Health> Vol.5 No.12A, December 2013

Is the whole greater than the sum of the parts? Self-rated health and transdisciplinarity

DownloadDownload as PDF (Size:125KB)  HTML    PP. 24-30  

ABSTRACT

Self-rated health (SRH)—a person’s subjective evaluation of his general health—is a more valid and powerful predictor of morbidity and mortality than any other combination of objective and self-reported measures. However, current theoretical frameworks fail to explain this association. Here, we sought to investigate SRH in relation to health outcomes from a transdisciplinary perspective. Using a selective review of epidemiological, clinical and qualitative SRH literature, we analyzed the relationships between this global subjective self-perception of health (the whole) and its directly measurable constituents (the parts). Although SRH often predicts major health outcomes, its underpinnings vary from person to person. Factors influencing individual’s health interact in complex ways evade reductionist methods assessing the parts, and may be best captured by global self-perceptions of health. The study of SRH from a transdisciplinary perspective exemplifies the notion that the whole is greater than the sum of its parts. Insight into individual’s experience of “health”, their association with physiological processes, and impact on the health/disease continuum may contribute to the development of individualized strategies for health care and promotion with aging. In particular, this should be most valuable for addressing non-communicable health conditions where cross-talk between health domains (biological, psychological, social, behavioral, spiritual) may significantly contribute to pathophysiology.

 

Cite this paper

Picard, M. , Juster, R. and Sabiston, C. (2013) Is the whole greater than the sum of the parts? Self-rated health and transdisciplinarity. Health, 5, 24-30. doi: 10.4236/health.2013.512A004.

