Health Risk Assessments (HRAs)

The Purpose of HRAs -- Every day, many people mortgage their long-term health with the lifestyle they lead today. Behaviors such as lack of exercise, smoking, poor diet, and not wearing seat belts are among the factors that increase a person's risk of getting sick or dying prematurely. However, general knowledge of these risks do not always change behavior, and people don't necessarily know which of their risks needs the most attention. Health risk assessments (HRAs) provide a scientific way of turning intuitive knowledge into measurable odds.

HRA Components -- HRAs have three standard elements:

• A questionnaire.
• A computation of risk.
• Educational messages and individual risk reports.

An HRA risk computation compares questionnaire answers to the data gathered from a large general population. Individual risk factors are matched with disease "precursors" such as high-fat diet and sedentary lifestyle which have been measurably associated with disease in the larger population. Every precursor has a numerical "relative risk" for every associated disease which indicates how much that precursor contributes to the disease. A number of diseases have multiple precursors. For example, heart disease can be affected by diet, exercise, and smoking.

Put simply, individual risk reports are based on statistics for the population group that matches the individual's surveyed characteristics. The HRA report generally includes the individual's chronological age; his or her calculated risk age (meaning how old the general population is that matches the individual's health status); a target or achievable age (meaning the age of the general population that has the characteristics the individual could achieve with improvements); and a summary of the person's various health risks and lifestyle behaviors with suggestions on how to reduce risk for disease.

Limitations of HRAs -- HRAs are extremely useful for assessing individual and group health risks. However, they are not substitutes for complete medical histories or medical exams. HRAs are also not appropriate for all people. People with chronic illnesses such as cancer or heart disease, for instance, will not obtain accurate risk projections in those areas. Also, some reference population databases exclude information on the very young or elderly, on socio-economically challenged populations, and on some minorities. In these cases, HRAs may not accurately project risks for these groups.

HRAs and Health Care -- HRAs were introduced more than 20 years ago by Lewis C. Robbins, M.D. to help doctors communicate health risks to their patients. Dr. Robbins and Jack Hall, M.D. published a book for physicians entitled How to Practice Prospective Medicine which explained how to create a health risk questionnaire and how to calculate and interpret the results. However, with advancing sophistication of health risk estimation methods, HRA use has become more widespread. A recent U.S. study reported HRA use in as many as 30 percent of workplaces. In the past decade, the number of HRAs has risen from 12 to over 50.

The questions asked by today's HRAs are not noticeably different from those asked 20 years ago, but how the answers are used is different. Today, prospective (preventive) medicine and HRAs play a big role in disease management. In fact, in recent years, large employers, insurance companies and managed care networks have used HRAs and national health statistics to project and prioritize group risks and plan health intervention programs.

For example, results of an employer's HRAs might indicate that a large number of employees are not physically active and could benefit from an exercise program at lunch. Or, a managed care network might discover that a large percentage of its members have high blood pressure and therefore might decide to develop and promote education information about diet, exercise and medication options for hypertension. One of the key benefits of HRAs is the identification of high risk individuals whose health status can be closely monitored.

Individual HRA Use -- The last decade has seen increasing use of HRAs in group settings usually for the purpose of assessing group health needs. However, individual use of HRAs offers truly personalized health education, and possibly the greatest potential for personal health improvement. The individual is in control throughout the entire process. Not only does the individual input their own data, but they receive prompt feedback on their personal health risk. This gives the individual control over the educational aspects of the instrument and provides them with prompt and detailed information about how health risks can be modified with changes in behavior.

Adapted from source:
KW Peterson and SB Hilles, (Editors): Society of Prospective Medicine. Handbook of Health Risk Appraisals, 3rd. edition. 1996, pages 5-29.

Take an Interactive Health Goals Checklist designed by the U.S. Army Center for Health Promotion and Preventive Medicine. This tool is designed to help you assess your health risk areas and determine where you might like to make changes.

"Union Pacific Railroad found that 80 percent of its workers believed that the company's exercise program helped to increase their productivity, while 75 percent felt that regular exercise was helping them to concentrate better at work."

For more information on HRAs:

Lifescan Health Risk Appraisal *
Live-Well *

* Disclaimer: These outside links are provided as resources to obtain more information on HRAs.