James S. Larson

The World Health Organization's definition of health: Social versus spiritual health

The World Health Organization formulated its definition of health following World War II, during a period when the social health of societies was in question. Since that definition in 1946, social scientists have dutifully followed its precepts and attempted to operationalize its concepts, including social well-being. But, American social scientists have found that psychosocial well-being may be a more accurate formulation of mental and social well-being, and they have questioned the reasonableness of a definition that requires complete health. It is proposed that scholars refine the WHO definition over the next several years, while at the same time creating bridges between a new conceptual definition and more detailed operational definitions. An expansion of the WHO definition may be necessary to include a spiritual dimension of health if social scientists can agree that spirituality is part of health and not merely an influence.

The measurement of social well-being

This paper provides a conceptual framework for viewing social well-being as composed of two elements: social adjustment and social support. Social adjustment is a combination of satisfaction with relationships, performance in social roles and adjustment to ones environment. Social support is composed of the number of contacts in ones social network and satisfaction with those contacts. Through the pioneering work of McDowell and Newell, comparative ratings of measures of social adjustment and social support are available. It appears that Weissmans Social Adjustment Scale and Sarasons Social Support Scale are currently the best measures in terms of validity and reliability. But, they are merely starting points for future measurement of these concepts.

An evaluation of provider educational needs in geriatric care.

Providers of geriatric care in Arkansas were surveyed to determine the desire for more information on their specialty as well as opportunities for further training. Those in the nursing profession were most interested in further training, and the major area of interest for all providers was in cognitive decline and mental health information. Specifically, information was sought in the areas of dementia, depression, and memory loss. It is recommended that improvement in geriatric care in the future should focus on nursing education and on raising the level of knowledge and academic prestige in the treatment of elderly patients, especially in the mental health areas.

The MOS 36-Item Short form Health Survey: A Conceptual Analysis

The SF-36 is a practical and widely-tested instrument for measuring health status and medical outcomes. This article is not a critique of the SF-36, rather, it underscores its viability as an instrument for measuring physical and mental health and well-being. The article is a conceptual analysis of the SF-36, from the viewpoint of four models of health: medical, World Health Organization, wellness, and environmental All four models suggest that the SF-36 be expanded to include other dimensions of health, especially mental and social. Specific dimensions to be included are: incidents of morbidity, satisfaction with quality of life, absence of mental disorders, social adjustment, social support, higher states offunctioning, and adjustment to the environment. The end result of the suggested additions would be an instrument with greater conceptual meaning, for use in medical outcomes studies or surveys of the general population.

Evaluating End-of-Life Care from the Perspective of the Patient’s Family

This article is written frompersonal experiences with the recent death of the authors’ mother. It highlights the problems the authors encountered, while acknowledging the positive aspects of treatment during a difficult time. The overall purpose is to improve end-of-life care by advancing policy through research, legislation, and education. The impetus for writing this article is personal experience, but its larger purpose is to address issues that many readers will face in the future and suggest possible reforms, especially in the area of education.

The weighting of an international health status index

The major purpose of this paper is to suggest possible weights for a global index of health status. The indicators for the global index are taken from the World Health Organizations definition of health as physical, mental and social well-being. These indicators are combined with mortality indicators to arrive at a finalized index. Survey methodology is used to make initial estimates of the weighting of appropriate indicators, based upon a sample of international health scholars. Preliminary results indicate that mortality is weighted 40%, physical health (morbidity and disability) 25%, mental health 15%, and social health 20%. These results are intended as a starting point for future research.

Two Scales for Measuring International Health Status.

This article develops two scales for measuring international health status, which are proposed as alternatives to the most popular current measure, the infant mortality rate. The first scale is derived from the Physical Quality of Life Index and is called Health Status I (HSI). It is an interval scale combining infant mortality, life expectancy, and the literacy rate. The second scale is called Health Status 2 (HS2), and is composed of HSI plus two other indicators -death rate for persons aged 65 and older and mental hospital admissions. The virtues of HSI and HS2 are discussed in relation to the current practice of using the infant mortality rate.

Knowledge of Aids Among Intravenous Drug Users Entering Prison

This article examines the knowledge and behavioral patterns of intravenous (IV) drug users as they relate to AIDS. The subsample (n=158) of IV drug users is taken from a larger sample (n=527) of inmates entering prison in Pine Bluff, Arkansas. Results indicate that entering inmates generally have a high level of knowledge concerning AIDS and its transmission, but have continued to engage in high risk behaviors, such as the sharing of needles, blood donations, and sexual relations with other IV drug users. Results also indicate that the best outlets of information on AIDS for IV drug users are radio, TV, pamphlets, and information accompanying the distribution of syringes.

International measures of comparative health care

Measures of health input and output are analysed for their advantages and disadvantages in assessing international health. Data from four countries are analysed using current international measures, then more refined indicators developed in the United States are discussed and related to the international indicators. An international health systems model is proposed using five indicators to measure overall system output.

Controlling the Growth of Federal Spending, 1954-1982: Did the 1974 Congressional Budget Reforms Help?

In 1974, Congress passed the Congressional Budget Control and Impoundment Act. Reformers expected the Act would aid Congress in containing the growth of federal spending. Did the reforms work-or were they just one more example of legislative reform without substantive impact? The analysis presented here suggests that in the pre-Reagan years, the rate of increase in federal spending was slowed. Whether this can be attributed directly to the reforms is less clear.