Incorporation of environmental factors into outcomes research

In health and disability arenas, it is increasingly being recognized that removing or modifying environmental factors can have a greater influence over outcomes than many individually focused interventions. In 2001, the World Health Organization endorsed a major revision of its framework for assessing and classifying health, disability and handicap, conceptualizing intervention and assessing outcome. This framework, the International Classification of Functioning, Disability and Health (ICF), is now defined by its recognition of the impact of environmental and personal factors on body function and structure, activities and participation in disablement. The ICF offers the potential to advance the understanding and integration of environmental dimensions into outcome research and measurement in health and disability. This paper proposes that a key future challenge for outcomes research is to understand and document environmental dimensions of health and disability using the precedent of the ICF. Potential steps and obstacles to this development are suggested, and the direct practice and broader policy applications gained by linking an international conceptual framework with clinical outcome research and practice are discussed.