Many people feel healthier when they are working, because it affords self-actualization and a sense of accomplishment. When employment conditions are so abject that they render it a bad idea to accept employment, that doesn&#x27;t necessarily mean people are happier not working. It just means they are happier not working vs. whatever the available working options are. If instead of trying to cut off their option to not work, forcing them to take jobs they hate whose mental health side effects in their lives aren&#x27;t worth the money made, we instead cut off the option of offering jobs with properties that would be hated, then they may decide working is worthwhile.<p>There are also a lot of status effects you don&#x27;t explore. Being poor in America means that even if you have the purchasing power of the richest 5% in India, you&#x27;re a total scumbag nobody for privileged people to shit on, hate, call lazy, etc. The effects of being embedded in that sort of social situation are significant. I&#x27;m even thinking of Robin Hanson&#x27;s article &quot;Cut Medicine in Half&quot; and also &quot;Showing That You Care&quot; -- which indicate that status effects for health are very real. Being the richest person in a poor neighborhood can be better than being the poorest person in a rich neighborhood, even if your overall consumption ability is higher in the second case.<p>I suspect this is likely true in this 5% American vs. 95% Indian example. Merely by having the status of being in the lowest 5% of the relevant social group you frequently interact with, that alone engenders negative life outcomes that can&#x27;t be overcome just by raising the absolute consumption available to that 5% person.<p>So I would definitely not characterize the overall quality of life of a 5% American as similar to that of a 95% Indian. It would be way more complicated than that. There are probably many 5% Americans with roughly better lives than 95% Indians. There are also probably many 5% Americans with absolutely worse lives than 95% Indians. And some with lives that are as bad as 5% <i>Indians</i> (in fact, I know some of those people in my home region of Appalachia).<p>Regarding your last comment, I think drug use might be a relevant topic, because it is related to poverty (though, as always, it&#x27;s complicated, good new data is hard to get [0]), and like mental illness, often creates a stigma against employment. There are many people in America who on paper may appear to have an amount of income that, in a worldwide sense, is very privileged, yet who nonetheless live lives that in some mental health or addiction adjusted QALY sense are some of the worst lives on the planet.<p>[0] <a href="http:&#x2F;&#x2F;www.nber.org&#x2F;chapters&#x2F;c11165.pdf" rel="nofollow">http:&#x2F;&#x2F;www.nber.org&#x2F;chapters&#x2F;c11165.pdf</a>