“It is health that is real wealth and not pieces of gold and silver” Mahatma Gandhi
What is health? It seems like a very simple question, but yet it had us students thinking, talking and arguing about it for a couple of minutes in our global health policy class.
The word “health” means different things to different people, depending on the situation and location. (1) The most famous modern definition of health was created by the World Health Organization (WHO), which states:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”(1)
How do we know if we have this “health”?
Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment.(2) Determinants of health are used to measure health of the people in a population.
According to WHO the determinants of health include: The social and economic environment; the physical environment, and the person’s individual characteristics and behaviors. (2) In other words, Determinants of health are a range of personal, social, economic, and environmental factors that influence health status.( 3)
Health might just be a feeling we feel and we may not be able to describe it, but we need to translate this “feeling” to variables and indicators in order to measure health.
The measurement of health started with Codman’s “end result” idea.(4) Codman’s idea of the End Result developed between 1902-1910.(5) The “idea” entailed following patients long enough to determine if treatments proved successful and taking comprehensive measures to prevent new failures if outcomes were undesirable.(4) This has been largely neglected in the history of health measurement. After Codman, clinical researchers and surgeons such as Visick, Karnofsky, Katz began to develop scales to measure the outcomes of procedures.(4) In the 1960s, increasing recognition of the importance of assessing a broader array of outcomes were witnessed when measuring the impact of disease.( 4)
The rising expectations of the past 150 years have led to a shift away from viewing health in terms of survival, through a phase of defining it in terms of freedom from disease, thence to an emphasis on the person’s ability to perform his daily activities, and more recently to an emphasis on positive themes of happiness, social and emotional well-being, and quality of life. (6) This shift, which occurred during the 1970s (5), was for a number reasons. First, the narrow definition of health in terms of morbidity and mortality was replaced by a broader definition of health as a “complete state of physical, mental and social well-being and not merely the absence of disease or infirmity”. Second, there was an increased interest in measuring more complex and subjective aspects of outcomes pertaining to the health impact of disease and/or treatment. Third, there was increased demand for clinicians to demonstrate evidence of cost-effectiveness, in which the benefits of a particular health service or intervention are weighed against the costs of that service or intervention. (5)
The ICF (International Classification of Functioning, Disability and Health), which was released by the WHO, has been accepted by 191 countries as the international standard to describe and measure health and disability. While traditional health indicators are based on the mortality rates of populations, the ICF shifts focus to “life”.(2) This can better help researchers measure the health status of an individuals and therefore a population.
The health of an entire population is determined by aggregating data collected on individuals. The health of an individual is easier to define than the health of a population. For reasons of simplicity and cost, nowadays, most health measures rely on verbal report rather than observation. Subjective health measurements hold several advantages. They extend the information obtainable from morbidity statistics or physical measures by describing the quality rather than merely the quantity of function. They give information about people whether they seek care or not, they can reflect the positive aspects of good health, and they do not require invasive procedures or expensive laboratory analyses. (6)
In past years, individual clinicians, based mainly on their personal experience, developed many widely used scales for health measurements. The process of developing a scale has become a long, complex, and expensive undertaking involving a team of experts, and in most cases, the quality of the resulting method is better. (6)
This post was inspired by the following links: