The Whole Person Health Index: A Self-Reported Tool to Assess Whole Person Health

Abstract

Whole Person Health is emerging as an important concept at the forefront of efforts to address the current “epidemic” of chronic disease in the US. Successfully tackling a research agenda on Whole Person Health and delivering actionable results requires a tool to (1) measure multiple outcomes related to Whole Person Health in an integrated manner, (2) assess whether an individual is moving toward or away from health by repeating the measurement over time, and (3) test interventions aimed at assisting individuals in moving toward better health. This Viewpoint article describes a new person-centered measure, the Whole Person Health Index (WPHI), derived from nine questions covering key elements of Whole Person Health. The nine questions are currently being administered in the cross-sectional National Health Interview Survey (NHIS) and the All of Us research cohort. Each question is rated on a 5 point scale (poor to excellent), and the WPHI can be calculated as the sum of scores such that an increase in WPHI over time represents improvement. The WPHI may be useful in research and surveillance as a measure of change in self-perceived health and health-related behaviors over time, and with individuals in clinical settings to promote greater engagement in self-care and achievement of personal health goals. The purpose of this Viewpoint communication is to make the research community aware of the opportunity to freely use the instrument questions.

Viewpoint

The overall health of the US population is in a state of crisis. The grim realization of declining life expectancy and “epidemics” of obesity, chronic diseases and poor mental health are sapping the collective wellbeing and morale of the country and creating an unsustainable drain on the US economy. In response to this challenge, the NIH has placed whole person health at the forefront of its emerging unified strategy to address the burden of chronic disease in the U.S. ¹ The purpose of this Viewpoint article is to alert the research community of a new instrument, the “Whole Person Health Index” (WPHI) in the hope that it will assist in this effort.

The term Whole Person Health juxtaposes two essential components: “whole person” which represents integration of physiological systems with psychological, spiritual, social and environmental factors, and “health” which represents an orientation toward positive health processes (eg, resilience, health restoration) rather than diseases and symptoms. A central hypothesis of research on Whole Person Health is that many chronic diseases share common roots--chronic stress, poor diet and sedentary lifestyle--that can be addressed with a combination of self-care, individual and social support, especially if applied early in life, to both prevent the deterioration of health over time, and restore health (Figure 1).^2,3

Figure 1.

Graphical representation of the Whole Person Health concept

Awareness of the importance of caring for the whole person is not new^4-6 and is a foundational principle of primary care and family medicine^7-9 and more recently lifestyle and functional medicine.^10,11 However, the long-standing emphasis on medical specialization over the past century and sub-optimal integration of individual patient care and public health in the US have been obstacles to implementing a coordinated strategy to promote whole person health. Furthermore, fragmentation of research along the lines of medical specialties has contributed to a lack of knowledge on the fundamentals of healthy whole person physiology and the optimal ways to promote and restore health.

Successfully tackling a research agenda on Whole Person Health and delivering actionable results requires a tool to (1) measure multiple outcomes related to Whole Person Health in an integrated manner, (2) assess whether an individual is moving toward or away from health by repeating the measurement over time, and (3) test interventions aimed at assisting individuals in moving toward better health.

As a first step toward this goal, the NIH has collaborated with the National Center for Health Statistics (NCHS) to rapidly develop and deploy a simple measurement tool consisting of nine self-reported questions that, together, give a “snapshot” of an individual’s self-rated health and health-related behaviors (Table 1). ¹² As each question is answered on a 5-point scale: poor (1), fair (2), good (3), very good (4) or excellent (5), calculation of the Whole Person Health Index (WPHI) is achieved by adding the scores where a higher score indicates improvement (Figure 2).

Table 1.

The Nine Whole Person Health Index questions. All items use the same response scale: Poor (1), Fair (2), Good (3), Very Good (4), Excellent (5)

Self-rated health	How would you say your health is in general?
Quality of life	How would you rate your quality of life, focusing on what matters most to you?
Social and family connections	How would you rate your social and family connections?
Diet	In general, how healthy is your overall diet?
Physical activity	How would you rate your physical activity, compared with people in your age group?
Ability to manage stress	How would you rate your ability to manage stress?
Sleep	How would you rate your sleep?
Meaning and purpose	How would you rate your ability to find meaning and purpose in your daily life?
Health management	How would you rate your ability to manage your health, focusing on aspects of your health that matter most to you?

Figure 2.

