Health beyond statistics: a capabilitarian revision of Daniels’ theory of just health

This paper examines how the biostatistical theory (BST), as endorsed by Norman Daniels' account of just health, can be integrated with the capabilities approach to address the 'lowering functioning objection'. This objection argues that the BST could mistakenly define a population as healthier if the prevalence of a certain pathology increases and becomes the new statistical norm. To tackle this issue and offer a more coherent and normatively robust account of just health, the paper introduces a two-tiered model. The first tier retains the biostatistical model to provide a non-comprehensive, evidence-based foundation for health, focusing on the distribution of biological functionings within a population. The second tier introduces a capabilitarian survey that normatively assesses whether the new statistical norm supports or hinders the achievement of valuable capabilities. This integration enables a more holistic, flexible, pluralistic and context-sensitive understanding of health, framing it as a quasi-normative meta-capability-namely, a capability grounded in biological functionings but not reducible to them, which is essential for achieving other valuable capabilities. After explaining the rationale for this integration and outlining a Rawlsian-inspired approach to selecting valuable capabilities, I conclude by suggesting the implications of this model for Daniels' theory.