Health

Introduction

Most lay people say that their health is more important than anything else. Though people value health, few question what it means. When asked, people define health in many ways depending on sociodemographic factors, on behaviour or personal factors, and on their culture. For example, common descriptions of health may include references to not being ill, absence of disease, behavioural functioning, role functioning, physical fitness, energy and vitality, emotional well-being, and social relationships. Even answers to the salutation ‘how are you?’ can be considered a general index of health or well-being (Feinstein, 1987).

Experts also define health in many ways and there is no right or wrong definition of health. However, few would disagree with the notion that health is a important dimension of quality of life. Healthcare professionals strive to help people achieve longer and better lives through interventions aimed to save lives, ameliorate suffering, improve functioning, and protect from disease. Ware (1987) indicated that the goal of healthcare is to maximize the health component of quality of life, which could be operationalized as returning patients to normal lives. Although health status and quality of life are used interchangeably (Bowling, 2001), quality of life in reference to health should be termed health-related quality of life. That is, health-related quality of life (HrQL) is the quality of life as it is affected by health. It represents the impact of a person's health on his/her ability to lead a normal or fulfilling life. Chronic disease affects and is affected by broader aspects of people's lives and it is impossible to separate disease from an individual's personal and social context. No illness exists in a vacuum. Using health assessments instruments or HrQL measures ensure that treatment and evaluations focus on the patient rather than the disease. These instruments complement the traditional focus on disease outcomes (objective, clinical, or biological measures of disease) by assessing variables such as the need for healthcare, the quality of service, and the effectiveness or cost utility of treatments and interventions. Outcomes are defined as the change in health status that results from health interventions, or the deliberate decision not to intervene. An HrQL outcome has come to mean the extent to which a change in a patient's functioning and well-being meets that patient's needs or expectations.