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A Definition of Health     

If life is a journey filled with wonderful opportunities and tremendous challenges, health can be defined as being able to getting the most enjoyment and fulfillment possible from the trip.  More specifically, that would mean being able to do the things that make life worth living for as long as possible, successfully meeting, learning, and growing from the challenges along the way, then dying peacefully having had the opportunity to reach  one's full potential as a human being.  Notice that by this definition, health is a verb, the slope of a multidimensional curve rather than a point somewhere on it.

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Goal-Oriented Health Care

Health care that supports the efforts of  each individual to clarify, pursue, and achieve their health-related goals. The most common health-related goal areas are:

1) Prevention of premature death and disability

2) Maintenance and enhancement of current quality of life

3) Optimization of personal growth and development

4) A good death. 

A foundational assumption of goal-directed health care is that the strategies derived from patient goals are likely to be more effective and efficient than those derived from problem-solving if the outcomes of interest are those that are meaningful to patients. 

Key Definitions:

  • Goal: A desired outcome that can stand on its own merits. That is, it makes little sense to ask, “so that ...?”

  • Objective: A measurable step along the path toward a goal.

  • Strategy: A way to reach the objectives and ultimately achieve a goal. [For example, my 90-year-old mother does balance and leg-strengthening exercises (strategy), in order to be able to walk safely without her walker (objective), so that she can go outside and take care of her plants (her goal).]

  • Obstacle: Anything that gets in the way of the achievement of a goal.

  • Challenge: An optimistic way to think about an obstacle.

  • Opportunity: An even more optimistic way to view an obstacle.

  • Threshold Principle: The idea that nearly all health challenges are the result of combinations of factors, and that, in each case, a threshold exists above which that combination of factors becomes a significant obstacle to achieving a health goal.

  • Prioritization: A ranking of strategies based upon their expected impact and feasibility.

  • Premature death: Death resulting from a potentially preventable cause.

  • Premature disability: Disability resulting from a potentially preventable cause.

  • Life expectancy: The number of additional years a person is expected to live.

  • Health expectancy: The number of additional years a person is expected to live free of disability.

  • Quality of Life: An assessment of how great it is to be alive based upon ones ability to participate in meaningful activities and relationships

  • Meaningful Life Activity: An activity that gives life joy, purpose, or meaning.

  • Optimal Growth and Development: 1) Achievement of major developmental tasks; 2) development of resilience, adaptability, and the ability handle challenges; and 3) acquisition of the skills required to help others.

  • A Good Death: A death that is 1) free from avoidable distress and suffering, for patients, family, and caregivers; 2) in general accord with the patients’ and families’ wishes; and 3) reasonably consistent with clinical, cultural, and ethical standards.

The original article proposing  goal-oriented health care, click here

Mold JW, Blake GH, and Becker LA. Goal-oriented medical care. Fam Med 1991, 23(1):46-51. 

(posted with permission from the Society of Teachers of Family Medicine).

A more recent article on goal-oriented health care that proposes a new definition of health that supports a goal-oriented approach to care, click here.

Mold JW. Goal-directed health care: Redefining health and health care in the era of value-based care. Cureus 2017 (Open Access)

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