Tell me how you are -- and I know how long you will live

The way people rate their health determines their probability of survival in the following decades. Researchers from the Institute of Social and Preventive Medicine at the University of Zurich demonstrate that for ratings ranging from "excellent," "good," "fair," and "poor" to "very poor," the risk of mortality increases steadily – independently of such known risk factors as smoking, low education levels or pre-existing diseases.

How would you rate your health? This is a question that often appears on questionnaires. The answer is linked to the respondent's probability of survival or death. Needless to say, a pessimistic assessment goes hand in hand with an increased risk of illness or death. It can be assumed that on average people who rate their health as poor have an unhealthier lifestyle, are often in a fragile state of health or are already sick. However, earlier studies that only monitored the participants for a few years after the survey reveal that the correlation persists even if these factors are taken into account.

Self-rating more permanent ...

Now, researchers from the Institute of Social and Preventive Medicine at the University of Zurich demonstrate that self-rated health is also linked to the probability of survival or death over a long period of more than thirty years. In the study, which was conducted in Switzerland, men who rated their health as "very poor" were 3.3 times more likely to die than men of the same age who rated their health as "excellent", and the risk of death was 1.9 times higher in women who rated their health as "very poor" than for those who rated it as "excellent". Here, the risk increased steadily from an optimistic to a pessimistic rating: people in "excellent" health had better chances of survival than those in "good" health, the latter better chances than those in a "fair" state of health, and so on. "The steady increase in risk and the long time of over thirty years between the self-rating and the end of the observation period render it practically impossible for medical history or a dark foreboding to be main causes of the correlation observed," explains head of the study Matthias Bopp.

... risk factors taken into consideration

Even taking education levels, marital status, tobacco-related strains, medical history, the use of medication, blood pressure and blood glucose into account, the correlation between self-rated health and mortality only weakened marginally. The difference in the risk of death between the best and the worst rating was still 1:2.9 in men and 1:1.5 in women. "Our results indicate that people who rate their state of health as excellent have attributes that improve and sustain their health," concludes specialist in preventive medicine David Fäh. "These might include a positive attitude, an optimistic outlook and a fundamental level of satisfaction with one's own life."

The results of the study support the broad concept of health advocated by the World Health Organization not as the absence of disease, but rather as complete physical, mental and social wellbeing. "Good doctors should therefore not just look for the presence of risk factors or diseases, but also check which health resources their patients have and boost and consolidate them if need be," says David Fäh.