1. Harvard University Initiative for Global Health Global Health Challenges Social Analysis 76: Lecture 2

2. Harvard University Initiative for Global Health Introduction Introduction Domains of Health and Domains of Well-being Domains of Health and Domains of Well-being Health versus Causes of Health Health versus Causes of Health Aggregation of Health Domains into Overall Health Aggregation of Health Domains into Overall Health Coping, Adaptation, Adjustment and the Environment Coping, Adaptation, Adjustment and the Environment Current State of Health and Survival Current State of Health and Survival Aggregating Individual Health into Population Health Aggregating Individual Health into Population Health

3. Harvard University Initiative for Global Health Why Do We Need Good Measures of Health? Set research and development priorities Establish health agendas Manage program implementation Monitor progress Evaluate what works and what does not

4. Harvard University Initiative for Global Health “A wise man should consider that health is the greatest of human blessings…” (Hippocrates, 460 BC - 377 BC, Regimen in Health). What is Health?

5. Harvard University Initiative for Global Health “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” World Health Organization Constitution What is Health?

6. Harvard University Initiative for Global Health Introduction Introduction Domains of Health and Domains of Well-being Domains of Health and Domains of Well-being Health versus Causes of Health Health versus Causes of Health Aggregation of Health Domains into Overall Health Aggregation of Health Domains into Overall Health Coping, Adaptation, Adjustment and the Environment Coping, Adaptation, Adjustment and the Environment Current State of Health and Survival Current State of Health and Survival Aggregating Individual Health into Population Health Aggregating Individual Health into Population Health

7. Harvard University Initiative for Global Health “What is the Good Life?”

8. Harvard University Initiative for Global Health Theories of the Good Life Hedonist Preference satisfaction Ideal theories

9. Harvard University Initiative for Global Health Domains of Well-Being Theories of the good life, through arguments of first principles or through empirical exploration of preferences, lead to a list of domains of well-being including health, freedom from hunger, shelter, education, etc.

10. Harvard University Initiative for Global Health Health Domains as a Subset of the Domains of Well-Being

11. Harvard University Initiative for Global Health Introduction Introduction Domains of Health and Domains of Well-being Domains of Health and Domains of Well-being Health versus Causes of Health Health versus Causes of Health Aggregation of Health Domains into Overall Health Aggregation of Health Domains into Overall Health Coping, Adaptation, Adjustment and the Environment Coping, Adaptation, Adjustment and the Environment Current State of Health and Survival Current State of Health and Survival Aggregating Individual Health into Population Health Aggregating Individual Health into Population Health

12. Harvard University Initiative for Global Health Health versus Causes of Health Does a smoker have worse health than a non- smoker? Is someone living in Jakarta, ceteris paribus, healthier than someone in Atlanta?

13. Harvard University Initiative for Global Health Causal Models

14. Harvard University Initiative for Global Health Introduction Introduction Domains of Health and Domains of Well-being Domains of Health and Domains of Well-being Health versus Causes of Health Health versus Causes of Health Aggregation of Health Domains into Overall Health Aggregation of Health Domains into Overall Health Coping, Adaptation, Adjustment and the Environment Coping, Adaptation, Adjustment and the Environment Current State of Health and Survival Current State of Health and Survival Aggregating Individual Health into Population Health Aggregating Individual Health into Population Health

15. Harvard University Initiative for Global Health “Susan is healthier than Sara.”

16. Harvard University Initiative for Global Health Overall judgment requires integration of domain-specific levels into one dimension. Aggregation functions may vary by culture, etc. Overall Health

17. Harvard University Initiative for Global Health Understanding How We Aggregate Health Domains into Overall Health How do you ask? Who do you ask? Respondent’s health or hypothetical individuals?

18. Harvard University Initiative for Global Health Introduction Introduction Domains of Health and Domains of Well-being Domains of Health and Domains of Well-being Health versus Causes of Health Health versus Causes of Health Aggregation of Health Domains into Overall Health Aggregation of Health Domains into Overall Health Coping, Adaptation, Adjustment and the Environment Coping, Adaptation, Adjustment and the Environment Current State of Health and Survival Current State of Health and Survival Aggregating Individual Health into Population Health Aggregating Individual Health into Population Health

19. Harvard University Initiative for Global Health | 29 Age Self- Reported Overall Health Status 100% Motorcycle Accident

20. Harvard University Initiative for Global Health Adaptation is the process by which an individual learns to undertake tasks in a new way leading to an increase in the individual’s level on a domain such as mobility or dexterity.

21. Harvard University Initiative for Global Health Coping is a change in expectations for a domain of health as opposed to a change in actual level of health.

22. Harvard University Initiative for Global Health Adjustment is when individuals change the way in which they aggregate different domains of health into an overall assessment of health towards domains where they retain better performance.

23. Harvard University Initiative for Global Health An individual with impaired vision can have his/her vision improved by glasses or contacts or laser surgery. Do all or any of these improve the individual’s health? Individual Health versus the Physical and Social Environment

24. Harvard University Initiative for Global Health Introduction Introduction Domains of Health and Domains of Well-being Domains of Health and Domains of Well-being Health versus Causes of Health Health versus Causes of Health Aggregation of Health Domains into Overall Health Aggregation of Health Domains into Overall Health Coping, Adaptation, Adjustment and the Environment Coping, Adaptation, Adjustment and the Environment Current State of Health and Survival Current State of Health and Survival Aggregating Individual Health into Population Health Aggregating Individual Health into Population Health

25. Harvard University Initiative for Global Health “Susan is healthier than Sara.”

26. Harvard University Initiative for Global Health 1)Taking into account only current levels on various domains of health, is Sara healthier than Susan? 2) After both Sara and Susan have died, did Sara or Susan live a healthier life overall? 3) For the remainder of their lives, do we expect that Sara or Susan will live a healthier life? Three Answers

27. Harvard University Initiative for Global Health

28. Question 2 is retrospective, who lived the healthier life? Question 3 is forward looking, who do we expect will live the healthier life? To answer question 3, we need to forecast the probability of different health events. If you are not comfortable with the concept of probability, discuss this with your section leader. Probability and Questions 2 and 3

29. Harvard University Initiative for Global Health Introduction Introduction Domains of Health and Domains of Well-being Domains of Health and Domains of Well-being Health versus Causes of Health Health versus Causes of Health Aggregation of Health Domains into Overall Health Aggregation of Health Domains into Overall Health Coping, Adaptation, Adjustment and the Environment Coping, Adaptation, Adjustment and the Environment Current State of Health and Survival Current State of Health and Survival Aggregating Individual Health into Population Health Aggregating Individual Health into Population Health

30. Harvard University Initiative for Global Health A birth cohort is a group of individuals that have all been born in the same year. How do we aggregate health of different individuals in a birth cohort?

31. Harvard University Initiative for Global Health Alaska101520 Alabama152025 Two Cohorts of Three Individuals with Healthy Life Expectancies as Shown: Which Cohort Is Healthier?

32. Harvard University Initiative for Global Health Alaska101520 Alabama 82025 Which Cohort Is Healthier?

33. Harvard University Initiative for Global Health Population health for a period – all individuals living in a population at a particular moment in time – requires integrating information about different cohorts. Aggregating health for a period requires many more assumptions and ethical positions.

34. Harvard University Initiative for Global Health Should assessments of population health be influenced by differences in the age distribution of two populations? Life expectancy is a common metric of age- specific mortality that is independent of population age-distribution; healthy life expectancy is a natural extension of this idea to include functional health status. Some Issues for Aggregating Population Health for a Period

35. Harvard University Initiative for Global Health Survivorship Function for a Population