.35

Denmark 7.11

Sweden 7.37

pp_misurazione_benessere_persone_eng

Documents

lifestyle subindex

bcfn approach

peoples wellbeing

camillo ricordi

gabriele riccardi

jeanpaul fitoussi

mario monti

claude fischler