Conceptualizing Health and Health Promotion: An Ethical Analysis

Negative and Positive Conceptions of Health

Turning to the first of the two issues just distinguished, there are two main views about the meaning of ‘health’. The first is a negative view: to be healthy is to lack something. The most prominent suggestion is the biomedical conception of health, i.e., health is the absence of disease. So, someone is healthy when they are free of disease, and unhealthy if, and to the extent that, they have a disease. The second main view about the meaning of ‘health’ is positive: to be healthy is to have or be something. The most prominent contender is the well-being conception of health according to which someone is healthy when, and to the extent that, they enjoy well-being.

This distinction between negative and positive conceptions of health seems to figure largely in lay, as well as professional, conceptions of health and illness (Calnan 1987: 26ff.). And the biomedical and well-being conceptions are clearly connected because disease tends to compromise well-being. This might suggest that disease and well-being vary inversely with one another, with more disease equating to less well-being and less disease amounting to more well-being. Given this, absence of disease and well-being are not really two definitions of health; rather, they are two ways of describing a single health concept.

Two main conceptual claims have been made in this chapter: there is more than one adequate understanding of health; and, on the definitions of health pertinent to public health, health is a value-laden notion. This gives rise to practical problems. When it comes to evaluating public health interventions, we have to ask two questions. Quite what is being protected and promoted by such-and-such an intervention; i.e., what meaning of ‘health’ is in play? And what – and whose values are being reflected in such-and-such an intervention; ones that can be defended and justified, or ones that are glibly assumed to be important and universal? Although such questions apply most obviously to health promotion, it has been demonstrated that they impact on other kinds of public health activity.

Tengland's article presents two models of health promotion and Rossi and Yudell give us three arguments that persuasive health communication is ethically problematic. Using our text and information learned so far in our course, present the main ethical problems of health promotion and discuss what ethical health promotion might look like.