The Healthy Life Health Risk Assessment links public health to primary care. With the HRA software patients and providers receive support to promote healthy behaviors and use of preventive services.

A Short Summary about Health Risk Assessments

  • Health Risk Assessment (HRA) is a way to describe a person’s chances or risks of becoming ill or dying from diseases and other causes.

  • Feedback in the form of a report can help a person decide how to reduce their risks.

  • Approximately 50 years of research has gone into developing the science of Health Risk Assessments.

  • Although the HRA was originally developed as a paper and pencil instrument, it has since evolved into an interactive electronic tool that provides a personal health assessment score, tailored educational messages and other resources to motivate behavior change and achieve risk reduction.


What is a Health Risk Assessment?

Health Risk Assessment (HRA) is the generic term applied to how we estimate and describe a person’s chances of becoming ill or dying from certain diseases (e.g. high blood pressure, heart disease) and other causes (e.g. smoking, not wearing seat belts) over a certain period of time (e.g. 10 years). It involves the following:

  • Reviewing information on a person’s lifestyle and health behaviors, laboratory values and physical measures;

  • Estimating the risk of death and/or illness (current risk age);

  • Estimating how much risk can be reduced based on epidemiologic data, mortality statistics, and actuarial techniques (target risk age);

  • Feedback in the form of a report is given based on the individual’s current and target risk age.


The ability to understand the natural history of disease and to use this knowledge for the benefit of the public is at the heart of the development of any health risk appraisal instrument.

  • It is a proactive response to the risk factors that cause disease or injury.

  • By knowing our risks for the onset of a given disease, priorities and programs can be developed to reduce these risks potentially forestalling or eliminating the disease or condition.


Through these combined activities, patients, health providers, scientists, health educators and technical experts can accelerate the achievement of our national health goals, bringing us ever closer to the ideal of a healthy nation.


History of Health Risk Assessments

Over half of all deaths before age 65 can now be attributed to lifestyle factors. In order to reduce the annual incidence of these causes of death, it is essential to understand the contribution of such factors as:

  • Smoking and smokeless tobacco

  • Alcohol consumption and other substance abuse

  • Nutrition, exercise and stress

  • Driving habits, seat belt usage, ATV use

  • Use of preventive services such as mammograms, pap smears and colonoscopies


The tools that can help to assess the impact of these precursors of disease and trauma include the methodology of health risk appraisal. Many of the decisions made in the course of development of a health risk appraisal instrument are inherently transient and subject to constant improvement and customization. Several factors contribute to the definition of any health risk appraisal. These include the following:

  • Age and sex

  • Culture of the target population

  • Selection of causes of illness, injury, or death

  • Identification of the precursors of these outcomes

  • Quality of the synthesis of the underlying science

Dating to the fifth century B.C., the Hippocratic tradition emphasized prognostication and prevention, using patient-centered regimens of dietetics and exercise to maintain or regain health. But it was not until 1968 that a system for appraising the health risks for individuals was first proposed in the practice literature as a component of comprehensive healthcare. Developed through a pilot study initiated in 1963, the method used a four-part rubric to assist physicians in assessing and mitigating adult patients’ health risks:

  • Basic average health hazards by age, sex, and race over a 10-year period

  • Health hazards for the individual, reflecting history and physical examination, routine tests, and specialized tests and consultations

  • Factors for adjusting individual health hazards

  • Individualized preventive medicine programming reflecting the whole-person concept


In 1970, a manual for physicians, How to Practice Prospective Medicine*, provided a sample HRA questionnaire, risk computations, and a feedback strategy. Although the medical profession did not generally adopt HRAs, instruments proliferated elsewhere, most notably through workplaces and community-based health promotion programs. In 1980, CDC released publicly available HRA software that used a 31-item, self-administered questionnaire to compute adult health risk.


In 1986, CDC collaborated with the Carter Center of Emory University in Atlanta to review the scientific basis for individual HRAs and began a program to distribute HRA software through state public health programs. At the end of that project, the HRA program was transferred to the Atlanta-based Carter Center, where it continued until 1991. At that time, a nonprofit corporation, Healthier People Network, was established to keep the HRA in the public domain.


Now, more than 40 years following publication of the first method of performing a clinical health assessment, HRAs are accepted processes to identify an array of risk factors associated with developing specific acute or chronic disease conditions. Further, it offers providers a tool for recommending clinical preventive screenings and treatment to support patients’ health improvement efforts.


Although the HRA was originally developed as a hand-tallied instrument to collect health risk data from individuals to produce a personalized epidemiological-based profile predicting future mortality, it has since evolved into an interactive electronic tool that provides a personal health assessment score such as a “health age” or “risk age,” tailored educational messages, on-line modeling of the effects of making lifestyle changes, goal setting guidance, and other resources to motivate behavior change and achieve risk reduction.


What is Risk Age?

YOUR RISK AGE NOW (this is one of the numbers in your report) compares your total risk from all causes of death to the total risk of those who are your age and sex. If you have a lot of risk factors, your Risk Age will go up because your risk of dying will increase and therefore be similar to someone older than you are who will die in a shorter number of years than an average person of your age. It gives you an idea of your risks compared with the population average in terms of an age.


YOUR TARGET RISK AGE (also in your report) indicates what your risk age would be if you made the recommended life style changes thereby reducing your risks. Thus YOUR TARGET RISK AGE will always be lower than YOUR RISK AGE NOW except for the rare individual who has no risk factors showing up on the questionnaire at all. In that case the two risk ages can be equal.


Appraised age (or risk age) is an overall measure of risk based on your current risk levels as compared with a hypothetical "average" person of your same age and sex. It is not a "biological age" nor is it a life expectancy estimate. It is merely an appealing numerical indicator intended to enable you to compare modifiable risk with peers.


An appraised age that is the same as the actual age signifies that you are at an average risk level for your age and sex group in the general U.S. population. Similarly, higher appraised ages signify above aver¬age risk and lower appraised ages indicate lower than average risk compared with a cohort with the same fixed characteristics. In general risk age is built on the concept that overall mortality risk increases geometrically with age at about 8% per year.


* Lewis C. Robbins and Jack H. Hall. 1970. How to Practice Prospective Medicine. Indianapolis: Methodist Hospital of Indiana.