Essay On Self-Measured Health

Self-Rated Health
Items measuring self-rated health are frequently found in surveys of many kinds. An example is a question asking respondents to characterize their overall state of health using categories such as excellent, good, fair, or poor. Such evaluations may or may not correspond to that which would be provided by a physician.
The person-centeredness of such questions make them extremely useful for a number of purposes in health research. First, self-related health is used in measures of health, psychological well-being, and health-related quality of life, concepts that are usually ill-defined but nearly always include some element of physical well-being and functioning. These are matters for which the individual is certainly the best source of information. Second, self-rated health can be used as a screening tool to identify high-risk groups and risk factors; poor self-rated health is consistently associated with low socioeconomic status and high levels of other illness risk factors in both national and international studies. Third, self-rated health can be used as an outcome in the evaluation of medical interventions as an important addition to the usual mortality and morbidity outcomes; treatments with similar effects on length of life may have different implications with respect to the quality of those years. Fourth, self-rated health can be used as a predictor of illness behavior, retirement, or the long-term use of medication and other health care services; studies of
retirement decision making have often included this measure as the only indicator of health status.
The number of such studies and the consistency of their findings is impressive for several reasons. The very appearance of so many studies in such a short time is noteworthy in itself, especially considering that the data reported are from longitudinal studies, many of which had been planned and were begun years earlier. The implication is that some question eliciting a global evaluation of health was used in the interviews for these studies because it had been deemed useful for some other purpose and subsequently was found to be related to mortality risk in secondary analyses. This large body of findings also presents two paradoxes. One is that the interviews on which the analyses were based were conducted in the language of the respondents, and few if any attempts were made to standardize the questions or the response categories. A second is that the countries involved vary a great deal in the proportion of respondents that evaluate their health in the poorest category (“poor,” “bad,” “extremely bad,” “very sick,” “worse health compared with others,” or “not healthy”). This variation renders the near uniformity of the findings all the more surprising, since cultural as well as linguistic meanings of health differ greatly from one country to another, as do the more objective morbidity and mortality rates. Indeed in many of the studies, poor self-related health predicts mortality with effect sizes and significance levels similar to those associated with smoking. These findings underscore, as few others could, the validity of lay perspectives on health and the usefulness of a holistic approach to defining health. Respondents to surveys are supplying their own meanings of health, which may include some or all of WHO's broad definition of human health (a “complete state of physical, mental, and social well-being”). Self-ratings of health thus provide a simple, direct, and economical way of capturing perceptions of health using criteria that are as broad and inclusive as the responding individual wants to make them.
Functional Status and Disability
The functional characterization of older persons along physical, cognitive, and social dimensions is extremely important in directing health policy.
Functional disability is uniquely common among older persons, and there is substantial potential for its prevention. Age-related increases in physical and cognitive disability are often a direct result of chronic medical conditions such as heart disease, stroke, vascular disease, arthritis,
Parkinson's