Barking and Havering Health & Lifestyle Survey
Synopsis:
This paper reviews the concepts underlying health status and health
related quality of life and the implications for commissioning and
clinical evaluation. While the emphasis of quality of life research has
been on clinical applications and resource choice linked to clinical
treatments, the health quality agenda is also important in assessing
population health status and progress in reducing inequality across
geographical areas and patient groups.
Many health resource evaluations rely on clinical endpoints such as
length of survival or measures of function after a certain therapy.
Technology or resourcing choices which compare costs with these clinical
or vital event measures usually occur within specialties.
This approach does not take into account changes in patients’ quality of
life. Valuations of treatments, which do include quality, mean that
resourcing choices can be based on marginal cost per unit of quality
gained. In the context of needs assessment and commissioning choices,
there is a reliance on surrogates for population morbidity, often based
on mortality or service use. This approach neglects variations in health
status over population sub-groups without major function limitation, and
may give a distorted picture of population health needs; for example,
many illnesses are not usually associated directly with mortality.
Measuring health status does however require use of relevant
instruments in lifestyle surveys, evaluation studies or even routine
service monitoring. A number of health status questionnaires are
increasingly used in both clinical studies and population health
surveys. These include the Euroqol and Short Form 36 (SF36). In the
present study the SF36 questionnaire from the 1994 Health and Lifestyle
Survey is used to derive health status profiles by area type, age, and
social class; this leads in turn to calculation of healthy life years as
a measure to complement traditional mortality based measures of need.
The analysis shows consistent differences in health status according
to the socio-economic characteristics of residents or the small areas
they live in. At age 60 the gap in remaining Healthy Life Years between
affluent and deprived wards is about 20% compared to a 10% gap in
ordinary life expectancies.
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