make this bias the essence of what they are interested in. For example, mortality data
are taken from hospital records or death certificates, and morbidity ratings are often
made by the health professionals rather than the individuals being studied. However,
subjective health measures ask the individual for their own experiences and beliefs in
terms of ‘How do you rate your health?’ or ‘How do you feel?’ They make no pretence
to be objective and rather than attempting to exclude the individuals’ beliefs they make
them their focus.
Subjectivity of the researcher
In addition, there is also a shift in the ways in which measures of health status con-
ceptualize the researcher. For example, mortality and morbidity rates are assumed to be
consistent regardless of who collected them; the researcher is assumed to be an objective
person. Subjective measures, however, attempt to address the issue of researcher
subjectivity. For example, self-report questionnaires and the use of closed questions aim
to minimize researcher input. However, the questions being asked and the response
frames given are still chosen by the researcher. In contrast, the individual quality of life
scale (O’Boyle et al. 1992) in effect presents the subject with a blank sheet and asks them
to devise their own scale.
Definition of health
Finally, such shifts epitomize the different perspectives of biomedicine and health
psychology. Therefore, if health status is regarded as the presence or absence of death,
then mortality rates provide a suitable assessment tool. Death is a reliable outcome
variable and mortality is appropriately simple. If, however, health status is regarded as
more complex than this, more complex measures are needed. Morbidity rates account
for a continuum model of health and illness and facilitate the assessment of the greyer
areas, and even some morbidity measures accept the subjective nature of health. How-
ever, if health psychology regards health status as made up of a complex range of
factors that can only be both chosen and evaluated by the individuals themselves, then
it could be argued that it is only measures that ask the individuals themselves to rate
their own health which are fully in line with a health psychology model of what health
means.
USING QUALITY OF LIFE IN RESEARCH
Quality of life measures, in the form of subjective health measures and both simple and
composite scales, play a central role in many debates within health psychology, medical
sociology, primary care and clinical medicine. Most funded trials are now required to
include a measure of quality of life among their outcome variables, and interventions
that only focus on mortality are generally regarded as narrow and old-fashioned. How-
ever, a recent analysis of the literature suggested that the vast majority of published
trials still do not report data on quality of life (Sanders et al. 1998). For example,
MEASURING HEALTH STATUS 391