An Excerpt from “A Theology of Health” by Tyler J. VanderWeele

While the health of the body can be defined by its functioning parts and systems, the health of the person is more complex. To flourish, we need to understand health in the context of God’s intent. In A Theology of Health: Wholeness and Human Flourishing, preeminent scholar Tyler J. VanderWeele presents a Christian understanding of the very concept of health, both the health of the body and the health of the person.

The etymology of the English word “health” is derived from Old English “hælþ” or wholeness. In other languages, this relation of health to wholeness or soundness is likewise present. To be whole is to be intact, to have all of the parts together, to be functioning as a thing ought, to not be missing something essential, to conform to what a thing characteristically is. If something has a purpose or end, then wholeness also entails that the thing is well-functioning. To what extent can the idea of wholeness be used to understand health?

The concept of health has been subject to considerable dispute. Some of the dispute revolves around the breadth of the concept. The World Health Organization defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” Many criticize this definition of health as being too broad. The criticisms of the World Health Organization’s definition of health include: that it extends beyond the purview of medicine, or expands the scope of medicine too far; that it seems to concern all of human well-being, or provides a standard that is too demanding; that it is impossible to operationalize; that it is such that there will not be consensus on what constitutes well-being; and that it may lead to endless expansion of what are considered rights. Many thus prefer a narrower definition of health, focused principally on the body.

However, our everyday language seems to suggest uses of the word “health” that do extend beyond the health of the body. We might say, for example, “Every day he just sits in his room; he is physically healthy, but he is not a healthy person.” Here “not . . . healthy” is used to indicate that something is not right or whole about the person, even though his body may be intact and well-functioning.

Arguably some of the disputes around health can be resolved by simply acknowledging that the word “health” is used in two related, but distinct, senses. There is a narrower conception of health that is focused on the health, or wholeness, of the body. However, there is also a broader conception of health that we might refer to as the health of the person, or the wholeness of the person. These two concepts of health are of course inter-related. As will be developed further below, the health of the person is in part constituted by the health of the body. Moreover, numerous aspects of the health of the person, such as psychological well-being, do often have effects on the health of the body. The relations between health of the body and health of the person are perhaps especially complicated when it comes to questions of mental health. The relations and distinctions are also important when it comes to trying to understand the scope and limits of medicine.

Rather than disputing whether “health” should be used in just one or the other of these two senses, it can be acknowledged that in our ordinary language we in fact use “health” in both of these senses, in different contexts. Greater clarity can be attained by acknowledging both uses, and then specifying, when relevant, whether the broader sense (health of persons) or narrower sense (health of bodies) of “health” is in view.

However, even if we grant these distinctions, yet further questions and disputes arise with regard to the definition of health. In discussions on the definition of health, some definitions are based on conformity to, or lack of deviation, from normality, while others are based on some notion of functionality or ability to achieve goals, with the former often being viewed as more objective or “value-neutral” than the latter. Both approaches, however, confront challenges. With regard to definitions based on normality, it is difficult to define what such normality means or how one goes about determining it. With regard to functionality, how the body or person is to function is itself a complex issue. Whether there exist objective standards for functionality, or whether functionality is simply to be understood as the capacity to function as one desires or to achieve whatever goals one decides upon is a contested issue; and the relation of values to functionality likewise continues to be an important issue of dispute, along with whether these values are objectively or subjectively grounded. Arguably neither of these approaches to defining health is adequate without an account of what the human body or the human person is meant to be, i.e., without some conception of its nature. Some of the disputes around the definition of health thus likely also pertain to competing accounts of human nature.

Theology has given its own accounts of what constitutes human nature. Such accounts in Christian theology are grounded in God’s intent for the human person and the human body in creation. In such accounts, the wholeness of the human body or the human person concerns its conformity to God’s intent. That intent is constituted in part by the intended end of the human body and human person, and that end is God himself. In the words of Saint Augustine, “Thou hast made us for thyself, O Lord, and our heart is restless until it finds its rest in thee.”

In subsequent sections, an understanding, from Christian theology, of God’s intent for the human person and the human body will be developed in greater detail. However, this grounding of the notion of health, of wholeness, in God’s intent arguably does resolve some of the aforementioned difficulties. It grounds normality in God’s intent since, at some level, that intent is the same across persons, though, as discussed further below, discerning that intent is still not necessarily straightforward. It provides content to what constitutes well-functioning of the human person, grounded principally in movement towards the person’s final end in God. It furthermore provides some relation between normality-based and functionality-based notions of health; both are grounded in conformity to God’s intent.

(excerpted from introduction)

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