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Current theoretical approaches to bioethics and public health ethics propose varied justifications as the basis for health care and public health, yet none captures a fundamental reality: people seek good health and the ability to pursue it. Existing models do not effectively address these twin goals.
The approach I espouse captures both of these orientations through a concept here called health capability. Conceptually, health capability illuminates the conditions that affect health and one's ability to make health choices. By respecting the health consequences individuals face and their health agency, health capability offers promise for finding a balance between paternalism and autonomy.
I offer a conceptual model of health capability and present a health capability profile to identify and address health capability gaps. (Am J Public Health. 2010;100:41-49. doi: 10.2105/AJPH.2008.143651)
VARIOUS ETHICAL approaches provide different justifications that underlie health care and public health. Some models assert consumer rationality in health behaviors and a willingness to forgo care beyond the individual's means. Other approaches focus on fair processes, equality of opportunity, utilitarianism, or equal distribution of goods. Libertarians emphasize autonomy. However, none of these approaches captures a fundamental reality in the health ethics realm: people seek both good health and the ability to pursue it. Existing models cannot effectively address these twin goals because they typically favor either a consequentialist (outcome-oriented) or a proceduralist (procedure-oriented) perspective.
The approach I develop captures both these intuitions in a concept I call health capability. Health capability integrates health outcomes and health agency.Why is it so difficult for some populations or individuals to translate health resources into health outcomes?Why have health literacy efforts been only moderately successful? Why do some individuals have such difficulty adhering to specific treatment regimens? Why are some individuals harmed or helped by cultural norms about health behaviors? Conceptually, health capability enables us to understand the conditions that facilitate and barriers that impede health and the ability to make health choices. It offers a more accurate evaluation of the aim and success of social policies and change.
Health capability is comprised of both health functioning and what I call health agency. I define health agency as individuals' ability to achieve health goals they value and act as agents of their own health; health agency achievement represents...