or intervention. At first, standard methods of behavior changed seemed to be fairly effective in individual cases, but in time it became evident that some of these behaviors were resistant to change and that improvement in national health status was a complicated goal. In answer to this perception, new issues in assessment arose. Schroeder (1991) indicates some of these issues and offers reports on them from a conference held at Kent State University in 1987. It was noted that the targets of intervention were no longer obvious as psychologists look at various social systems such as the family or work and find that complex factors interact to produce health outcomes. Health assessment becomes a more complex process when it must consider community-wide or population-wide factors and their relative importance in producing health outcomes.
Dever (1991) also indicates an awareness of the complexity when noting the need for an association of health status statistics with lifestyle, environment, education, socioeconomic status, and biology as a way of assessing the effect of the health services (health system goals) on the health and well-being (health status goals) of the population (p. 195). Dana and Hoffmann (1987) approach the issue by trying to provide a more useful definition of holistic health assessment, one that permits distinctions to be made among health assessment domains such as health hazard appraisal, health status, holistic health, well-being, and wellness.
Evans, Kliewer, and Martin (1991) note how the physical environment can influence the behavior of children and examine six underlying dimensions of the physical environment that can have an effect on behavior and health: pathogenic conditions, stimulation levels, functional complexity, control, structure and predictability, and exploration. A knowledge of these underlying dimensions can help in designing an environment that will be optimal for the health of t...