On its establishment, the World Health Organization (WHO) defined health as a fundamental human right deserving legal protection. Subsequently, the Ottawa Charter reaffirmed health as a fundamental right, and emphasized health promotion as the most appropriate response to global health issues. Here we suggest that the WHO definition of health as more than simply the absence of illness is not normative, and therefore requires standardization. To date such standardization unfortunately is lacking.

Definitions of health in terms of some kind of balance form a category of their own within the sphere of health definition. Such definitions have their roots in the beginnings of scientific medicine, and popular versions are common among lay people. It has even been claimed that balance is fundamental to health for all species. Several present-day definitions of health in terms of balance are presented here. Particular attention is given to the call for a (...) definition of health applicable to both humans and animals within the One Health approach, involving human medicine, veterinary medicine and ecology. Definitions in terms of balance have been suggested but none has been thoroughly analysed with regard to its suitability. There are therefore three concerns in this paper. The first is to introduce versions of the category of balance, as a first step towards a nomenclature of health definitions. The second is to analyse the claim made recently that balance is a universal criterion of health in all species including humans. The third is to ascertain whether any of the versions discussed is suited to the One Health approach. (shrink)

A multifactorial and growing crisis of health care systems in the developed world has affected medicine. In order to provide rational responses, some central concepts of the past, such as the definitions of health and disease, need to be updated. For this purpose physicians should initiate a new debate. As a point of departure the following definitions are proposed: Health is a dynamic state of wellbeing characterized by a physical, mental and social potential, which satisfies the demands (...) of a life commensurate with age, culture, and personal responsibility. If the potential is insufficient to satisfy these demands the state is disease. This term includes sickness, illness, ill health, and malady. The described potential is divided into a biologically given and a personally acquired partial potential. Their proportions vary throughout the life cycle. The proposed definitions render it empirically possible to diagnose persons as healthy or diseased and to apportion some of the responsibility for their state of health to individuals themselves. Treatment strategies should always consider three therapeutic routes: improvements of the biologically given and of the personally acquired partial potentials and adaptations of the demands of life. These consequences favourably contrast with those resulting from the WHO-definition of health. (shrink)

Sridhar Venkatapuram's Health Justice argues that health is a ‘metacapability’ – specifically, as the metacapability of having the ten ‘central human capabilities’ described by Martha Nussbaum. This cannot be right, as it provides no basis for distinguishing health from education, riches, or love. An amendment correcting this problem is suggested, namely that health is the involuntary, bodily aspect of the metacapability for the central capabilities. This amendment is defended against the objection that it fails to capture (...) some important aspects of mental health. (shrink)

This article is about a new definition of health and how this relates to transition processes. It focuses on the practical translation of the new concepts into challenges for mental health nurses. To that aim the Engagement Model is examined and operationalized. We did so as nurse researcher and lecturer involved in training nurse practitioners.

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant (...) evidence for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

This paper discusses attempts to define health within a public policy arena and practical and conceptual difficulties that arise. An Australian Aboriginal definition of health is examined. Although there are certain difficulties of translation, this definition is prominent in current Australian health policy and discourse about health. The definition can be seen as broadly holistic in comparison to other holistic definitions such as that of the World Health Organization. The nature of this (...) holism and its grounding within the context of Aboriginal Australia is discussed. In particular, its implications for the phenomenon of medicalization, which may be associated with a holistic notion of health, is critically explored, as is the link of notions of health to culture and the question of the possibility of a universal definition of health. The question of to what extent a definition of health is inspirational or operational is also raised. (shrink)

This paper argues that the existing definition of pandemics is not nuanced enough, because it is predicated solely on the criterion of spread, rather than on the criteria of spread and severity. This definitional challenge is what I call ‘the conflation problem’: there is a conflation of two different realities of global health, namely global health emergencies (i.e., severe communicable diseases that spread across borders) and nonemergencies (i.e., communicable or noncommunicable diseases that spread across borders and that (...) may be severe). To put this argument forth, this paper begins by discussing the existing and internationally accepted definition of pandemics, its requirements, as well as its strengths (section 1). Section 2 then considers the problem with the standard definition of pandemics (i.e., the conflation problem) and some examples of it. Finally, section 3 evaluates some practical implications of the conflation problem to then explore conceptual clarity as the adequate solution. (shrink)

