The pitfalls of the "positive concept of health"

One of the most structured critiques of the biomedical model, in general, and particularly with regards to its application to collective interventions under the aegis of traditional public health, focuses on the distortions produced by the central role played by disease, which would in turn lead to a series of unwanted consequences. As a counterpoint, there is an ever increasing demand for health promotion based on a "positive concept" of health, which in order to go beyond the limitations of a mere avoidance of diseases, aims to restore the wider values of life in their full extension. This paper presents two counterpoints, one to the criticism and the other to the proposals that arise from it. First, the problem is not exactly with the concept of disease but in its reification, that is: the term disease can be understood as a theoretical and heuristic artifact that organizes the available knowledge and delimits a certain class of problems where the technical intervention is not only justified but mandated, circumscribes the sphere of action of health care professionals an creates, at least in principle, a barrier to medicalization. Second, the risk of an excessive emphasis on a supposed "positive definition" of health as a guideline for the functioning of health care lies in the extension of the range of action of the so called "health sector" to all aspects of life, of the human experience, in an even more radical form of medicalization than what was denounced by the pioneers of the field four decades ago.

Health; disease; epistemology; thought style; paradigm

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