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Year : 2019  |  Volume : 11  |  Issue : 3  |  Page : 89-90
State of The Globe: Health-related quality of life as health status measure: Time to move on

Department of Community Medicine, Dr. RPGMC, Kangra, Himachal Pradesh, India

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Date of Web Publication26-Aug-2019

How to cite this article:
Raina SK. State of The Globe: Health-related quality of life as health status measure: Time to move on. J Global Infect Dis 2019;11:89-90

How to cite this URL:
Raina SK. State of The Globe: Health-related quality of life as health status measure: Time to move on. J Global Infect Dis [serial online] 2019 [cited 2023 Feb 1];11:89-90. Available from:

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity – Preamble to the Constitution of the World Health Organization (WHO), 1946.[1] Despite this definition being more than seven decades old, health across the world has conventionally been measured narrowly and from a deficit perspective. The most common indicators of measurement are measures of morbidity or mortality.

Over the past few years, however, the health system has started to recognize health as a multidimensional construct incorporating the core principles of WHO definition.[1] Guided probably by this idea as also because of better treatments of existing diseases and delayed mortality, the measurement of health outcomes has started to shift from lives saved to improving the quality of lives. Although this change is largely limited to clinical practice, the change is both welcome and perceptible.

The concept of quality of life (QOL) is a broad and multidimensional and is prone to subjective interpretations, which generally include both positive and negative aspects of life.[2] These subjective interpretations make it challenging to measure. Over the last few decades, researchers, however, have been able to develop techniques that help measure multiple domains of QOL as also understand their relationship with one another.

As the broader concepts of QOL spilled over into health, a concept of health-related QOL (HRQOL) started emerging. The HRQOL and its underlying concepts evolved since the 1980s. The idea was to encompass those aspects of overall QOL that can be clearly shown to affect health—either physical or mental.[3],[4],[5] The key concerns of HRQOL are to develop models bridging boundaries between social, mental, and medical services for the overall improvement in health. HRQOL involves both diseases and their risk factors.[3] Therefore, measuring HRQOL can help determine the burden of chronic diseases as well provide valuable new insights into the relationships between HRQOL and risk factors.

Tuberculosis (TB) remains a major public health. The WHO declared TB and HIV as one of the leading causes of death. Together these diseases killed almost 1.5 million people in 2014. Importantly, most of these deaths occurred in the developing world.[6] As with other diseases of chronic nature, the focus in TB care has been the clinical outcomes of therapy and microbiological cure. However, HRQOL among patients with TB has been a neglected area.

TB is known to interfere with physical, psychological, financial, and social well-being of an individual.[7] It adversely affects patients' ability to perform activities of daily life. However, more important than this is the individuals own perception about the impact of the TB on their daily activities and functioning. It is this aspect that generally reflects on the HRQOL. Limiting outcome evaluation in TB cure to clinical and microbiological cure only limits our understanding of how patients respond to TB treatment. It also prevents us for developing an understanding of the barriers working against large-scale TB-related interventions. The implication of this is there for all of us to reflect on. Therefore, it is important to evaluate HRQOL in patients in TB as this will help better plan patient-oriented TB intervention.

The WHO QOL-BREF questionnaire is specifically designed to capture physical capacity, psychological and social relationship, and environmental influences. Therefore, QOL-BREF questionnaire allows multidimensional understanding of HRQOL.[8] An article on assessment of health-related quality of life among tuberculosis patients in a public primary care facility in Indonesia is a clear illustration of the same.[9]

The flip side to assessment of HRQOL, however, stays and will continue to stay in clinical research and clinical practice, purely for its ease of assessment in these settings. The difficult part will be to take this to the public health. Unless this happens there will be little advancement in the use of HRQOL as a health status measure. Necessary political will, availability of adequate resources, big data, and policy researchers will be needed to advance its use as a health status measures among policymakers.

The current policy-making relies on available big data. These data lack HRQOL as a health status measure and predominantly includes morbidity and mortality data only. Therefore, studies focusing on collection of data that incorporate a broad spectrum of health outcomes (impairment, functional status, and perceptions) in addition to death will go a long way in building data related to health and QOL. This shift in data collection, how so ever, rudimentary will be effective in improving accessibility and quality of health care.

Therefore, probably, it is about time that researchers across the globe start collecting data using composite index, including QOL as a domain and policy-makers start using such index for planning public health interventions.

   References Top

Preamble to the Constitution of the World Health Organization as Adopted by the International Health Conference. Signed on 22 July 1946 by the Representatives of 61 States (Official Records of the World Health Organization, no 2, p. 100) and Entered into Force on 7 April 1948. New York; June, 1946. p. 19-22.  Back to cited text no. 1
The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL). Development and psychometric properties. Soc Sci Med 1998;46:1569-85.  Back to cited text no. 2
Centers for Disease Control and Prevention. Measuring Healthy Days: Population Assessment of Health-Related Quality Of Life. Atlanta, Georgia: Centers for Disease Control and Prevention; 2000.  Back to cited text no. 3
Gandek B, Sinclair SJ, Kosinski M, Ware JE Jr. Psychometric evaluation of the SF-36 health survey in Medicare managed care. Health Care Financ Rev 2004;25:5-25.  Back to cited text no. 4
Selim AJ, Rogers W, Fleishman JA, Qian SX, Fincke BG, Rothendler JA, et al. Updated U.S. Population standard for the veterans RAND 12-item health survey (VR-12). Qual Life Res 2009;18:43-52.  Back to cited text no. 5
World Health Organization. Global tuberculosis Report 2014; 2014. Available from: [Last accessed on 2018 Nov 09].  Back to cited text no. 6
World Health Organization. Global Tuberculosis Report 2015. Geneva: World Health Organization; 2015. Available from: [Last accessed on 2018 Nov 09].  Back to cited text no. 7
Skevington SM, Lotfy M, O'Connell KA, WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004;13:299-310.  Back to cited text no. 8
Sartika I, Insani WN, Abdulah R. Assessment of health-related quality of life among tuberculosis patients in a public primary care facility in Indonesia. J Global Infect Dis 2019;11:102-6.  Back to cited text no. 9
  [Full text]  

Correspondence Address:
Dr. Sunil Kumar Raina
Department of Community Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jgid.jgid_163_18

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