DEBATE DEBATE

In For a General Theory of Health: Preliminary Epistemological and Anthropological Notes, Naomar Almeida Filho proposes an entire research program that could result in the formulation of a General Theory of Health.

Almeida Filho's article provides a careful review of production concerning the concepts and analytical categories proposed by different authors for an understanding of the health-disease processes, critically highlighting the limitation of models that have focused primarily on disease rather than health. Faced with this reiterative observation concerning the contributions of medical sociology, anthropology, and epistemology, we must ask the reason for such a sharp detour? Where precisely lies the impossibility of conceiving of health? One hypothesis, based on the contributions of Canguilhem and Agnes Heller, suggests searching the theories of needs for a possible explanation. Disease, as a concrete need objectified by individuals, necessarily appears as the object of reflection and action. Canguilhem calls attention to the existential fact that the suffering derived from diseases historically precedes the theoretical elaboration of diseases, thus giving precedence to what is experienced or "lived" as compared to what is reflected upon. Meanwhile, health is a utopia, a radical need in the sense used by Agnes Heller. In practice, the limits of capitalist social organization made health needs impossible (and thus radical) for significant portions of the population. To what extent might this utopian nature of health have functioned as an epistemological obstacle to the formulation of a positive theory?

Returning to the beginning of the article, there are several remarks to be made to help expand the research program proposed therein.

Beginning with the contributions of medical sociology, I consider two aspects fundamental. The author emphasizes the predominantly biological reference in the approaches he analyzes. Still, more than the biological aspects, what appears to be at stake is the exclusively functionalist approach present in all the contributions and the fact that the analyses are limited to the individual, the hypothetical subject of the diseases, illnesses, sicknesses, etc. None of these contributions succeeds in conceiving of disease as a social and historical phenomenon with a collective dimension. In addition, the abstract systemic conception prevents the identification of different hierarchical levels among the phenomena. Hence the emphasis on the biological per se does not explain the insufficiency of these approaches, although it has certainly contributed in the sense that the "negation of the biological" has appeared as an alternative for the construction of more appropriate theories in the anthropological watershed.

Furthermore, the author limits himself to analyzing functionalist contributions from medical sociology. The absence of representatives of other currents of thought like Siegerist, Pollack, and Juan Cesar Garcia further accents the critical analysis presented by the author, in the sense of the theoretical priority ascribed to disease, to the detriment of health. I do not mean to suggest that such authors have solved the problem presented here, but their contributions could be as useful to the undertaking as those of the functionalist sociologists. Such recourse to their work could allow for the incorporation of elements from medical sociology into the more promising contributions of both medical anthropology and epistemology.

In this sense the analytical scheme of Bibeau and Corin appears as a truly social formulation among those analyzed by the author, recovering the historical, social, and collective dimensions of the health-disease process, although it continues to concede greater relevance to the disease pole. Nevertheless, it would be worthwhile to ask whether this development is sufficient to consider it an adequate descriptor for the category of social health proposed by the author. Is the attempt at "closing" the framework not too hasty, given the precarious state of the reflections?

The contributions contained in Juan Samaja's creative reflection allow one to glimpse the possibility of overcoming many of the antinomies that have marked the health field. The theory of adaptive complex systems doubtless furnishes a matrix to conceive of links between the biological/natural/historical/social; to more consistently elaborate the relations of determination and mediation between the different hierarchical levels in the constitution of reality; to overcome the subjectivization/objectivization dichotomy.

The scheme proposed by Almeida Filho in Figure 1 can serve as a map to begin the march in this research program, but along the road there will most certainly be a series of detours and sidesteps that will not make the path easier, but which may lead us to discover a more beautiful landscape.