Why is Health Good for You?

“Brush your teeth,” a mother says to her son. She’s exhausted. She spent a long day organizing a series of speaking events hosted by her department, Bioethics, at the NIH. A tough year at the NIH followed several tough years of fierce public and academic debate over the legitimacy of public health efforts and the value of scientific medicine. He needs to go to bed. First, he needs to brush his teeth. What she doesn’t need is—

Our sleepless bioethicist has arrived at what I believe is a genuine and difficult philosophical puzzle, one that has not received near its due in bioethics, political philosophy, or philosophy of medicine. Why is health good for you? The prudential value of health is often simply taken for granted in public and philosophical discourse. And its value is relied upon in explanations of the moral significance of providing healthcare, regulating health insurance, establishing public health-payers (like Medicare in the U.S.), promoting public health efforts, and more. Those explanations, however, are only as valid and informative as this assumption is well-founded. I’m not suggesting that health isn’t (often) good for you, but the foundation for its value (and by extension the proper limits of its value) is obscure.

Having diagnosed this philosophical malady, I have some suggestions about its etiology and a recommendation for its treatment.

Why is health good for you?

One reasonable thought is that addressing this question requires, first, addressing the following.

What is health?

Definitional (or analytical) questions are often treated as prior to evaluative ones: we must first be clear, the thought goes, on what we’re talking about before we can meaningfully determine its relation to values.

So, it seems we can’t address the value of health without first addressing what it is. Unfortunately, a consensus answer to the what-question remains elusive after generations of philosophers of medicine working on it. They don’t even agree on the kind of thing health is (see below). Given this disagreement, it’s unsurprising that philosophers have yet to turn significant attention to the value-question: addressing why health is good for you might be thought infeasible without a better grasp on the nature of health.

To motivate this account of the root cause of our failing to address why health is good for you adequately, consider three prominent approaches to defining health in the literature. Each responds to an important set of associations we commonly have with health. And each offers a distinct path to explaining its value.

1. The Biostatistical Theory

On this view, health is the absence of disease (or “pathology,” to include injury). A disease is, roughly, a disposition of some part of one’s body (or mind) to contribute to the normal functioning of one’s body (or mind) less well than is typical. So, some heart arrhythmias dispose the cardiovascular system to circulate oxygen to the heart and the rest of the body less well overall than a normally performing heart. A fractured femur disposes one’s leg to support one’s weight while walking or standing less well than an unbroken bone. And so on.

Why might health be good for you, on such a view? Not having a heart arrhythmia is instrumentally beneficial since these conditions can lead to fainting, dizziness, and even death in some cases; not having a broken leg helps you get around. These two forms of pathology can also be painful and produce other unwanted symptoms. The normal functioning they obstruct can be beneficial in myriad other ways. So far, so good. The problem is that not all dysfunctions are like these. Many cases of prostate cancer will remain symptomless for the entirety of the man’s life. Infertility is prudentially bad for someone who wants to start a family, but might be neutral (or convenient) for those who don’t.

One influential response to this problem is to argue that normal function is systematically linked to opportunities for a good life. Infertility due to dysfunction deprives a valuable opportunity, the response goes, even when that opportunity is not presently being pursued. But this response raises some worries. First, it’s not clear that the systematic correlation holds. Second, this response assumes that having more valuable opportunities in one’s life is beneficial. But that may not be so.

Imagine two Halloween candy buckets: In one bucket are more pieces of candy than you could reasonably eat. There are a few of your favorites (for me: Snickers, Starburst, Milky Way), but many more that you like but don’t prefer (does anyone even like Necco wafers?). In another bucket are far fewer pieces, but plenty, and with a high concentration of your favorites. Which bucket would you prefer to take home? This analogy can be strengthened by imagining that you can’t see inside the bucket when selecting a piece of candy to eat and that you are limited to a handful of pieces: in life, after all, we only pursue a tiny fraction of our valuable opportunities and often lack knowledge and control over which we have and which we choose. Bigger buckets are not always better, whether we’re talking candy or valuable opportunities.

2. The Harmful Dysfunction Account

A second view of health aims to address precisely this disconnection between health and its value. According to it, health is the absence of “disorder,” where what counts as a disorder is, roughly, a subclass of what the last view called “diseases” or “pathologies”: namely, those diseases that are harmful to the bearer. This view neatly addresses the value-question. Conditions that detract from your health (“disorders”) are bad for you by definition.

