The Role of Functioning in Measuring Well-Being

Jennifer Madans, Ph.D. Associate Director for Science, NCHS

4th OECD World Forum on Statistics, Knowledge and Policy - Measuring Well-Being for Development and

Policy Making

October, 2012

What is Health?

• Medically-based objective definitions • Focus on pathologies/biology

• Subjective measure (self-report) used as a proxy for objective measures

• Disease state• Use of health care

• Subjective measures (self-report) used as the intended indicator of a dimension of health

• What concepts are we trying to measure?• How can we operationalize the concept?• Need to address issues of validity and

reliability

Commonly Used Objective Measures

• Laboratory tests

• Radiological tests

• Physical exams

• Performance measures

• Medical records

Commonly Used Subjective Measures as the Intended

Indicator• Summary measures of health

• Self-reported health status (also used as proxy for objective measures)

• Composite measures

• Functioning/disability measures• Functioning ‘within the skin’• Interaction with the environment• Impact of accommodation

• Health-related quality of life/well-being

Functioning as the Key to Well Being for Health and Health Care

Policy

• Role of health statistical agency: Monitor key indicators of health and health care over time and across population subgroups to inform policy

• Need for easy to understand summary or composite measures

Functioning as the Key to Well Being for Health and Health Care

Policy

• Functioning is a critical aspect of health

• Functioning can be seen as the outcome of:

• Determinants and risk factors• Disease states• Use of health care• Environmental barriers and facilitators

Functioning as the Key to Well Being for Health and Health Care

Policy

• Policy objective -- Minimize participation restrictions due to limitations in functioning ‘within the skin’

• Statistical data used to:• Measure level of participation and monitor change in participation

• Measure level of functioning and change in functional abilities ‘within the skin’ and with accommodation

• Relate to program and policy interventions

International Efforts in the Measurement of Functioning

and Disability

• The Budapest Initiative on the Measurement of Health Status

• The Washington Group on Disability Statistics