Classification of Consequences of Disease and Health Care Planning and Evaluation

In a preliminary report to the WHO Study Group on the Measurement of Levels of Health/ Sir Andrew Davidson, a WHO consultant, stated, 'The whole problem (of measurement of health levels) obviously bristles with difficulties, appears almost insoluble and fully justifies the comment of the Secretary-General of the United Nations Organization . . . "a most difficult and challenging problem".' If measurement of health levels is difficult, as undoubtedly it is, the measurement of the consequences of disease is certainly no less so. The WHO is, therefore, to be congratulated for undertaking the almost impossible task of publishing, on a trial basis, the International Classification of Impairments, Disabilities and Handicaps (ICIDH). There is no knowing at this time if the ICIDH, or a revised version of it, will ever enjoy the currency and stature of the now authoritative International Classification of Diseases (ICD). But one thing is certain, and that is, the ICIDH will serve as a stimulant to the health care community for a profound rethinking of the problems of health and disease that hopefully will lead to some needed changes in the structure and complexion of health care as we know it today. Traditionally, health care, particularly medical care in the narrower sense of the term, has been disease-oriented rather than health-oriented. Even in developed countries where the impact of infectious and many other types of diseases on health has been reduced practically to zero, the typical health practitioner still treats diseases instead of people as individual persons. This emphasis on diseases, rather than people, as the authors of the ICIDH note, is no longer adequate because the majority of the people with health problems are not sufferers from aetiologically-known and treatable diseases. Rather, as life expectancies continue to rise, more and more people are suffering from such things as arteriosclerosis, arthritis and other degenerative conditions for which biomedical research has yet to produce a cure. It thus behoves the health care community to re-assess its role and perhaps modify both its attitude and its practices to meet human needs. The ICIDH may be just the catalyst to start the processes of change. New Approaches to Care In the past few years many thinking scientists of the health care community have become disaffected with traditional health care practices and have initiated actions to change them. The emergence of what is known as behavioural medicine is a notable example. The main thrust of behavioural medicine is the marshalling and integration of biological, social science and behavioural knowledge to get a patient well. Whether or not this branch of medicine, which focuses on persons and behaviour, will become accepted by the health care community and the people it serves remains to be seen. It can be said at this time that if behavioural medicine will make a contribution to health care it will be because of its commitment to the resolution of health problems whether or not their aetiologies are known.