While neat, one may worry that this way of solving the value-question—namely, by building value into the definition of health—doesn’t so much explain health’s value as simply assert it. It’s like responding to the child’s question, “Why should I take an interest in my dental health?” with “Because you have an interest in your dental health.” Many of us will readily grant that health is good for us, but if we take up the child’s query, it’s because we’re looking for a deeper explanation of what we believe unreflectively. An increasing number of us, moreover, are reluctant to grant health’s value. If philosophers hope to speak to that reluctance, appealing to this definition is unlikely to be persuasive.

3. Agential Accounts

A third approach to defining health takes a different tack. It starts with the thought that a state of good health might be understood in terms of its role or impact on one’s agency. Flourishing agency reveals good health, and physical or mental conditions (heart arrhythmia or a broken leg) manifest as pathologies by limiting one’s agency (dizziness or difficulty walking). Of course, there are other factors for flourishing agency (knowledge, favorable circumstances, etc.), so turning this thought into an account of health requires some restriction.

On one specific proposal, health is roughly the ability to realize (or strive after) your goals. What matters here are your actual goals, rather than goals you could or should have. But some of your goals result from your being a goal-directed organism (whose body aims, so to speak, at preserving itself, etc.). Other goals include the content of your desires, deliberations, and so on. So, some heart arrhythmias are unhealthy conditions because they predispose you to dizziness and fainting, among other things, and thereby undermine any number of goals. A broken leg is unhealthy insofar as your goals involve walking or standing. Infertility, insofar as you want to conceive a child. These quick examples suggest of the subtlety of the view. Though there are hard cases and some unintuitive results (e.g., symptomless prostate cancer might not be unhealthy and health might be more attainable for the lazy than the unambitious).

On the one hand, linking health conceptually to agency helps to explain its value. We care about our agency—both because it enables our attaining goods and because it itself might be an intrinsic good. (Thought experiment: If you had a choice between being the agent you are and living a life of a passive recipient—a patient—of pleasant sensations, like Thomas Nagel’s famous “contented infant,” which would you choose?) If part of what it is to be an (effective) agent is to be healthy, then we have a clear path to a non-trivial explanation of the prudential value of health.

On the other hand, what we value in our agency is not, I think, fully captured by the goals we happen to have. I don’t just value the attainment of the goals I have, or the ability to strive after them, or the fact that I have goals. I also value my capacity to set goals for myself, and not just any goals; good or what we might call autonomous ones. And at least some of the physical or mental conditions that undermine these capacities (an injury that renders me Nagel’s contented infant or so-called trauma bonding and the like) are unhealthy, too, even when they result in a perfect fit between one’s goals and abilities.

I’m a fan of the approach to defining health by linking health and agency, but I don’t think an adequate definition of this sort has yet been proposed.

Three approaches to analyzing health carve out three paths for explaining its value. The first path—that avoiding illness is often but not always instrumentally valuable—falls short of justifying our concern to promote health. The second—that illness is definitionally harmful—insists where it should explain. And the third—that health is tied to our agency—is promising, perhaps, but implausible as is. The disparate directions these paths take might be thought to support the view that definition should come before evaluation.

But I suggest we draw the opposite lesson: by focusing on what health is, philosophers have been distracted from how poor their explanations of its value have been.

Because the what-question has been taken as primary, and the value-question regarded as secondary, philosophers of medicine have often been content to provide limited and even knowingly inadequate answers to the latter in their accounts of the former. But it seems to me reasonable to expect of a good account of health that it will explain why and to what extent health is good, since the very scientific and practical endeavors most concerned with understanding health are at the same time just as concerned with promoting it.

So, my simple recommendation for how to treat this philosophical malady is to position the explanation of health’s value as part of the aim of the endeavor of defining it (as a desideratum): not to reverse the priority of what- and value-questions, but to tackle them simultaneously. (I should note that this proposal resonates with calls made by Elizabeth Barnes and Somogy Varga, though neither goes so far as to attempt the sort of account I’m calling for.)

Some will say the result risks being an account not of health-as-such but of health-insofar-as-it-is-good-for-you. Here, at least, I think a shrug is appropriate.