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R11: Quality of Life

Framework Component

Population Results - Trends and Reductions in Disparities

Indicator Description

Changes in population behaviors that reflect achievement of improved quality of life.

Background and Context

According to Healthy People 2020, "Health-related quality of life (HRQOL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning." The concept of HRQOL was first introduced in the 1980s but is a relatively new objective for monitoring the population's health in Healthy People 2020. According to CDC, self-assessments of health status can be just as powerful as other objective measures of health.

Healthy People 2020 has set a pair of objectives for HRQOL:

  • Increase the percentage of adults who self-report good or better physical health to 79.8 percent
  • Increase the percentage of adults who self-report good or better mental health to 80.1 percent

Outcome Measures

What to Measure

The preferred measure is the CDC's "Healthy Days Measures," which includes the following questions:

  • Would you say that in general your health is excellent, very good, good, fair, or poor?
  • Now thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?
  • Now thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during the past 30 days was your mental health not good?
  • During the past 30 days, approximately how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

The CDC recommends using the following calculations:

Unhealthy days are an estimate of the overall number of days during the previous 30 days when the respondent felt that either his or her physical or mental health was not good. To obtain this estimate, responses to questions 2 and 3 are combined to calculate a summary index of overall unhealthy days, with a logical maximum of 30 unhealthy days. For example, a person who reports 4 physically unhealthy days and 2 mentally unhealthy days is assigned a value of 6 unhealthy days, and someone who reports 30 physically unhealthy days and 30 mentally unhealthy days is assigned the maximum of 30 unhealthy days. Healthy days are the positive complementary form of unhealthy days. Healthy days estimates the number of recent days when a person's physical and mental health was good (or better) and is calculated by subtracting the number of unhealthy days from 30 days.

While not every state, territory, or tribe administers the BRFSS, this survey represents the most definitive source on health at the state level. States or communities that do not administer the BRFSS could incorporate the aforementioned survey questions in their own locally administered health surveys. One area of potential confusion in R11 is that the survey was designed for telephone methodology. The nature of "healthy days" versus "unhealthy days" may require some explanation by a well-trained survey interviewer. Thus, if a SNAP-Ed program were to implement a paper and pencil or electronic survey, some additional explanation of these concepts may be necessary.

Other approaches to measuring quality of life in adults include the WHO (Five) Well-Being Index, a questionnaire that measures mental well-being in the previous 2 weeks. For youth aged 12-18 years, the Youth Quality of Life-Short Form Instrument (YQOL-SF) is a generic quality of life self-administered questionnaire. The tool is appropriate for surveillance in adolescent populations and can be added to ongoing school-based or other surveys.

Choose a survey that is appropriate for your population of interest, and conduct population-level assessments on an annual or biennial basis. Year one would become the baseline, and trends could be measured over time.


Adults and youth (ages 12-18)

Surveys and Data Collection Tools



Additional Resources or Supporting Citations

CDC Health-Related Quality of Life