Which health outcomes should be measured in health related environmental quality of life studies?

Although both research fields share the term quality of life (QOL), the research on environmental quality of life (EQOL) and health related quality of life (HRQOL) has been completely separated from each other and use the term in a different way. Thus, the choice of instruments used in HRQOL may not easily fit in a project that requires the integration of instruments targeting a common construct of QOL. Necessarily, the conceptual basis of the available instruments has to be evaluated beforehand. This paper discusses the problems surrounding conceptual issues in the selection and use of indicators to measure QOL in environmental and health related studies. Possible means to resolve these conceptual difficulties are outlined. The QOL models of Sen and Lindström are identified as possible sources for that purpose. The conceptual basis of the SF-36 and the WHOQOL are described and checked for their suitability. One practical example of both integrated use of model and instruments in environmental health is presented. Finally, some minimal content requirements are derived. Instruments should cover: main domains and facets of health, contain a broad range of health expressions including positive health, be sensitive enough for the research question and indicators measured subjectively and objectively.