How Healthy Do You Think You Are?

Does your health largely depend on how healthy you think you are? Studies show that people who rate their health positively are far less likely to die than those who think they are unwell, even when results were adjusted for actual medical condition.

This factor (called “self-rated health,” or SRH) might be significant for people with diabetes. In a Swiss study of 8200 people, those who rated their health as “good” were 7–22% more likely to die over a 30-year period than those who called their health “excellent.” People who said their health was “fair” were 40% more likely to die than the “excellents.” People who thought their health was “poor” or “very poor” were up to 180% more likely to die.


Of course, people who call their health “very poor” probably have a reason for that. Critics of SRH studies say that people who rated their health as poor were picking up problems before their physicians did. But there may be more going on.

In the 70’s, the Swiss government surveyed residents of five towns about their health. One of the questions was a five-point rating of their health. The new study examined census records for the next 30 years to find out which of the survey subjects had died.

The statistics were adjusted for a variety of parameters, including nationality, educational level, marital status, smoking status, blood pressure, fasting blood glucose, medical history (diabetes, heart attack, stroke), and current medical treatment. Still, those rating their health as poor or very poor had far higher death rates. What did they know that their doctors didn’t? And how can we use this information to promote our own health?

The simplest explanation for the SRH/death rate connection is that people tend to know how healthy they are. If they think they’re sick, they are sick, no matter what the lab tests say.

But not always. Say you have two people who are in identical physical health, as far as any test can show. One rates their health as poor and the other rates theirs as good. Why? One person might be depressed, which is known to be unhealthy. Or one might be more stressed, or lonelier, or feel their life doesn’t make any sense.

A Swedish study published in Population Health Metrics in 2006 found that “SRH, self-esteem, social support, sleep quality and sense of coherence might be predictors of future SRH and therefore possibly also of various future health outcomes.”

“Sense of coherence” (SOC) is defined on PsychCentral as “‘The extent to which one has a pervasive…feeling of confidence that one’s environment is predictable and that things will work out as well as can reasonably be expected.’ In other words, it’s a mixture of optimism and control.” SOC is strongly associated with better health.

It’s easy to see how higher SRH, self-esteem, social support, sleep quality, and SOC could lead to better health. You might feel healthy enough to go for a hike instead of staying home, or confident enough to go into a social situation and make friends. If you value yourself (self-esteem), you might be motivated to check your blood glucose or take better care of yourself in general. So the connection might be that higher SRH leads to healthier ways of living.

Or it might be emotions — happiness is known to be associated with longevity, and depression with higher death rates.

So does thinking you are healthy actually promote health? The Swiss researchers think so: “Persons rating their health as ‘excellent’ may have an advantage over others,” they wrote, “not primarily because of absence of disease but because of a high satisfaction with their life…reporting ‘positive emotions’ was strongly and consistently associated with lower mortality after a follow-up of 28 years.” So even if you have a diagnosis like “diabetes,” with positive emotions you can still get the benefits of high SRH and live a long life.

If SRH is so healthy, how can you raise your SRH? Perhaps the key is to live as if you were healthy. Do the things healthy people do, even if you can’t do as much of them. If you plan for the future, socialize, move your body, eat in a healthy way without obsessing over every bite, your SRH will tend to go up. If you relax, if you manage and reduce stress, if you do things that make you happy, your SOC will go up, which improves SRH and probably health.

SRH may or may not be as effective as, say, metformin or insulin. But it’s free and has no side effects I can think of. What do you think? Where would you rate yourself? Do you think it makes any difference?

A couple of SRH notes:

• The protective effect of high SRH was stronger in men than in women. Women tended to stay closer to the middle in their ratings and not give so many “excellents” or “very poors.”

• Changes in SRH are a stronger predictor of mortality than baseline SRH. So if you’ve been rating “poor” for 30 years, you’re more likely to be OK than if you suddenly change from “good” to “poor.”

• Reporting your health status as “I don’t know” doesn’t get you off the hook. “I don’t know” was associated with higher mortality than in all the other groups except the “very poor.”

Happy New Year to everyone! If you haven’t read my blogs on fiber, please check them out here and here. I know it sounds boring, but it’s a different take on fiber than you’ve probably ever heard. Also, I’m collecting diagnosis stories here and would appreciate your story.

  • Ferne

    If I listened to the Chief of Endocrinology I would really rate low. He told me that being a diabetic was a downward spiral the rest of my life and he be I’d be on insulin in 6 months. Well, I didn’t listen to him and I’m in just as good health now as I was at least 5 years ago when he told me that. What we don’t need is the medical profession bringing us down. I’m an RN and almost 80 and have had diabetes since they chanaged the guidelines from 140 to 126. I’m doing fine and the medical problems I have are partly do to my age but in my mind I’m still young. At least I never have to see that doctor again but wonder if he is still putting down diabetics.

  • Susan Massad MD

    The SRH data is just one more confirmation of the socio-cultural nature of illness. In the office and other medical environments Diabetes is related to as an isolated, abstracted disease located in the individual and the numbers are the object of treatment. I applaud efforts like Ferne and others who are taking charge of their illness and environments that can make a difference in their own and their communities health.