Sunday, December 18, 2011

Measurement of Healthiness Part 1: Measurements, Summaries and Goals

How can we measure healthiness?

Healthiness must be measured comprehensively, using the hierarchy of health. We need to measure many components in each layer in the hierarchy: genetics, nutrients, cells, tissues, organs, systems, body, mind, spirits and communities, to create a useful measure of healthiness.

There are many different types of 'health measurement', some of which are more appropriate, more accurate, and more effective than others.

Direct vs Indirect Measurements
It is silly to measure brightness by searching shadows, and superficial to measure healthiness by searching sicknesses.

Health measurements should measure healthiness as directly as possible. Resting heart rate is a direct measurement of healthiness. Heart rate after exercise is a measurement of strength, not a measurement of healthiness.  Erratic heart rate is a measure of illness, not a direct measurement of healthiness, although it can be a useful indirect measurement of healthiness.

Illness and death measurements and statistics are indirect measurements of health, and should be viewed with caution. Death statistics and illness statistics might measure healthiness of a community, or not.  Improvements in medicine can help people live longer without actually increasing their healthiness. Improvements in, or changes to diagnostic protocols can increase illness statistics without actually decreasing healthiness.

Tests against a Scale vs Binary Measurements

Scales of healthiness are more useful than yes/no answers. A effective healthiness scale clearly identifies and quantifies the grey areas that exist in all aspects of health. It is much more powerful, from a health point of view, to say 'your pulse rate is 10 percent above your optimum'. Of course it is extremely difficult to identify optimum health measurements for different groups of people and more difficult for individuals. Difficult should not stop us from trying.

Tests that provide results on a scale, need independent scoring for variations above and below the optimum goal. If your pulse target is 50 beats per minute - and your heart rate is 50 bpm below the target - you are dead.  But if your heart rate is 50 above the target, it is still within the 'acceptable' range from an illness point of view. You could easily be alive with a heart rate well above 100 bpm.

Objective over Subjective

Health measurements that are more objective are preferred over subjective measurements, although both may be relevant. A measurement of your pulse rate by a professional, even by an amateur, is a more accurate and useful measurement than asking - does your heart seem to beat faster than it should?

Targets should be Health Oriented, not Illness Avoidance Oriented

As discussed in a prior blog post: Are You Measuring Illness or Healthiness? a measurement of your pulse that is intended to detect illness uses a different target than a healthiness measurement.  If you are not ill, your resting pulse might be somewhere in a wide range, from 60 to 100 beats per minute. The result of the illness test is binary - you are in the healthy range (healthy) or not (ill). A healthiness test, on the other hand, will have a target - which might be 50 beats per minute - and detect the amount of deviation from the health target - giving a result on a scale.

Avoid tests with Short Term Temporary Variations

A test of alertness is not a test of healthiness - it may be a test of how awake the subject is, or how much coffee or alcohol they have consumed in the last few hours. It is not a test of healthiness. A measurement of illness needs to know 'are you sick right now'.  A measurement of healthiness is more useful if it tells 'how healthy you are this month', ignoring the temporary, short term deviations. Resting pulse rate is more relevant than 'randomly tested pulse rate'.

Summary Measurements

Because the measurement of healthiness is in its infancy, we have not developed any techniques to summarize different measurements to create a healthiness profile for each layer in the hierarchy, nor a overall healthiness profile. As we learn to measure healthiness - we will learn which measurements more accurately represent overall healthiness, and which are less useful.  A fundamental goal for summary measurements is to ensure that the summary for each layer is on a scale of zero to 100 percent.

Multiple Goals are Required

It is important that health scales, against which a measurement is compared, be as comprehensive as possible.  A measurement of Vitamin C consumption might compare the result of the measurement against the minimum RDA (Recommended Daily Allowance), the minimum RDI (Recommended Daily Intake), the maximum UL (Upper Limit) as well as optimal recommendations from various sources.  At this time - there are no officially recognized optimal rates for consumption of Vitamin C for healthiness. We must rely on the best available sources - and not throw up our hands in resignation.

Each person must have the freedom to make their own decisions, and even adjust their own goals, based on information available from multiple sources.  It will be valuable to compare analysis using different sources of target goals.

Presentation of Results

Analysis of the results of a series of healthiness measurements will require sophisticated techniques, that change as we learn more about healthiness.  It is essential that healthiness measurements be stored in a computer system so that they can easily be brought forward and re-analyzed as theory develops.  Let's look at a hypothetical subject: Alice.

Alice has many aspects of her healthiness measured today, and scores calculated for each layer in the HH (Hierarchy of Health). The measurements - are clearly defined. The calculated scores are based on current knowledge about healthiness.

In two years, Alice might have her healthiness tested again. There may be more measurements taken, and some might be no longer considered relevant - therefore not measured. The scoring algorithm will have changed as well. Over time, our knowledge about healthiness will change - but the measurements made today are historical and do not change.

When Alice receives her results, two years from today she will receive a fresh analysis of her healthiness at each level in the hierarchy - and an overall healthiness result.

She will also want to have a comparison of her new results with today's results - based on the new analysis model.  Of course the new model will may have different measurements - some new and possibly some missing.

An effective comparison must compare the measurements that are the same, and if possible extrapolate some measurements that are missing - and then prepare a comparative analysis based on the measurements that are common. This is clearly a job for a computer program - which will also evolve over time as we learn more about meta-healthiness.

Measurement of Healthiness - Current Status

It is clear that we do not measure healthiness in any comprehensive fashion today.  It may be a long time before we develop efficient and effective techniques to measure healthiness. We do have some individual measurements of healthiness, but even those are suspect and may be very poor quality. We have not yet analyzed any health measurements to determine if they are effective in measuring healthiness.

Health Freedom

I believe we might never have absolute answers about health and healthiness.  There will, and should always be, conflicting ideas and opinions.  Each individual must make their own decisions and must be free to make decisions affecting their healthiness. We have much room for our knowledge to grow.

yours in health, tracy
Personal Health Freedom

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Tracy is the author of two book about healthicine: