Taking Health Economics and Outcomes Research Forward: Expanding the Definition of Value to Include Whole Health
Abstract
ISPOR’s Strategic Plan 2030 includes a
new vision for healthcare decision making. The new vision conceptualizes
health as a multifaceted construct that transcends the physical
dimension of health to include economic, social, and spiritual
dimensions. A multifaceted view of health is not new. For several
decades, notions of a holistic approach to health have been proposed
including salutogenesis,1
patient-centered care, person-centered care, integrated care, and
population health. Notably, in 1984, the World Health Organization
revisited and updated its definition of health, shifting it from a
desirable state of being to a dynamic set of resources for living
well—”the extent to which an individual or group is able to realize
aspirations and satisfy needs to change or cope with the environment…
health is a resource for everyday life, not the objective”—that
emphasized the social and personal resources, as well as physical
capabilities that are a part of health.2
With
this expanded definition of health in mind, ISPOR’s vision of “a world
in which healthcare is accessible, effective, efficient, and affordable
for all”
3
has novel implications for healthcare and health economics and outcomes
research (HEOR). Excellence in HEOR and evidence generation will
require more attention to a broader range of health factors. Equally,
the strategy calls on ISPOR to expand the definition of value in health
to explicitly include whole health. For too long, the scientists
involved in healthcare evidence generation have taken a rather narrow
view of value in assessing healthcare interventions, often focusing on a
limited set of outcomes and costs. Moving forward, ISPOR will lead the
evolution of HEOR methods and their applications to support the use of a
broader and more representative notion of health—one that is consistent
with the whole health paradigm-to define value. In this article, we
summarize definitions of whole health, articulate the reasoning for its
inclusion in ISPOR’s Strategic Plan, and outline the implications of
adopting this definition for the field of HEOR.
Authors
Laura T. Pizzi
Robert M. Abbott
Eberechukwu Onukwugha