Compared to whom? An investigation of the relative health comparisons of well people.

Responses to the self-reported health (SRH) question, "In general how would you rate your health? Excellent, very good, good, fair or poor", have been repeatedly demonstrated to predict mortality. Survival curves plotted for each response category show that the likelihood of death increases in a stepped fashion with each progressively negative response category and the relationship persists for up to 12 years following initial measurement. To whom do people compare themselves when answering the self-reported health question?Twenty-one interviews with people who selected the better-health response choices (i.e., good, very good, or excellent) were conducted in a Canadian city. Qualitative content analysis was undertaken and the interviews were approached with no pre-conceived ideas about what the participants would say.Analysis of the interviews suggested that there are three key features in making a health comparison: the type (i.e., with whom), direction (i.e., upward or downward), and magnitude of the comparison (i.e., with a few people or an ideal person vs. many other people). These key features varied in a systematic way with the chosen response.The findings related to the direction of comparison contradict, somewhat, the theories of social psychologists but these differences may have occurred because the participants were well. Healthy people may use different factors than ill people when making social comparisons as they select a self-reported health question response category. The nature of the comparisons are complex and the responses indicate that they are affected by age, gender, and life experience.