Friday, May 13, 2011

What Does a Healthy Population Look Like?

How do you quantify something as complex and dynamic as a person's health?

First, you define it. What does health mean? Or asked another way, what does it look like to be healthy? The World Health Organization defines health as
"a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."
For a long time, I found that answer sufficient. Then I became an evaluator. Now I reflect on this definition, and find that it does surprisingly little to help clarify or make measurable what health means. Replacing the word "health" with "well-being" does not provide much additional guidance and it's only somewhat useful to know that health is not equivalent to the absence, or lack of, a medical diagnosis.

Now, I don't mean to undercut the importance of WHO's game-changing definition in the history of our understanding of wellness and illness. I am saying that measuring what we mean by "health" (as well as many other constructs in the social sciences) takes significant effort. It is a complex task indeed!

A few months ago the Institute of Medicine (IOM) took a stab at defining what health means by releasing its Leading Health Indicators for Healthy People 2020 report. The report prioritizes 12 health indicators and 24 health objectives for the US government's Healthy People initiative, including indicators of access to care, mental health, tobacco use, responsible sexual behavior, and obesity. The indicators were picked from among 43 topics and nearly 600 objectives!

An editorial in the Lancet highlights that for the first time objectives for lesbian, gay, bisexual, and transgender health are addressed, particularly around increasing health insurance coverage and reducing obesity.

These indicators have long been an important way to prioritize and track changes in our nation's health. It provides leverage for advocates of particular issues and vulnerable populations. In addition, it helps allocate funding to address gaps and areas that are most lagging in progress over the course of the decade.

Yet, I can't help but find it ironic that the single best measure of health comes from a simple survey question often asked by the CDC. It has been validated and recognized as credible in multiple studies through the years. To assess health, all that's needed is to ask:

Would you say that in general your health is excellent, very good, good, fair or poor?

Now that's something to think about...