PERTANIKA
Journal of Quality of Life Studies
Full-Length Research Article
The Roles of Health System Capacity and Infrastructure in the Associations of Cognitive Human Capital, Wealth, and Health Expenditure with Subjective Well-Being: A Cross-National Path Analysis
Rico Langea, David Beckera, Heiner Rindermanna
a
Department of Psychology, Chemnitz University of Technology, Wilhelm-Raabe-Str. 43, D-09107 Chemnitz, Germany
Abstract
This study examined whether health-related resources and infrastructure help explain cross-national differences in subjective well-being. Using a country-level dataset covering up to 218 countries and political entities, with construct-specific coverage varying, we estimated theory-guided path models linking cognitive human capital, wealth, health expenditure, access to water and sanitation, and health system capacity with two indicators of subjective well-being: happiness and life satisfaction. The analysis used temporally aggregated indicators from secondary data sources and applied structural equation modeling with full information maximum likelihood to retain partially observed cases. Cognitive human capital was positively associated with wealth (β = .67), and greater levels of both cognitive human capital and wealth were associated with higher health expenditure (β = .20–.46). Health expenditure showed significant positive direct associations with both subjective well-being indicators (β = .27–.55). Wealth had a significant positive direct association only with happiness (β = .44), whereas cognitive human capital showed such an association only with life satisfaction (β = .34). Access to water and sanitation was positively associated with cognitive human capital and health expenditure (β = .23–.37), while health system capacity was positively associated with cognitive human capital and wealth (β = .14–.60). Model-implied indirect effects suggested that health expenditure, access to water and sanitation, or both partly explained the associations of cognitive human capital and wealth with subjective well-being. The study contributes by distinguishing health expenditure, health infrastructure, and health system capacity as separate macro-level pathways rather than a single health construct.
Keywords: cognitive competences; cognitive capital; health; subjective well-being; cross-national
Sustainable Development Goals (SDG): SDG 3: Good Health and Well-being
Cite As (APA)
Lange, R., Becker, D., & Rindermann, H. (2026). The roles of health system capacity and infrastructure in the associations of cognitive human capital, wealth, and health expenditure with subjective well-being: A cross-national path analysis. Pertanika Journal of Quality of Life Studies, 1(1), Article e009.
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