Morbidity and mortality have long been the World Health Organization’s (WHO) two indicators of global human health, tracking acute illness and deaths as they fluctuate. While following these metrics is crucial to supporting populations, it doesn’t cater to anything other than illness. Health can be measured in various dimensions.
Now, a secret third option called human functioning shifts focus away from death and illness and to everyday living and how any one person can live their best life.
A paper published on May 31 in the journal Frontiers in Science by researchers from the University of Lucerne in Switzerland explains how human functioning could be the x-factor missing from public health.
What is human functioning?
Researchers define human functioning as the intersection of someone’s capabilities and environment. It begs questions about what someone’s body is able to do, what tools that person needs, and whether those tools integrate smoothly with that person’s environment. While functioning looks at a single person’s capabilities, it also focuses on the accessibility of their surroundings; are those surroundings accessible to the tools everyone needs in order to function?
For example, someone with a spinal cord injury may not be able to walk. An electric wheelchair can be the tool that helps equip this person with the capacity to move. While that tool restores their mobility, this method also reckons with the environment around them. If their environment doesn’t accommodate electric wheelchairs, then this person’s functioning is mitigated by factors that have nothing to do with their own health and abilities. If someone’s environment hinders the use of their tools, like a wheelchair or a hearing aid, then the environment compromises their well-being.
Human functioning is crucial to well-being, the authors argue, and too often, well-being becomes synonymous with markers of physical health. It leaves out how many different systems interact with each other.
“In healthcare, the typical definition of health is always physical health, but functioning shows that very often what matters to people is what they can do with their health,” says co-author Sara Rubinelli, a professor of health sciences at the University of Lucerne. The focus, she says, switches from what qualities someone has to what those qualities enable them to do.
Where did this idea come from?
While the notion of accessibility is nothing new, Rubinelli says this formal idea of human functioning originates from the International Classification of Functioning, Disability and Health (ICF), which is the WHO’s framework for measuring health and disability. The ICF originated in 2002 with the paper’s co-author Jerome Bickenbock, a professor emeritus of bioethics philosophy at Queen’s University, among its developers.
How does this change healthcare?
Bringing functioning into the fold adds common terminology among healthcare providers, Rubinelli says. This framework intends to unify what she sees as a fragmented healthcare system within a patient-centered mission.
In other words, health isn’t only cholesterol levels and vision scores; it’s how those data translate into abilities and experiences.
“With functioning, you ask the person, ‘What would you like to do? What's your objective?’” Healthcare, she says, becomes not only about alleviating illness and symptoms but productively integrating more people within their environments.
On a larger scale, the authors argue that incorporating human functioning can better support the United Nations’ third Sustainable Development Goal: health and well-being. Employed successfully, human functioning can be an avenue to human flourishing, Rubinelli says.
