Disease prioritarianism: a flawed principle


Disease prioritarianism is a principle that is often implicitly or explicitly employed in the realm of healthcare prioritization. This principle states that the healthcare system ought to prioritize the treatment of disease before any other problem. This article argues that disease prioritarianism ought to be rejected. Instead, we should adopt ‘the problem-oriented heuristic’ when making prioritizations in the healthcare system. According to this idea, we ought to focus on specific problems and whether or not it is possible and efficient to address them with medical means. This has radical implications for the extension of the healthcare system. First, getting rid of the binary disease/no-disease dichotomy implicit in disease prioritarianism would improve the ability of the healthcare system to address chronic conditions and disabilities that often defy easy classification. Second, the problem-oriented heuristic could empower medical practitioners to address social problems without the need to pathologize these conditions. Third, the problem-oriented heuristic clearly states that what we choose to treat is a normative consideration. Under this assumption, we can engage in a discussion on de-medicalization without distorting preconceptions. Fourth, this pragmatic and de-compartmentalizing approach should allow us to reconsider the term ‘efficiency’.

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  1. 1.

    The term ‘medicalization’, first coined by social critics, describes the social process by which a human condition comes to be seen as a medical problem.

  2. 2.

    In this context ‘effective’ refers to the power of an intervention to produce a desired effect. By contrast, ‘efficient’ means ‘cost-effective’ in this context.

  3. 3.

    I am thankful to an anonymous reviewer for this comment.

  4. 4.

    This observation is valid notwithstanding normative theory. If, for example, retributivists believe that the criminal system ought to punish criminals rather than prevent reoffending, this punishment could be administered by medical means. This is, in fact, the case in some states in the US where lethal injection is used to execute people.

  5. 5.

    However, it is worth pointing out that this intervention is very efficient in terms of QALY (see Henteleff et al. 2013).


  1. Adam, David. 2013. Mental health: on the spectrum. Nature 496(7446): 416–418. doi:10.1038/496416a.

    Article  Google Scholar 

  2. Barendregt, Jan J., Luc Bonneux, and Paul J. van der Maas. 1997. The health care costs of smoking. New England Journal of Medicine 337(15): 1052–1057. doi:10.1056/NEJM199710093371506.

    Article  Google Scholar 

  3. Boorse, Christopher. 2011. Concepts of health and disease. In Philosophy of medicine, ed. Fred Gifford, 16–13. North Holland: Elsevier.

  4. Brülde, Bengt. 2010. On defining ‘mental disorder’: purposes and conditions of adequacy. Theoretical Medicine and Bioethics 31(1): 19–33. doi:10.1007/s11017-010-9133-1.

    Article  Google Scholar 

  5. Caplan, Arthur L., James J. McCartney, and Dominic A. Sisti. 2004. Health, disease, and illness: concepts in medicine. Washington, D.C.: Georgetown University Press.

    Google Scholar 

  6. Crisp, Roger. 2003. Equality, priority, and compassion. Ethics 113(4): 745–763.

    Article  Google Scholar 

  7. Fleishman, Sam. 2012. Insomnia: medicalization of sleep may be needed. Nature 491(7425): 527-527. doi:10.1038/491527d.

    Article  Google Scholar 

  8. Fraser, Lin, Dan H. Karasic, Walter J. Meyer, and Kevan Wylie. 2010. Recommendations for revision of the dsm diagnosis of gender identity disorder in adults. International Journal of Transgenderism 12(2): 80–85. doi:10.1080/15532739.2010.509202.

    Article  Google Scholar 

  9. Greenberg, Gary. 2010. Manufacturing depression: the secret history of an american disease. New York: Simon & Schuster.

    Google Scholar 

  10. Henteleff, Harry J., Daniel W. Birch, Peter T. Hallowell, and CAGS/ACS Evidence Based Reviews in Surgery Group. 2013. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Canadian Journal of Surgery 56(5): 353–355.

    Article  Google Scholar 

  11. Hesslow, Germund. 1993. Do we need a concept of disease? Theoretical Medicine 14(1): 1–14. doi:10.1007/BF00993984.

    Article  Google Scholar 

  12. Illich, Ivan. 1982. Medical nemesis: the expropriation of health. New York: Pantheon Books.

    Google Scholar 

  13. Juth, Niklas. 2015. Challenges for principles of need in health care. Health Care Analysis 23(1): 73–87.

  14. Kessler, Ronald C., Patricia Berglund, Olga Demler, Robert Jin, Kathleen R. Merikangas, and Ellen E. Walters. 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62(6): 593–602. doi:10.1001/archpsyc.62.6.593.

    Article  Google Scholar 

  15. Kingma, Elselijn. 2010. Paracetamol, poison, and polio: why Boorse’s account of function fails to distinguish health and disease. British Journal for the Philosophy of Science 61(2): 241–264.

