“Self-perceived health” is a measure used frequently in health studies. When a simple question such as "How is your health now?" is asked, an overall assessment of health, both mental and physical health is obtained. Meanwhile, those who respond will assess and compare their health with that of their peers.
How a person assesses their own health gives good information about use of the health services, future morbidity and mortality.
- Those who perceive their health to be good live longer than those who perceive it to be bad.
- Adults who perceive their health as bad have higher health care utilisation than those who consider that their health is good.
- Unemployed people of both sexes report their health as worse than people who are in work.
8 of 10 adults have good self-perceived health
Health and living conditions studies are conducted by Statistics Norway every three years. In 1985, 1995, 1998, 2002, 2005, 2008 and 2012 the following question about an individual’s health was asked by personal interview; "How do you assess your own health in general. Would you say that it is; very good, good, fair, bad or very bad?"
Approximately 80 per cent of adults who participate in health and living conditions studies assess their health as good or very good. Figure 1 shows that the proportion is slightly higher among men than women, but the differences are small. The proportion reporting bad / very bad health is about 5 per cent. See Figure 2
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|Figure 1. Proportion with good or very good health (top) and the proportion with bad / very bad health (bottom). Women and men from 16 years. Per cent. The figure is interactive.
Source: Living conditions studies on health care and social contact 2002-2008, Statistics Norway.
Two out of three elderly people have good self-perceived health
Among people over 75 years of age, approximately 65 per cent consider their health to be good / very good. Those who are in institutions (hospitals, nursing homes, prisons, etc.) are not interviewed in the health and living conditions studies. The results apply to older people living at home.
8 of 10 children and adolescents have good self-perceived health
Self-perceived health is also a good measure of adolescent well-being. In Norway, there are two types of studies. The Norwegian Institute of Public Health has conducted health studies in secondary schools (10th graders) in several counties, including Oslo (Oslo Health Study-youth part). Every fourth year, the HEMIL Centre in Bergen, Norway conducts the Norwegian part of a health habit study among 11, 13 and 15 year-olds (HEVAS) as directed by WHO.
About nine out of ten secondary school students in the 10th grade perceive that their health is good or very good. This is shown in the Oslo Health Study – youth part in 2000-2001. A higher proportion of the youngest students (11 year-olds) perceived their health as "very good" compared with older pupils, according to results from the HEVAS study.
Only one per cent of 10th graders (15-16 years old) assess their health as very bad. In addition, 8 per cent of boys and 15 per cent of girls perceived their health as "not very good."
Small gender differences
There is a slight difference between young boys and girls, fewer girls perceive their health as good / very good compared to boys. In particular, the gender difference is evident in the proportion that considers their health as very good; 40 per cent of boys compared with 27 per cent of girls (Oslo Health Study – youth part). There is also a gender difference in the proportion who says they "do not have very good" health; more girls than boys reported this, particularly in the two oldest age groups (HEVAS).
These gender differences increase with increasing age, and may to some extent be explained by different understanding of the concept of health. It can also be considered as being less tough for boys than for girls to report that they are not in very good health.
It is important to take the girls' assessment of their own health seriously. A study among Swedish adolescents showed that about one third of those who experienced their health as bad had considered suicide. In comparison, only about one tenth of teenagers who experienced their health as good had considered the same.
Economics and physical activity are important
Those who are most physically active often perceive that their health is "very good." The least physically active more often report their health as "not very good" according to results from the HEVAS study (Ref. Nesheim and Haugland 2003).
Adolescents with plans for general upper secondary or higher education more often consider their own health as good / excellent than adolescents with plans for vocational education. The differences are greater for girls than for boys (Figure 3).
Adolescents from families with "bad economy in relation to other families in Norway" more often report self-assessed bad health than adolescents from families with good economy (Grøtvedt 2002).
Assessment of own health is similar in young adults as in adolescents.
International comparisons are difficult to interpret in terms of self-assessed health, because cultural differences are involved in determining how people respond.
In Europe, studies suggest that self-perceived health is better in the West than the East. Two studies support this:
- People from former communist states had worse self-perceived health than people from Western countries. People from Denmark, Ireland, Sweden and Switzerland had the highest average scores for self-perceived health (Carlson 1998).
- A comparison between 21 countries shows that people in England, Ireland and the Nordic countries had the highest average scores for self-perceived health. People from Eastern Europe had the lowest average score. The UK, Ireland, the four Nordic countries, 11 countries from Central and Southern Europe and four countries from Eastern Europe took part (Olsen 2007).
- Carlson P. Self-perceived health in east and west Europe: Another European health divide. Social Science & Med 1998; 46: 1355-66.
- Fosse NE. Haas SA. Validity and stability of self-reported health among adolescents in a longitudinal, nationally representative study. Pediatrics2009; 123: 496-501.
- Fylkesnes K. Determinants of health care utilisation – visits and referrals. Scand J Soc Med1993;21:40-50.
- Grøtvedt L. Health Profile for Oslo, Adults (pdf). NIPH 2002. See summary: Health Profile for Oslo - youth, adults and older (in Norwegian only)
- Heistaro S, Jousilahti P, Lahelma E, Puska P. Self-rated health and mortality: A long term prospective study in eastern Finland. J Epidemiol Community Health 2001; 55: 227-32.
- Kaplan G, Barell V, Lusky A. Subjective state of health and survival in elderly adults. J Gerontol 1998; 43:114-20.
- Kaplan G, Camacho T Perceived health and mortality: a nine year follow-up of the Human Population Laboratory cohort. Am J of Epidemiology 1983; 117:292-8.
- Kaplan G, Goldberg D, Everson S, Cohen R, Salonen R, Tuomilehto J, Salonen J. Perceived health status and morbidity and mortality: evidence from the Kuopio ischaemic heart disease risk factor study. Int J Epidemiol 1996; 25:259-65.
- Kelly K, Ehrvehr M, Erneholm T, Gundevall C, Wennerberg I, Wettergren L. Self-reported health status and use of medical care by 3500 adolescents in Western Sweden. Acta Paediatr Scand 1991; 80: 837-43.
- Nesheim T, Haugland S. Physical activity and perceived health among Norwegian 11-15-year-olds. Tidsskr Nor Lægerforen 2003; 123: 772-4 (in Norwegian only).
- Olsen KM, Dahl S-Å, Health differences between European countries. Social Science & Med 2007; 64: 1665-78.
- Roos E, Lahelma E, Saastamoinen P, Elstad JI. The association of employment status and family status with health among women and men in four Nordic countries. Scandinavian Journal of Public Health 2005; 33: 250-60.
- Schou M., Krokstad S., Westin S. What significance does self-perceived health have for mortality? Tidsskr Nor Laegeforen 2006; 126:2644-7 (in Norwegian only).
- Zimmer Z et al 2000 A cross-national examination of the determinants of self-addressed health. J. Health and Social Behavior 41: 465-481