Health

Health is one of the oldest and most contested concepts in medicine. Everyone knows what it means to feel healthy, yet no definition has satisfied physicians, philosophers, and patients simultaneously. The WHO declared in 1948 that health is “a state of complete physical, mental and social well-being,” but most philosophers reject this as impossibly demanding. The ancient Greeks defined health as balance — of fluids, forces, and qualities within the body. The French philosopher Georges Canguilhem argued that health is not a measurable state at all but the organism’s capacity to create new norms when its environment changes. The debate matters because how a society defines health determines who counts as sick, what medicine is for, and who deserves care.

Health as Balance

The earliest surviving attempt to define health in naturalistic terms belongs to Alcmaeon of Croton, a physician-philosopher working around 500 BCE. Alcmaeon proposed that health is the equal distribution of bodily forces — moist, dry, cold, hot, bitter, sweet — and that disease arises when any single force dominates the rest. (Nutton, 2023) His vocabulary was borrowed from Athenian political life: health was isonomia, the equality of forces; disease was monarchia, the tyranny of one. (Nutton, 2023) The body politic and the political body were already inseparable.

The Hippocratic Corpus absorbed and extended this framework. Health, for the Hippocratic authors, was equilibrium and illness an upset. The text On the Nature of Man established the four humours — blood, yellow bile, black bile, and phlegm — correlated to four qualities, four seasons, and four ages of life, creating an explanatory system of impressive versatility. (Porter, 1997) But Nutton warns against reading the four-humour theory back onto the whole Corpus: the two most clinically important humours were phlegm and bile, visible at the bedside and easily associated with illness, and most Hippocratic authors operated with these two rather than four. (Nutton, 2023)

The Corpus also contained a broader, more flexible view of health that was not limited to a single balance point. Some authors described health as a wide band in which a certain disequilibrium is permitted rather than a knife-edge from which any deviation counts as illness. (Nutton, 2023) This distinction — between a narrow conception (you are either well or ill) and a broad one (health is a range, not a point) — would recur throughout the history of medicine, reaching its sharpest formulation in Canguilhem’s twentieth-century critique.

Empedocles, working a generation before the Hippocratic texts, had proposed that health depends on a balanced mixture of the four cosmic elements — earth, air, fire, and water. (Nutton, 2023) It was his four-element scheme, with its satisfying cosmological symmetry, that gave the four-humour theory its explanatory ambition and ultimately its dominance.

The Healing Power of Nature

If health is the body’s natural state, then disease is a disturbance from which the body may be capable of recovering on its own. The Hippocratic Corpus was the first body of medical literature to establish spontaneous healing as a medical fact and to elevate the organism’s self-help to a foundational assumption of rational therapeutics. (Neuburger, 1943) This move — from treating disease as divine punishment requiring priestly intervention to treating it as a natural process the body itself works to resolve — marked what Neuburger, in The Doctrine of the Healing Power of Nature (1932), identified as the boundary between theurgic and scientific medicine.

The Hippocratic authors described disease not merely as pathos (suffering) but also as ponos (work or effort). The symptom picture therefore contained signs of both damage and defense, and distinguishing between them was essential for prognosis and therapy. (Neuburger, 1943) The physician’s role was explicitly that of servant of nature (hyperetes tes physeos): to watch the natural healing process, regulate conditions through diet and environment, and intervene only when nature’s own efforts were delayed, absent, or misdirected. (Neuburger, 1943)

Not everyone agreed. Asclepiades of Prusa, the first major ancient physician to practice on atomist-mechanist grounds, denied the vis medicatrix naturae outright, calling nature “vainly laboring” and dismissing Hippocratic expectative therapy as “meditation on death.” (Neuburger, 1943) The debate he opened — between those who trust the body’s own healing capacity and those who insist the physician must actively intervene — has never closed.

