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Are happy people healthier? An instrumental variable approach using data from Greece
  1. Ilias Kyriopoulos1,
  2. Kostas Athanasakis2,
  3. John Kyriopoulos2
  1. 1 LSE Health, London School of Economics, London, UK
  2. 2 Department of Health Economics, National School of Public Health, Athens, Greece
  1. Correspondence to Mr Ilias Kyriopoulos, London School of Economics, London WC2A 2AE, UK; i.kyriopoulos{at}


Background From a theoretical perspective, several studies indicate that happiness and health are—in some extent—interrelated. Despite the mechanisms explaining the relationship between happiness and health, there is still no consensus regarding this link. Using recently collected primary data, this study aims to examine the relationship between happiness and health, and identify potential heterogeneity in the association depending on socioeconomic status (SES).

Methods This study draws on data from a nationally representative cross-sectional survey, conducted by the Greek National School of Public Health in 2015. We applied an instrumental variable (IV) approach to address the endogeneity, arising from the simultaneous determination of happiness and health. Controlling for several confounders (ie, socioeconomic, demographic, lifestyle, social capital variables) we employed several IV models, including two-stage least squares, IV probit and bivariate probit models.

Results We report strong evidence of a relationship between happiness and health. This association remains strong after correcting for endogeneity, and is robust across different specifications. Further, we find a positive relationship between happiness and self-rated health (SRH) for low educated, but not for high educated. Similarly, we find a strong relationship between happiness and health for the lower socioeconomic strata, but not for the higher ones.

Conclusions Overall, we show that happiness is positively associated with health. Further, happiness significantly influences SRH in low-SES individuals, but this association wanes for the higher socioeconomic strata. This finding has significant implications for health promotion, prevention and public health, and suggests that policymakers have a wider array of choices for improving health and tackling health inequalities.

  • public health policy
  • self-rated health
  • prevention
  • socioeconomic

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  • Contributors IK, KA and JK contributed to the conception and the design of the study. IK contributed to the analysis and interpretation of data. IK and KA drafted the manuscript. JK contributed to the critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval We obtained ethical approval from the Bioethics Committee of the National School of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.