Philosophy of Population Health Philosophy for a New Public Health Era History and Philosophy of Biology Series

Population health has recently grown from a series of loosely connected critiques of twentieth-century public health and medicine into a theoretical framework with a corresponding ?eld of research?population health science. Its approach is to promote the public?s health through improving everyday human life: afford-able nutritious food, clean air, safe places where children can play, living wages, etc. It recognizes that addressing contemporary health challenges such as the prevalence of type 2 diabetes will take much more than good hospitals and public health departments.

Blending philosophy of science/medicine, public health ethics and history, this book offers a framework that explains, analyses and largely endorses the features that de?ne this relatively new ?eld. Presenting a philosophical perspective, Valles helps to clarify what these features are and why they matter, including: searching for health?s "upstream" causes in social life, embracing a professional commitment to studying and ameliorating the staggering health inequities in and between populations; and reforming scienti?c practices to foster humility and respect among the many scientists and non- scientists who must work collaboratively to promote health.

Featuring illustrative case studies from around the globe at the end of all main chapters, this radical monograph is written to be accessible to all scholars and advanced students who have an interest in health?from public health students to professional philosophers.

Acknowledgements

Chapter 1: Blueprint of a philosophy of—and for—population health science

A brief overview

Introduction

What is population health science?

Why write a book on philosophy of population health science?

What will this book accomplish?

What are the book’s philosophical methods and commitments?

What this book is not, and what it will not do

Onward

Section 1 What should health mean in population health science?

Chapter 2 A brief history of the social concept of health and its role in population health science

Introduction

The biomedical model and the Biostatistical Theory of health

Population health as (metaphysically) social health

Health is (empirically) social

Conclusion: Moving toward a thoroughly social health concept of health

Case study: The Standing Rock Sioux Water Protectors

Chapter 3 Health as a life course trajectory of complete well-being in social context

Introduction: The many debates over health’s meaning

Life Course Theory

Life course lesson 1: Health is best understood as a lifelong phenomenon, not in time slices

Life course lesson 2: Population health and individual health are best understood as co-developing dynamically

The World Health Organization’s definition of health, not what it seems

The WHO definition of health is not an operationalized tool for health assessment; it is a toolbox that guides the gathering of tools

Making room for health pluralisms: metaphysical, empirical, ethical and methodological

Conclusion: An updated health concept for an expansive population health mission

Case Study: Addressing health disparities between Aboriginal Australians and settler Australians

Section 2 Which causes and effects matter most in population health?

Chapter 4 Expanding the boundaries of population health

Introduction: health as life course of complete well-being in social context calls for a broad health promotion mandate

Continuing from Chapter 3: ‘Health issues’ ≠ ‘healthcare issues’

"Boundary problem" problems

Political theory and population health

An unnecessary philosophical assumption: If X becomes a public health problem then it must be primarily or exclusively a public health problem

An incorrect empirical prediction: Broad conceptions of public health predictably lead to harms to the public health professions or to the populations they serve

The epistemic risks of erring on the side of wide vs. narrow boundaries for public health

Conclusion: Expanding philosophy of population health to catch up with the science and practice

Case Study: Global climate change

Chapter 5 Prioritizing the right population health causes and effects

Introduction: Addressing population health problems at the roots

"Fundamental-cause theory": the wrong name for the right approach

"Fundamental causes": Paramount importance because of a unique type of stability

What is and isn’t wrong with risk factors

Turning attention from "causes of cases" to "causes of incidence"

Philosophy of salutogenesis vs. philosophy of pathogenesis

Conclusion

Case study: Brazil’s AIDS response

Section 3 How can population health science better promote health equity?

Chapter 6 Managing the inevitable trade-offs in population health science practice

Introduction

The problem of heterogeneity: Lumping vs. splitting in population health

The high risk approach vs. the population approach

Decentering the healthcare system to promote population health vs. expanding outward from the healthcare system

Evidence-based medicine vs. public health pragmatism

Conclusion

Case study: the heterogeneous health of migrants

Chapter 7 Ethics and Evidence in the Population Health Equity Debates

Introduction: Population health science and health equity

Health equity is built into population health science

The (real and imagined) consequences of an ambiguous understanding of "health equity"

Equitable health promotion and health governance

Hypothetical problems’ outsized influence in population health equity deliberations

Conclusion

Case study: Investigating racism and racial health disparities

Conclusion

Chapter 8 Humility as the way forward for population health science, and philosophy thereof

Introduction: A spirit of humility and collaboration

Embracing epistemic humility

Sectoral humility: Non-hierarchical intersectorality

Disciplinary Humility: Non-hierarchical interdisciplinarity

Population health science education for health professionals

Population health science education for all

Philosophy of population health science, from a position of service

Sean A. Valles is Associate Professor, jointly appointed to Michigan State University’s Lyman Briggs College and Department of Philosophy, USA.