Galen, writing in the second century CE, systematized the Hippocratic intuition. He identified four natural powers and gave pride of place to the excretory power (dynamis apokritike), which effected the crisis and expelled the disease-producing material. (Neuburger, 1943) García-Ballester’s study of Galen’s clinical practice reveals that Galen went further, treating health as a moral obligation: he considered most illnesses consequences of errors in lifestyle and therefore avoidable, making health and illness “a problem of moral responsibility, a cause for reflection and moral improvement” (García-Ballester, Luis, 2002). Galen’s On the Preservation of Health (De sanitate tuenda) gave this approach a positive content. He defined health there as “the state of right balance between elementary qualities such as hot, cold, dry and wet, within the homoeomerous parts of the body,” though this balance was relative: “peculiar” (oikeia) not only to different species but to individual people, varying by age, gender, climate, and mode of life (R.J. Hankinson (ed.), 2008). The hygienic regimen he built on this foundation included a typology of fatigue (kopos) and a recovery practice he called apotherapy, a combination of massage, breathing exercises, and other measures applied after exertion (R.J. Hankinson (ed.), 2008). His framework carried the healing power of nature into the Islamic medical tradition. Avicenna described the disease-nature relationship as a duel, with crisis as nature’s triumph; even in apparently hopeless cases, he insisted, one must rely on the innate healing strength, “for the true healer is man’s own strength and not his doctor.” (Neuburger, 1943)

The early modern period re-fought the ancient debate with new theoretical weapons. Paracelsus, the first major Renaissance champion of the healing power, conceived of an internal physician he called the archeus and insisted that in wound care the physician’s only task was to keep the wound clean so that nature’s balsam could complete the healing. (Neuburger, 1943) Thomas Sydenham — the “English Hippocrates” — made nature the supreme guide in acute disease and defined disease itself as “nothing else but an effort of nature” to exterminate morbific matter, an effort the physician should support rather than suppress. (Neuburger, 1943)

Robert Boyle attacked this position head-on. He dismissed the notion of a conscious, purposeful healing force, arguing that recovery depends instead on the God-ordained mechanism of the body; he proposed replacing the word “Nature” with “mechanism” in all scientific writing. (Neuburger, 1943) The eighteenth century saw the debate crystallize into formal schools. Georg Ernst Stahl made natural healing the absolute keystone of his system, conceiving every manifestation of disease as a healing endeavor of the soul (anima). (Neuburger, 1943) He also recognized, however, that nature’s healing actions could be too weak, too violent, misguided, or simply wrong. (Neuburger, 1943) Friedrich Hoffmann, Stahl’s contemporary and rival at the University of Halle, rejected conscious purposeful regulation outright, insisting that healing occurs per accidens through mechanical necessity and that the physician’s job is to distinguish which of the body’s reactions are useful and which are damaging. (Neuburger, 1943)

David Gaub, writing in the mid-eighteenth century, produced the first pathology textbook with a dedicated chapter on the Vires naturae medicatrices, establishing for the first time a systematic distinction between symptoms caused directly by the disease and those arising from the organism’s own healing reaction. (Neuburger, 1943) This distinction — which disease manifestations are part of the problem and which are part of the solution — remains a live question in clinical practice.

By the nineteenth century, therapeutic pessimism in the Paris clinical school had revived the Hippocratic emphasis on nature. Laennec, the inventor of the stethoscope, compensated for his doubts about medicine’s curative powers by extolling the old Hippocratic notion of the healing power of nature — the body’s capacity to restore itself without doctors. (Bynum, 1994)

The Normal and the Pathological

Georges Canguilhem, a philosopher and physician who defended his medical thesis at Strasbourg in 1943, produced the twentieth century’s most sustained philosophical analysis of health. His target was a specific nineteenth-century dogma: the quantitative identity of normal and pathological phenomena — the claim that disease is merely more or less of the same processes that constitute health.