References

[1] Brower, V. (2006) Mind-body research moves towards the mainstream. EMBO Reports, 7, 358-361.
http://dx.doi.org/10.1038/sj.embor.7400671
[2] Carlson, L.E. and Bultz, B.D. (2008) Mind-body interventions in oncology. Current Treatment Options in Oncology, 9, 127-134.
http://dx.doi.org/10.1007/s11864-008-0064-2
[3] Picard, M., Sabiston, C.M. and McNamara, J.K. (2011) The need for a trans-disciplinary, global health framework. Journal of Alternative and Complementary Medicine, 17, 179-184.
http://dx.doi.org/10.1089/acm.2010.0149
[4] Vitetta, L., Anton, B., Cortizo, F. and Sali, A. (2005) Mind-body medicine: Stress and its impact on overall health and longevity. Annals of the New York Academy of Sciences, 1057, 492-505.
http://dx.doi.org/10.1196/annals.1322.038
[5] Fava, G.A. and Sonino, N. (2005) The clinical domains of psychosomatic medicine. Journal of Clinical Psychiatry, 66, 849-858. http://dx.doi.org/10.4088/JCP.v66n0707
[6] Cohen, S., Janicki-Deverts, D. and Miller, G.E. (2007) Psychological stress and disease. Journal of the American Medical Association, 298, 1685-1687.
http://dx.doi.org/10.1001/jama.298.14.1685
[7] Picard, M. (2011) Pathways to aging: The mitochondrion at the intersection of biological and psychosocial sciences. Journal of Aging Research, 2011, Article ID: 814096.
http://dx.doi.org/10.4061/2011/814096
[8] Taylor, A.G., Goehler, L.E., Galper, D.I., Innes, K.E. and Bourguignon, C. (2010) Top-down and bottom-up mechanisms in mind-body medicine: Development of an integrative framework for psychophysiological research. Explore New York, 6, 29-41.
[9] McEwen, B.S. (1998) Protective and damaging effects of stress mediators. The New England Journal of Medicine, 338, 171-179.
http://dx.doi.org/10.1056/NEJM199801153380307
[10] Kessel, F., Rosenfield, P.L. and Anderson, N.B. (2008) Interdisciplinary research: Case studies from health and social science. Oxford University Press, New York.
http://dx.doi.org/10.1093/acprof:oso/9780195324273.001.0001
[11] Engel, G.L. (1977) The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136.
http://dx.doi.org/10.1126/science.847460
[12] Lander, E.S., Linton, L.M., Birren, B., Nusbaum, C., Zody, M.C., Baldwin, J., et al. (2001) Initial sequencing and analysis of the human genome. Nature, 409, 860-921.
http://dx.doi.org/10.1038/35057062
[13] Center for Disease Control (2012) Exposomes and exposomics. http://www.cdc.gov/niosh/topics/exposome/
[14] Bell, I.R., Caspi, O., Schwartz, G.E., Grant, K.L., Gaudet, T.W., Rychener, D., et al. (2002) Integrative medicine and systemic outcomes research: Issues in the emergence of a new model for primary health care. Archives of Internal Medicine, 162, 133-140.
[15] Bell, I.R. and Koithan, M. (2006) Models for the study of whole systems. Integrative Cancer Therapies, 5, 293-307.
[16] Jylha, M. (2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science & Medicine, 69, 307-316.
[17] Statistics Canada (2009) Canadian community health survey. http://wwwstatcangcca/cgi-bin/imdb/p2SVpl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8& dis=2
[18] Ware Jr., J.E. and Sherbourne, CD. (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473-483.
http://dx.doi.org/10.1097/00005650-199206000-00002
[19] Idler, E.L. and Benyamini, Y. (1997) Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21-37.
http://dx.doi.org/10.2307/2955359
[20] Kaplan, G. and Baron-Epel, O. (2003) What lies behind the subjective evaluation of health status? Social Science & Medicine, 56, 1669-1676.
http://dx.doi.org/10.1001/jama.298.14.1685
[21] Jylha, M., Volpato, S. and Guralnik, J.M. (2006) Selfrated health showed a graded association with frequently used biomarkers in a large population sample. Journal of Clinical Epidemiology, 59, 465-471.
http://dx.doi.org/10.1016/j.jclinepi.2005.12.004
[22] Mossey, J.M. and Shapiro, E. (1982) Self-rated health: A predictor of mortality among the elderly. American Journal of Public Health, 72, 800-808.
http://dx.doi.org/10.2105/AJPH.72.8.800
[23] Mason, C., Katzmarzyk, P.T., Craig, C.L. and Gauvin, L. (2007) Mortality and self-rated health in Canada. Journal of physical Activity & Health, 4, 423-433.
[24] Nishi, A., Kawachi, I., Shirai, K., Hirai, H., Jeong, S. and Kondo, K. (2012) Sex/gender and socioeconomic differences in the predictive ability of self-rated health for mortality. PloS One, 7, Article ID: e30179.
http://dx.doi.org/10.1371/journal.pone.0030179
[25] Latham, K. and Peek, C.W. (2012) Self-rated health and morbidity onset among late midlife US adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 68, 107-116.
http://dx.doi.org/10.1093/geronb/gbs104
[26] Schoenfeld, D.E., Malmrose, L.C., Blazer, D.G., Gold, D.T. and Seeman, T.E. (1994) Self-rated health and mortality in the high-functioning elderly—A closer look at healthy individuals: MacArthur field study of successful aging. The Journals of Gerontology, 49, M109-M115.
http://dx.doi.org/10.1093/geronj/49.3.M109
