Choosing Health Concepts: A Matter of Epistemic Justice

In healthcare, definitions matter. The way we define "health" is not just a technical issue — it shapes research priorities, clinical decisions, healthcare policies, and even citizens' rights. In my recent article, Health Concepts in Medicine and the Role of Philosophy, I argue that philosophers of medicine have an important role to play in this process. Choosing between competing concepts of health means not just offering better definitions, but also asking critical questions about the goals behind them and whose interests they serve.

Health and wellbeing

Although the article does not explicitly discuss epistemic injustice, the connection is clear. Epistemic injustice occurs when individuals or groups are wronged specifically in their capacity as knowers — when their experiences, knowledge, or perspectives are dismissed or undervalued. Conceptual choices in healthcare can either help correct these injustices or reinforce them. 

A narrow definition of health as simply the absence of disease, for example, can be useful if we want to defend healthcare as a universal right, but can marginalize people living with chronic conditions who still consider themselves healthy. On the other hand, concepts that emphasize adaptation and self-management may place unfair burdens on individuals in disadvantaged circumstances, turning social inequalities into personal "failures" of health.

In this sense, choosing a concept of health is not epistemically neutral. Different definitions elevate different voices — whether those of patients, clinicians, policymakers, or researchers. Some concepts recognize and validate the experiences of marginalized groups, while others risk silencing them. A focus on self-management, for instance, might overlook the structural barriers that make adaptation difficult for many.

Cover of Lalumera's new book

Importantly, the same concerns apply to other concepts in healthcare, such as well-being and quality of life. These are not purely descriptive terms; they are value-laden, and how we define them has real consequences for research, clinical care, and policy. I explore these broader issues in my forthcoming book, Health, Well-Being, and Quality of Life: A Philosophical Analysis, where I extend the framework of conceptual choice to these crucial notions. 

Ultimately, conceptual choice in healthcare is not just a theoretical exercise. It is a site where epistemic justice is at stake. Being attentive to whose experiences are recognized — and whose are left out — is essential if we want health concepts to serve everyone, not just a privileged few.

Elisabetta Lalumera is Associate Professor in the Department for Life Quality Studies at the University of Bologna and she is also one of the partners of project EPIC. Her research applies philosophical analysis to conceptual and methodological issues in medicine.