In this paper, I argue that health plays a special role in the promotion of well-being within the capabilities approach framework. I do this by first presenting a scenario involving two individuals, both of whom lack access to only one capability. The first cannot secure the capability of bodily health due to an unhealthy lifestyle, whilst the second lacks access to bodily integrity due to a life of celibacy. Second, I explore these scenarios by assessing the nature of disadvantage suffered in both instances. I suggest that corrosive disadvantage (or the type of disadvantage that adversely impacts one’s ability to secure other valuable things) is what leads us to conclude that health is of special moral importance in the promotion of justice and the endorsing of well-being.
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While I recognize there is an incredibly rich discussion of what constitutes health, in keeping with other aspects of this piece I will follow Norman Daniel’s conception of health. In Just Health: Meeting Health Needs Fairly (2008), Daniels suggests a shift away from two misunderstandings of health. The first is that health is the absence of disease. This is because, of course, the notion of ‘disease’ is too narrow to capture all that we aim to capture when discussing health. Daniels also pushes away from the World Health Organization (WHO) definition: “health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (WHO 1946). I think Daniels (2008) is correct when he states that the WHO conception risks turning all disadvantage into health. More recently, Venkatapuram’s conception of health advanced in his Health Justice: An Argument from the Capabilities Approach (2011) seems to commit us to a somewhat vacuous conception of health, categorizing any deprivation of the central capabilities as being the result of poor health. Instead of relying upon a subjective account of health like the WHO’s or Venkatapuram’s which seems incompatible with an objective theory of the good-life (e.g. the capabilities approach), Daniels relies upon an objective understanding. He suggests that health should be understood as the absence of pathology (Daniels 2008). Here we are to understand ‘pathology’ to refer to deviations from species typical functioning. While this conception may itself be too broad of a notion of health, I do want to leave such disagreement to the sideline for the time-being.
I briefly explain the capabilities approach and its main components in Sect. 3 below.
Daniels’ notion of functioning differs from the functionings that are components of the capabilities approach and discussed in further detail in Sect. 3 below.
Of course there may be other opportunity protectors that are important as a matter of justice, and we need not concern ourselves with a lexicographical ordering of these for the time being. As I argue in Sect. 5, I suspect that we can at least create two classifications of capabilities. I suggest that health resides in the category of capabilities that should be given special moral importance over the other class. I thank an anonymous reviewer for this nuanced point.
The most important of which I take to be: Ruger (2009) Health and social justice. Oxford University Press, New York.; Ruger (2006) Toward a theory of a right to health: capability and incompletely theorized agreements. Yale J L Human 17:273–326.; and Anderson (1999) What is the point of equality? Ethics 109:287–337.
I acknowledge the perhaps troubling use of the word ‘dignity’ in greater detail in Riddle (2013).
I advance this position in greater depth in Riddle (2011).
I first encountered the example of celibacy and monks in Arneson (2005) ‘Good enough’ is not good enough. In Kauffman A (ed) Capabilities equality: basic issues and problems. Routledge, New York.
I would like to thank Jerome Bickenbach for making this suggestion.
It is important to note that the claim being made is that health has special moral importance. This claim does not exclude the fact that other capabilities might also reside in the category of things with special moral importance. The capability of ‘bodily health’ is simply being used as an example of a capability that resides in a subset of capabilities that Nussbaum fails to acknowledge as requiring special attention. Certainly the corrosiveness of capabilities resides on a spectrum that is difficult to measure definitely. That said, I employ the two examples of health and celibacy to point to two obvious cases of disadvantage: one that prompts justice considerations, and another that does not. One could point to other capabilities that are more difficult to classify as residing in the subset of capabilities that result in corrosive disadvantage if not secured. Thus, further work is required on establishing what threshold is employed to classify capabilities. Nonetheless, I suspect the point holds that there are some disadvantages that prompt justice considerations because of the corrosiveness of that disadvantage, and there are some forms of disadvantage that do not. Poor health results in disadvantage that warrants concern in the realm of justice, whilst celibacy does not. The point being made concerns the fact that we need to distinguish between classes of disadvantage that result from the absence of a functioning, and not a question about how we should go about parsing the capabilities.
For two of the many research projects that affirm this, see: Nibert et al. (1989) Assaults against residents of a psychiatric institution: residents’ history of abuse. J Interpers Violence 4:342–349; or Satistics Canada Centre for Justice Statistics (1994) Wife assault: the findings of a national survey. Juristat 14:1–21.
At this point one might be inclined to suggest that the importance of health might be exaggerated. Take for example Michel Petrucciani. Petrucciani was a famous jazz pianist who died at age 36 and suffered from a very substantial disability. One could reasonably conclude that he would not have traded his art for a longer, or healthier life. Examples of people sacrificing bodily health for their art are abundant. Maybe we can view the Petrucciani example and other cases like it as evidence that health need not always trump other goods. I suspect this might be a reasonable claim. That said, if we continue to operate within the confines of the capabilities approach we can see that while this claim might be a distinct critique of capabilities, I do not feel it is a refutation of my intended point. I am operating within the parameters set by the capabilities approach. These parameters state, amongst other things that the goal of justice should be to maximize the number of capabilities one has a minimally just level of access to. This implies that a capability that minimizes the amount of capabilities one has a minimally just level of access to is particularly important. It has special importance because without it, other capabilities are more difficult to secure. If the goal of the capabilities approach is to maximize the number of capabilities one has minimal access to, then the argument being advanced in this work—that health resides in a class of capabilities that have special moral importance because of the corrosive disadvantage that results from a failure to secure a healthy life—seems to follow. The critique concerning the exaggeration of the importance of health seems to suggest that the antecedent of the previous claim—that the goal of justice is to maximize the number of capabilities one has minimal access to—is false. This is a distinct critique of the capabilities approach, and not a direct critique of the remarks being made here that assume the antecedent is true and offer critical remarks of the capabilities approach that grant its design is correct, whilst suggesting that its implementation is troubled.
Thank you to an anonymous reviewer for the wonderful preceding critique and example.
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Riddle, C.A. Well-Being and the Capability of Health. Topoi 32, 153–160 (2013). https://doi.org/10.1007/s11245-013-9167-x