[27] Farkas, J., Nabb, S., Zaletel-Kragelj, L., Cleland, J.G. and Lainscak, M. (2009) Self-rated health and mortality in patients with chronic heart failure. European Journal of Heart Failure, 1, 518-524.
http://dx.doi.org/10.1093/eurjhf/hfp038
[28] Shadbolt, B., Barresi, J. and Craft, P. (2002) Self-rated health as a predictor of survival among patients with advanced cancer. Journal of Clinical Oncology, 20, 2514-2519. http://dx.doi.org/10.1200/JCO.2002.08.060
[29] DeSalvo, K.B., Bloser, N., Reynolds, K., He, J. and Muntner, P. (2006) Mortality prediction with a single general self-rated health question. A meta-analysis. Journal of General Internal Medicine, 21, 267-275.
http://dx.doi.org/10.1111/j.1525-1497.2005.00291.x
[30] Janszky, I., Lekander, M., Blom, M., Georgiades, A. and Ahnve, S. (2005) Self-rated health and vital exhaustion, but not depression, is related to inflammation in women with coronary heart disease. Brain, Behavior, and Immunity, 19, 555-563.
http://dx.doi.org/10.1016/j.bbi.2005.01.001
[31] Abu-Omar, K., Rutten, A. and Robine, J.M. (2004) Selfrated health and physical activity in the European Union. Soz Praventivmed, 49, 235-242.
http://dx.doi.org/10.1007/s00038-004-3107-x
[32] Pan, S.Y., Cameron, C., Desmeules, M., Morrison, H., Craig, C.L. and Jiang, X. (2009) Individual, social, environmental, and physical environmental correlates with physical activity among Canadians: A cross-sectional study. BMC Public Health, 9, 21.
http://dx.doi.org/10.1186/1471-2458-9-21
[33] Ruo, B., Bertenthal, D., Sen, S., Bittner, V., Ireland, C.C. and Hlatky, M.A. (2006) Self-rated health among women with coronary disease: Depression is as important as recent cardiovascular events. American Heart Journal, 152, 921, e1-e7. http://dx.doi.org/10.1016/j.ahj.2006.01.012
[34] Benyamini, Y., Idler, E.L., Leventhal, H. and Leventhal, E.A. (2000) Positive affect and function as influences on self-assessments of health: Expanding our view beyond illness and disability. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55, P107-P116. http://dx.doi.org/10.1093/geronb/55.2.P107
[35] Krause, N.M. and Jay, GM. (1994) What do global selfrated health items measure? Medical Care, 32, 930-942.
http://dx.doi.org/10.1097/00005650-199409000-00004
[36] Harrington, J., Perry, I.J., Lutomski, J., Fitzgerald, A.P., Shiely, F., McGee, H., et al. (2009) Living longer and feeling better: Healthy lifestyle, self-rated health, obesity and depression in Ireland. European Journal of Public Health, 20, 91-95.
http://dx.doi.org/10.1093/eurpub/ckp102
[37] Demakakos, P., Nazroo, J., Breeze, E. and Marmot, M. (2008) Socioeconomic status and health: The role of subjective social status. Social Science & Medicine, 67, 330-340. http://dx.doi.org/10.1016/j.socscimed.2008.03.038
[38] Foraker, R.E., Rose, K.M., Chang, P.P., McNeill, A.M., Suchindran, C.M., Selvin, E., et al. (2011) Socioeconomic status and the trajectory of self-rated health. Age and Ageing, 40, 706-711.
http://dx.doi.org/10.1093/ageing/afr069
[39] Goodman, E., Huang, B., Schafer-Kalkhoff, T. and Adler, N.E. (2007) Perceived socioeconomic status: A new type of identity that influences adolescents’ self-rated health. The Journal of Adolescent Health, 41, 479-487.
http://dx.doi.org/10.1016/j.jadohealth.2007.05.020
[40] Kondo, N., Sembajwe, G., Kawachi, I., van Dam, R.M., Subramanian, S.V. and Yamagata, Z. (2009) Income inequality, mortality, and self rated health: Meta-analysis of multilevel studies. British Medical Journal, 339, Article ID: b4471. http://dx.doi.org/10.1136/bmj.b4471
[41] Bendtsen, P., Leijon, M., Sofie Sommer, A. and Kristenson, M. (2003) Measuring health-related quality of life in patients with chronic obstructive pulmonary disease in a routine hospital setting: Feasibility and perceived value. Health and Quality of Life Outcomes, 1, 5.
http://dx.doi.org/10.1186/1477-7525-1-5
[42] Litva, A. and Eyles, J. (1994) Health or healthy: Why people are not sick in a southern Ontarian town. Social Science & Medicine, 39, 1083-1091.
http://dx.doi.org/10.1016/0277-9536(94)90380-8
[43] Wilcox, V.L., Kasl, S.V. and Idler, E.L. (1996) Self-rated health and physical disability in elderly survivors of a major medical event. The Journals of Gerontology: Series B, 51, S96-S104.
http://dx.doi.org/10.1093/geronb/51B.2.S96
[44] Kroenke, K., Wyrwich, K.W., Tierney, W.M., Babu, A.N. and Wolinsky, F.D. (2006) Physician-estimated disease severity in patients with chronic heart or lung disease: A cross-sectional analysis. Health and Quality of Life Outcomes, 4, 60. http://dx.doi.org/10.1186/1477-7525-4-60
[45] Ruo, B., Rumsfeld, J.S., Hlatky, M.A., Liu, H., Browner, W.S. and Whooley, M.A. (2003) Depressive symptoms and health-related quality of life: The heart and soul study. The Journal of the American Medical Association, 290, 215-221. http://dx.doi.org/10.1001/jama.290.2.215
[46] Smith, K.V. and Goldman, N. (2011) Measuring health status: Self-, interviewer, and physician reports of overall health. Journal of Aging and Health, 23, 242-266.
