Taking Health Economics and Outcomes Research Forward: Expanding the Definition of Value to Include Whole Health

ISPOR’s Strategic Plan 2030 includes a new vision for healthcare decision making. The new vision conceptualizes health as a multifaceted construct that transcends the physical dimension of health to include economic, social, and spiritual dimensions. A multifaceted view of health is not new. For several decades, notions of a holistic approach to health have been proposed including salutogenesis,1 patient-centered care, person-centered care, integrated care, and population health. Notably, in 1984, the World Health Organization revisited and updated its definition of health, shifting it from a desirable state of being to a dynamic set of resources for living well—”the extent to which an individual or group is able to realize aspirations and satisfy needs to change or cope with the environment… health is a resource for everyday life, not the objective”—that emphasized the social and personal resources, as well as physical capabilities that are a part of health.2 With this expanded definition of health in mind, ISPOR’s vision of “a world in which healthcare is accessible, effective, efficient, and affordable for all”3 has novel implications for healthcare and health economics and outcomes research (HEOR). Excellence in HEOR and evidence generation will require more attention to a broader range of health factors. Equally, the strategy calls on ISPOR to expand the definition of value in health to explicitly include whole health. For too long, the scientists involved in healthcare evidence generation have taken a rather narrow view of value in assessing healthcare interventions, often focusing on a limited set of outcomes and costs. Moving forward, ISPOR will lead the evolution of HEOR methods and their applications to support the use of a broader and more representative notion of health—one that is consistent with the whole health paradigm-to define value. In this article, we summarize definitions of whole health, articulate the reasoning for its inclusion in ISPOR’s Strategic Plan, and outline the implications of adopting this definition for the field of HEOR.