Canguilhem traced this idea to Francois-Joseph-Victor Broussais, whose “physiological medicine” of 1816 reduced all disease to excessive or insufficient stimulation of organic tissues. (Canguilhem, 1978) Auguste Comte then elevated Broussais’s local medical thesis into a universal philosophical principle: if normal and pathological states differ only in degree, then pathological social states could serve as natural experiments on normal social functions, justifying a science of society modeled on biology. (Canguilhem, 1978) Claude Bernard completed the chain, arguing that experimental medicine requires the premise of continuity between normal and pathological — without this continuity, experiments on disease could tell us nothing about health. (Canguilhem, 1978)

Canguilhem’s critique was precise. The quantitative identity thesis requires a concept of the “normal” as a measurable value — but the physiological constant is derived from populations. The average man of Quetelet is a statistical artifact; it does not describe any individual organism, and to call an individual “normal” or “abnormal” relative to a population average is to import a category from social arithmetic into biology where it does not belong. (Canguilhem, 1978) If the normal is simply the average, then medicine has no normative basis for deciding that any particular deviation is bad. The normal-as-average is descriptive, but medicine requires the normal-as-ideal, which is evaluative. The two senses cannot be conflated without confusion. (Canguilhem, 1978)

Against the quantitative thesis, Canguilhem deployed the phenomenology of Rene Leriche. Leriche defined health as “life in the silence of the organs” — health is the absence of awareness of organic function, and disease announces itself by interrupting this silence. (Canguilhem, 1978) This definition cannot be expressed in quantitative terms. A sick person is not a physiology with a modified coefficient; the sick person has lost certain powers and measures that loss by the values they cannot achieve.

Canguilhem’s own conclusion was that disease is not physiology-with-more or physiology-with-less. The sick organism lives under different norms — norms that are restricted, less flexible, and less capable of tolerating environmental variation. Disease is a different mode of life, not a displaced point on a normal curve. (Canguilhem, 1978) Health, correspondingly, is not a state but a capacity: the capacity to establish new norms in response to new situations. Medicine, because it aims at health (a value, not a fact), is irreducibly normative rather than purely descriptive — it is not, and will never become, an exact science in the strict sense. (Canguilhem, 1978)

The importance of Canguilhem’s argument extends beyond philosophy of medicine. It established that the doctor cannot practice medicine without a concept of health, and that this concept cannot be supplied by physiology alone — it must be evaluated. (Canguilhem, 1978) This insight runs directly counter to the biomedical assumption that increasingly precise measurement will eventually resolve the question of what counts as healthy. Canguilhem’s answer was that no amount of measurement can settle a question that is, at bottom, about values.

Defining Health in Modern Philosophy

The contemporary philosophical debate over health, as Stegenga maps it in Care and Cure (2018), runs along three independent dimensions: neutralism versus positive health (is health merely the absence of disease, or something more?), objectivism versus subjectivism (does health depend on measurable facts or on the person’s own experience?), and naturalism versus normativism (is health a biological fact or a value judgment?). (Stegenga, 2018)

The WHO’s 1948 definition — health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” — represents the most ambitious positive conception. (Dominic Murphy, 2020) (Stegenga, 2018) Most philosophers reject it as too demanding (no one is ever in complete well-being), but it has framed the debate by insisting that mere absence of disease is not enough.

The most influential naturalist account is Christopher Boorse’s biostatistical theory (BST), developed in the 1970s. Boorse argued that the medical conception of health as absence of disease is a value-free theoretical notion whose main elements are biological function and statistical normality. (Boorse, Christopher, 1977) Diseases, on this view, are internal states that depress functional ability below species-typical levels; health as freedom from disease is statistical normality of function. (Boorse, Christopher, 1977) He distinguished sharply between theoretical health (the absence of disease) and practical health (roughly the absence of treatable illness), arguing that most previous discussions of health had conflated the two. (Boorse, Christopher, 1977) The distinction mattered because Boorse observed that medicine already recognizes a rough boundary between disease and illness: being ill involves having a disease serious enough to be incapacitating, which supports normative judgments about treatment — but not every disease makes its bearer ill. (Boorse, Christopher, 1977) Disease judgments, on his view, are value-neutral: if diseases are deviations from the species biological design, their recognition is a matter of natural science, not evaluative decision. (Boorse, Christopher, 1977)