Internationally, there are reports of adverse health effects (AHE) in the environs of industrial wind turbines (IWT). There was multidisciplinary confirmation of the key characteristics of the AHE at the first international symposium on AHE/iwt. The symptoms being reported are consistent internationally and are characterized by crossover findings or a predictable appearance of signs and symptoms present with exposure to IWT sound energy and amelioration when the exposure ceases. There is also a revealed preference of victims to seek restoration (...) away from their homes. This article identifies the need to create a case definition to establish a clinical diagnosis. A case definition is proposed that identifies the sine qua non diagnostic criteria for a diagnosis of adverse health effects in the environs of industrial wind turbines. Possible, probable, and confirmed diagnoses are detailed. The goal is to foster the adoption of a common case definition that will facilitate future research efforts. (shrink)

의학 현상학은 질병의 원인을 단순하게 환자의 신체 밖에 존재하는 병원체에서만 찾는 것이 아니라 신체 내부의 환경에서도 찾으려고 시도한다. 의학 현상학은 현상학적 세계 고찰을 통해서 환자의 내면적 체험을 중시하게 되었다. 최근 의학과 간호학에서 현상학적 연구 방법에 기초해서 이러한 환자의 체험에 대한 분석을 담은 연구들을 진행하고 있다. 그러나 전통 현상학 자체에 대한 이해 부족으로 연구 명칭은 현상학적 방법론이지만 그 내용은 형식적인 틀에 머물고 있는 연구물들이 많이 등장하고 있다. 이에 현상학자들의 텍스트 분석을 통해서 현상학의 기본 개념들이 어떻게 의학 현상학에서 응용될 수 있는지에 대한 (...) 기초 작업이 요구된다. 실재로 국내에는 현상학자들의 텍스트에 기초해서 의학 현상학을 소개하는 전문적인 논문들이 매우 적은 편이다. 이런 기초 작업을 위해서 연구자는 이 논문에서 하이데거의 『시간과 존재』에 기술된 ‘내집에 없음’(Unheimlichkeit)이란 개념과 질환 체험과 건강 체험의 유사성에 대해서 고찰하고 있다. 하이데거의 현상학적 존재론의 몇 가지 중요한 개념들을 분석하면서 이것들이 어떻게 의학 현상학에서 응용될 수 있는지를 밝히는 것이 이 논문의 최종 목표이다. (shrink)

The article defines a comprehensive concept of cognitive objectivity (CCCO) applied to embodied subjects in health care. The aims of this study were: (1) to specify some necessary conditions for the definition of a CCCO that will allow objective descriptions and assessments in health care, (2) to formulate criteria for application of such a CCCO, and (3) to investigate the usefulness of the criteria in work disability assessments in medical certificates from health care provided for social (...) security purposes. The study design was based on a philosophical conceptual analysis of objectivity and subjectivity, the phenomenological notions ‘embodied subject’, ‘life-world’, ‘phenomenological object’ and ‘empathy’, and an interpretation of certificates as texts. The study material consisted of 18 disability assessments from a total collection of 86 medical certificates provided for social security purposes, written in a Norwegian hospital-based mental health clinic. Four necessary conditions identified for defining a CCCO were: (A) acknowledging the patient’s social context and life-world, (B) perceiving patients as cognitive objects providing a variety of meaningful data (clinical, psychometric, and behavioural data – i.e. activities and actions, meaningful expressions and self-reflection), (C) interpreting data in context, and (D) using general epistemological principles. The criteria corresponding to these conditions were: (a) describing the patient’s social context and recognizing the patient’s perspective, (b) taking into consideration a variety of quantitative and qualitative data drawn from the clinician’s perceptions of the patient as embodied subject, (c) being aware of the need to interpret the data in context, and (d) applying epistemological principles (professional expertise, dialogical intersubjectivity, impartiality, accuracy and correctness). Genuine communication is presupposed. These criteria were tested in the work disability assessments of medical certificates. The criteria were useful for understanding both how objectivity fails during work disability assessments and how it can be improved in the writing of certificates. The article specifies four necessary conditions for the definition of a CCCO in health care and social security medicine and the corresponding criteria for its application. Analysis of the objectivity of work disability assessments in medical certificates for social security confirmed the usefulness of the criteria. (shrink)

