Defining Health, Disability, and the Aims of Health Promotion

How did this new understanding of health contribute to changing meanings of health? Unfortunately, despite advancing greater recognition of the public’s role and social and environmental factors in health outcomes, the changes left key elements in the dominant understanding of health unchallenged. For instance the women’s health movement contended that women should understand their bodies and that their perspectives should be respected within the healthcare encounter, but health was still understood as the absence of disease. In many cases these health movements served to reify and entrench biomedical approaches to understanding health into a broader ideology of medicalization upheld by an ever-increasing range of social functions (Crawford, 1980). The prominent (biomedical) conception of health, seen as a sense of well-being achieved through the mitigation of disease, illness, injury, and social impairments, was coming to be understood as not only a medical diagnosis but also as a matter of individual responsibility (Berthelot-Raffard, 2018; Crawford, 1980). Robert Crawford (1980) describes the emergence of healthism as a new health consciousness that situated the “problem” of health as primarily an individual issue and product of personal actions, attitudes, and behaviours, achieved through modifications in lifestyle and sometimes with the help of therapeutic services. Health promotion entailed providing individuals with the necessary knowledge to make healthy choices that encourage healthy behaviour, resisting harmful influences, and reforming their mental responses to social stressors. In effect, the new health consciousness movements laid the groundwork for an “age of medicalization” in which the pursuit of health became a fundamental characteristic of popular culture and everyday life. As Crawford states, “while modifications of dominant medical practices [were] being adopted, some of the most fundamental and disabling medical and other dominant cultural conceptions have remained untouched” (p. 369).

Media Moment

Take a moment to engage with the following public health promotion videos created by ParticipACTION, a Canadian nonprofit charitable organization promoting physical activity. You can watch the videos below or access the transcripts.

Time: 30 seconds

Fall in with an active crowd

Time: 4 minutes, 35 seconds

ParticipACTION Workout Videos | Break from Busy

Reflection Moment

How do these two health promotion interventions conceptualize health and disability?

In the readings associated with this module, Agnès Berthelot-Raffard (2022) discusses the gap between the public health profession on the one hand and disability rights activists and scholars on the other in terms of how they conceptualize health and disability, and how these concepts frame health promotion. While the disability community has advocated for the inclusion, de-stigmatization, and de-institutionalization of people with disabilities as central aims in health promotion, the definition of health that has persisted in the public health field is rooted in the absence and prevention of disease, illness, injury, or other impairments to “normal functioning” (Berthelot-Raffard, 2022; Crawford, 1980). In this definition, disability is seen as a form of deviance understood in contrast to the state of health, which is defined in terms of biostatistical markers of “normal functioning” based on the most common levels of functioning for people of a particular age and sex (Berthelot-Raffard, 2022; Foucault, 1961). Critical theorists such as Michel Foucault have illustrated how the administration of normalizing biomedical categories have served as a form of population control from which conceptions of “deviance,” “pathology,” and “madness” arose. These concepts have long characterized people with disabilities as social “problems” to be solved, treated, or extradited (Tremain, 2015; Foucault, 1961). In this framework, health is seen as the absence of impairment, and the role of public health is to minimize, prevent, and treat conditions that limit normal functioning to the greatest degree possible (Berthelot-Raffard, 2022).

Media Moment

Read this infographic or access the PDF here:

What Can Happen to Your Hands and How to Protect Them

Consider the ways that the disability rights community and the public health field each conceive of the aims of health promotion. What are their shared aims and how do they differ?

Healthy Difference

But physical and mental variations are a natural part of the human condition, and these variations do not necessarily translate to poor health (although they may result in certain disadvantages and vulnerabilities in some settings) (Berthelot-Raffard, 2022). Indigenous knowledge frameworks have long understood variation and difference as common aspects of being that inform the interdependence of all things (Norris, 2014; Schelbert, 2003). Indigenous models of kinship offer understandings of health that are not based on statistical normalcy, binaries or individualism. Instead they conceive of a “‘spider web’ of relations” (Little Bear, 2000) in which all are equal, and all contribute to the continual give-and-take of all life (Schelbert, 2003). In Anishinaabe culture, for instance, people are recognized for the unique gifts they bring to the community, rather than focusing on what they lack or cannot do (Ineese-Nash, 2020). Leo Schelbert (2003) offers a description of how all life’s entities are valued with equal personhood and as sacred forces in the health of the collective:

The disability rights community have long echoed these relational understandings of health and well-being in their problematizations of the prevailing discourses on health and disability (Berthelot-Raffard, 2022; Sherwin, 1998). These relational frameworks conceive health as rooted in the interconnections between people and the supports they need to be well (e.g., people, resources, technologies). Through this framework, disability is understood as a social construct that arises from the relationship between people and the social environment which creates barriers that exclude and limit them from full participation in society (Schwartz et al., 2023; Oliver, 1996; Goodley et al., 2019). Oftentimes, these barriers create obstacles to accessing the social resources needed to be well, resulting in harms such as food insecurity (Berthelot-Raffard, 2022; Schwartz et al., 2023).

However, there is nothing inherently unhealthy or pathological about being disabled or having an impairment. Berthelot-Raffard (2022) gives the example that someone who is deaf or blind may need additional supports to access information provided in a society that assumes a capacity to see or hear, but they do not necessarily require any treatment. Someone who is on the autism spectrum may be diagnosed as such because they are not easily understood by the biomedical field of rationality, but they can still be regarded as healthy.