Boorse arrived at this position by systematically eliminating seven alternative analyses of health current in the literature. Value cannot define disease, because being short may reduce a person’s quality of life more than a minor allergy, yet shortness is not a disease; conversely, diseases like cowpox can be advantageous. (Boorse, Christopher, 1977) (Boorse, Christopher, 1977) Treatment by physicians fails as a criterion because physicians treat conditions they do not regard as diseases (cosmetic surgery, contraception) and regard as diseases conditions they cannot treat. (Boorse, Christopher, 1977) (Boorse, Christopher, 1977) Statistical normality alone cannot work because unusual conditions like type O blood may be perfectly healthy, while unhealthy conditions like atherosclerosis may be nearly universal. (Boorse, Christopher, 1977) Neither can adaptation, since symptoms of disease such as inflammation may themselves be adaptive responses. (Boorse, Christopher, 1977) Homeostasis fails because many life functions are not homeostatic: perception, locomotion, growth, and reproduction upset an equilibrium rather than maintain one. (Boorse, Christopher, 1977)

Having cleared this ground, Boorse built his positive account on the intuition that the normal is the natural — an idea he traced through the classical medical tradition. (Boorse, Christopher, 1977) He cited Temkin’s summary of the Galenic view: health is a state according to Nature, disease contrary to Nature, resting on a teleologically conceived biology in which all parts of the body are built and function so as to allow man to lead a good life. (Boorse, Christopher, 1977) The formal proposal has four elements: the reference class is an age group of a sex of a species; a normal function is a statistically typical contribution to individual survival and reproduction; health is the readiness of each internal part to perform all its normal functions on typical occasions with at least typical efficiency; and a disease is a type of internal state that reduces one or more functional abilities below typical efficiency. (Boorse, Christopher, 1977) The species design on which health judgments rest is an empirical ideal type — statistical, not moral or normative — compiled from the typical hierarchy of interlocking functional systems observed in a sufficiently large sample. (Boorse, Christopher, 1977) Boorse argued that this notion of species design is not inconsistent with evolutionary biology: on all but evolutionary time scales, biological designs have a massive constancy vigorously maintained by normalizing selection. (Boorse, Christopher, 1977)

The theory’s explanatory successes are real. It explains why hemophilia is a disease but inability to regenerate limbs is not: blood-clotting is a typical human function, limb regeneration is not. (Boorse, Christopher, 1977) It explains why controlled diabetes remains a disease while controlled scurvy is simply the absence of disease: humans manufacture insulin but not vitamin C. (Boorse, Christopher, 1977) And it explains why two people with identical functional output — one normal, one a strong man with Addison’s disease — are distinguished by the abnormality of a microfunction (adrenocortical secretion) rather than by any difference in gross disability. (Boorse, Christopher, 1977) Boorse acknowledged two anomalies his account could not resolve: purely structural disorders (minor deformities of the nose or ear that disturb no function) and universal diseases of normal aging, where senile decline caused from within cannot be called disease under an age-relative definition. (Boorse, Christopher, 1977)

Boorse also introduced a distinction between intrinsic and instrumental health that carries clinical weight. Having an appendix is instrumentally unhealthy (it makes appendicitis possible) but intrinsically healthy (the appendix itself is not a disease). (Boorse, Christopher, 1977) This distinction matters for the positive health debate: Boorse argued that preventive medicine’s shift from cure to prevention does not change the underlying concept of health as long as what is prevented is still disease — the shift is merely from intrinsic to instrumental health. (Boorse, Christopher, 1977) A true positive conception enters only if functional excellence is held to be healthier in itself, and here Boorse identified three varieties — the individual-potential view, the species-potential view, and the unlimited view — all of which, unlike negative health, force evaluative choices about which form of excellence to pursue. (Boorse, Christopher, 1977) His concluding argument was that negative health (freedom from disease) requires no value judgment about admirable forms of human life, while positive health ideals are not discoverable but only advocable — and the trouble with calling excellence “health” is that it unites a value-neutral notion with the most controversial of all prescriptions. (Boorse, Christopher, 1977) (Boorse, Christopher, 1977)

Boorse also noted that the broad medical usage of “disease” — encompassing injuries, birth defects, and causes of death alongside infection syndromes — dates back at least to 1855, when William Farr employed it in his proposal to the Paris Congress. (Boorse, Christopher, 1977) The BST is built on this comprehensive usage: health cannot be the absence of disease unless disease covers everything from spina bifida to drowning.

