Health status measurement in the evaluation of health promotion.

A step beyond treatment and even the prevention of disease is coming onto the health agenda. It is health promotion--"the advancement of well-being and the avoidance of health risks by achieving the optimal levels of the behavioral, societal, environmental and biomedical determinants of health." It differs from medical service in that the latter is directed largely toward overcoming poor health, disequilibrium with one's environment. Health promotion is aimed at maintaining the level of health and, insofar as possible, strengthening the potential (resources) for health. The emergence of health promotion raises an issue for those concerned with health status measurement: whether we consider health as having only biologic elements as traditionally understood in biomedical science, and role (performance) elements as traditionally understood in sociomedical science; or whether we add to these considerations a view of health as the dynamic equilibrium of individuals or groups of people with their environment, their capacity to live physically, mentally, and socially. The latter view entails measuring the health of people on a continuum extending from "perfect" harmony with one's environment and maximum potential for responding to adversities, on the one hand, to extreme invalidism and no reserves, i.e., the premorbid state, at the other extreme. That view also entails expanding attention to the whole population, not just the sick. It also means considering the relative emphasis to be given conceptual and methodologic work, individual versus community responsibilities for health, and the alleged medicalization of life.