Whose Health?

Craig Stephen

THE CHALLENGE OF DEFINING HEALTH

In 2009, the government of Canada embarked on one of its largest and most expensive public inquiries. The Commission of Inquiry into the Decline of Fraser River Sockeye Salmon aimed to explain why this iconic species returned to its natal river in surprisingly and alarming low numbers in one year. The final report of the Commission used the word health 400 times. Never once did it describe how to recognize a healthy salmon or a healthy population. Optimal health seems to be an almost universal goal. Healthy individuals, healthy communities, and healthy ecosystems feature prominently in government policies, community plans, resource management guidelines, and personal goals. But it is rare for such aspirations to clearly prescribe how to recognize health. We are much more adept at recognizing when health is absent or tracking the conditions and contributors to health. This chapter introduces some of the ways health is conceived for people, animals, or ecosystems and discusses the need to understand these differences before embarking on an interspecies health program.

The definition of health is the subject of long-standing debate in the philosophy of medicine. The dividing line between health and diseases and the combinations of capacities, attributes, and attitudes that define a healthy state have varied over time and between cultures, disciplines, and subdisciplines. Broadly speaking, there are three perspectives of health (Ereshefsky, 2009). “Naturalists” regard health as normal and natural biological functioning. A “normative” view regards health as shared judgements about what we value and what an individual (or group) can do. The hybrid view declares something is healthy when there is no detectable harm or deprivation of benefit as judged by the standards of a culture and when that thing can perform its normal functions. Each of these perspectives includes the ideas of normal and values. This makes health a subjective concept created and accepted by the people in a society rather than an objective, irrefutable biological state determined by biology alone.

Health is a “humpty-dumpty” problem. Like the old English nursery rhyme of the shattered anthropomorphic egg that could not be put back together again by “all the King’s horses and all the King’s men,” many pieces of biomedical, sociological, ecological, and individual knowledge can be assembled to define health, but there is no guarantee that different groups of people will assemble all the components together in the same way. As such, there can be several true, but conflicting, perspectives of health held by different individuals in the same circumstances. Take for example the case of a captive whale housed in an aquarium. This animal may show no pathophysiological abnormality, be normal in form and function, be able to reproduce, and can fully exploit the resources offered to her. Yet she is neither able to fulfil her evolutionarily destiny nor exhibit all behaviours typical of her wild peers. Whereas one group may conclude that she is biologically healthy, other would see impediments to her ability to express normal behaviour an affront to her welfare and therefore, not healthy. In this case, individual animal health concerns clash with the desire to learn more about the species and foster public goodwill that promotes conservation of the wild cohort (Minteer and Collins, 2013). As another example, social conflicts and disagreements over health have been one of the biggest impediments to salmon aquaculture securing its social license to operate (Stephen and Wade, 2019). Proponents see aquaculture contributing to healthy communities and ecosystems by reducing exploitation of wild stocks and contributing to food security and employment. Opponents see the potential transmission of infectious disease to free-ranging wild animals, habitat alterations, and imposition on aboriginal rights for sustainable ocean resources combining to create an unhealthy situation.

Patience, persistence, and flexibility are critical skills for the health promotion at the junction of differing views and values of health. Interdisciplinary and interspecies health promoters need to be able to negotiate a common agenda for action, rather than impose their health definitions on partners, stakeholders, and rights holders.

 
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