Sridhar Venkatapuram’s Health Justice and Open Lifespan

The following excerpt is the edited second part of the Health and longevity: conceptual twins, separated at birth chapter of my HDCA paper (see slides of my talk) analysing the first proposed central capability I presented in early September at UCL in London. See earlier installations of this study here.

The point of this post is to connect the Open Lifespan project to an already existing approach within the Capability Approach. Here it goes.

Concerning health-centric approaches, there’s a separate strand of literature around health justice within the Capability Approach, where the current discussion is driven by the reception of Sridhar Venkatapuram’s book, Health Justice:An Argument from the Capabilities Approach published in 2011. We abbreviate this approach as CH, adopting Venkatapuram’s own usage, standing for the ‘capability to be healthy’.

In what follows, keeping references and interpretation at a minimum, I extract some domain-relevant claims, explicit or sometimes hidden, from Venkatapuram’s PhD thesis, called Health and justice: The capability to be healthy, from 2007 [1], that served as the basis of Health Justice. The job is to highlight convergences and differences between this health-centric and my longevity-centric approach.

The  CH view.

  • Health is the central capability, every list of basic capabilities should start with that.
  • Health is a metacapability to achieve a cluster of basic capabilities and functionings.
  • Capability based theory of health causation and distribution integrates biomedical with social determinants research beyond clinical disease.
  • Lifespan and longevity are parts of the health bundle, but not separate, standalone topics by themselves [2].
  • Aging is not a separate topic yet within this approach [3].
  • Aiming for the upper bounds of longevity is a valuable claim on part of individuals.

This last claim is the most important from the point of view of convergence with our argument, so let’s cite the crucial passage here:

There is something of value in being able to live as long as possible for every human being. This means that making life prospects relative to each society denies what is shared across the human species. It should be the case that every human being would also give value to being maximally unimpaired throughout a life span that reaches for the upper bounds.

p206 in Sridhar Venkatapuram: Health and justice: The capability to be healthy, Doctoral Dissertation, 2007. King’s College
University of Cambridge

Interestingly it only shows up during Chapter 8 of the thesis as part of a complicated argument against the ‘nationalist’/local approach of social justice, and as part of the argument to situate the health capability approach as part of a global/cosmopolitan justice theory. 

In the Health Justice book, but not in the thesis, the joint phrase ‘health and longevity’ is being highlighted and used frequently as concepts central to this approach [4]. Based on these extracts here are some arguments against integrating lifespan and longevity fully into health.

i.,  Biological aging is universal, affects all members of the humanity, reaching full development at least. Hence social factors don’t play a role in baseline level biological aging that presents the health problems and restricts people in their basic capabilities and functionings. As such it is not considered and represented well within the CH theory in its current format and needs a separate philosophical treatment within CA. If the counterargument here is that accelerated or decelerated aging is down to social factors too, hence biological aging and the prospects of longevity should be integrated fully into the CH approach, then the answer is that there is a fundamental difference between the default health problems presented by baseline, so far unavoidable biological aging and the acceleration/deceleration of aging. The difference is like between speed and its first derivative, acceleration/deceleration. Acknowledging the social factors of  accelerated/decelerated aging cannot be used to ignore problem of universal biological aging at all.

ii., The comprehensive scientific understanding and emerging consensus about biological aging is so new, the results of the last 5-6 years,  that it outdates the level of the scientific understanding of the CH approach. Since CA is an inter-disciplinary, some say ‘post-disciplinary’, approach it needs periodic updates concerning some emerging disciplinary standards. That time is now related to biological aging and prospects of healthy longevity. See next section.

iii., Biological aging is currently not classified as a disease according to the ICD and there’s an ongoing huge debate emerging now, mainly framed as a legal question whether it should be classified as one. The main incentive behind this approach that drugs and treatment interventions can only be developed financially in the biotechnology and medical industry if the FDA approves those interventions against the root causes of biological aging. The initial starting point of the Health Justice approach was to attack the weakness of defining health with the lack of disease where disease is specified by the biostatistical theory. There is a whole new approach needed when rethinking the connection between aging and disease. This point was missed entirely by the CH approach so far and provides direction for further research.

iv., Since the focus is on health, the topic of the second proposed central capability, the first central capability related to ‘the end of a human life of normal length’  does not get detailed attention from the CH approach. Current work does this job.

To conclude this section, the CH approach missed the opportunity to provide proper conceptual treatment of biological aging and healthy longevity. This is party due to health and longevity being conceptual twins, but separated at birth and partly due to not yet updated scientific standards on the technological and social opportunities. Our current approach fills in some details concerning this project, providing a complementer angle that might lead to better health and longevity policies downstream. By now, we maintain that there might have been a reason Martha Nussbaum has chosen the conceptual bundle around life, lifespan and longevity as the topic of the first capability and considered bodily health only the second.

Notes

[1] Sridhar Venkatapuram: Health and justice: The capability to be healthy, Doctoral Dissertation, King’s College, University of Cambridge, 2007. available at https://core.ac.uk/download/pdf/1321509.pdf

[2] ‘the problem with ranking the basic capabilities as well as the impossibility of separating out a capability to live a long lifespan from a CH gets solved.’ p55 in Sridhar Venkatapuram: Doctoral Dissertation, 2007.

[3] ‘At this point, it does not offer case studies as does Daniels, nor has it been applied to particular problems such as aging populations, women’s health, or HIV/AIDS’.

[4] In the freely downloadable Amazon sample of the book containing the Introduction the phrase ‘health and longevity’ can be found 24 times.