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Overall Health Status

Summary measures of overall health status and health-related quality of life (HRQOL) provide information on the health of a population. People's subjective assessment of their physical and mental health status and level of disability is important because when people feel healthy, they are more likely to participate socially and economically in their community. Areas with unhealthy populations lose productivity due to lost work time. Healthy residents are essential for creating a vibrant and successful community. HRQOL measures have been included in Healthy People 2000, 2010, 2020, and 2030.

Self-assessed health status is a measure of how an individual perceives their health-rating it as excellent, very good, good, fair, or poor. Self-assessed health status has been validated as a useful indicator of health for a variety of populations and allows for broad comparisons across different conditions and populations.

Physically and mentally unhealthy days measure the number of days in the past 30 days that individuals rated their physical or mental health as not good.

Limitation of activity refers to a long-term reduction in a person's ability to do their usual activities. Since 1997, in the National Health Interview Survey, limitation of activity has been assessed by asking people about their limitations in:
  • Activities of daily living (such as bathing/showering, dressing, eating, getting in and out of bed, walking, using the toilet)
  • Instrumental activities of daily living (such as using the telephone, doing light housework, doing heavy housework, preparing meals, shopping for personal items, managing money)
  • Play, school, or work
  • Remembering
  • Any other activity that they cannot do because of limitations caused by physical, mental, or emotional problems

The term disability describes people at risk of a limitation in their ability to fully participate in society. People are identified as having a disability through a set of 6 standardized questions developed for the American Community Survey (ACS). These questions ask if a person has difficulty in any of these 6 domains of functioning:
  • Hearing
  • Seeing
  • Concentrating and remembering or making decisions
  • Walking or climbing stairs
  • Dressing or bathing
  • Doing errands alone

In Healthy People 2020, the cross-cutting summary measures are called Foundation Health Measures. These include measures of Overall Health Status, activity limitation and disability. Such measures are a cornerstone of Healthy People because they reflect the impact of actions and interventions implemented to achieve the Healthy People objectives and goals. The measures are used to monitor improvement in population health in the broadest sense.

  • Self-assessed health status: In 2017, 17.6% of adults in the United States reported their health to be fair or poor. Self-assessed health status varies by age with older adults being more likely to report fair or poor health.
  • Unhealthy days: In 2017, adults in the United States reported on average 4.0 physically unhealthy days and 4.0 mentally unhealthy days in the past 30 days with a combined average of 6.8 mentally or physically unhealthy days compared to 5.3 days among those 65 and older. Physically unhealthy days increased with age with younger adults (aged 18-34) reporting 2.4 physically unhealthy days compared to 5.3 days among those 65 and older. Mentally unhealthy days decreased with age with adults aged 18-34 reporting 4.9 mentally unhealthy days compared to 2.5 days among those 65 and older.
  • Limitation of activity: In 2017, 5.5% of adults ages 18 to 34 (11.2 million adults) had a functional limitation of activity while 20.6% of adults age 65 and older (9.5 million adults) had a limitation of activity.
  • Disability: 22.5% of adults in the U.S. have some type of disability. Adults with disabilities are more likely to be inactive, smoke, have high blood pressure and have obesity. It is estimated that 17% of total health care expenditures are associated with disability. In Hawai'i. this amounts to about $1 billion per year.

