The ICF as a Conceptual Platform to Specify and Discuss Health and Health-Related Concepts

 

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Abstract

Background: The World Health Organization's International Classification of Functioning, Disability and Health (ICF) has provided a new foundation for our understanding of health, functioning, and disability. As a content-valid, comprehensive and universally applicable health classification, it serves as a platform to clarify and specify health-related concepts that are frequently used in the medical literature. The health concepts to which we refer are: well-being, health status, quality of life (QoL) and health-related quality of life (HRQoL).

Objective: The aim of this paper is to use the ICF as a conceptual platform to specify and discuss health-related concepts.

Methods: The ICF entities health and health-related domains and functioning will be used as starting point to reach the objective of the paper. Health domains refer to domains intrinsic to the person as a physiological and psychological entity, such as mental functions, seeing functions, and mobility. Health-related domains are not part of a person's health but are so closely related that a description of a person's lived experience of health would be incomplete without them. Examples of health-related domains are work, education, and social activities. Functioning refers to all health and health-related domains within the ICF.

Results: Well-being is made up of health, health-related, and non-health-related domains, such as autonomy and integrity. Health state is a health profile that results from collecting together health domains. Functioning states is a profile that results from collecting both health and health-related domains. Health status is a summary measure of health state. Functioning status is a summary measure of functioning state. QoL is the individual's perceptions of how the life is going in health, health-related, and non-health domains. HRQoL is the individual's perceptions of how the life is going in health and health-related domains.

Discussion: “HRQoL is to QoL as functioning is to well-being”. The ICF represents a standardized and international basis for the operationalization of health based on its health domains. It refers to the more restricted concepts of health state and health status. The ICF is also the basis for the operationalization of functioning based on all health and health-related domains contained therein. The authors argue that functioning is an operationalization of health from a broader perspective. It refers to an operational concept of health in terms of a set of health domains (‘under the skin’) and health-related domains (‘outside the skin’) that consider the individual person not only as a biological but also as a social entity. Health from this perspective refers to the broader notion of functioning state and functioning status. Nevertheless, the ICF provides more than a basis for the operationalization of health and functioning. The ICF also contains contextual factors.

Zusammenfassung

Hintergrund: Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit bietet eine neue Grundlage für unser Verständnis von Gesundheit, Funktionsfähigkeit und Behinderung. Sie ist eine inhaltsvalide, umfassende und allgemein akzeptierte Klassifikation der Gesundheit, die als Plattform zur Klärung gesundheitsbezogener Konzepte, die häufig in der medizinischen Literatur vorkommen, dient. Diese Konzepte sind Wohlbefinden, Gesundheitsstatus, Lebensqualität (QoL) und gesundheitsbezogene QoL (HRQoL).

Ziel: Das Ziel dieser Publikation ist es, die ICF als eine konzeptionelle Plattform zu verwenden, um gesundheitsbezogene Begriffe zu klären und zu diskutieren.

Methoden: Die ICF-basierten Begrifflichkeiten „health domains”, „health-related domains” und Funktionsfähigkeit sind der Ausgangpunkt dieses Klärungsansatzes. „Health domains” beziehen sich auf Domänen, die der Person als physiologische und/oder psychologische Entität innewohnen. Beispiele dafür sind Seh- und mentale Funktionen und Mobilität. „Health-related domains” sind kein Bestandteil der Gesundheit einer Person, aber so eng damit assoziiert, dass die Beschreibung der Gesundheitserfahrung einer Person ohne diese Domänen nicht vollständig wäre. Beispiele dafür sind Arbeit, Ausbildung und soziale Aktivitäten. Funktionsfähigkeit bezieht sich auf alle „health domains” und „health-related domains”.

Ergebnisse: Wohlbefinden besteht aus „health domains”, „health-related domains” und aus „non-health domains”, wie z.B. Autonomie und persönliche Integrität. Gesundheitszustand ist ein Profil, das sich aus verschiedenen „health domains” zusammensetzt. Funktionsfähigkeitszuständ ist ein Profil, das aus „health domains” und „health-related domains” besteht. Gesundheitsstatus ist ein Summenscore, der aus dem Profil des Gesundheitszustands entsteht. Funktionsfähigkeitsstatus ist ein Summenscore, der aus dem Profil des Funktionsfähigkeitszustands entsteht. QoL ist die subjektive Wahrnehmung einer Person, wie es ihr hinsichtlich „health domains”, „health-related domains” und „non-health domains” geht. HRQoL ist die subjektive Wahrnehmung einer Person, wie es ihr hinsichtlich „health domains” und „health-related domains” geht.

Diskussion: “HRQoL ist für QoL, was Funktionsfähigkeit für Wohlbefinden ist.“ Die ICF stellt eine standardisierte und internationale Grundlage zur Operationalisierung von Gesundheit auf der Basis ihrer „health domains” dar. Diese bezieht sich auf die enger begrenzten Begrifflichkeiten Gesundheitszustand und Gesundheitsstatus. Die ICF ist zudem die Grundlage zur Operationalisierung von Funktionsfähigkeit, basierend auf allen „health domains” und „health-related domains”. Die Autoren behaupten, dass Funktionsfähigkeit eine Operationalisierung von Gesundheit ist. Gleichwohl stellt die ICF mehr als nur die Grundlage zur Operationalisierung von Gesundheit und Funktionsfähigkeit dar. Die ICF enthält zudem Kontextfaktoren.

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1 The opinions expressed in this paper are those of the author and do not necessarily represent the views of the World Health Organization.

2 To make matters more confusing, there are terms that are plainly related to the notion of well-being but which are more commonly used in other disciplines such as economics and philosophy: ‘happiness’, ‘welfare’, ‘utility’, and so on. Although what we have to say below may have application to these other terms, we do not propose to pursue this here.

3 To avoid cumbersome repetition, from this point on we use ‘domains’ to refer to both domains and categories.

Correspondence

Dr. A. CiezaMPH 

ICF Research Branch of WHO CC FIC (DIMDI)

Institute for Health and Rehabilitation Sciences

Ludwig-Maximilian University

Marchioninistr. 17

81377 Munich

Email: alarcos.cieza@med.uni-muenchen.de