Throughout history, schools of economic thought have defined political economy—or economics—and its object of study in multiple ways. This paper reflects on the definitions of economics by schools of economic thought and also proposes the concepts of value and scarcity as key concepts to explain the differences between them. The most important findings of the paper are: (a) the ontological and epistemological characteristics of the concept of value and scarcity have shaped the definitions of economics; (b) the boundaries of the (...) study object of economics have been expanded since today’s mainstream economics deals with multiple topics as diverse as crime, education, development, health, etc. However, the methodological tools used in mainstream economics have been narrowed since approaches such as the philosophical, ethical, historical, and institutional approaches have been left behind; (c) the part of reality that mainstream economics can grasp have left behind important issues of the contemporary world, such as gender, social, and environmental issues. A clear understanding of the scope and boundaries of economics could help to define more realistic research questions for economic science, and it would help to define new economic paradigms that address the contemporary issues. (shrink)

Philosophical discussions of health and disease have traditionally been dominated by a debate between normativists, who hold that health is an inescapably value-laded concept and naturalists, such as Christopher Boorse, who believe that it is possible to derive a purely descriptive or theoretical definition of health based upon biological function. In this paper I defend a distinctive view which traces its origins in Aristotle's naturalistic ethics. An Arisotelian would agree with Boorse that health and disease (...) are ubiquitous features of the natural world and thus not mere projections of human interests and values. She would differ from him in rejecting the idea that value is a non-natural quality. I conclude my discussion with some comments of the normative character of living systems. (shrink)

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health (‘health’ is not (...) defined as absence of disease but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority. (shrink)

This paper draws on Kukla’s “Institutional Definition of Health” to provide a definition of “psychiatric condition” that delineates the proper bounds of psychiatry. I argue that this definition must include requirements that psychiatrization of a condition benefit the well-being of 1) the society as a collective, and 2) the individual whose condition is in question. I then suggest that psychiatry understand individual well-being in terms of the subjective values of individuals. Finally, I propose that psychiatry’s understanding (...) of collective well-being should be the result of a “socially objective” process, and give certain desiderata for this understanding. (shrink)

The concepts of health and disease are foundational to biomedical ethics. This essay critiques two widely used approaches to understanding health and disease: the World Health Organization definition of health as "complete physical, mental and social well-being," and the attempts by Thomas Szasz and Christopher Boorse to define health and disease in objective, value-free terms. Drawing particularly on the thought of Karl Barth, I argue that in Christian perspective, health must be understood in (...) terms of the goods and goals toward which human life is directed, which must themselves be understood in terms of God's good purposes made known in Christ. We are called to "will to be healthy" and resist disease, but understanding what this entails in particular concrete situations requires skills and habits of attentiveness to God's command, cultivated in the context of the Christian community and its practices. (shrink)

A satisfactory account of the nature of health is important for a wide range of theoretical and practical reasons. No theory offered in the literature thus far has been able to meet all the desiderata for an adequate theory of health. This article introduces a new theory of health, according to which health is best defined in terms of dispositions at the level of the organism as a whole. After outlining the main features of the account (...) and providing formal definitions of ‘health’, ‘healthy’, and ‘healthier than’, I present the main strengths of the proposed account. I argue that the proposed dispositional theory accounts for all paradigm cases of health and pathology, that it circumvents a number of problems faced by rival theories, and that it makes for a naturalistic theory of health with a rigorous metaphysical underpinning. 1Introduction 2The Dispositional Account 3Further Specification of the Dispositional Account 3.1Reference classes 3.2Comparison classes 3.3Which dispositions? 4Advantages of the Dispositional view 5Three Objections and Replies 5.1Objection 1: Counter-examples 5.2Objection 2: Issues with holism 5.3Objection 3: Expediting medicalization 6Final Remarks. (shrink)

Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders (...) in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration. (shrink)