The central philosophical debate divides along the naturalist/constructivist line: naturalists hold that biological malfunction is discoverable by science independently of human values; constructivists hold that values alone determine what counts as disease. (Dominic Murphy, 2020) Boorse’s theory has been under sustained attack. (Dominic Murphy, 2020) (Stegenga, 2018) The reference class problem, identified by Stegenga and others, demonstrates that nature itself does not sort people into reference classes — specifying the relevant biological subgroup for “species-typical” functioning requires importing normative background knowledge, undermining the claim to value-independence. (Stegenga, 2018) Constructivism, however, faces its own difficulty: it cannot explain why we distinguish the sick from the merely deviant. Societies routinely disapprove of the ugly, the poor, and the unlucky without medicalizing them, so disapproval alone cannot be what disease judgments track. (Dominic Murphy, 2020)

The historicity of disease classification sharpens the constructivist case. Psychiatry has classified homosexuality as illness; Samuel Cartwright argued in 1843 that enslaved people who tried to escape suffered from “drapetomania”; Soviet psychiatrists diagnosed political dissidents with “sluggish schizophrenia.” (Dominic Murphy, 2020) Naturalists reply that these are cases of the concept being misapplied, not evidence that the concept itself is defective.

Against both naturalism and constructivism, phenomenological approaches have proposed that health cannot be captured by third-person measurement at all. Gadamer, in The Enigma of Health (1996), argued that health is not something one can introspect as a feeling; it is “a condition of being involved, of being in the world, of being together with one’s fellow human beings, of active and rewarding engagement in one’s everyday tasks.” (Dominic Murphy, 2020) Health, on this view, is not something that can simply be produced, and its ultimate aim is to be forgotten — to regain one’s health is to forget that one is healthy. (Gadamer, 1996) Care for health is an original manifestation of human existence, not a technical problem. (Gadamer, 1996)

Havi Carel extended this into a phenomenology of the lived body: health is the experience of being “at home in one’s lived body,” and even someone with a biological disease can be healthy in this sense if they are adapted to their bodily predicament. (Dominic Murphy, 2020) Lennart Nordenfelt offered a capacity-based theory: a person is healthy if they can satisfy their “vital goals” — those necessary and sufficient for minimal happiness. (Dominic Murphy, 2020) And Canguilhem’s own definition, which anticipated these phenomenological approaches by half a century, held that health is flexibility and normative power — the healthy organism can tolerate environmental impacts, adapt to new situations, and possesses “a store of energy and audacity” that cannot be measured by physiology. (Dominic Murphy, 2020)

Health and Society

The question of what health is cannot be separated from the question of who has it. Rene-Louis Villerme’s statistical analysis of differential mortality among the Paris arrondissements in the early nineteenth century tested every conventional environmental explanation — altitude, soil, climate — and found that none accounted for the patterns. What did account for them was poverty and wealth. (Porter, 1997)

Thomas McKeown’s work in the 1970s sharpened the point. McKeown demonstrated that the major decline in tuberculosis mortality began long before antibiotics and was driven primarily by improved nutrition from greater socioeconomic equality. (Stegenga, 2018) Michael Marmot’s Whitehall Study confirmed that socioeconomic status causally influenced health outcomes even among British civil servants who were not destitute — lower-ranking officials had higher cardiovascular mortality even after controlling for obesity, smoking, activity, and blood pressure. The mechanism Marmot proposed was stress mediated by lack of control over one’s work life. (Stegenga, 2018) Health inequalities, Stegenga argues, are distinguished from mere health differences by their causal origin in unjust social structures rather than in chance or individual choice. (Stegenga, 2018)

