Positive health

The literature now also speaks of a ‘broad-based health approach’ or a ‘broad concept of health’. This is the umbrella term under which a variety of health concepts now fall, including positive health.

In practice we tend to focus on people’s complaints and health problems. Positive health, however, takes another perspective: namely, your capacity to adapt and to manage your responses to life’s social, physical and emotional challenges. It takes a broad view of health, along six dimensions: 1. bodily functions, 2. mental well-being, 3. meaningfulness, 4. quality of life, 5. participation, and 6. daily functioning.

Spider web model

By reference to these six dimensions a person can map their own condition and decide which of these dimensions they want to work on. The website of the Institute for Positive Health (IPH) explains how this works; it includes a tool explaining how to use the so-called spider web model to chart your own positive health.

By looking more broadly at health we are focusing on what a person can do. We are looking at what they deem important in order to feel healthy, and what they need to achieve this. This gives the person control over their own life. Positive health is also important for achieving desirable transfers in care. Health, rather than illness, has become the first principle in the Integrated Care Agreement and the Appropriate Care Framework of the National Health Care Institute.

We were present at the foundation of the development of the concept of positive health, having funded research by its founder, Machteld Huber. Together, we have continued to develop the concept, and continue to stimulate its discussion at the national and international level for policy, research, educational and practical purposes.

• We work with a broad approach to health, because research programmes can then contribute towards the necessary transformation of care: from illness and curing to health and prevention. It is therefore also an important pillar of what we call responsible programming.
   

  Societal relevance	Quality
  	Scientific quality	Integrity	Efficiency
  Stakeholder participation*	Methodological innovation	Transparency/openness of research/(pre)registration	Re-use of existing data / eResearch / Citizen science
  Co-funding*	Diversity in research content	Replication (research)	Stimulation of systematic reviews / knowledge syntheses
  Diversity of committee composition	Practice-oriented research (HBO, MBO)	Countering publication bias	Appropriate (alternative) designs
  Broad concept of health	Ground-breaking research	Training and quality control	Dealing with (potential) inclusion/operational problems
  Participative knowledge infrastructure	Interdisciplinary and international collaboration and knowledge development	Other functions / conflict of interests	Effective design of programme processes
  Added value of knowledge in practice, policy and/or education	Diversity/variety in assessment process
  	Variety in (transfer of) output*

  The Responsible Programming Assessment Framework, comprising indicators for the two principal criteria of ‘societal relevance’ and ‘quality’. Indicators with an asterisk (*) are forms of productive interaction.

• We have research evaluated and measured in terms of its contribution to health improvements in people. We also support it by ensuring that the correct methodology and outcome measures  are employed.
• We support the dissemination and application of good examples, e.g. using Knowledge vouchers.

• We stimulate the debate on positive health and offer a platform at national and international level for policy, research, educational and practical purposes.

More research is needed for this broader approach to health to be given a more solid basis. We have set up two lines of research support:

Creating more evidence through ongoing research

The inclusion of this approach into national basic health insurance cover will require hard evidence of its value. Much knowledge is being developed within ZonMw, but to generate impact this knowledge needs to be practically valuable. We therefore employ assessment criteria for the projects and programmes we support, in which positive health is an important indicator in meeting the criterion of societal relevance.

Giving more attention to methodology

To find out what transitions in care provision achieve, appropriate instruments are needed in order to evaluate health and the effects on health; in other words, besides the usual physical outcome measures and quality-of-life questionnaires, instruments are needed which take a broader view. A number of locations are working on the development of such instruments. For instance, we are funding a research project that uses a systematic, scientific and participative approach to develop a measuring instrument, or set of instruments, with which to carry out a broad-based health assessment for adults and vulnerable people. In this way, we are also supporting the use of appropriate methods and outcome measures. For more, read the article ‘JBZ vindt geen instrument om positieve gezondheid te meten’ in Skipr.

Measuring positive health is not straightforward and has been occupying minds for some time. There is considerable interest in the subject, and starting in 2020 we have facilitated a debate on it that began with a blog post by Caroline Terwee (Amsterdam UMC, VUmc location) that claimed it would actually be impossible to measure Positive Health. Machteld Huber and Marja van Vliet (IPH) are of the opinion that this would be possible, and the debate has generated many reactions. You can follow the discussion and take part in the debate here.

The broad approach to health has been adopted as the starting point of ZonMw’s new policy plan (2020-2024), with the aim of contributing towards a meaningful life.

The Living, Support and Care for the Elderly programme (Ondersteuning en Zorg voor Ouderen, Wozo), the Integrated Care Agreement (Integraal Zorgakkoord, IZA), the Appropriate Care Framework, the VWS’ Knowledge in Innovation Agenda (Kennis in Innovatieagenda, KIC) and the 2020-2024 national memorandum on public health (landelijke nota volksgezondheid, 2020-2024) also share this approach.

We support the ambitions of this policy; our programming and our project results contribute usefully to its realisation.

Education programmes, too, should reflect the transition taking place in healthcare. The starting point is not the existing supply of care professions and programmes, but the projected demand for care (Kaljouw & Van Vliet 2015, see also the following section). We support the plan to set up a network of secondary vocational, higher professional and university programmes for Positive Health in which to hammer out the issues with regard to curriculum, examination and experience. The 10th-year anniversary conference ‘Health as the ability to adapt and self-manage’, which was part-organised by ZonMw, included a workshop on this topic.

We have stimulated the development of many successful practical examples, a number of which have been included for inspirational purposes on the websites of iPH and Alles is Gezondheid, such as the iPH evaluation guide. ZonMw Knowledge vouchers have also contributed towards the dissemination of the underlying ideas.

The Institute for Positive Health has collected every game (some for adults, others for children) that can be played to find out more about positive health, and placed links to them online. A number of these games were developed by ZonMw.