Currently, under the law of intellectual property, IP owners may exclude from use or production substances and processes that we would ordinarily consider to be products of nature. This has helped companies monopolize disease genes, and thus diagnostic testing for those diseases, and “biosimilar” products, pharmaceutical materials that mimic biological materials. Extending the current paradigm to the world of synthetic biology and nanotechnology will create further injustices in the delivery of health care to billions of people around the world. (...) As such, I advocate heading this trend off at the pass. Scientists ought to conduct basic research into the building blocks of biology and matter in the open, publishing their results, releasing knowledge into the public domain upstream so that beneficial innovation can be produced without fear of downstream litigation, and so that what ought to remain in the public domain as a matter of right (products of nature) does not become unjustly monopolized. (shrink)

Ideal for students in the philosophy of medicine, healthcare and public health, this book offers an introduction to the philosophical debates around health justice. It presents clear conceptual definitions of health, disease and illness and the various theories of justice, developing a specific normative argument in the debate on health justice.

In a warm and enjoyable dialogue the meaning of health, in its fullest sense, becomes a philosophical issue as much as a biological. For isn't the essence of health a general sense of well-being? Health can be seen as reflecting satisfaction with our quality of life; but how do we achieve that? Here, a character who is heading off for a job teaching health has an extended conversation with a trusted mentor, and they test various definitions, (...) various visions, and some of the infinite possibilities of the idea of health, in the process coming to a deeper and more invigorating understanding of life itself. They arrive at the notion of symbiosis - a living together to the advantage of each. And isn't a good conversation a sort of living together to the advantage of each? In such dialogue, we engage with our hearts and minds. When are we more alive than that? What is the peak of health if not this life, this engagement? The two friends want to know what health is. But they want more: They want to be healthy. They see three basic types of health - bodily, mental, and societal. These three types affect one another. How they affect one another matters in a critical way. But there is more. A friendly conversation allows special access to what is critical. Our guard is down in such a conversation. We are less likely to be defensive. We are more likely to keep our minds open and clear. We are likely to feel the confidence it takes to learn. (shrink)

The principle aim of this thesis is to provide an account of the nature of health. The starting-point is that health is a normative concept: health implies a standard or norm in relation to which an organism’s state is evaluated. Many philosophers take this to imply that health must be defined in subjective terms. They either think health consists in a certain type of subjective experience, or that health is relative to subjective values and (...) goals. I argue that subjective definitions of health fail to capture the essential properties of health and attempt to show that health is something normative and yet entirely objective. This would imply that there are normative facts in the world, and to support this claim I turn to debates in contemporary meta-ethics. I develop a meta-ethical theory according to which a subset of non-moral goods is grounded in objective features of living beings, and argue that this meta-ethical theory opens the possibility for an objective account of health. I then proceed to develop a theory of health that aims to capture what it means for any living to be healthy. I argue that the concept of health latches onto organisms’ capacities : the greater an organism’s range of capacities, i.e. the more it is capable of doing, the healthier it is. The norm relative to which an organism’s range of capacities is measured in evaluations of health, I go on to argue, is the maximum range of capacities possible for the species. Accordingly, an organism is healthy if it is capable of performing all species-specific activities. A closer analysis of this claim yields the formal definition that health consists in a multiplicity of potential activity vis-à-vis factual limitations set by the species. This definition of health is defended against various objections and potential counterexamples. In the context of human health, I attempt to show this definition of health captures both physical and mental dimensions of health; that it establishes a direct link between health and individual autonomy; and that it supports a Nietzschean account of ‘the greathealth’—the idea that being able to give up the concern for one’s health constitutes a superior kind of health. In the conclusions, I reflect on whether this conception of health could function as an ethical ideal, and consider the form that a health-based ethics could take. (shrink)

By means of a survey of Thoreau's writings, this article analyses his thoughts on health, emphasising some features that fit well with contemporary debates in the philosophy of medicine. Thoreau understands health as an environmental value, one that cannot be achieved without a personal relation to nature, but he does not provide a static definition of health within a fixed hierarchy of values. Thus he avoids a certain degree of essentialism that, when imposed on his work, (...) makes it seem more utopian and anti-scientific than it really is. The meaning of health for Thoreau is often contradictory and hard to disambiguate, and his context was different in many respects to ours, but his ideas on this topic still serve to criticise some of modern medicine's views on health and disease, and to steer it towards a more environmentally-informed approach to these phenomena. (shrink)

