How to Approach Health Risk Factor Assessment

There are different ways to approach risk factor assessment, but all of them should be taken together as they are complementary (adapted from Duke Personalized Medicine).

Disease Risk Assessments

Disease risk assessments use an individual’s personal, genetic, and environmental information to determine a quantitative or qualitative value of risk for developing specific diseases such as heart disease, cancer and osteoporosis. The tools calculate a personalized risk assessment "score" based on individual risk factors such as diet, exercise, smoking, alcohol consumption, family history, DNA, and biomarkers (blood tests, functional tests, or imaging tests that reflect normal physiologic or pathologic processes—such as blood sugar and blood pressure levels).

These risk assessment scores are the end product of research studies looking at the contribution of individual risk factors for each disease state.

For example, the Framingham Study identified several risk factors for the development of heart disease. It did this by collecting data on a large number of individuals living in Framingham, Massachusetts over a period of decades. At the end, researchers were able to statistically compare information from those who had heart attacks to those who did not, to identify which items were important risk factors for developing a heart attack.
These numbers allow both the patient and the physician to objectively determine where a patient’s current health status is compared to the general population and to their personal goal.
Changes in risk assessment scores over time can show the positive and negative impact from modifiable behaviors. In our example above, if a patient lowered his/her cholesterol through diet and exercise, the change in the Framingham score would provide objective feedback on how behavior has improved their health risk.

Health Assessments

In addition to these disease risk assessments, health assessments exist whereby health assessments are designed not to calculate risk for a specific disease, but to assess markers of the patient’s well-being--such as quality of life, functional status (ability to perform normal activities), satisfaction with health status, health-related goals, and intention to change health-related behaviors.

Combining these patient-centered measures with other traditional measures of health helps providers and patients to better communicate with each other, and gives providers the information they need to help motivate patients to change unhealthy behaviors.

Health Risk Assessments

Health Risk Assessments combine features of both disease risk assessments and health assessments in the form of questionnaires. A comprehensive assessment should include questions that address a fundamental set of risk factors: health behaviors (tobacco use, physical activity, dietary intake, sexual practices, alcohol and other drug use, injury prevention, exposure to ultraviolet light, dental hygiene); mental health and functional status; risk factors from medications, past medical and family history; occupational and environmental exposures; travel history; and the status of recommended screening tests, immunizations, and chemoprophylaxis.

The answers to your questions should then direct your doctor to give you absolute and relative risk estimates for various diseases (a risk factor profile) and a plan to modify those health behaviors that can be changed to modify the existing risk factor profiles.

Family health history (FHH)

Family health history (FHH) is a unique disease risk assessment tool based on information about health conditions that affect members of your family.

Within families, blood relatives share similar environments, lifestyles, and genetic backgrounds. As a result, FHH reflects the complex combination of all these factors on an individual's risk for developing health conditions.

To encourage more people to take advantage of this powerful tool, the Department of Health & Human Services has launched a Family History Initiative and the U.S. Surgeon General has declared that Thanksgiving Day also be known as National Family History Day. The free, online tool, My Family Health Portrait, was created to help people collect and store their family information. In addition, the Centers for Disease Control (CDC) has created a Family History topic page with multiple links to information about family history with resources for the public and health professionals.

Take home message: It is important for you to ask your doctor to conduct these various types of risk and health assessments at the initial “new patient” visit and to continually update them as risk factors and your health change. However, few doctors do these assessments due to a lack of training, knowledge, time or reimbursement incentives. Preventive medicine specialists are specifically trained to conduct these assessments and help you modify health behaviors within your own environmental context to decrease your chances of developing disease and enhance your health.