The Measurement of Health and Health Status

Concepts, Methods and Applications from a Multidisciplinary Perspective

Paul Krabbe

• Publisher: Academic Press
• Year: 2016
• ISBN:
  9780128017203
• Topic: Medicine
• Subtopic: Health Policy

The Measurement of Health and Health Status: Concepts, Methods and Applications from a Multidisciplinary Perspective presents a unifying perspective on how to select the best measurement framework for any situation. Serving as a one-stop shop that unifies material currently available in various locations, this book illuminates the intuition behind each method, explaining how each method has special purposes, what developments are occurring, and how new combinations among methods might be relevant to specific situations. It especially emphasizes the measurement of health and health states (quality-of-life), giving significant attention to newly developed methods. The book introduces technically complex, new methods for both introductory and technically-proficient readers.

• Assumes that the best measure depends entirely on the situation
• Covers preference-based methods, classical test theory, and item response theory
• Features illustrations and animations drawn from diverse fields and disciplines

Part I

Outline

Chapter 1. Introduction

Chapter 2. Health Outcomes

Chapter 3. Health Summary Measures

Chapter 1

Introduction

Abstract

This chapter starts by introducing the prevailing perspectives and notions about health. What is health and how important is it? Apparently, health has not always been perceived in the way it is defined and observed nowadays. In general, “health” can be seen as a human condition that is affected and determined by many factors. Health models play an important role in clarifying the connections and relationships between all these factors. Ultimately, health status as perceived by individuals is the most important element in these models. As the actual health condition is what matters most to people, and to patients in particular, it is not surprising that we can observe a shift from the physician-centered system toward a patient-centered partnership.

Keywords

Basic needs; Health; Health models; Patient; Patient centered; Patient reported

Chapter Outline

Introduction

Defining Health

Importance of Health

Health Models

Patient Reported

Patient Centeredness

Digital Revolution

References

Introduction

Ask any medical gathering whether 1 year of life is about the same as any other and you will surely hear a resounding chorus of “no.” It is not just the quantity but also the quality of life that concerns people, medical professionals or otherwise. This applies to the life years saved in life-and-death situations as much as to interventions explicitly geared to changing morbidity and raising health status. So it can probably be agreed that the measurement of “quality of life” or “quality of health” is a necessary part of health evaluation (Brooks, 1995).

Although traditional health outcomes such as dead or alive or surviving are indisputable, these measures are often insufficient when studying chronic diseases or conditions such as pain, migraine, fatigue, mental status, or depression. That is mainly because survival does not play a major role in these types of problems. In addition, while we can measure a biological response, we may not be able to determine whether that response makes a noticeable difference to the patient. For example, when treating anemia (decrease in the amount of red blood cells), we can measure hemoglobin levels, but we should also know if the biologic response results in changes such as a perceived reduction in fatigue.

This realization also has led to changes in health policy. In evaluating health care, there is a noticeable shift in emphasis from traditional, simple-to-measure clinical indicators such as mortality and morbidity to more complex patient-based outcomes such as disability and “quality of life.” For example, in the English National Health Service, health-status measurement is at the center of the reform effort, as seen in the development of PROMs (Devlin & Appleby, 2010) (Box 1.1, Fig. 1.1).

Box 1.1

Concerning happiness, however, and what it is, they are in dispute, and ordinary people do not give the same answer as wise ones. For ordinary people think it as one of the plainly evident things, such as pleasure or wealth or honor—some taking it to be one thing, others another. And often the same person thinks it as different things, since when he or she gets a disease, it is health, whereas when he or she is poor, it is wealth.

From Ethica Nichomachea (translation Reeve, C.D.C., 2014. Hackett Publishing Company, Indianapolis, p. 14).

Defining Health

Defining health is, at best, problematic. Its definition reflects the historical period and culture to which it applies. Over the past 150 years, rising expectations have changed the definition of health in the United States: from survival, it shifted to freedom from disease, to an ability to perform daily activities, and even came to embrace a sense of happiness and well-being. Americans seem to expect their health to be not merely adequate but good, if not excellent. Expectations in other cultures are lower. In many African countries, for example, certain afflictions are so prevalent that they are not even considered diseases. Drawing the line between being sick or well may also depend upon age and sex. For instance, the elderly normally endure more sickness than the young or middle aged. Therefore, the definition of health for an elderly person may include pain and discomfort not experienced by younger persons. Pregnant women in developing countries do not get the medical attention that most women in developed countries get and may therefore undergo more pain and discomfort in pregnancy. Definitions of health are likely to reflect the ideology and culture of the most powerful groups in society. In modem societies, there is a tendency to consider more conditions as diseases, such as alcoholism, drug dependence, and delinquency. There is also a greater tolerance of the diseased person (Larson, 1991).

Figure 1.1 Aristotle (384–322 BC).

Importance of Health

Abraham Maslow (1908–70) was an American psychologist who is best known for creating a hierarchy of needs. His theory is often represented as a pyramid with five hierarchical levels (Fig. 1.2). Based on motivational theory in psychology, it presumes that once people have met their basic needs, they seek to meet successively higher needs. Maslow called the bottom four levels of the pyramid “deficiency needs”: a person does not feel anything if they are met but becomes anxious if they are not. Thus, physiological needs such as eating, drinking, and sleeping are deficiency needs, as are safety needs, social needs such as friendship and sexual intimacy, and ego needs including self-esteem and recognition. Whether this is really the case for all deficiency needs is open to discussion, but it seems reasonable for health. In contrast, the fifth level of the pyramid is called a “growth need” because it enables a person to “self-actualize” or reach one's fullest potential as a human being. Although Maslow's hierarchy of needs has been criticized for being overly schematic and lacking in scientific grounding, it presents an intuitive and potentially useful theory of human motivation. Interestingly, it regards health as a basic condition of life. Good health is a requirement for attaining other important things in life or reaching the next Maslow level, although there are some exceptions. Sometimes, despite a bad health condition, people seem to be able to reach all the other Maslow levels. A good example is the physicist and cosmologist Stephen Hawking. Despite suffering from amyotrophic lateral sclerosis (characterized by stiff muscles, muscle twitching, and gradually worsening weakness), he was not only able to produce impressive theories about the universe but also got married, had children and—as the story goes—was dancing in his wheelchair to operatic music of Richard Wagner.

Figure 1.2 Maslow's hierarchy of needs.

Health Models

Epidemiology is largely concerned with the causes and mechanisms of poor health and disease, whereas physicians are more interested in interventions to improve health. A theoretical framework may provide guidance not only on how to improve health but also on who is best qualified to design and administer such interventions and when these might be most effective. As a poor health condition is reflected in a low health status, it is paramount to measure and monitor the health status of patients (Costa & King, 2013). A distinction should be made between the determinants (causes) and the manifestations (effects) of health (Chapter 6). Determinants are events or experiences that in some sense cause variation in the manifestations of health. This was recently noted by Costa and King (2013): “Which events and experiences are manifestations and which are determinants depends on the definition of health adopted. If responses to an instrument are aggregated across manifestations and determinants, resultant scores co...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Preface
• Acknowledgments
• Part I
• Part II
• Part III
• Part IV
• Further Reading
• Glossary
• Index