Self-Rated Health and Public Health: A Critical Perspective

IntroductIon Self-rated health (SRH) is a simple, easy to administer measure of general health. It is a valid and reliable measure among those without cognitive impairment. Initially, it replaced clinical assessments in survey research (1). It is commonly used in psychological research, clinical settings, and in general population surveys. SRH is typically measured as a single-item, the most common wording of which is “In general, would you say your health is” with the response items “excellent,” “very good,” “good,” “fair,” or “poor.” Early studies using SRH involved assessing the relationship between SRH with sociodemographic, physical health, and psychosocial variables (e.g., 2, 3). Additional uses of SRH involved investigating relationships between health constructs, sociodemographic, physical, and psychosocial variables, clarifying measurement issues, attempting to explain health and illness behavior, or describing populations’ health (e.g., 2–4). SRH was found to be at least moderately associated with physicians’ assessments of health (2, 4–8). SRH allows respondents to prioritize and evaluate different aspects of their health, maximizing the measure’s sensitivity to respondent views of health (9). SRH’s somewhat abstract nature also affords researchers the opportunity to examine the cognitive processes involved in evaluating self-health (9). A significant, independent effect of SRH on mortality has been demonstrated in numerous studies and diverse populations (10–12). Other health outcomes including chronic disease incidence, diabetes complications, physical and cognitive functional limitations, health services use, and clinical biomarkers have also been investigated (13–20). A large body of literature concerning SRH, its determinants, and its outcomes has accumulated from studies conducted throughout the world. Recently, public health researchers have begun to deploy SRH either implicitly or explicitly to gage individuals’ willingness to engage in behavior modification. This paper critically assesses the literature on SRH and health behaviors. It examines the theoretical and ethical utility of SRH as a tool in healthrelated behavior modification.