Health Capability: Conceptualization and Operationalization

Abstract

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.

‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

“…As Marmot explains, 'the lower a person's social position, the worse his or her health' (2010: p. 9). Personal autonomy over health, understood in substantiverelational terms as the genuine opportunities or capabilities people have to act to sustain and/or improve their health, is substantially shaped by these social determinants (Abel and Frohlich 2010;Owens and Cribb 2013;Prah Ruger 2010;Sen 1992;).…”

Cosmopolitanism and foreign policy for health: ethics for and beyond the state

“…The sovereignty of states is one commonly unquestioned good that must be weighed against the good of human flourishing [40]. The good of state sovereignty is important when various transnational interests seek to undermine health-protective state policy [41].…”

Reply

“…She notes: ‘institutional power impedes the “equitable distribution” of resources within and across households … This applies … to the healthcare women typically provide.’ Nakray wonders how such power relates to ‘health capability’, ‘a unique analytical concept proposed by Ruger.’ I agree this relationship is important and requires further investigation (Ruger, 2010a), which is why colleagues and I are currently studying women’s health capability and maternal and child health in India. In that study we aim to better understand women’s health capability in the context of a participatory community maternal and child health project in Uttar Pradesh, focusing on power and inequality within and outside households.…”