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Health Care Analysis
Published in: Health Care Analysis 2/2021

Open Access 01-06-2021 | Original Article

How to Draw the Line Between Health and Disease? Start with Suffering

Author: Bjørn Hofmann

Published in: Health Care Analysis | Issue 2/2021

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Abstract

How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization.
Footnotes
1
The distinction between measures and indicators may seem subtle, and Rogers and Walker are not clear about these concepts. In this article it is assumed that a measure of a function is closer to the function than an indicator. For example, HbA1C is an indicator of glycemic control, while glycemic control is a measure of blood glucose regulation. In the quotes by Rogers and Walker on the UTI, they do not only point to the line-drawing problem, but also the problem of selecting which measures that count.
 
2
Correspondingly, the issue of variation and context can be taken into account: If a person experiences that (s)he is not able to function in the job as a teacher, combined with a family life with three children and three elderly and frail parents close by, then the level of cardiac output may indicate reduced cardiac function even though another person with exact the same (age, weight and) CO may be labelled as healthy.
 
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Metadata
Title
How to Draw the Line Between Health and Disease? Start with Suffering
Author
Bjørn Hofmann
Publication date
01-06-2021
Publisher
Springer US
Published in
Health Care Analysis / Issue 2/2021
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-021-00434-0

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