Mahesh Ananth: In Defense of an Evolutionary Concept of Health: Nature, Norms and Human Biology

Abstract

The concept of health has always been a debatable aspect when WHO defines it as ‘not merely an absence of disease but a state of physical, mental and social wellbeing’. The ambiguity implicit in the second part of the concept is still debatable. Health also described through capability approach situating within the context of Justice as well as productivity-based approach that uses DALY as a way to understand health, highlights the importance attached to the concept. In philosophy of medicine, the debate has been slightly different as to whether the concept of health is value free and objective as claimed by naturalists or as that embedded in the context that has a greater bearing of what one qualifies as healthy as argued by normativists. Though this debate appears to be more of clinical significance, as an offshoot from the field of philosophy of medicine its insinuation has lot to offer in the current studies in the field of sociology of health and illness that examines the social production of disease and health care and even in the field of bioethics. The book by Ananth on an evolutionary concept of health is an attempt to examine the concept of health grounded within the debates in philosophy of medicine. He is absolutely right in choosing the definition by Christopher Boorse, one of the strong proponents from Naturalists stream, which is still the dominant definition in the field despite having faced several criticisms from the normativists camp. It is interesting to find that the forward for the book is written by H. Tristam Engelhardt Jr., one of the strong proponents of normativist camp on the concept of health. Not only does the concept of health remain as a strong influence in medical practice, but also is an important determinant in the current discourse on public health and health policy. The attempt by Ananth to address the complexity of the concept of health needs to be appreciated as it brings a better clarity on a complex concept and also about disease acknowledging its own limitations. This leaves scope for applying it not only in the fields of public health but also informs the engagement of biomedicine with other systems of medicine. This may appear as an over emphasis, but part of the reason could be due to the fact that the implications of a minor orientation in the core concept of health and/or disease can influence all the above fields tremendously. The book starts with an introductory note on the concept of health and the various dimensions it generates and confines his inquiry only to physical health which he himself considers is capable of informing other dimensions of health too. The above inquiry to the concept of health offers new orientation to other disciplines due to the trans-disciplinary characteristic of the concept per se. Though Boorse M. George (&) Centre for Public Health, School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai 400088, India e-mail: matsajo@gmail.com URL: http://www.tiss.edu/faculty/dr.-mathew-george/