Operationalization of Concepts of Health and Disability

  • Renata Tiene De Carvalho Yokota
  • Herman Van Oyen
Part of the International Handbooks of Population book series (IHOP, volume 9)


Health is a complex concept. Health covers various domains including physical, mental and social health and each can be defined in different dimensions ranging from positive health, ill health, diseases, impairments, disability, and, more recently, frailty. Constructs of health and its dimensions have evolved over time from a pure medical model to more biopsychosocial models, linked to changes in societal challenges. Since there is no single measure of health, the range of measures tell (in)consistent stories about the health of the population as each cover different dimensions. Due to differences in objectives and settings, the operationalisation of health measures range from complex multiple question instruments to more parsimonious and even single item instruments. Although they vary substantially, most of these instruments are complementary and provide different insights to the health of populations. The chapter reviews existing methods of operationalising the concepts of health, disability, and frailty in population health research.


Health Disability Frailty Concepts 


  1. Aguayo, G. A., Donneau, A.-F., Vaillant, M. T., et al. (2017). Agreement between 35 published frailty scores in the general population. American Journal of Epidemiology, 186, 420–434. Scholar
  2. Bailis, D. S., Segall, A., & Chipperfield, J. G. (2003). Two views of self-rated general health status. Social Science & Medicine, 56, 203–217.CrossRefGoogle Scholar
  3. Becker, C. (2011). Re: How should we define health? BMJ, 343, d4163.CrossRefGoogle Scholar
  4. Berger, N., Van Oyen, H., & EHLEIS Team. (2014). WP7: A blueprint for an internationally harmonised summary measure of population health. Brussels: Scientific Institute of Public Health.Google Scholar
  5. Berger, N., Van der Heyden, J., & Van Oyen, H. (2015a). The global activity limitation indicator and self-rated health: Two complementary predictors of mortality. Archives of Public Health, 73, 25. Scholar
  6. Berger, N., Van Oyen, H., Cambois, E., et al. (2015b). Assessing the validity of the Global Activity Limitation Indicator in fourteen European countries. BMC Medical Research Methodology, 15, 1. Scholar
  7. Berger, N., Robine, J.-M., Ojima, T., et al. (2016). Harmonising summary measures of population health using global survey instruments. Journal of Epidemiology and Community Health, 70, 1039–1044. Scholar
  8. Bogaert, P., Van Oyen, H., Beluche, I., et al. (2018). The use of the global activity limitation Indicator and healthy life years by member states and the European Commission. Archives of Public Health, 76, 30. Scholar
  9. Bombak, A. E. (2013). Self-rated health and public health: A critical perspective. Front Public Health, 1, 15. Scholar
  10. Breslow, L. (1972). A quantitative approach to the World Health Organization definition of health: Physical, mental and social well-being. International Journal of Epidemiology, 1, 347–355. Scholar
  11. Breslow, L. (1989). Health status measurement in the evaluation of health promotion. Medical Care, 27, S205–S216.CrossRefGoogle Scholar
  12. Cabasés, J., & Rabin, R. (2014). Introduction. In Self-reported population health: An international perspective based on EQ-5D (pp. 1–6). Dordrecht: Springer.Google Scholar
  13. Card, A. J. (2017). Moving beyond the WHO definition of health: A new perspective for an aging world and the emerging era of value-based care. World Medical & Health Policy, 9, 127–137. Scholar
  14. Chatterji, S., Ustün, B. L., Sadana, R., et al. (2002). The conceptual basis for measuring and reporting on health. Geneva: WHO.Google Scholar
  15. Clegg, A., Young, J., Iliffe, S., et al. (2013). Frailty in elderly people. Lancet, 381, 752–762. Scholar
  16. Cox, B., Van Oyen, H., Cambois, E., et al. (2009). The reliability of the minimum European health module. International Journal of Public Health, 54, 55–60. Scholar