Few people in my memory have a name that more appropriately defines the life they have lived. “Charitable purpose” as defined in O.C.G.A. § 43-17-2 includes any charitable or benevolent purpose including health, education, or social welfare. Anyone who knew Charity Scott knows that she lived a life devoted to providing and improving the health of her community, the education of law students about health law and its use to improve the health of her community, and (...) social welfare by addressing the socio-economic determinants of health. If she had not been assigned that name at birth, those of us who knew her could have easily assigned Charity as a nickname. (shrink)

In this paper I provide a critique of a set of assumptions relating to agency, choice and the legitimacy of actions impacting health that can be seen in some approaches to health promotion. After a brief discussion about the definition of health promotion, I outline two contrasting approaches to this area of health care practice. The first is focused on the provision of information and the second is concerned with seeking to change people’s preferences in (...) a particular way. It has been argued by a number of critics of health promotion that only the first approach is ethical, as it is for individuals to make their own lifestyle choices and adopt their own conception of the good life. I argue against this ‘information’ approach to health promotion on two grounds. First, I suggest that given the aims of health promotion, the provision of information is, as a matter of fact, of limited effectiveness in achieving these aims. Second, I argue that we have good reasons to question the appropriateness of respecting many of the preferences that individuals happen to have, given the origins and quality of such preferences. I then go on to argue, that by contrast we have good reasons to focus on changing at least some of the preferences that people have related to their lifestyle choices. This involves a commitment to both paternalism and a defence of a certain conception of the good life, but both can be defended. I use the example of potential responses to the growing problem of obesity to illustrate my argument, arguing that only policy that, at least sometimes, aims at preference change will be both effective and ethical. (shrink)

"Every man has his particular way of being in good health" - Emanuel Kant. Emanuel Kant's description of health stands in stark contrast to accepted definitions of health. For example, the WHO defines ‘health’ as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. However, as people get on with day-to-day living, no one can achieve the goal of ‘complete physical, mental and social well-being’. It is odd (...) to define ‘health’ as a negative state that puts it beyond the reach of everyone. This paper explores the idea of health being a personal state, health being the product of every man's particular way of making sense of his particular circumstances. (shrink)

The official definition of ‘pain’ by the International Association for the Study of Pain (IASP) hasn’t seen much revision since its publication in 1979. There have been various criticisms of the definition in the literature from different quarters: that the definition implies a dubious metaphysical dualism, that it requires a strong form of consciousness as well as linguistic abilities, that it excludes many vulnerable groups that are otherwise perfectly capable of experiencing pain, that it has therefore unacceptable (...) practical as well as ethical consequences, that it is unhelpful to the health-care professional as an operational definition, that it is too narrow, and many others. In my view, most of these criticisms depend on misunderstandings or on uncharitable interpretations. My aim is to go over the definition, clarify some potential ambiguities, and argue that these criticisms don’t cut much ice. At the end, I will present a few slightly reworded versions of the definition that I claim are more felicitous and capture the original intended meaning by the members of the taxonomic committee in a much better and transparent way that avoids all the major extant criticisms in the literature. (Written for interdisciplinary audiences.). (shrink)

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health and a positive conception (...) of health. An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority. (shrink)

