Improve health-related quality of life and well-being for all individuals

Healthy People 2020 emphasizes the importance of health-related quality of life and well-being by including it as one of the initiative’s overarching goals, “promoting quality of life, healthy development, and health behaviors across all life stages.” It also was established as one of the HP2020 foundation health measures.

The significance of quality of life and well-being as a public health concern is not new. Since 1949, the World Health Organization (WHO) has noted that health is “a state of complete physical, mental, and social well-being and not merely an absence of disease and infirmity.” In 2005, WHO recognized the importance of evaluating and improving people’s quality of life in a position paper. Because people are living longer than ever before, researchers have changed the way they examine health, looking beyond causes of death and morbidity to examine the relationship of health to the quality of an individual life.

When quality of life is considered in the context of health and disease, it’s commonly referred to as health-related quality of life (HRQOL). Researchers today agree that HRQOL is multidimensional and includes domains that are related to physical, mental, emotional, and social functioning and the social context in which people live.

Well-Being Concepts

Well-being is a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well. Good living conditions (e.g., housing, employment) are fundamental to well-being. Tracking these conditions is important for public policy. However, many indicators that measure living conditions fail to measure what people think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life—i.e., their “well-being.” Well-being generally includes global judgments of life satisfaction and feelings ranging from depression to joy.

How does well-being relate to health promotion?

Health is more than the absence of disease; it is a resource that allows people to realize their aspirations, satisfy their needs and to cope with the environment in order to live a long, productive, and fruitful life. In this sense, health enables social, economic and personal development fundamental to well-being. Health promotion is the process of enabling people to increase control over, and to improve their health. Environmental and social resources for health can include: peace, economic security, a stable ecosystem, and safe housing. Individual resources for health can include: physical activity, healthful diet, social ties, resiliency, positive emotions, and autonomy. Health promotion activities aimed at strengthening such individual, environmental and social resources may ultimately improve well-being.

How is well-being measured?

Because well-being is subjective, it is typically measured with self-reports. The use of self-reported measures is fundamentally different from using objective measures (e.g., household income, unemployment levels, neighborhood crime) often used to assess well-being. The use of both objective and subjective measures, when available, are desirable for public policy purposes.

Different instruments may include:

• National Health and Nutrition Examination Survey (NHANES)
• National Health Interview Survey (NHIS)
• Behavioral Risk Factor Surveillance System (BRFSS)
• Porter Novelli Healthstyles Survey
• The World Health Organization Quality of Life (WHOQOL)

Do you have experience of monitoring the wellbeing of patients? Perhaps you have filled in a survey yourself – did the results surprise you and help you take action?