Map of life expectancy at birth from Global Education Project.

Monday, April 29, 2013

A simple question

In general, would you say your health is excellent, very good, good, fair or poor?

Believe it or not, how you answer that question is a good predictor of how long you will live -- whether you are a young person, or an older person with cancer. It doesn't much matter exactly how it's worded -- you can ask, "How would you rate your overall health during the past week?" or "How do you regard your health?" or anything similar. It doesn't really matter what response categories you offer either -- the excellent to poor scale I used, or a 100 point visual analogue scale, or a seven point scale. And it doesn't really matter if you ask people to compare themselves to others their own age, or just ask the question in a very general way.

The power of this question is a bit of a mystery. People are presumably using different comparators -- e.g. how they felt before they were diagnosed with Annamannapunna, or people they know, or their parents at the same age, or some imaginary ideal. Who knows?

And health obviously means different things to different people. It's actually impossible to define compellingly. "The absence of disease" seems basically circular, since the only way to define disease is as a state of less than optimal health. "Well being" might be a synonym but then what does that mean? People usually think of health as having biological, psychological and social components -- some people want to sneak in spiritual but I think that's just a psychological state. But which of those is most important? If you're happy even though you have MS are you healthy? What if you're the world decathlon champion but you're sad?

None of this seems to make any difference. The question is better correlated with the highly specific and reliable end point of longevity from time now than most physical indicators. Why do you think that is? And what does it mean to you?


roger said...

i'd say my health is excellent. i'm guessing that that correlates with longer life, but i missed where you made that connection. could be a hiccup in my mental health. as to why... ???????

Cervantes said...

Second sentence of the post, Rog:

"Believe it or not, how you answer that question is a good predictor of how long you will live -- whether you are a young person, or an older person with cancer." This has been found in lots of studies.

Anonymous said...

Intersting question.

Firstly, own judgement of health relates to confidence, to willingness to pursue health and fight disease, to live longer and in more acceptable ways (in no matter what conditions.) It is an individualistic frame of analysis, - you know - Don’t give up! Fight the cancer! She overcame obstacles! (both from self and others..) implying some ppl are ‘strong’, others, heh, not so much. Part of this framework also includes, don’t listen to the Docs!

However, it is also reasonable to state that ppl have an intuitive grasp of their health status and what the future holds for them. Their predictions are based on all kinds of knowledge, and are not just self-fulfilling prophecies (thru lack of action, collaboration, or standing strong, etc.) The knowledge concerns how they will be viewed, their position in society, the advice they will be given, the treatments available or not.

To stereotype, a poor woman in the US with no health insurance and breast cancer will view her health as ‘desperate’ as her expectations are dim. A richer one will not - many of her friends have survived .. one can live fine with no breasts .. marry for a second time .. etc. These expectations will have some considerable statistical correctness.

Thirdly, there is the undefinable of how different societies support their dependent members, in function of what criteria. They may neglect and condemn, or support and help. They may name maladies in discriminative, rejecting, ways (heroin addicts, meth traders, felons, bi-polar, etc.) or may just accept them as part of ordinary life which deserves sympathy and some soft explanations which are accepted by all. E.g. care for the senile elderly in some parts of Africa.