A clear understanding of the concept of health plays a key role in defining what health care should comprise and in developing adequate strategies for overcoming the current "health care crisis". This volume is the result of an international and interdisciplinary cooperation between medicine and philosophy on the current debate on the concept of health.Besides offering a critical analysis of the WHO definition and a review of both ancient and contemporary conceptions of health, the (...) cooperative effort of physicians and philosophers presented in this book works through the challenges which any definition of health faces, if it is to be both truly personalist, and at the same time operational.The overall purpose of this book is to capture the essentials of human health and to propose the outlines for a personalist understanding of this concept, i.e., a conception that does justice to the personal nature of human beings by introducing dimensions that are essential to personal life and well-being, such as the realms of rationality, affectivity and freedom, the realms of meaning, values, morality, and spirituality, the realms of social and interpersonal relations. To grasp the uniqueness of the human person is not yet to grasp the specific nature of personal health. But it is certainly a first step, and it becomes evident that every theory of human health presupposes a theory of the person. Accordingly, the debate presented in this book is no less a debate about the nature of the human person than it is a debate about the nature of health.The investigations offered in this volume intend to provide an impetus for new conceptions of personhood and human health. The phenomenological approach has the advantage of advocating a systematic conception of the total person which combines surface experiences (subjective experiences of well-being) with deeper dimensions of the person (value and being). An adequate conception of the human person has enormous implications not only for our understanding of what constitutes the health and well-being of the person, but also for our conception of what health care should comprise. Hence, answering the philosophical questions, such as those raised in this volume about health, is crucial for the solution of political problems such as how to legislate health care policy. (shrink)

Through hypothetical scenarios, this paper analyses whether machine learning (ML) could resolve one of the main shortcomings present in Christopher Boorse’s Biostatistical Theory of health (BST). In doing so, it foregrounds the boundaries and challenges of employing ML in formulating a naturalist (i.e., prima facie value-free) definition of health. The paper argues that a sweeping dataist approach cannot fully make the BST truly naturalistic, as prior theories and values persist. It also points out that supervised learning introduces (...) circularity, rendering it incompatible with a naturalistic perspective. Additionally, it underscores the need for pre-existing auxiliary theories to assess results from unsupervised learning. It emphasizes the importance of understanding the epistemological entanglements between data and data processing methods to manage expectations about what data patterns can predict. In conclusion, the paper argues against delegating the final authority for defining complex concepts like health to AI systems, as it necessitates ethical judgment and capacities for deliberation that AI currently lacks. It also warns against granting creators and deployers of AI systems the discretionary authority to determine these definitions outside the wider social discussion, advocating for ongoing public engagement on normative notions. Failure to do so risks limiting individuals and collectives’ ability to shape a just digital future and diminishes their fundamental epistemic agency. (shrink)

This paper examines the economic rationale of affordability exemptions in the context of a health insurance mandate. I provide an economic definition of affordability and discuss how it is implemented in the contexts of food, housing, and health care. Affordability standards are frequently used in making food and housing policy, but both empirically and theoretically health care operates quite differently than these other merit goods. This helps explain why the use of affordability in health policymaking (...) is so different from its use in these other contexts. I conclude with some suggestions about how to improve affordability exemption rules in health policymaking. (shrink)

Human rights advocates often use inflated and thus underspecified terminologies when addressing the content of their claims. One example of such loose terminology is the term ‘well-being’, as currently employed in connection with a definition for the right to health. What I call the ‘well-being conception of health’ conflates the distinct ideas of basic and non-basic health needs, as well as those of individual autonomy and freedom. I call this the conflation problem. This paper argues for (...) the need of an understanding of the right to health, nuanced enough to capture not only these distinct ideas, but also their moral relevance for the common good. (shrink)

The starting point for the contemporary debate about theories of health should be the holistic theory of Lennart Nordenfelt, claims George Khushf, not the refuted theory of Christopher Boorse. The present paper is an attempt to challenge Nordenfelt and to present an alternative theory to his and other theories, including Boorse’s. The main problems with Nordenfelt’s theory are that it is relativistic, that it leads to counter-intuitive results as to what goals can count as healthy, that it focuses on (...) the wrong kind of abilities, that it makes measuring health extra difficult, and that it does not give us a sufficient account of health, at most a necessary one. The alternative theory proposed is two-dimensional. First, health is to have developed the abilities and dispositions that members of one’s culture typically develop, and be able to use them, in acceptable circumstances; and second, health is to experience positive moods and sensations, the kinds that have internal causes. The theory solves the problems attached to Nordenfelt’s theory by not being individual relativistic, by eliminating the goals in the definition, by giving an alternative interpretation of “ability,” by making health easier to measure, and by adding the dimension of well-being that, together with health as ability, not only gives us a necessary, but also a sufficient, account of health. (shrink)