  17. Crimmins, E. M., & Saito, Y. (1993). Getting better and getting worse. Journal of Aging and Health, 5, 3–36. Scholar
  18. De Bruin, A., Picavet, H. S., & Nossikov, A. (1996). Health interview surveys. Towards international harmonization of methods and instruments. WHO Regional Publications. European Series, 58, 1–161.Google Scholar
  19. Dent, E., Kowal, P., & Hoogendijk, E. O. (2016). Frailty measurement in research and clinical practice: A review. European Journal of Internal Medicine, 31, 3–10. Scholar
  20. DeSalvo, K. B., Fisher, W. P., Tran, K., et al. (2006). Assessing measurement properties of two single-item general health measures. Quality of Life Research, 15, 191–201. Scholar
  21. Dijkers, M. P. (2010). Issues in the conceptualization and measurement of participation: An overview. Archives of Physical Medicine and Rehabilitation, 91, S5–S16. Scholar
  22. EuroQol Group. (1990). EuroQol – A new facility for the measurement of health-related quality of life. Health Policy, 16, 199–208.CrossRefGoogle Scholar
  23. Fried, L. P., Tangen, C. M., Walston, J., et al. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56, M146–M156. Scholar
  24. Fried, L. P., Ferrucci, L., Darer, J., et al. (2004). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59, 255–263. Scholar
  25. Fuentes-García, A. (2014). Katz activities of daily living scale. In Encyclopedia of quality of life and well-being research (pp. 3465–3468). Dordrecht: Springer.CrossRefGoogle Scholar
  26. Gallup Inc. (2019). Gallup world poll. Washington, DC: Gallup Inc.Google Scholar
  27. Gill, T. M. (2010). Assessment of function and disability in longitudinal studies. Journal of the American Geriatrics Society, 58(Suppl 2), S308–S312. Scholar
  28. Gobbens, R. J. J., Luijkx, K. G., Wijnen-Sponselee, M. T., et al. (2010a). Towards an integral conceptual model of frailty. The Journal of Nutrition, Health & Aging, 14, 175–181.CrossRefGoogle Scholar
  29. Gobbens, R. J. J., Luijkx, K. G., Wijnen-Sponselee, M. T., et al. (2010b). In search of an integral conceptual definition of frailty: Opinions of experts. Journal of the American Medical Directors Association, 11, 338–343. Scholar
  30. Gobbens, R. J. J., van Assen, M. A. L. M., Luijkx, K. G., et al. (2010c). The Tilburg frailty Indicator: Psychometric properties. Journal of the American Medical Directors Association, 11, 344–355. Scholar
  31. Gobbens, R. J. J., van Assen, M. A. L. M., Luijkx, K. G., et al. (2012). The predictive validity of the Tilburg frailty Indicator: Disability, health care utilization, and quality of life in a population at risk. Gerontologist, 52, 619–631. Scholar
  32. Gobbens, R., Schols, J., & van Assen, M. (2017). Exploring the efficiency of the Tilburg frailty Indicator: A review. Clinical Interventions in Aging, 12, 1739–1752. Scholar
  33. Godlee, F. (2011). What is health? BMJ, 343, d4817–d4817. Scholar
  34. Goering, S. (2015). Rethinking disability: The social model of disability and chronic disease. Current Reviews in Musculoskeletal Medicine, 8, 134–138. Scholar
  35. Hamerman, D. (1999). Toward an understanding of frailty. Annals of Internal Medicine, 130, 945. Scholar
  36. Hogan, D. B., MacKnight, C., Bergman, H., et al. (2003). Models, definitions, and criteria of frailty. Aging Clinical and Experimental Research, 15, 1–29.CrossRefGoogle Scholar
  37. Hsiao, R.-L., Wu, C.-H., Hsu, C.-W., et al. (2019). Validation of the global activity limitation indicator in Taiwan. BMC Medical Research Methodology, 19, 52. Scholar
  38. Huber, M., Knottnerus, J. A., Green, L., et al. (2011). How should we define health? BMJ, 343, d4163–d4163. Scholar
  39. Huber, M., van Vliet, M., Giezenberg, M., et al. (2016). Towards a “patient-centred” operationalisation of the new dynamic concept of health: A mixed methods study. BMJ Open, 6, e010091. Scholar
  40. Hyder, A. A., Puvanachandra, P., & Morrow, R. H. (2012). Measuring the health of populations: Explaining composite indicators. Journal of Public Health Research, 1, 222–228. Scholar
