Health, Functioning, and Well-being: Individual and Societal

Published:March 26, 2019DOI:


      As a society we invest an enormous amount of resources in health because we are convinced that health is linked in some way to a person’s well-being, and that population health is linked to overall societal welfare. But the nature of this link, and the evidence for it, are more controversial. After exploring current attempts to operationalize well-being in a manner amenable to measurement, in this article we offer a way for securing the link between the provision of health care and individual well-being, and societal welfare by highlighting what matters to people about their health. We argue that it is the lived experience of health and its effect on daily life that matters. This experience is captured by the notion of functioning in the World Health Organization’s International Classification of Functioning, Disability and Health. Moreover, viewed as an indicator of health on par with mortality and morbidity, functioning provides the essential bridge that links the provision of health care both to individual well-being and, at the population level, societal welfare.


      List of abbreviations:

      ICF (International Classification of Functioning, Disability, and Health), WHO (World Health Organization)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        Constitution of the World Health Organization.
        (Available at:) (Accessed May 16, 2019)
        • Organization for Economic Co-operation and Development
        Better life initiative; compendium of OECD well-being indicators.
        (Available at:) (Accessed May 16, 2019)
        • Organization for Economic Co-operation and Development
        How’s life? Measuring well-being.
        (Available at:) (Accessed May 16, 2019)
        • United Nations Development Programme
        Human Development Index.
        (Available at:) (Accessed May 16, 2019)
        • United Nations Development Programme
        Millennium Development Goals.
        (Available at:) (Accessed May 16, 2019)
        • United Nations
        Sustainable Development Goals.
        (Available at:) (Accessed May 16, 2019)
        • Parfit D.
        Reasons and persons.
        Oxford University Press, New York1984
        • Diener E.
        Subjective well-being: the science of happiness and a proposal for a national index.
        Amer Psych. 2000; 55: 34-43
        • Ryff C.D.
        • Singer B.H.
        Psychological well-being: meaning, measurement, and implications for psychotherapy research.
        Psychother Psychosom. 1996; 65: 14-23
        • Sen A.
        Well-being, agency and freedom: the Dewey lectures 1984.
        J Phil. 1985; 82: 169-221
        • Sen A.
        Development as freedom.
        Oxford University Press, New York1999
        • Nussbaum M.
        Human functioning and social justice: in defense of Aristotelian essentialism.
        Pol Theory. 1992; 20: 202-246
        • Nussbaum M.
        Creating capabilities.
        Harvard University Press, Cambridge2011
        • Venkatapuram S.
        Health justice: an argument from the capabilities approach.
        Polity Press, Cambridge2011
        • Rugar J.P.
        Health and social justice.
        Oxford University Press, New York2009
        • Daniels N.
        Just health.
        Harvard University Press, Cambridge2009
        • Office of Disease Prevention and Health Promotion
        Health related quality of life and well-being.
        (Available at:) (Accessed May 16, 2019)
      1. Healthy People 2020. Foundation health measure report. Health-related quality of life and well-being. November 2010. Available at Accessed June 17, 2019.

        • Jadad A.R.
        • O'Grady L.
        How should health be defined?.
        BMJ. 2008; 337: a2900
        • Salomon J.
        • Mathers C.
        • Chatterji S.
        • et al.
        Quantifying individual levels of health: definitions, concepts, and measurement issues.
        in: Murray C.J. Evans Murray C.J. Evans D.B. Health systems performance assessment: debates, methods and empiricism. World Health Organization, Geneva2003: 301-318
        • Stucki G.
        • Bickenbach J.
        • Melvin J.
        Strengthening rehabilitation in health systems worldwide by integrating information on functioning in national health information systems.
        Am J Phys Med Rehabil. 2017; 96: 677-681
        • World Health Organization
        World report on ageing and health.
        World Health Organization, Geneva, Switzerland2015
        • World Health Organization
        Declaration of Alma-Ata.
        (Available at:) (Accessed May 16, 2019)
        • World Health Organization
        Universal health coverage (UHC).
        (Available at:) (Accessed May 16, 2019)
        • Stucki G.
        • Bickenbach J.
        • Gutenbrunner C.
        • Melvin J.
        Rehabilitation: the health strategy of the 21st century.
        J Rehabil Med. 2018; 50: 309-316
        • World Health Organization
        (Available at:) (Accessed May 16, 2019)
        • Stucki G.
        • Boonen A.
        • Tugwell P.
        • Cieza A.
        • Boers M.
        The World Health Organization International Classification of Functioning, Disability and Health: a conceptual model and interface for the OMERACT process.
        J Rheumatol. 2007; 34: 600-606
        • Stucki G.
        • Bickenbach J.
        Functioning—the third health indicator in the health system and the key indicator for rehabilitation.
        Eur J Phys Rehabil Med. 2017; 53: 134-138
        • Stucki G.
        • Zampolini M.
        • Juocevicius A.
        • Negrini S.
        • Christodoulou N.
        Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine.
        Eur J Phys Rehabil Med. 2017; 53: 299-307