Example of radar graph display for Whole Person Health nine question ratings and change in Whole Person Health Index in the same individual over time

The Whole Person Health questionnaire was validated by NCHS against existing questionnaires in each of the covered domains, ¹³ and a detailed report on its psychometric properties is provided in the accompanying paper by Cibelli Hibben et al. ¹⁴ The Whole Person Health questionnaire was administered to over 24,000 adults in the cross-sectional National Health Interview Survey (NHIS) in 2025, and will be featured again in 2026 and 2027, and is being rolled out longitudinally in the All of Us research cohort of over 600,000 individuals. This will immediately begin to give benchmark information and a baseline for measuring changes over time. Comparing various ways of calculating the total score (eg, by weighting individual questions) or displaying the results (eg, using a table, bar graph or “radar plot”) will be the subject of future research, beginning with the All of Us cohort. De-identified data on individual All of Us participant genotypes, environmental exposures, physical measurements, health records and wearable sensors will provide additional opportunities to explore relationships between WPHI individual questions, WPHI aggregated index scores, and objective measures across multiple health-related domains. Researchers are encouraged to freely use the current instrument questions as well as the resources available via the NHIS ¹⁵ and All of Us ¹⁶ open access databases.

It is important to note that the WPHI has not been validated in terms of any known prediction or association with future clinical outcome or change in response to an intervention. Current clinical trials testing non-pharmacological lifestyle interventions that focus on a symptom or biological outcome (eg, pain, blood pressure) often report small effect sizes. Bearing in mind that the use of a single primary outcome for power calculations is an important component of rigorous clinical study design, it is possible that larger effect sizes might emerge if the single outcome were an integrated measure capturing multiple health-related components, rather than a symptom or biological measurement. This may be especially relevant when a multicomponent intervention affects several systems or outcomes (ie, psychological, physical, social etc.). As a first step, the aggregated WPHI score would first need to be used as a secondary outcome in clinical studies, in order to acquire the necessary data on its sensitivity to change and variance in response to interventions. Only then could it be used as a primary outcome, if appropriate, in future studies. Based on these initial data, WPHI questions could be revised, if needed, to maximize responsiveness to change, especially when testing the effects of multicomponent lifestyle interventions. Future work could also develop a “long form” of the WPHI for research purposes to provide more detailed information in each of the nine question domains. Future research in groups of individuals with specific clinical conditions could also delineate how the WPHI relates to specific symptoms (eg, chronic pain), behaviors (eg, smoking) or health outcomes (eg, blood pressure).

While other self-report instruments on Whole Person Health, wellbeing, wellness and quality-of-life exist,^17-21 none adequately capture the main elements of the framework shown in Figure 1 while remaining sufficiently succinct. For example, the WPHI shares several elements with the PROMIS-Global-10, including overall health, quality of life, physical activity and social relationships. However, the WPHI also includes questions on diet, sleep and stress management which are not found in the short PROMIS-Global-10. ²² Furthermore, unlike the PROMIS-Global-10 and PROMIS 29 questionnaires, which predominantly assess negative symptoms (pain, fatigue, anxiety, depression), the WPHI focuses on positive aspects of health, such as self-perceived ability to manage stress and finding meaning and purpose in daily life. We want to stress that each question of the WPHI is not meant to be used by itself to assess a component such as diet or sleep, for which well validated questionnaires exist within PROMIS and elsewhere. Clearly, a more comprehensive questionnaire evaluating a person’s diet, for example, would give a more accurate estimate than a single question—if that were the main objective. On the other hand, as the objective of the WPHI is to cover all nine health-related domains, having multiple questions per domain would result in a prohibitively large number of questions which could decrease its usefulness.

The WPHI combines elements that are commonly used as health outcomes (overall health, quality of life, social and family connections, sleep, meaning and purpose) and health-related behaviors (diet, physical activity, stress management, health management). Health-related behaviors can be viewed as “determinants” of health, but also as outcomes. For example, a health coaching intervention could result in improved stress management and/or physical activity--that themselves could be indicators of health. In the accompanying psychometric analysis, Cibelli Hibben et al. found that the subjective ratings on the nine questions, when used together, manifest a single underlying dimension of health. ¹⁴ We propose that this dimension reflects a gestalt-like whole—greater than the sum of its parts—aligned with the overarching concept of Whole Person Health.

In both clinical and research settings, we believe that the essential simplicity and brevity of the WPHI will be key to its usefulness. In clinical care, we envisage that the WPHI could be useful to promote greater engagement in self-care and achievement of personal health goals. The urgency of addressing the cumulative burden of chronic diseases in the US is becoming increasingly apparent. Research has demonstrated time and again that having the right tool at the right time can be transformative. The Whole Person Health Index was developed to meet the challenges of this pivotal moment.