A classification of sociomedical health indicators: perspectives for health administrators and health planners

Social disadvantage in the international classification of impairments, disabilities, and handicap

The revision process of the international classification of impairments, disabilities and handicaps (ICIDH) is now in progress. Major changes are being considered which question one of the main fields, that of handicap, or social disadvantage. The scope of these changes goes beyond simple technical adjustments. It reaches the level where fundamental positions are adopted regarding the mainspring of public health policies. The purpose of this article is to review and discuss the main criticisms that have appeared in the literature about the dimension of handicap, including a study of the consequences that may result from keeping this dimension or from leaving it out. We suggest that the definition of handicap as a disadvantage has been overlooked, so that discussion has mainly taken place about the environment. Our opinion is that each criticism is based upon the emphasis given to a choice of strategy for preventing or reducing disablement. For some experts, the emphasis is on health care. For others, it is on social change. We share this interest in strategy. This is why we suggest that the conceptual framework is meant only for description, that it does not and should not include choices of strategy. We argue that it is the best way to promote appropriate description and therefore appropriate choice of strategies. Finally, we state that social disadvantage is a major dimension of the consequences of disorders and related problems, and should therefore remain in the framework, in order to provide appropriate information for better choices in strategy.

A quantitative approach to perceived health status: a validation study

The current recognition of the importance of perceived health status as a predictor of need for, and utilisation of, health services has led to attempts to produce indicators which assess subjective rather than objective health problems. The development of the Nottingham Health Profile is described, together with a study which tested the validity of the instrument on four groups of elderly people differing in health status. The results showed that the profile was capable of discriminating between groups differing in terms of diagnosed chronic illness, number of consultations at primary care level, and physiological fitness. Age, sex, and marital status were not significant overall in affecting scores. In these elderly subjects, perceived health status accorded well with objective health status. Further tests of the profile are now taking place on younger groups of subjects.

Measures of community health status for health planning

The National Health Planning and Resources Development Act of 1974 (P.L. 93-641) requires health systems agencies (HSAs) to assess the health status of their area populations but limits their data-collecting activity. Numerous measures of health status have been devised, but many of these require data that are not yet available or are available only on the national level. Proposed measures are reviewed, and the problems of applying them to the measurement of health status in small areas, under current technical and practical constraints, are discussed. Several measures have promise for giving reasonable results, but only with further development of data sources, estimation techniques, and social indicator models; under present constraints, HSAs will have to work with less precise and less useful methods.