We speak of health
as if it were a single thing.
A metric.
A number.
A checkbox marked “good” or “bad.”
But health is not one shape.
It is a shifting sky.
It is how we move through the world,
yes—
but also how the world moves through us.
And when we try to measure health utility—
to decide how much one health state is worth,
how desirable or bearable or meaningful it is—
we are not just measuring function.
We are measuring life itself,
as it is felt.
The Body Is Only the Beginning
When we think of health,
we often begin with the body.
Can you walk?
Can you see?
Can you breathe with ease?
But what counts in health utility
is more than physical capacity.
It is:
- Pain — not just if it exists, but how it endures.
- Fatigue — the kind that erases possibility before the day begins.
- Dependence — on machines, on people, on systems.
- Mobility — not just distance, but freedom.
- Function — not just doing, but being able to do what matters.
And yet, even this isn’t enough.
Because what counts
is not just what the body can do,
but how the person inside the body experiences it.
The Quiet Dimensions of Experience
What also counts—often invisibly—is:
- Emotional distress
The weight of anxiety, the fog of depression,
the ache of being seen only as a patient. - Social participation
Can I meet friends?
Can I work, laugh, belong? - Dignity
Am I still treated as whole? - Meaning
Can I still feel that my life, in this state,
is mine to live?
These dimensions do not live in lab results.
But they live in us.
And when we ignore them,
we measure health as survival—
but not as life.
Whose Experience Counts?
And then the question deepens:
Whose voice defines health utility?
- The clinician’s?
- The researcher’s?
- The patient’s?
Do we trust the healthy to imagine what it’s like to live with illness?
Or do we trust those who have lived inside the storm,
who have adapted,
and sometimes even thrived in what once looked unbearable?
Because what counts in health utility
must begin with perspective—
and end with compassion.
Otherwise, we risk building systems
that treat people as data points,
not as lives being lived.
A Closing Reflection
If you are ever asked—explicitly or silently—
to measure the worth of a health condition,
pause.
Ask:
- Am I counting only what can be seen?
- Am I considering how this person still finds joy, or connection, or meaning?
- What would I want counted,
if it were my life on the line?
Because health is not just the absence of illness.
It is the presence of possibility.
Of dignity.
Of agency.
And what counts in health utility
is not just the cost to treat—
but the life that remains,
and how fully it can still be lived.
And in the end, what counts in health utility reminds us
that value is never just about function.
It is about the full human experience.
The body, yes—
but also the heart.
The spirit.
The relationships and the rituals,
the ordinary pleasures and personal freedoms
that make a day more than just endurable—
but worthwhile.
And when we measure with that in mind,
we do not just plan care.
We honor lives.