Paul Farmer, a physician-anthropologist working in Haiti, extended this analysis to its sharpest formulation. What victims of structural violence share, Farmer argued, is not personal attributes, culture, language, or race, but “the experience of occupying the bottom rung of the social ladder in inegalitarian societies.” (Farmer, 2005) Liberation theology’s “preferential option for the poor” has an epidemiological corollary: diseases themselves make a preferential option for the poor, because every careful survey, across boundaries of time and space, shows the poor are sicker than the nonpoor. (Farmer, 2005) Structural violence — the political, economic, and social forces that translate into individual suffering and disease — means that poverty, racism, and gender inequality function as risk factors no less real than microbes. (Farmer, 2005)

The Prevention Paradox and Disease Creep

Geoffrey Rose identified a structural problem embedded in all preventive approaches to population health. Because most disease cases come from large low-risk populations rather than small high-risk groups, population-wide preventive interventions avoid more disease overall but mean that the vast majority of treated individuals gain no personal benefit. (Stegenga, 2018) The paradox is not merely statistical but ethical: it forces a choice between maximizing total cases prevented and maximizing personal benefit from any given intervention.

Rose’s insight has been compounded by a phenomenon Stegenga calls disease creep: the thresholds for pre-disease conditions — pre-hypertension, pre-diabetes, borderline cholesterol — have been repeatedly lowered by expert committees, expanding the populations eligible for pharmaceutical intervention. Each lowering creates millions of new patients. Cynics have noted that the committees responsible for such decisions are composed of experts with financial ties to the manufacturers of those interventions. (Stegenga, 2018)

The Meaning of Health

Owsei Temkin, the historian of medicine, identified three historically distinct roles for the physician, each oriented toward a different conception of health: the Hippocratic healer responsible to the individual patient, the physician-scientist concerned with universal knowledge for all mankind, and the public-minded physician as citizen concerned with community health. There has never been complete harmony between them, Temkin observed, although they all share a common aim: health. (Temkin, 1977) Medicine has been meaningful to society across history even when it could not cure disease, serving the social function of responding to the need to aid the sick and protect the healthy. Temkin criticized the “all or nothing” demand of therapeutic nihilism — the insistence that medicine either cure or step aside. (Temkin, 1977)

The modern expansion of medicine into what Temkin called a “health industry” has created a consumer demand for health as a right, driven by the conviction that medicine can cure and prolong life. But this expansion has also produced new predicaments, including prolonged invalidism in old age and the economic pressures of overpopulation — the very effectiveness of Western medicine generating problems that no further medical intervention can solve. (Temkin, 1977)

