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part of the discussion plays out between a
Biostatistical Theory of health
(BST),
as presented by Christopher Boorse and the more encompassing
Holistic Theory
of Health
(HTH) suggested by Lennard Nordenfeld. The opposition of these two
theories is one between a naturalist and a normativist understanding of health and
disease; Boorse understanding himself as an “unrepentant naturalist” [2, p. 5]. It is
the simplicity, rather than the accuracy, of these two theories, which makes them an
ideal point of departure. The brief outline of these positions serves as parameter to
position the theory of disease suggested by Sadegh-Zadeh and to test it against the
current discourse.
Roughly spoken, Boorse suggests in his classical and straightforward definition
to understand disease as “a type of internal state which impairs health, i.e. reduces
one or more functional abilities below typical efficiency” (Boorse 1977, 555). Such
a definition has the benefits of referring - in theory - to objective empirical data
allowing for drawing clear boundaries between health and disease. Healthy is some-
one without a reduction of the functional abilities necessary for life. The practice,
however, turns out to deal with the challenging problem of having to define statis-
tical normality, biological function and the frame of reference. Biological function
is defined with reference to the causal conditions to suit the individuals and species
survival. Reference class pertains to a specific “an age group of a sex of a species”
[2, p. 7]. Abilities are relative to sex and age group, otherwise old age might gen-
erally be considered as a disease, a consequence that Boorse wants to avoid. This
functional explanation of health is supposedly, as Boorse argues, a value free def-
inition of disease and should therefore allow for a more or less clear delimitation
between health and disease. Health in turn is defined as the absence of disease:
“Health is the absence of disease” [2, p. 8]. Such binary logic is nicely embedded
within the context of evolutionary biology. Serving somewhat of a standard model
in the field of the philosophy of medicine (having a similar function as the four prin-
ciples of Beauchamp and Childress in the bioethical discourse), a large number of
challenges have been raised against Boorse's theory. Nevertheless, proofed wrong
over and over again, due to its simplicity it has remained the standard theory, the
default model as it were, of health and disease: “It is as if the health concepts de-
bate got stuck in a loop. After each contribution it reboots to Boorse” [4, p. 19].
A prominent theory challenging Boorse's is the one of Nordenfelt. His account of
health focuses more on the quality of life (or welfare) rather than on survival. “A is
completely healthy if, and only if, A has the ability, given standard circumstances,
to reach all of her vital goals.” [10, p. 7] Optimum health is reached if the person
is able on the biological as well as psychological level “to have the second-order
ability to realize, given reasonable circumstances, all her or his vital goals.” [8,
p. 72] The qualifier “second-order ability” pertains to the fact that not the actual
ability (e.g. of driving a bike) is necessary for being healthy but the potential abil-
ity (e.g. the ability of learning to drive a bike given a regular amount of exercise).
Rather than some functional ability, health is understood teleologically as the ability
“given standard circumstances, to reach all of her vital goals.” [10, p. 7] Standard
circumstances do not refer to statistical means or functional ability but rather to
the social and cultural framework. Health is relative to the social expectation, too.
