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Ronald M. Epstein
Jan 31, 2024
Nov 27, 2023
Oct 10, 2023
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Health matters to people and society. People generally desire to live longer, continue to function independently, and experience well-being throughout their lives. Yet, despite the United States spending more per person on health care than any other country, population health in the United States is declining and below its peer countries with persistent, stark racial and socioeconomic inequities.1-3
One potential contributor to poor US health is conceptual opacity regarding the meaning of health. When health’s meaning is opaque, health is tacitly defined narrowly as the absence of disease. This conceptual opacity perpetuates the biomedical paradigm in health care with its focus on diagnosing and treating disease. This tacit biomedical definition yields poor investment in people’s inherent health potential relative to drugs and technology, thus fostering a misalignment between the goals of health care and the goals of individuals, communities, public health, and society.
This paper aims to explore a broader, holistic understanding of health that includes biomedical health in addition to positive health that addresses the enhancement of human capabilities and well-being. We examine how the absence of a clear definition of health defaults to a narrow, biomedical meaning within the health care system with ensuing adverse consequences such as the objectification of people and the undermining of health care’s role in fostering the full health potential. Finally, we address the steps and challenges that must be considered to adopt a whole health meaning with the potential to transform and humanize health care and effectively promote equity in whole health.
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The Milbank Quarterly is an editorially independent multidisciplinary journal that offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.