The Defining and Measuring of Health Systems
Health, as defined by the World Health Organization, is a state of full physical, emotional and social well being and not just the absence of sickness and disease. A number of definitions have been applied to health throughout the history of medical philosophy. The dictionary definition is, “health” : “the condition of being healthy.” Another version states, “health is the state of being able to maintain one’s health.” Still another says, “the quality of health” is the object of desire.
A variety of other approaches have also attempted to define health. According to one school of thought, health is a process that begins with a primary belief and ends with the accomplishment of some objective. According to this school, in order to be healthy, humans must first believe in the value of health, then take steps towards achieving it, and finally feel the pleasure and satisfaction that results when health has been achieved. In this approach, health is neither a function of the body but something that can be attained through conscious effort.
An additional definition is, “good health maintenance.” In this conception, health is a state that is attained through the control of agents (e.g., behavior) that create risks and transmit them. Good health is then viewed as a sum of individual well-being, rather than the sum of separate persons (e.g., illness). Thus, the goal of preventing illness is seen as promoting wellness, rather than simply illness prevention. In this approach, wellness is considered a state rather than a product of individual experience. The focus on individual experience, furthermore, differs from the more traditional approaches, which seek to attribute positive qualities to the illness and to attribute poor health to the individual’s failure to meet recommended health maintenance practices.
There are also two broad approaches to defining health: subjective and objective. The former focuses on an individual’s view of his or her health status. Subjective measures include self-report questionnaires that ask about one’s perceived health, and are therefore of limited value for tracking changes over time; and self-rating scales that use objective measures to assess health needs, which are more reliable in the long run. Both approaches share some common characteristics, such as the need to use a wide range of measure to observe changes over time and the need to make many measurements to monitor changes.
A third definition is “systems biology.” This approach focuses on the interdependence of cells, tissues, organs, and systems within the body. It also views health as the sum of all of a person’s individual components, with the goal of improving the systems and making sure that the individual gets the best care possible at any point along the process. For example, the most efficient health systems will provide the greatest opportunities for the most efficient treatment. It also recognizes that even the best health systems may fail, so identifying the kinds of failures that might lead to health consequences is an important part of the process.
There are many possible interpretations of these four broad definitions, and different approaches to assessing health, but they all share a common point: each health system is part of a larger system of care, with the patient’s care taking the central focus. In other words, even when the system is described as a “system” or “organ,” it can only be understood in relation to the patient’s care. So, how does a definition of health differ when the focus is on care? To begin, the overall definition includes activities like prevention, early detection, and treatment. However, when researchers and practitioners focus on improving health systems, they often refer to these activities as “procedures” or “means” instead of “systems.”