The 1948 constitution of the World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. It was a bold and revolutionary health idea to gain international consensus in a period characterized by fervent anti-communism. This article explores the genealogy of the health definition and demonstrates how it was possible to expand the scope of health, redefine it as ‘well-being’, and (...) overcome ideological resistance to progressive and international health approaches. The first part of the article demonstrates how the health definition was composed through a trajectory of draft ideas from scholars in the history of medicine, as well as political actors working to promote national health insurance. The definition was authored by League of Nations veteran Raymond Gautier, but secretly drew heavily on medical historian Henry E. Sigerist’s controversial book Socialized Medicine in the Soviet Union (1937). The second part analyses how it was possible to resist the ideological pushback against the WHO and secure US ratification. The WHO’s progressive constitution was not simply a deviation from dominant health ideas, but a direct outcome of the entrenched health conflict. The genealogy is based on original archival material from international organizations and US government archives. The article contributes to understandings of the political controversies surrounding the WHO and to scholarship on understandings of health. It also illustrates how influential health ideas cross the boundaries between politics and health sciences, as well as the boundaries between domestic health policy and global health. (shrink)

From a scientific standpoint, the world is more prepared than ever to respond to infectious disease outbreaks; paradoxically, globalization and air travel, antimicrobial resistance, the threat of bioterrorism, and newly emerging pathogens driven by ecological, socioeconomic, and environmental factors, have increased the risk of global epidemics.1,2,3 Following the 2002–2003 severe acute respiratory syndrome (SARS), global efforts to build global emergency response capabilities to contain infectious disease outbreaks were put in place.4,5,6 But the recent H1N1, Ebola, and Zika global epidemics have (...) shown unnecessary delays and insufficient coordination in response efforts.7,8,9,10 In a thoughtful and compelling essay,11 Thana C. de Campos argues that greater clarity in the definition of pandemics would probably result in more timely effective emergency responses, and pandemic preparedness. In her view, a central problem is that the definition of pandemics is based solely on disease transmission across several countries, and not on spread and severity together, which conflates two very different situations: emergency and nonemergency disease outbreaks. A greater emphasis on severity, such that pandemics are defined as severe and rapidly spreading infectious disease outbreaks, would make them “true global health emergencies,” allowing for priority resource allocation and effective collective actions in emergency response efforts. Sympathetic to the position taken by de Campos, here I highlight some of the challenges in the definition of severity during an infectious disease outbreak. (shrink)

Globally, there is a lack of adherence to the WHO definition of live birth. This is leading to untenable ethical inconsistencies due to significant variation in which infants are being acknowledged and registered as alive. If an infant is not registered as alive, there can be no acknowledgement of their rights as a child, and there are subsequent implications for worldwide child health resources and funding. Being alive should not be a quality that is geographically determined. This paper (...) explores the differing definitions that are used regarding live birth and the ethical and practical implications for infants, their families and child health worldwide. (shrink)

The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the alternative reading, I argue that the WHO definition puts forward a (...) holistic account, not a notion of perfect health. I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are relevant but that the holistic interpretation is more adept for political aims. (shrink)

Today, health systems around the world are under pressure to create greater value for patients and society [81, p. 1, 119]; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating (...) higher value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system’s customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery. (shrink)

In the climate of concern about high medical costs, the relationship between the trade and professional aspects of medical practice is receiving close scrutiny. In the United Kingdom there is talk of increasing privatisation of health services, and in the United States the Federal Trade Commission (FTC) has attempted to define medicine as a trade for the purposes of commercial regulation. The Supreme Court recently upheld the FTC charge that the American Medical Association (AMA) has been in restraint of (...) trade because of ethical strictures against advertising. The concept of profession, as it has been analyzed in sociological, legal, philosophical, and historical perspectives, reveals the importance of an ethic of service as well as technical expertise as defining characteristics of professions. It is suggested that the medical profession should pay more attention to its service ideal at this time when doctors are widely perceived to be technically preoccupied. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical (...) terms on which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

