Philosophical Foundations of Health Assessment: Towards a Dynamic and Integrative Conception of Health

Contemporary trends push health care towards gaining evidencebased knowledge of the severity of health conditions and the efficacy of health interventions. To this end, generic health assessment instruments are developed, which are questionnaires designed for (self)evaluation of health on broader dimensions like physical, mental, and social health. The aggregated scores of the instruments represent a quantified assessment of the overall degree of health and well-being attached to certain health conditions.


However, when operationalizing the overall state of health and well-being into quantified and measurable items on a questionnaire, the instruments implicitly rely on substantial philosophical assumptions about the nature of these phenomena. In the first article of this project, the philosophical workings and assumptions of these instruments are elucidated through a qualitative study of health professionals’ thoughts on the practice. To really gauge what conceptions of health and disease are at play in the instruments, the dichotomy of normativism and naturalism within philosophy of health is used as an interpretive key. I strive to let the empirical investigations inform the theoretical and vice versa to avoid both a strictly bottom-up and top-down approach.


The juxtaposition of philosophical theories with qualitative analysis exposes weaknesses in established positions, which the remaining articles seek to revise. The second article argues that the discussion between normativism and naturalism founded on conceptual analysis is caught in a deadlock and suggests an ontological approach instead, which construes health and disease as a relation between capacities to adapt and demands imposed upon the organism if it is to thrive. The third article criticizes the current trend of phenomenology of illness for being too one-sided and psychologizing, instead proposing that health and illness manifest themselves phenomenologically as the preservation of or fundamental broaches upon conative activities. In recent times, certain movements within medicine like personalized medicine claim that health conditions are fundamentally individual and variable. The fourth article asks what this entails, and what model of medical anthropology is needed to accommodate such a perspective. As a whole, the project works towards providing the groundwork for a more dynamic and integrative conception of health and disease. Whether a maximalistic theory of health and disease is amenable with the measurement of generic health is, however, an open question, and the project is concluded by a discussion thereof.