Reflective Journal Entry: Measurements of Health

1 Reflective Journal Entry: Measurements of Health How do members from different constituencies measure health?

Health is a complex phenomenon that can be conceptualized and measured in various ways depending on one's position and values. From a biomedical perspective, physicians and healthcare systems emphasize clinical outcomes and disease-centric health indicators. Common metrics include morbidity, mortality, life expectancy, and the prevalence of illnesses and risk factors like obesity, hypertension, and high cholesterol. The biomedical model focuses on bodily health and mitigating disease states.

Public health professionals take a broader population-level view, tracking health equity, social determinants, and community-wide outcomes beyond just individual clinical measures (CDC, 2018). They examine factors like access to care, food security, education, environmental risks, and the distribution of health and illness across groups. The social justice model of health requires looking beyond medical conditions to the social, economic, and political structures shaping health inequities.

Health economists analyze how macro-level healthcare resources are allocated and utilized (Fuchs, 2011). They study costs, quality, access, efficiency, and insurance coverage through metrics like per capita spending, utilization rates, and health program budgets and funding (Tikkanen & Abrams, 2022). Cost-benefit analysis is commonly applied to weigh healthcare interventions and policies.

Public officials and governmental health agencies rely heavily on population health metrics to guide policy decisions, target interventions, and distribute funding (ODPHP, 2022).

Disease rates, mortality, life expectancy, and use of health services commonly inform public health planning and resource allocation.

2 Patients and their families often assess health more holistically. Clinical measures certainly matter, but personal definitions also incorporate quality of life, happiness, purpose, functioning, and the capability to pursue valued activities. Physical, emotional, social, spiritual, and environmental realms intersect in lived experiences of health.

Among marginalized communities, conceptions of health justice also emerge based on higher burdens of illness, racism, discrimination, and barriers to care (Metzl & Hansen, 2014).

Health equity, from their lens, requires addressing systemic inequities shaped by race, class, gender, sexual orientation, immigration status, disability, and other identities. The lived experience exposes flaws in dominant clinical models.

Some spiritual conceptions of health emphasize harmony between mind, body, and spirit.

Balance among the physical, emotional, social, and transcendent aspects of humanity represents health from this holistic viewpoint. Indigenous knowledge systems also understand health in terms of relationships within families, communities, the natural world, and ancestral wisdom (Sherwood, 2013). Clearly, definitions and measures of health substantially vary across different societal positions and worldviews. This has profound implications for health policy and outcomes.

What are the implications of these perhaps varying definitions and measurements of health?

Varying conceptualizations of health carry significant real-world policy and practical implications. If the only lens applied is biomedicine's focus on clinical outcomes like morbidity, mortality, and physical risk factors, critical aspects of health injustice and inequality along racial, socioeconomic, and geographic lines may be obscured (Metzl & Hansen, 2014). Strictly biomedical models can render invisible the social, behavioral, and environmental determinants of

3 health. Reliance on limited clinical data risks misrepresenting population needs and misdirecting resource allocation.

Conversely, conceptions of health and wellbeing encompassing equity, capability, and justice could better unveil systemic disparities and prompt policies to remedy social determinants driving unequal outcomes. Tracking population-level differences in mortality, chronic disease, mental health, and access could spur public health investments in struggling communities (Tikkanen & Abrams, 2022). Incorporating lived experiences through community-based participatory research may surface problems and solutions missed by dominant health paradigms.

Holistic models considering spiritual, emotional, and environmental realms could fuel more comprehensive, patient-centered care models and interventions beyond simply the medical treatment of physical symptoms.

Thoughtful determination of appropriate health measures is crucial. Metrics must balance clinical priorities, social justice, efficiency, patient perspectives, and the ultimate purpose driving measurement, whether it be targeting funding, guiding individual care, or providing a snapshot of societal health. The application of diverse health lenses could yield a more complete and humanistic understanding of this multidimensional concept to inform practical and ethical health policy and practice.

4 References Centers for Disease Control and Prevention. (2018). Wellbeing concepts. https://www.cdc.gov/hrqol/wellbeing.htm Fuchs, V. R. (2011). Healthcare is different—That is why expenditures matter. JAMA, 303(18), 1859-1860. https://doi.org/10.1001/jama.2011.601 Metzl, J. M., & Hansen, H. (2014). Structural competency: theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126-133. https://doi.org/10.1016/j.socscimed.2013.06.032 Office of Disease Prevention and Health Promotion. (2022). Healthy People 2030 framework. https://health.gov/healthypeople/about/healthy-people-2030-framework Sherwood, J. (2013). Colonization - bad for your health: The context of Aboriginal health.

Contemporary Nurse, 46(1), 28–40. https://doi.org/10.5172/conu.2013.46.1.28 Tikkanen, R., & Abrams, M.K. (2020). U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? Commonwealth Fund. https://doi.org/10.26099/7avy-fc29