In Hawai'i in 2017 (BRFSS):
  • 14.8% of adults reported their health status to be fair or poor. There was no difference in health status by sex, but 25.6% of those aged 75 or older reported fair or poor health compared to only 9.8% among those 18-24 years old. Native Hawaiians (24.6%) were the most likely to report fair or poor health status compared to 11.5% of Caucasians. Low self-reported health status varied by education (40.0% among those with 8th grade education or lower vs. 7.5% among 4-year college graduates or higher) and income (30.8% among those in households earning less than $10,000/year compared to 7.9% in those earning $75,000 or more).
  • 10.4% of adults (age-adjusted prevalence) reported 14 or more days of poor physical health and 9.7% reported 14 or more days of poor mental health in the past 30 days.
    • Poor physical health varied by age (17.1% of those 75 years or older and 6.6% of those 18-24 years old), race ethnicity (15.9% among Other Pacific Islanders vs 8.1% among Japanese), education (18.0% among those with less than a high school diploma compared to 6.5% among college graduates), and household income (18.6% among those earning less than $10,000/yr compared to 6.6% among those earning $75,000/year).
    • Poor mental health was highest among Other Pacific Islanders (16.7%) and Native Hawaiians (14.4%) and lowest among Chinese and Filipinos (7.1%, respectively). There were also differences by age (12.6% among those 25-34 year olds and 5.4% among those 75 years and older), education (16.9% among those with less than a high school diploma compared to 7.4% among college graduates), and income (23.2% among those in households earning $10,000 to $14,999/year compared to 7.4% among those earning $75,000 or more).
  • 20.3% of adults reported at least one disability* in 2017. Disability varied by age with 48.4% of those over age 75 reporting at least one disability, race ethnicity (39.6% of Other Pacific Islanders and 32.6% of Native Hawaiians compared to 10.6% of Chinese), education (54.5% among those who did not attend high school compared to 12.6% among college graduates), household income (46.3% among those earning less than $10,000/year compared to 11.5% among those earning $75,000 or more), and employment status (83.5% of those who are unable to work report at least one disability compared to 14.8% of those employed for wages).

* Based on a series of questions. Are you blind or do you have serious difficulty seeing, even when wearing glasses? Are you deaf or do you have serious difficulty hearing? Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? Do you have difficulty dressing or bathing? Do you have serious difficulty walking or climbing stairs?

There is no sole determinant of individual well-being. However, well-being is usually dependent upon good health, positive social relationships, and availability and access to basic resources (e.g., shelter, income).

Numerous studies have examined the associations between determinants of individual and national levels of well-being. Many of these studies have used different measures of well-being (e.g., life satisfaction, positive affect, psychological well-being), and different methodologies resulting in occasional inconsistent findings related to well-being and its predictors. In general, life satisfaction is dependent more closely on the availability of basic needs being met (food, shelter, income) as well as access to modern conveniences (e.g., electricity). Pleasant emotions are more closely associated with having supportive relationships.
  • Some personality factors that are strongly associated with well-being include optimism, extroversion and self-esteem.
  • Men and women tend to have similar levels of well-being.
  • There is a U-shaped distribution of well-being by age where young and older adults tend to have more well-being than middle age adults.
  • The relationship between income and well-being is complex. Depending on which types of measures are used and which comparisons are made, income correlates only modestly with well-being. In general, associations between income and well-being (usually measured in terms of life satisfaction) are stronger for those at lower economic levels, but studies also have found effects for those at higher income levels. Paid employment is critical to the well-being of individuals by conferring direct access to resources, as well as fostering satisfaction, meaning and purpose for some. Unemployment negatively affects well-being, both in the short- and long-term.
  • Having supportive relationships is one of the strongest predictors of well-being, having a notably positive effect.

Self-assessed health status and activity limitation are collected via the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), and the Youth Risk Behavior Survey (YRBS).

Disability is collected via the American Community Survey (ACS) and the BRFSS.

The CDC Healthy Days measures are an acknowledged standard for population health surveillance by national and international groups. The Healthy Days questions have been included in the following surveillance systems:
  • Behavioral Risk Factor Surveillance System (BRFSS) from 1993 through present
  • National Health and Nutrition Examination Survey (NHANES) to respondents aged 12 years or older from 2000 to 2012
  • Medicare Health Outcomes Survey (HOS) of Medicare Advantage beneficiaries since 2003. The National Committee for Quality Assurance has adopted the HOS as a component of HEDIS (Health Plan Employer Data and Information Set), the most widely used set of performance measures in the managed care industry.

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