The concepts of ‘health’ and ‘disease’: Underlying assumptions in the idea of value in medical interventions

Excerpt

This chapter provides an overview of the problem of conceptual definition of ‘health’ and ‘disease’ as a background to situate and introduce the discussion about health outcomes and value of new medical interventions. This work reflects and discusses broader literature on this topic by highlighting the available – and lacking – definitions in the specific context of health institutions in the UK. After introducing the World Health Organization's (WHO) definition of ‘health’ and some general criticisms of it, two more recent and particularly relevant positive definitions of ‘health’ are presented, stressing the potential connection between such definitions and the role of healthcare services. This is followed by a more extensive analysis of positive definitions of ‘disease’ since the technical literature seems particularly prolific and relevant. In order to organise the discussion, this chapter frames the different approaches to positive definitions of ‘disease’ within the fact/value problem. At the same time that it introduces three of the most influential conceptualisations of disease (Biostatistical Theory, The APA Task Force work and the Harm Dysfunction Analysis), it illustrates three possible positions regarding the fact/value problem in this matter (strong descriptivism, strong normativism, and mixed descriptive/normativism, respectively). Finally, because of the lack of a successful and agreed definition of ‘disease’, this chapter highlights recent efforts to embrace the disjunctive and vague elements of this concept, allowing and encouraging specific and contextual cluster definitions of ‘disease’, which seem particularly useful to contextualise and open the discussion on how to think about the idea of health outcomes and value in medical interventions.