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Abstract
The association of self-rated health with mortality is well established but poorly
understood. This paper provides new insights into self-rated health that help integrate
information from different disciplines, both social and biological, into one unified
conceptual framework. It proposes, first, a model describing the health assessment
process to show how self-rated health can reflect the states of the human body and
mind. Here, an analytic distinction is made between the different types of information
on which people base their health assessments and the contextual frameworks in which
this information is evaluated and summarized. The model helps us understand why self-ratings
of health may be modified by age or culture, but still be a valid measure of health
status. Second, based on the proposed model, the paper examines the association of
self-rated health with mortality. The key question is, what do people know and how
do they know what they know that makes self-rated health such an inclusive and universal
predictor of the most absolute biological event, death. The focus is on the social
and biological pathways that mediate information from the human organism to individual
consciousness, thus incorporating that information into self-ratings of health. A
unique source of information is provided by the bodily sensations that are directly
available only to the individual him- or herself. According to recent findings in
human biology, these sensations may reflect important physiological dysregulations,
such as inflammatory processes. Third, the paper discusses the advantages and limitations
of self-rated health as a measure of health in research and clinical practice. Future
research should investigate both the logics that govern people's reasoning about their
health and the physiological processes that underlie bodily feelings and sensations.
Self-rated health lies at the cross-roads of culture and biology, therefore a collaborative
effort between different disciplines can only improve our understanding of this key
measure of health status.