ABSTRACT
Health is a comprehensive and complex concept for which no generally accepted definition is available. Extensive discussions are held about what should be excluded from the concept (either as a cause or a result of (poor) health), what elements or dimensions should be distinguished within the concept and how elements or dimensions would be interrelated. Its complexity leaves room for various approaches. For example, several approaches may be recognized in five outcome measures of treatment or health care interventions. This set of five has a long history and is known as “the five Ds”: death—disease—disability—discomfort—dissatisfaction (Elinson, 1972). These five Ds reflect a development in time: initially, methods were completely determined by a biomedical approach, gradually socio-medical and psychological approaches were added as well.
