Grujić V, Martinov-Cvejin M, Legetić B
Institut za zastitu zdravlja, Medicinski Fakultet, Novi Sad.
Med Pregl. 1998 Jul-Aug;51(7-8):315-8.
For a long period of time analyses of health status have been based on mortality data, while in this century indicators of morbidity have been introduced as well. However, these two indicators also have limitations because health of the total population was estimated on the basis of data referring to the diseased or deceased during a certain period of time. The definition of health by the World Health Organization was a progress, because the medical model of health was extended to the sociological model with emphasis on well-being, achievement of goals, functioning in the society and social rules. Subjective interpretation of health also has a significant place in assessment of health status of an individual or population groups.
Health has a subjective and an objective dimension. It can be analyzed as a global quality, but also as a sum of specific qualities--physical, social and psychological. Health analyses include the following parameters: mental well-being (affective status, mental functioning), physical health (ability to proceed with activities, body integrity, general physical capacity), general well-being and functioning (perceiving general health and expectations in regard to health in the future). Health is a prerequisite of social and economic status, and that is why emphasis is on social adaptation, but social support as well.
Health measurement can be functional with diagnostic, prognostic or evaluation purpose. Health indicators can also be descriptive, focused on a certain organ, diagnostic methods, but complex as well measuring syndromes, global health and quality of life. Development of health promotion and programs of disease prevention, follow-up of their application, progress and results require various categories of measurement. Some of them identify or quantify the problem, others describe the determinants. There exists a need to measure the contents and processes of intervention and evaluation. Numerous scales of health measurement, that is different aspects of health and quality of life, have been developed, but many of them have limitations, particularly concerning validity and reliability.
Most of existing indicators reflect the model of disease, while contemporary approach to health deals primarily with health itself. This model is oriented towards everyday life and relationships between individuals or groups of people and their physical and social environment as well as towards the way they influence health and well-being. The model also emphasizes well-being, achievement of goals, functioning in the society and social roles. Subjective assessment of health is significant in evaluation of health status, that is quality of life in regard to health, which is being done by different scales. The development of such scales is slow due to different opinions concerning the definition of health and health measurement. Efforts to develop scales which would satisfy the basic characteristics of measurement have largely focused on validity, reliability, accuracy, sensibility, specificity and feasibility.
长期以来，健康状况分析一直基于死亡率数据，而在本世纪也引入了发病率指标。然而，这两个指标也有局限性，因为总人口的健康状况是根据某一时期内患病或死亡的数据来估计的。世界卫生组织对健康的定义是一大进步，因为健康的医学模式扩展到了社会学模式，强调幸福、目标的实现、在社会中的功能以及社会规则。健康的主观诠释在评估个人或人群的健康状况中也占有重要地位。
健康具有主观和客观两个维度。它既可以作为一种整体质量来分析，也可以作为特定质量（身体、社会和心理）的总和来分析。健康分析包括以下参数：心理健康（情感状态、心理功能）、身体健康（进行活动的能力、身体完整性、总体身体能力）、总体幸福感和功能（感知总体健康状况以及对未来健康的期望）。健康是社会和经济地位的先决条件，这就是为什么既要强调社会适应，也要强调社会支持。
健康测量可以具有诊断、预后或评估目的。健康指标也可以是描述性的，侧重于某个器官、诊断方法，但也可以是复杂的，用于测量综合征、总体健康状况和生活质量。健康促进和疾病预防计划的制定、其应用情况的跟踪、进展和结果需要各类测量。其中一些测量用于识别或量化问题，另一些则描述决定因素。需要测量干预和评估的内容及过程。已经开发了众多健康测量量表，即健康和生活质量的不同方面，但其中许多量表都有局限性，特别是在有效性和可靠性方面。
现有的大多数指标反映的是疾病模式，而当代的健康方法主要关注健康本身。这种模式面向日常生活以及个人或人群与其身体和社会环境之间的关系，也面向它们影响健康和幸福的方式。该模式还强调幸福、目标的实现、在社会中的功能以及社会角色。健康的主观评估在评估健康状况（即与健康相关的生活质量）方面具有重要意义，这是通过不同量表来进行的。由于对健康定义和健康测量存在不同观点，此类量表的开发进展缓慢。为开发满足测量基本特征的量表所做的努力主要集中在有效性、可靠性、准确性、敏感性、特异性和可行性方面。
