New initiative seeks to improve health and well-being in the face of disease, injury and aging

The 'Lucerne Initiative for Functioning Health and Well-being' (LIFE) is seeking to improve health and well-being in the face of disease, injury and aging. To achieve this, it is raising awareness of the concept of 'functioning' developed by the World Health Organisation (WHO) as a new way of understanding health in society and rooting it as an indicator of health. A conference on this is taking place this week at the University of Lucerne.

Healthcare systems across the globe are facing huge challenges. Overcoming these requires a fundamental examination of the framework conditions for the healthcare systems of the future. This poses the question of how we can design our healthcare systems to ensure that they meet the needs of an aging population and people with chronic diseases as effectively as possible.

Optimizing functioning is a primary focus for such people, both on an individual level and for society as a whole. The healthcare strategies that will enable this are health promotion and rehabilitation.

Taking our 'lived health' into account

Functioning is a concept developed by the World Health Organisation (WHO) that covers both the 'biological health' and the 'lived health' of human beings. Lived health relates to all everyday activities such as 'self-management' and mobility, as well as participation in all areas of life including family, work, leisure time and sport. Unlike biological health, lived health interacts with a person's social and physical environment, which can have a positive or negative impact. For example, an accessible environment may mean that a person with limited mobility is still able to participate in all areas of life.

The WHO's concept of functioning is not yet widely known by the general public or in the health sciences. Furthermore, functioning is not yet rooted in the healthcare system as a measurement parameter for health, alongside morbidity (frequency of diseases in a social group) and mortality (frequency of deaths in a social group).

New dimension for healthcare information systems

The aim of LIFE is to make society aware of the concept of functioning and move from a two-dimensional healthcare information system to a three-dimensional one. This lays the foundations for reorienting the healthcare system to tap the potential of health promotion and rehabilitation. The University of Lucerne is thus seeking to make a key contribution to ensuring that the healthcare system of the future is effective, appropriate and viable.

Scientific fundamentals

The scientific fundamentals for implementing functioning as a third measurement parameter in healthcare information systems have been developed in recent years in conjunction with the WHO. One crucial element was a project under the National Research Programme 74 'Smarter Health Care', which enabled standardized recording of functioning data, for example as part of the national program for quality development in hospitals and clinics (ANQ).

Another vital contribution came from the research team under Prof. Gerold Stucki, initially at the Ludwig Maximilian University in Munich, and then since 2009 at the Faculty of Health Sciences and Medicine at the University of Lucerne and Swiss Paraplegic Research (SPF) in Nottwil. The paradigm shift required in healthcare was set out by the initiative's directors, Prof. Gerold Stucki and Prof. Sara Rubinelli, together with other authors in their 2023 publication 'The Human Functioning Revolution'.

First use of the concept for paraplegic research

For the first time anywhere in the world, the WHO concept of functioning was used by Swiss Paraplegic Research (SPF) in Nottwil as the basis for population studies in the field of spinal cord injury. An initial national population study was expanded to 42 countries in conjunction with the WHO. The results of these research endeavours form the foundations for making ongoing improvements to healthcare provision, and thus to the living conditions of people with spinal paralysis in Switzerland and around the world.

LIFE Forum

The initiative's first official event is the LIFE Forum on Rehabilitation, taking place at the University of Lucerne on 15 February. The forum is an opportunity for researchers, practicians and political decision-makers to come together and examine the WHO resolution to 'Strengthen Rehabilitation in Health Systems' and address what this means for Switzerland. February 2024 will also see the University of Lucerne hosting an international workshop in cooperation with the National Academy of Medicine in the USA, covering the topic of 'Aging, Functioning and Rehabilitation'.