The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
For many, that level of health remains elusive — there is an increasing number of individuals worldwide who report a general malaise even in the absence of a diagnosable disorder. Professor Wei Wang, pro-vice-chancellor at Edith Cowan University in Perth, Australia, coined the term “suboptimal health status” to describe this condition, and has developed a tool to measure “SHS” with the goal of bringing more precision to preventative health care.
Wang and his team at ECU define suboptimal health as “a physical state between health and disease,” characterized by ambiguous health complaints as well as general weakness and periods of low energy. Wang, who has been studying medicine for 30 years, says suboptimal health also describes a reversible stage of a chronic disease, which is a crucial distinction in how physicians can approach any number of health conditions.
“Since prognosis is improved in all disorders by early detection, it is prudent to underscore the potential to improve not only individual well-being, but also that of their family and caregivers, to reduce the overall burden on the health-care system,” Wang said in an email.
Addressing a public-health challenge
In Wang’s native China, there has been an increase in the number of people who report symptoms indicating illness but without the presence of a specific disease or disorder. Drawing on his familiarity with traditional Chinese medicine, which has long identified a physical state between health and disease, Wang developed a comprehensive suboptimal health questionnaire, called SHSQ-25, in 2009. Wang now leads two teams in SHS study — one at ECU and another in Beijing.
Although suboptimal health status has become a public-health challenge in urban China — including indications that SHS could lead to or exacerbate cardiovascular problems and metabolic diseases — there are few reports of actual SHS investigations, says Wang.
Tackling crippling public-health problems like dementia requires early diagnosis and prevention, a mission characterized by understanding the intermediate stages linking health and disease.
In 2010, researchers used Wang’s questionnaire as part of a study associating SHS and cardiovascular risk factors among urban Chinese workers. The study of 4,881 workers measured blood pressure, glucose levels, body mass, and other factors linked to cardiovascular disease, with an overall “SHS score” derived from these results and data collected in the questionnaire.
Thanks in part to Wang’s survey, the study found a correlation between SHS and various cardiovascular disease risk factors. Additionally, the prevalence of suboptimal health symptoms increases alongside age, a trend consistent with the rise of cardiovascular-related issues in urban China. As treatments for cardiovascular and other non-communicable illnesses are often implemented after disease onset, understanding SHS is a means of approaching health complaints from the perspective of predictive, preventive, and personalized medicine, Wang says.
“Suboptimal health status is associated with cardiovascular risk factors and contributes to the development of the disease,” he says. “SHS should be recognized in the health-care system, especially in primary care.”
A powerful predictive instrument
An author of over 200 scientific papers on suboptimal health and related topics, Wang created the questionnaire keeping in mind the increased relevance of SHS intervention and prognosis. Focus-group discussions provided the basis for the survey, while a small pilot study included tests for reliability and internal consistency. The final questionnaire is short and easy to complete, containing 25 items narrowed down to five subcategories: fatigue, the cardiovascular system, digestive system, immune system, and mental health status.
Experts say China — whose recently abolished one-child family-planning policy has resulted in a rapidly aging population — has a higher incidence of chronic illnesses than other middle-income countries. For example, Wang points to a nationwide onslaught of dementia forecasted to reach 23.3 million cases by 2030, according to WHO and also Wang’s research on dementia published in the well-known journal of Lancet.
Tackling crippling public-health problems like dementia requires early diagnosis and prevention, a mission characterized by understanding the intermediate stages linking health and disease, says Wang.
Suboptimal health status is also a potential risk assessment for diabetes mellitus — commonly referred to as diabetes — a group of metabolic disorders characterized by high blood-sugar levels over a prolonged period. Diabetes affects more than 425 million people globally, with Type 2 diabetes accounting for over 90 percent of all cases. The International Diabetes Federation relates Type 2 diabetes to physical inactivity and an unhealthy diet. An increased prevalence of the disease among adolescents and young adults is likely due to a rise in childhood obesity.
These individuals often remain undiagnosed for decades, necessitating the intervention of non-invasive screening tools like SHSQ-25. Research in China found that a higher SHS score among questionnaire respondents indicated a higher occurrence of diabetes. Meanwhile, a separate study in Ghana — where 440,000 people were documented to have the illness as of 2013 — pointed to SHSQ-25 as “a platform for prediction, prevention, and treatment” of Type 2 diabetes. “This is vital, particularly for a region where laboratory-based measures are not routinely available,” the study said.
In recent years, Wang’s work has centered on using glycans to produce an objective measure of suboptimal health. Known generally as simple and complex carbohydrates, glycans have long been known to play major metabolic, structural, and physical roles in biological systems.
As a committee member and key researcher in the Human Glycome Project, Wang aims to understand the role glycans play in the progress of diabetes, cardiovascular disorder, and other chronic illnesses. According to Wang, glycans can also be objective health markers — a powerful predictor when integrated with the suboptimal health measures endorsed by the university.
ECU’s questionnaire has already been translated into Chinese, English and Russian. Use of the tool across additional populations can result in early detection of chronic diseases, says Wang, ideally reducing the burden these illnesses place on society.
