Chapter 20

Historic changes in population health and medical care within the United States (US) have stimulated interest in "health-related quality of life" (QOL). This term has been difficult to define precisely, but there is increasing agreement that "health-related QOL" refers to the degree to which valued aspects of a person's life have been influenced, positively or negatively, by health and/or health-related interventions such as medical care.

This chapter presents a comprehensive review of health-related QOL. Among the topics we discuss are: the social, political and economic forces that have contributed to the concept's emergence; important definitional and methodological developments; the constituencies, such as the pharmaceutical industry, which have emerged for information concerning health-related QOL; and the application of health-related QOL assessment to the patient care. Specifically, we examine why health-related QOL considerations and assessment methods have not become integrated with the care of patients with chronic or life-threatening illnesses and/or impairments. These are among the individuals who tend to be vulnerable to losses in health-related QOL and, conceivably, who may benefit most from increased health, illness and medical progress.