In recent years, the concept of vulnerability has emerged in bioethics eroding the primacy of the autonomous and self-sufficient individual of the mainstream approach, regarding vulnerability as an obstacle to be removed. The Covid-19 pandemic has underscored an awareness that is not new, yet often little considered, namely that vulnerability is both a universal condition, and a special state dependent on social and economic causes, making the traditional concept of health inadequate to provide answers in the healthcare field. The (...) aim of the work is to examine how the pandemic has challenged the well-being conception of health, and the impact on healthcare and healthcare workers of a definition of health based on vulnerability. Indeed, the connection between health and vulnerability has some practical implications. Particularly, it can shift the focus to vulnerability of healthcare professionals, who have always been considered almost immune from it with the effect of obscuring the dimension of reciprocity between the patient and the physician. The Covid-19 pandemic has made a contribution in the process already began of rethinking health in the light of vulnerability, by bringing out the notion of relational health, and stressing the need to educate to a new approach, in order to increase the wellbeing of all subjects involved in the caring relationship. (shrink)

Differences in guidance from various organisations is preventing uniform standards of practiceThe emphasis in medical law and ethics on protecting the patient’s right to choose is at an all time high. Apart from circumscribed situations, for instance where the Mental Health Act 19831 is applicable, the only justification for medically treating an adult patient against his or her wishes is on the basis of common law, using the principle of best interests, and only when he or she lacks capacity (...) to refuse treatment. As a result, it is important that clinicians should be able to assess capacity to refuse treatment. Given that judgements of incapacity involve deciding that a person does not have the ability to refuse treatment, a great deal of care needs to go into the assessment and characterisation of incapacity.There is divergence between the characterisation of capacity that is used by the courts and that which is recommended by the British Medical Association . The BMA usefully expands on the first element of capacity as set out in the standard legal definition of capacity in the Re C judgment2 but ignores the other two elements. By doing this, the BMA makes it unclear whether it is rejecting these as relevant to capacity; it also misses the opportunity to expand on these elements in a clinically useful way.We will begin with a description of the BMA’s advice3 and the standard English legal definition of capacity.2,4 Then we will show that there are important discrepancies between these two sources of advice. We think that the BMA ought to clarify its position on capacity in order to safeguard the interests of physicians, healthcare workers, and patients.THE RE C TESTMr C was a patient in a psychiatric secure hospital who had chronic paranoid schizophrenia with …. (shrink)

Assessing the normative status of concepts of health and disease involves one in questions regarding the relationship between fact and value. Some have argued that Christopher Boorse's conception of health and disease lacks such a valuational element because it cannot account for types of harms which, while disvalued, do not have evolutionarily dysfunctional consequences. I take Boorse's account and incorporate some Humean-like sociobiological assumptions in order to respond to this challenge. The possession of moral sentiments, I argue, offers (...) an evolutionary advantage (thus falling within Boorse's definition of normal functional abilities). However, this does not amount to emotivism: on the contrary, these sentiments can be the basis of a value system. This value structure introduces the concept of sympathizing with a fellow being's suffering as the basis of a normative dimension to disease. For example, it holds the disvalue of disease to lie in the fact that disease involves suffering and functional limitations.The naturalistic Humean type of account presented here thus jumps the normative-descriptive divide. When Boorse's account is extended to include social sentiments and behaviors, a conception of health emerges which is broader than Boorse's or Kass's, but narrower than the WHO's. (shrink)

Despite the longstanding debate on definitions of health and disease concepts, and the multitude of accounts that have been developed, no consensus has been reached. This is problematic, as the way we define health and disease has far-reaching practical consequences. In recent contributions it is proposed to view health and disease as practical- and plural concepts. Instead of searching for a general definition, it is proposed to stipulate context-specific definitions. However, it is not clear how this (...) should be realized. In this paper, we review recent contributions to the debate, and examine the importance of context-specific definitions. In particular, we explore the usefulness of analyzing the relation between the practical function of a definition and the context it is deployed in. We demonstrate that the variety of functions that health and disease concepts need to serve makes the formulation of monistic definitions not only problematic but also undesirable. We conclude that the analysis of the practical function in relation to the context is key when formulating context-specific definitions for health and disease. At last, we discuss challenges for the pluralist stance and make recommendations for future research. (shrink)