February 19, 2009

The concept of health can be seen from two different perspectives. Health was originally defined as state in which there is an absence of disease or infirmity. In 1948, however, the World Health Organization (WHO) moved away from this definition to include psychological and social factors. The WHO currently defines health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity”. Although this perspective of health attempts to include variables that may impact the health status of an individual, it represents a challenge for clinicians and researchers who aim to construct instruments measures to monitor the results of medical interventions. The challenges stem from difficulties in defining “well-being”. As such, many measures still focus on the absence of disease or infirmity.

The WHO’s modification of what constitutes health has translated into greater attempts to measures quality of life—this has specifically resulted in the creation of the fields of health outcome research and health technology assessment. Appropriate health outcome measures are crucial for the creation of an evidence-based body of knowledge and the implementation of best-practice guidelines. They serve to monitor the efficacy of treatments as well as the cost-effectiveness and the net-benefits of interventions. Nonetheless, these measures must respect the patient’s perspective. Clinicians and researchers must remember that patients tend to place different values on health states than physicians and other clinician groups. There is therefore a need for outcome measures that respect the perspective of patients as well as other stakeholders such as clinicians and researchers. Measures will only be respected if they adhere to the perspective of key stakeholders, such as the ones of physicians and researchers, in the process. This will likely raise the question of how these stakeholders value outcomes that are deemed necessary by patients, and hence, who will bear the responsibility to decide which measures to incorporate in the evaluation. To this day, the search for adequate measures produces highly contested debates….but the future looks promising.

– by Nath

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