Fourth-century physicians elevated dietetics to the same level as surgery and pharmacology in the battle against disease, with some placing it above them on the grounds that dietetic medicine plays a role in preventing as well as curing disease. (Nutton, 2023) Diocles prioritized experience over theory in dietetics, arguing that the effects of foodstuffs cannot always be predicted from knowledge of their properties and are better understood through the “whole nature” of a substance — the specific interaction of all its constituents together. (Nutton, 2023) Ancient humoral ideas of individual balance and environment continue to shape how modern patients understand their health: studies in London have shown that lay belief in the six non-naturals as prime determinants of health persists. (Nutton, 2023) The concept of the “six non-naturals” that came to organize all subsequent Galenic therapeutics was itself a product of textual compilation rather than Galen’s own formulation. Nutton traces how late antique commentators conflated a brief Galenic remark on factors altering the pulse with a commentary passage explaining Hippocrates’ view of health determinants — diet, environment, exertion, sleep, excretions, and mental activity — to produce what appeared to be a programmatic statement of the aims of medicine as a whole. (Nutton, 2023) The technical term “non-naturals” was likewise manufactured by combining several Galenic passages. This conflation, performed in the Alexandrian medical schools by the sixth century, became the organizational backbone of Galenic preventive medicine for over a millennium. Medieval Galenic medicine embedded the management of health within a systematic framework of the six non-naturals: diet, exercise, rest, environmental conditions, excretions, and psychological well-being. Siraisi describes this as the central mechanism of preventive medicine — the physician was supposed to maintain health “by tailoring the patient’s diet, exercise, rest, environmental conditions, and psychological well-being so as to maintain him or her with the optimum complexion.”(Siraisi, 1990) Medical care in this tradition was “as much in a preventive health regime as in the treatment of disease” — the non-naturals were adjustable variables the physician manipulated to keep the individual’s humoral balance optimal, and any significant illness was classified as a failure of one or more of these conditions.(Siraisi, 1990) The Salernitan tradition codified this approach in the Regimen Sanitatis Salernitanum, the verse health-poem addressed to the English king. Its most famous prescription condensed the regimen into three figures: “Use three Physicians still: first Doctor Quiet, next Doctor Merry-man, and Doctor Diet.” The Salernitan emphasis on rest, cheerful spirits, and moderation was reduced to a mnemonic for laypeople.(John Harington (trans.), 1920) The non-naturals framework remained the standard language for discussing healthy living through the early modern period. Canguilhem’s Part Two extended the argument to its positive thesis: biological normativity is the claim that life is not indifferent to its conditions but actively posits values — the living being distinguishes between what favors and what threatens its existence, and this distinction is irreducible to physics or chemistry. (Canguilhem, 1978) Health is therefore defined as the capacity to establish new norms — to tolerate infidelities of the environment, to overcome organic crises, and to institute new equilibria. (Canguilhem, 1978) Disease, correspondingly, is not the absence of normativity but a restriction of it: the sick organism operates under norms that are more rigid, less tolerant of variation, and less open to the environment. (Canguilhem, 1978) Cure, on this account, is not the return to pre-disease norms but the acquisition of new ones — there is no return to biological innocence. (Canguilhem, 1978) Bernardino Ramazzini, working in late seventeenth-century Padua, produced what Ackerknecht calls “the first classic text on occupational diseases,” appearing in the same generation that saw Wepfer’s work on stroke and Glisson’s on rickets.(Ackerknecht, 1955) Sigerist places Ramazzini’s work in the wave of disease-specific monographs that Sydenham’s clinical method made possible: “the peculiarities of the diseases that tended to affect those who followed particular occupations.”(Henry E. Sigerist, 1933) Percivall Pott’s identification in 1775 of scrotal cancer among chimneysweeps exposed to soot extended this tradition into the recognition of occupational carcinogens. (Porter, 1997) Industrialization jeopardized health through dangerous trades, child labor, and factory conditions that produced pneumoconiosis, “phossy jaw,” silicosis, and other occupational diseases. (Porter, 1997) Aaron Antonovsky, a medical sociologist, proposed in Unraveling the Mystery of Health (1987) that the fundamental question of health research had been asked backwards. The dominant pathogenic orientation asks why people get sick; Antonovsky’s salutogenic orientation asks why people stay well. This is not merely the reverse of the same question — it is, Antonovsky argued, a radically different orientation of at least equal scientific significance. (Antonovsky, 1987) The salutogenic model rests on the assumption that heterostasis, disorder, and entropic pressure are the prototypical characteristics of living organisms, not the homeostatic self-regulation assumed by the pathogenic model. Disease, on this view, is not an unusual occurrence but an ordinary feature of the human condition. (Antonovsky, 1987) Health should therefore be conceived not as a dichotomy between healthy and diseased persons but as a multidimensional continuum — what Antonovsky called the “health ease/dis-ease continuum.” We are all terminal cases, Antonovsky observed, and we all are, so long as there is breath in us, in some measure healthy. (Antonovsky, 1987) The factors that promote movement toward the healthy end of this continuum are often different from the risk factors implicated in causing disease, a distinction invisible to the purely pathogenic orientation. (Antonovsky, 1987)

See Also

• Vis Medicatrix Naturae
• Humoral Theory
• Social Determinants of Health
• Epidemiology
• Insanity
• Holism
• Reductionism
• Placebo Effect
• Preventive Medicine
• Medical Ethics

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