A commentary on Marja Jylhä's “What is self-rated health and why does it predict mortality? Towards a unified conceptual model”(69:3, 2009, 307–316)

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Abstract

This is a commentary on Marja Jylhä's paper “What is self-rated health and why does it predict mortality? Toward a unified conceptual model” (2009) published recently in this journal. In this commentary we address two issues that we believe the paper raises. Firstly, we react to the theory proposed by Jylhä about how individuals form an assessment of their own health. Secondly, we discuss what we believe amounts to an existing confusion about what self-rated health can and should be considered to measure. We conclude that the cognitive process that Jylhä introduces in her paper should be expanded to include external and internal states that influence the process illogically and irrationally, as well as a long-term ongoing component reflecting that people are continuously presented with health-relevant information during their lives and continuously evaluate and change their assessment of health according to this information. Further, we conclude that self-rated health should best be viewed as a measure of people's perception of their health rather than a measure of true health.

Section snippets

The process of health assessment

How people assess their health can be understood as a cognitive process that consists of several stages. Jylhä suggests that the health assessment process can be broken down into the following three stages: 1) recognizing the meaning of health and indentifying the components that should be included as components of self health, 2) considering the way in which those components should be taken into account, and 3) deciding which of the levels in the presented scale best summarizes these

Self-rated health is a valid measure of what?

The part of the paper that discusses why self-rated health predicts mortality is enlightening and it is difficult not to reach the same conclusion as the author does: “I suggest that the advantage of global self-ratings comes partly from the fact that empirical studies are necessarily constrained in the range and number of health variables they can include, and partly from the individual's superior ability to employ, more or less consciously, subtle and even non-conceptualized sensations of his

Conclusion

In general, the paper about self-rated health by Marja Jylhä reflects great scholarship and many researchers will find it helpful for providing a theoretical basis for their hypotheses and analysis relating to self-rated health. In this commentary we have addressed two issues that we believe require further discussion. The first is the exact nature of the cognitive process that underlies people's assessment of health. The second is the attribute that self-rated health measures. Is it supposed

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    Most importantly, our goal is not to suggest that one or more of these different indicators of subjective health should always be used, but to help demonstrate the most appropriate use of and assumptions about these different variables when studying health in early life. Most contemporary research operationalizes SRH – and similar measures (e.g., self-perceived health) – as indicative of an individual's subjective overall health status, drawing on a large body of sociological, psychological, and epidemiological research that speaks to the difficulty of identifying a singular definition for “health” (Huisman and Deeg 2010; Jylhä 2009). Building from this research, our study defines “Subjective Overall Health” as a person's self-assessment of their physical, mental, and emotional well-being as a whole.

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