  41. International Health Conference. (1946). Constitution of the World Health Organization. Accessed 14 July 2019.
  42. Jagger, C., Gillies, C., Moscone, F., et al. (2008). Inequalities in healthy life years in the 25 countries of the European Union in 2005: A cross-national meta-regression analysis. Lancet (London, England), 372, 2124–2131. Scholar
  43. Jagger, C., Gillies, C., Cambois, E., et al. (2010). The global activity limitation index measured function and disability similarly across European countries. Journal of Clinical Epidemiology, 63, 892–899. Scholar
  44. Jambroes, M., Nederland, T., Kaljouw, M., et al. (2016). Implications of health as ‘the ability to adapt and self-manage’ for public health policy: A qualitative study. European Journal of Public Health, 26, 412–416. Scholar
  45. Jette, A. M. (2009). Toward a common language of disablement. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64, 1165–1168. Scholar
  46. Jylhä, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science & Medicine, 69, 307–316. Scholar
  47. Katz, S. (1963). Activities of daily living. JAMA, 185, 914. Scholar
  48. Klijs, B., Nusselder, W., Looman, C., et al. (2011). Contribution of chronic disease to the burden of disability. PLoS One, 6, e25325. Scholar
  49. Lagiewka, K. (2012). European innovation partnership on active and healthy ageing: Triggers of setting the headline target of 2 additional healthy life years at birth at EU average by 2020. Archives of Public Health, 70, 23. Scholar
  50. Larson, J. S. (1999). The conceptualization of health. Medical Care Research and Review, 56, 123–136. Scholar
  51. Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186. Scholar
  52. Leonardi, M. (2010). Measuring health and disability: Supporting policy development. The European MHADIE project. Disability and Rehabilitation, 32, S1–S8. Scholar
  53. Macaulay, A. (2011). Re: How should we define health? BMJ, 343, d4163.CrossRefGoogle Scholar
  54. Mackenbach, J. P., Simon, J. G., Looman, C. W., et al. (2002). Self-assessed health and mortality: Could psychosocial factors explain the association? International Journal of Epidemiology, 31, 1162–1168. Scholar
  55. Madans, J. H., Altman, B. M., Rasch, E. K., et al. (2004). Washington Group Position paper on the proposed purpose of an internationally comparable general disability measure. Brussels: Washington Group Meeting.Google Scholar
  56. Madans, J. H., Loeb, M. E., & Altman, B. M. (2011). Measuring disability and monitoring the UN convention on the rights of persons with disabilities: The work of the Washington Group on Disability Statistics. BMC Public Health, 11, S4. Scholar
  57. Mäki, N., Martikainen, P., Eikemo, T., et al. (2013). Educational differences in disability-free life expectancy: A comparative study of long-standing activity limitation in eight European countries. Social Science & Medicine, 94, 1–8. Scholar
  58. Miller, K. (2016). Summary of Washington group question evaluation studies. In B. M. Altman (Ed.), International measurement of disability – Purpose, method and application – The work of the Washington Group (pp. 69–84). Cham: Springer.Google Scholar
  59. Mitnitski, A. B., Mogilner, A. J., & Rockwood, K. (2001). Accumulation of deficits as a proxy measure of aging. Scientific World Journal, 1, 323–336. Scholar
  60. Mont, D. (2007). Measuring disability prevalence. Washington, DC: Washington Group on Disability Statistics.Google Scholar
  61. Murray, C. J. L., Salomon, J. A., Mathers, C. D., et al. (2002). Summary measures of population health: Concepts, ethics, measurement and applications. Geneva: World Health Organization.Google Scholar
  62. Nagi, S. (1965). Some conceptual issues in disability and rehabilitation. In M. Sussman (Ed.), Sociology and rehabilitation (pp. 100–113). Washington: American Sociological Association.Google Scholar
  63. Omran, A. R. (2005). The epidemiologic transition: A theory of the epidemiology of population change. The Milbank Quarterly, 83, 731–757. Scholar
  64. Pettitt, D., Raza, S., Naughton, B., et al. (2016). The limitations of QALY: A literature review. Journal of Stem Cell Research & Therapy, 6, 4. Scholar
  65. Robine, J.-M., & Jagger, C. (2003). Creating a coherent set of indicators to monitor health across Europe: The Euro-REVES 2 project. European Journal of Public Health, 13, 6–14.CrossRefGoogle Scholar
