The World Health Organization has been at the forefront of developing this new concept of ‘human functioning’, as well as an assessment framework to capture the multi-dimensional nature of our everyday health experience.

“Despite its great promise, this new tool has not been implemented widely in healthcare and policy,” said Prof Gerold Stucki, a senior member of a research team at Swiss Paraplegic Research and the University of Lucerne, Switzerland. “Our team’s goal is to make it happen.”

In their article published in Frontiers in Science, Prof Stucki and colleagues unveil an innovative framework for integrating the assessment and treatment of functioning into health and social systems.

“We believe this approach can profoundly change health practice, education, research and policy,” added Prof Jerome Bickenbach.  

Human functioning augments the traditional biomedical approach by adding the ‘lived health’ dimension. This aspect of health reflects individuals’ capacity to engage in a range of activities, from eating independently to socialising and working. Since our biological and lived health are intertwined, it’s argued that this approach provides a more complete understanding of human health.

Mobility impairments are a clear example of why an assessment of functioning is important. A disabled person may have poor lived health in a physical environment that is not accessible. But their functioning can be enhanced through assistive devices and changes to the built environment.

“Functioning also clarifies how our health is linked to our wellbeing,” Prof Sara Rubinelli explained. “It isn’t just about the absence of disease, injury, or other physical issues, but also the ability to take part in daily life and achieve personal goals. Nurturing individual wellbeing on a large scale could truly transform our society, ultimately enhancing societal welfare.”

Complementing morbidity and mortality

To achieve this vision, the team developed a multipronged strategy for implementing standardised assessment of functioning into health and social systems. The first step is to recognise functioning as the third major health indicator.

“Morbidity and mortality are the two main indicators currently used to assess population health and the efficacy of policies and interventions,” said Cristiana Baffone.

“While this strategy has brought us enormous benefits, it doesn’t encompass lived health. Recognising functioning as the third main indictor will bridge this gap. Once we begin systematically collecting functioning data, we can use it to inform and guide public policy.”

The article explains that this approach can also advance the UN’s third Sustainable Development Goal (SDG3): ‘to ensure healthy lives and promote wellbeing for all’. Although SDG3 targets both health and wellbeing, its progress is assessed using mortality and morbidity data. Systematically tracking and analysing human functioning data across populations can guide efforts to achieve the full vision of SDG3, the authors add.

Human functioning sciences

Integrating functioning into healthcare is a complex process requiring significant investment and involvement from healthcare providers, policymakers, and the public. One major issue raised by the authors is a general lack of awareness about the extensive potential benefits of this approach, which they suggest could be tackled through effective communication campaigns. They also highlight the need for a new generation of researchers, healthcare professionals and policy entrepreneurs to form a ‘human functioning’ workforce.

“We can facilitate this step by establishing a new scientific field called ‘human functioning sciences’,” Stucki explained. “This field will integrate distinct disciplines to deepen our understanding of health and guide research, healthcare and policy.”

Rehabilitation is one example of a discipline where human functioning has already been well-integrated, helping to define guidelines and driving technical developments.  

“Rehabilitation is an evolving success story that can help guide us through the ‘functioning revolution’,” concluded Bickenbach. “While we’re well on our way to resolving methodological challenges, large-scale implementation is still in its infancy. Societal economic investment is essential for realising the promise of human functioning.”