http://dx.doi.org/10.1177/0898264310383421
[47] Powers, B.A. (1988) Self-perceived health of elderly institutionalized people. Journal of Cross-Cultural Gerontology, 3, 299-321.
http://dx.doi.org/10.1007/BF00116681
[48] Mavaddat, N., Kinmonth, A.L., Sanderson, S., Surtees, P., Bingham, S. and Khaw, K.T. (2010) What determines self-rated health (SRH)? A cross-sectional study of SF-36 health domains in the EPIC-Norfolk cohort. Journal of Epidemiology & Community Health, 65, 800-806.
http://dx.doi.org/jech.2009.090845v1
[49] Schwartz, C.E. and Finkelstein, J.A. (2009) Understanding inconsistencies in patient-reported outcomes after spine treatment: Response shift phenomena. The Spine Journal, 9, 1039-1045.
http://dx.doi.org/10.1016/j.spinee.2009.05.010
[50] Hampson, S.E., Goldberg, L.R., Vogt, T.M., Hillier, T.A. and Dubanoski, J.P. (2009) Using physiological dysregulation to assess global health status: Associations with self-rated health and health behaviors. Journal of Health Psychology, 14, 232-241.
http://dx.doi.org/10.1177/1359105308100207
[51] Galenkamp, H., Braam, A.W., Huisman, M. and Deeg, D.J. (2012) Seventeen-year time trend in poor self-rated health in older adults: Changing contributions of chronic diseases and disability. European Journal of Public Health, 23, 511-517.
http://dx.doi.org/10.1093/eurpub/cks031
[52] Lang, T. and Delpierre, C. (2009) “How are you?”: What do you mean? European Journal of Public Health, 19, 353. http://dx.doi.org/10.1093/eurpub/ckp083
[53] Murata, C., Kondo, T., Tamakoshi, K., Yatsuya, H. and Toyoshima, H. (2006) Determinants of self-rated health: Could health status explain the association between self-rated health and mortality? Archives of Gerontology and Geriatrics, 43, 369-380.
http://dx.doi.org/10.1016/j.archger.2006.01.002
[54] Albrecht, G., Freeman, S. and Higginbotham, N. (1998) Complexity and human health: The case for a transdisciplinary paradigm. Culture, Medicine and Psychiatry, 22, 55-92. http://dx.doi.org/10.1023/A:1005328821675
[55] Martin, C.M. (2003) Making a case for transdisciplinarity. Canadian Family Physician, 49, 905-908.
[56] Nicolescu, B. (2008) In vitro and In vivo knowledge: Methodology of transdisciplinarity. In: Nicolescu, B., Ed., Transdisciplinarity: Theory and Practice, Hampton Press, Cresskil.
[57] Choi, B.C. and Pak, A.W. (2006) Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clinical & Investigative Medicine, 29, 351-364.
[58] Singer, B. and Ryff, C.D. (2001) New horizons in health: An integrative approach. By the committee on future directions for behavioral and social sciences research at the National Institutes of Health. National Academy Press, Washington DC.
[59] Freitas, L., Morin, E. and Nicolescu, B. (1994) Charter of transdisciplinarity. Adopted at the first World Congress of Trandisciplinarity. Convento da Arrábida, Portugal, 2-6 November 1994, 1.
[60] Rosenfield, P.L. (1992) The potential of transdisciplinary research for sustaining and extending linkages between the health and social sciences. Social Science & Medicine, 35, 1343-1357.
http://dx.doi.org/10.1016/0277-9536(92)90038-R
[61] Engel, G.L. (1980) The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535-544.
[62] Canadian Institutes of Health Research (2003) The future of public health in Canada: Developing a public health system for the 21st century. CIHR, Ottawa.
[63] Kessel, F. and Rosenfield, P.L. (2008) Toward transdisciplinary research: Historical and contemporary perspectives. American Journal of Preventive Medicine, 35, S225-S234.
http://dx.doi.org/10.1016/j.amepre.2008.05.005
[64] Loiselle, C.G., Bottorff, J.L., Butler, L. and Degner, L.F. (2004) PORT—Psychosocial oncology research training: A newly funded strategic initiative in health research. The Canadian Journal of Nursing Research, 36, 159-164.
[65] Knox, S.S. (2010) From ‘omics’ to complex disease: A systems biology approach to gene-environment interactions in cancer. Cancer Cell International, 10, 11.
http://dx.doi.org/10.1186/1475-2867-10-11
[66] Tessler, R. and Mechanic, D. (1978) Psychological distress and perceived health status. Journal of Health and Social Behavior, 19, 254-262.
http://www.jstor.org/stable/2136558
[67] Federoff, H.J. and Gostin, L.O. (2009) Evolving from reductionism to holism: Is there a future for systems medicine? Journal of the American Medical Association, 302, 994-996. http://dx.doi.org/10.1001/jama.2009.1264
[68] Cundiff, J.M., Smith, T.W., Uchino, B.N. and Berg, C.A. (2013) Subjective social status: Construct validity and associations with psychosocial vulnerability and selfrated health. International Journal of Behavioral Medicine, 20, 148-158.
http://dx.doi.org/10.1007/s12529-011-9206-1
[69] Levy, B.R., Slade, M.D., Kunkel, S.R. and Kasl, S.V. (2002) Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83, 261-270.
http://dx.doi.org/10.1037/0022-3514.83.2.261

  
comments powered by Disqus

Copyright © 2014 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.