  66. Rockwood, K., & Mitnitski, A. (2011). Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clinics in Geriatric Medicine, 27, 17–26. Scholar
  67. Rockwood, K., Song, X., MacKnight, C., et al. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173, 489–495. Scholar
  68. Sabariego, C., Oberhauser, C., Posarac, A., et al. (2015). Measuring disability: Comparing the impact of two data collection approaches on disability rates. International Journal of Environmental Research and Public Health, 12, 10329–10351. Scholar
  69. Saito, Y., Robine, J.-M., & Crimmins, E. M. (2014). The methods and materials of health expectancy. Statistical Journal of the IAOS, 30, 209–223. Scholar
  70. Smith, R., O’Grady, L., & Jadad, A. R. (2009). In search of health. Journal of Evaluation in Clinical Practice, 15, 743–744. Scholar
  71. Sternberg, S. A., Schwartz, A. W., Karunananthan, S., et al. (2011). The identification of frailty: A systematic literature review. Journal of the American Geriatrics Society, 59, 2129–2138. Scholar
  72. Swaine, Z. (2011). Medical Model. In Encyclopedia of clinical neuropsychology (pp. 1542–1543). New York: Springer.CrossRefGoogle Scholar
  73. Tocchi, C. (2015). Frailty in older adults: An evolutionary concept analysis. Research and Theory for Nursing Practice, 29, 66–84.CrossRefGoogle Scholar
  74. United Nations. (2006). Convention on the rights of persons with disabilities. Accessed 30 Aug 2016.
  75. Üstün, T., Kostanjse, N., Chatterji, S., et al. (2010a). Measuring health and disability: Manual for WHO disability assessment schedule. Geneva: World Health Organization.Google Scholar
  76. Üstün, T. B., Chatterji, S., Kostanjsek, N., et al. (2010b). Developing the World Health Organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88, 815–823. Scholar
  77. Van Oyen, H., Van der Heyden, J., Perenboom, R., et al. (2006). Monitoring population disability: Evaluation of a new Global Activity Limitation Indicator (GALI). Sozial- und Präventivmedizin, 51, 153–161.CrossRefGoogle Scholar
  78. Van Oyen, H., Berger, N., Nusselder, W., et al. (2014). The effect of smoking on the duration of life with and without disability, Belgium 1997-2011. BMC Public Health, 14, 723. Scholar
  79. Van Oyen, H., Bogaert, P., Yokota, R. T. C., et al. (2018). Measuring disability: A systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). Archives of Public Health, 76, 25. Scholar
  80. Verbrugge, L. M. (2016). Disability experience and measurement. Journal of Aging and Health, 28, 1124–1158. Scholar
  81. Verbrugge, L. M., & Jette, A. M. (1994). The disablement process. Social Science & Medicine, 38, 1–14.CrossRefGoogle Scholar
  82. Ware, J. E., Brook, R. H., Davies, A. R., et al. (1981). Choosing measures of health status for individuals in general populations. American Journal of Public Health, 71, 620–625. Scholar
  83. Whitehead, S. J., & Ali, S. (2010). Health outcomes in economic evaluation: The QALY and utilities. British Medical Bulletin, 96, 5–21. Scholar
  84. World Health Organization. (1980). International classification of impairments, disabilities, and handicaps. Geneva: WHO.Google Scholar
  85. World Health Organization. (2001). International classification of functioning, disability and health. Geneva: ICF.Google Scholar
  86. World Health Organization. (2011a). International statistical classification of diseases and related health problems, 10th Revis. Geneva: World Health Organization.Google Scholar
  87. World Health Organization. (2011b). WHO|world report on disability. Geneva: World Health Organization.Google Scholar
  88. Wu, S., Wang, R., Zhao, Y., et al. (2013). The relationship between self-rated health and objective health status: A population-based study. BMC Public Health, 13, 320. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Renata Tiene De Carvalho Yokota
    • 1
    • 2
  • Herman Van Oyen
    • 1
    • 3
  1. 1.Department of Epidemiology and Public HealthSciensanoBrusselsBelgium
  2. 2.Department of Sociology, Interface DemographyVrije Universiteit BrusselBrusselsBelgium
  3. 3.Department of Public Health and Primary CareGhent UniversityGhentBelgium

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