    Article  Google Scholar 

  16. Larochelle, Sébastien, Louis Diguer, Olivier Laverdière, Dominick Gamache, Paul Samuel Greenman, and Jean Descôteaux. 2010. Psychological dimensions of antisocial personality disorder as predictors of psychotherapy noncompletion among sexual offenders. Bulletin of the Menninger Clinic 74(1): 1–28. doi:10.1521/bumc.2010.74.1.1.

    Article  Google Scholar 

  17. Larsson, Jan. 2007. Prioriteringar i hälso- och sjukvården Socialstyrelsen analys och slutsatser utifrån rapporten “Vårdens alltför svåra val?”. 2007-103-4. Socialstyrelsen. http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8951/2007-103-4_20071034.pdf.

  18. Lichtenstein, Paul, Linda Halldner, Johan Zetterqvist, Arvid Sjölander, Eva Serlachius, Seena Fazel, Niklas Långström, and Henrik Larsson. 2012. Medication for attention deficit-hyperactivity disorder and criminality. New England Journal of Medicine 367(21): 2006–2014. doi:10.1056/NEJMoa1203241.

    Article  Google Scholar 

  19. Livingston, James D., and Jennifer E. Boyd. 2010. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Social Science and Medicine (1982) 71(12): 2150–2161. doi:10.1016/j.socscimed.2010.09.030.

    Article  Google Scholar 

  20. Marmot, M.G. 2005. The status syndrome: how social standing affects our health and longevity. New York: Henry Holt.

    Google Scholar 

  21. Moynihan, Ray, Iona Heath, and David Henry. 2002. Selling sickness: the pharmaceutical industry and disease mongering. British Medical Journal 324(7342): 886–891.

    Article  Google Scholar 

  22. Mytton, Oliver, Alastair Gray, Mike Rayner, and Harry Rutter. 2007. Could targeted food taxes improve health? Journal of Epidemiology and Community Health 61(8): 689–694. doi:10.1136/jech.2006.047746.

    Article  Google Scholar 

  23. OECD. 2013. What future for health spending?. No. 19. OECD Economics Department Policy Notes. http://www.oecd.org/eco/growth/aaaaaawhatfuture.pdf.

  24. Rachels, James. 2001. Theory and practice. In Encyclopedia of ethics, ed. Lawrence Becker and Charlotte Becker, 2nd edn. vol. 3, 1706–1708. New York: Routledge.

  25. Reznek, Lawrie. 1987. The nature of disease. London: Routledge & Kegan Paul.

    Google Scholar 

  26. Salkever, D.S. 1995. Updated estimates of earnings benefits from reduced exposure of children to environmental lead. Environmental Research 70(1): 1–6. doi:10.1006/enrs.1995.1038.

    Article  Google Scholar 

  27. Sandel, Michael J. 2007. The case against perfection: ethics in the age of genetic engineering. Cambridge: Belknap Press of Harvard University Press.

    Google Scholar 

  28. Scheffler, Richard M., Timothy T. Brown, Brent D. Fulton, Stephen P. Hinshaw, Peter Levine, and Susan Stone. 2009. Positive association between attention-deficit/hyperactivity disorder medication use and academic achievement during elementary school. Pediatrics 123(5): 1273–1279. doi:10.1542/peds.2008-1597.

    Article  Google Scholar 

  29. Wakefield, J.C. 1992. The concept of mental disorder. on the boundary between biological facts and social values. The American Psychologist 47(3): 373–388.

    Article  Google Scholar 

  30. Wang, D., M. Connock, P. Barton, A. Fry-Smith, P. Aveyard, and D. Moore. 2008. ‘Cut down to quit’ with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis. Health Technology Assessment (Winchester, England) 12(2): iii–iv, ix–xi, 1–135.

  31. Wang, Haidong, Laura Dwyer-Lindgren, Katherine T. Lofgren, Julie Knoll Rajaratnam, Jacob R. Marcus, Alison Levin-Rector, Carly E. Levitz, Alan D. Lopez, and Christopher J.L. Murray. 2012. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 380(9859): 2071–2094. doi:10.1016/S0140-6736(12)61719-X.

    Article  Google Scholar 

  32. Wilkinson, Stephen. 2000. Is ‘normal grief’ a mental disorder? The Philosophical Quarterly 50(200): 290–304. doi:10.1111/j.0031-8094.2000.00186.x.

    Article  Google Scholar 

  33. Wray, Sharon, and Ruth Deery. 2008. The medicalization of body size and women’s healthcare. Health Care for Women International 29(3): 227–243. doi:10.1080/07399330701738291.

    Article  Google Scholar 

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Correspondence to Karim Jebari.

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Jebari, K. Disease prioritarianism: a flawed principle. Med Health Care and Philos 19, 95–101 (2016). https://doi.org/10.1007/s11019-015-9649-2

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  • Medical ethics
  • Medicalization
  • Disease
  • Prioritization
  • Cost-benefit analysis