1. The Role of Functioning in Measuring Well-Being Jennifer Madans, Ph.D. Associate Director for Science, NCHS 4 th OECD World Forum on Statistics, Knowledge and Policy - Measuring Well-Being for Development and Policy Making October, 2012

2. What is Health? Medically-based objective definitions Focus on pathologies/biology Subjective measure (self-report) used as a proxy for objective measures Disease state Use of health care Subjective measures (self-report) used as the intended indicator of a dimension of health What concepts are we trying to measure? How can we operationalize the concept? Need to address issues of validity and reliability

3. Commonly Used Objective Measures Laboratory tests Radiological tests Physical exams Performance measures Medical records

4. Commonly Used Subjective Measures as the Intended Indicator Summary measures of health Self-reported health status (also used as proxy for objective measures) Composite measures Functioning/disability measures Functioning ‘within the skin’ Interaction with the environment Impact of accommodation Health-related quality of life/well-being

5. Functioning as the Key to Well Being for Health and Health Care Policy Role of health statistical agency: Monitor key indicators of health and health care over time and across population subgroups to inform policy Need for easy to understand summary or composite measures

6. Functioning as the Key to Well Being for Health and Health Care Policy Functioning is a critical aspect of health Functioning can be seen as the outcome of: Determinants and risk factors Disease states Use of health care Environmental barriers and facilitators

7. Functioning as the Key to Well Being for Health and Health Care Policy Policy objective -- Minimize participation restrictions due to limitations in functioning ‘within the skin’ Statistical data used to: Measure level of participation and monitor change in participation Measure level of functioning and change in functional abilities ‘within the skin’ and with accommodation Relate to program and policy interventions

8. International Efforts in the Measurement of Functioning and Disability The Budapest Initiative on the Measurement of Health Status The Washington Group on Disability Statistics