Contribution
It reopens Canguilhem’s refusal of “public health” as a concept of health. Canguilhem is, on Giroux’s account, the author who “has gone the furthest in defending an individualist conception of health and disease” (Introduction). The paper sets his biological reasons against later philosophy of biology and his conception against social epidemiology, and concludes that population health is “more pertinent and more necessary than Canguilhem would seem to have envisaged” (Conclusion), while keeping the organism as the strongest unit.
Key insight
Canguilhem ties health to normativity and normativity to the organism as a whole. Loosen the second tie, as debates on units of selection and biological individuality have, and the concept of health can in principle extend to entities with a weaker, relative unity, such as populations whose properties, like herd immunity, have no analogue in their members.
Assumptions
- Canguilhem as reported. His positions are given through his own texts in translation: The Normal and the Pathological (Zone, 1991), Writings on Medicine (2012) and Knowledge of Life (2008). The record holds none of these as read.
- Rose’s distributions as evidence of population properties. The shift of the whole cholesterol distribution between eastern Finland and south Japan, and immigrants’ convergence toward their host country, are read as contextual effects “not reducible” to the individual level.
- Durkheim’s social facts as the precedent for relatively autonomous population phenomena.
Key results
The paper is an argument, with no data of its own.
- Health as normativity (section “Health as individual normativity”). Canguilhem rejects the “positivist dogma” that disease differs from health only by degree. Disease is “the emergence of a ‘new individual norm’” (Canguilhem 1991, p. 194) constituting “another way of life” (p. 89). The pathological can be distinguished “only at the level of organic totality” (pp. 87–88). Note 8 gives the capacity in his words: “[w]hat characterizes health is the possibility of transcending the norm, which defines the momentary normal, the possibility of tolerating infractions of the habitual norm and instituting new norms in new situations” (pp. 196–197), and “[h]ealth is a regulatory flywheel of the possibilities of reaction” (p. 198).
- Biological foundations (section “Biological foundations …”). Individuality is an organic totality. A society “is neither an individual nor a species. It is not an individual, because it is not an organism endowed with a purpose and a totality that are obtained by a specialized system of devices of regulation” (Canguilhem 2012, pp. 76–77). Darwinian selection gives “a new criterion of normality” (1988, p. 137), and on Canguilhem’s mutationism, “irregularity and anomaly are conceived not as accidents affecting an individual but as its very existence” (2008, p. 125).
- Controversies since 1943. Function debates (whether biological function is normative), units and levels of selection (genes, groups, species), species as individuals, superorganisms. “In every case, the individual organism loses the supremacy that it at first sight possessed.” A “return of the organism” is noted (Huneman, Nicholson) but the debate is “far from closed” (Sholl).
- Modern epidemiology is individualist. Cohort and case–control studies make the individual the level of measurement and inference; the population is “a purely statistical concept”, “a useful detour for making predictions of risk at the level of individuals”. Canguilhem calls the extension of health to a population a “semantic departure” (1988, p. 23) and keeps “hygiene” or “salubrity” for it.
- Three arguments for population health. (1) Population comparisons reveal associations that are invisible within populations where an exposure is ubiquitous (diet and cholesterol, salt and blood pressure); on its own this may be only methodological. (2) Integral variables, “properties of a population for which there is no measurable analogue at the level of the individual” (population density, social disorganization, social capital, herd immunity), against derived ones. Herd immunity is “a property constitutive of the population, distinct from the simple sum of individual immunities”. (3) Rose’s population causality: “why do some individuals have higher serum cholesterol levels than others?” (causes of cases) differs from “why do the Finish have higher cholesterol than the Japanese?” (causes of incidence); Sober’s selection-for as population-level causality is the parallel.
- Rose’s limit, and Giroux’s. Rose: “healthiness is a characteristic of the population as a whole and not simply of its individual members” (1992, p. 62), but complete independence of society from its members is “far too extreme”. Giroux: the relative autonomy of the population level “should not, however, lead one to consider that the population has an ontological unity as strong as that of the individual organism” (Conclusion).
Claims
| id | claim | strength | support |
|---|---|---|---|
| C1 | For Canguilhem, health is normativity, the capacity to tolerate infractions of the habitual norm and institute new norms | strong as a report | Canguilhem 1991 quoted (note 8, pp. 196–197) |
| C2 | For Canguilhem, normativity and so health belong only to the individual organism; a society is not an individual | strong as a report | Canguilhem 1991, 2012 quoted |
| C3 | Post-1943 philosophy of biology loosens the link between individuality and the organism | moderate | survey of units-of-selection and individuality debates, cited |
| C4 | Some health properties, such as herd immunity, belong to populations and have no individual analogue | moderate | definition of herd immunity (Topley and Wilson 1923), integral variables (Diez-Roux, Morgenstern) |
| C5 | Causes of incidence differ in kind from causes of cases | moderate | Rose 1985, with Sober’s parallel |
| C6 | A concept of population health is justified, with less ontological unity than an organism has | argued | from C3–C5 |
Concepts
- Biological normativity — Canguilhem’s term for health as the capacity to institute new norms in new situations, not mere conformity to a norm (note 8).
- Individual (ontological) vs organism (level of organization) — Giroux separates the degree of ontological unity from the level of organization; Canguilhem identifies them.
- Integral (global) vs derived (aggregate) variables — properties of a population with no individual analogue, against summaries of individual measurements.
- Causes of cases vs causes of incidence — Rose’s two questions.
- Ecological and individualistic (atomistic) fallacies — inferring individual relations from group data, and assuming individual effects are wholly explained by individual characteristics.
Connections
Its picture of Canguilhem draws on Gayon (1998) and Méthot (2020), and its reading of the population level on Rose, Krieger, Diez Roux and the Canadian population-health approach. Its use of biological individuality (Wilson and Barker; Bouchard and Huneman) meets the record’s readings on individuation, such as Baedke’s objection that closure criteria take in colonies (LIT-167, NOTE-148). Vissio 2020 (LIT-1876, read in NOTE-1447) reads the same Canguilhem as a vitalist philosopher of values and reports the same refusal of a social pathology.
Bearing on the record
- CLAIM-018: partly. The claim’s defeat condition is “a reading of Canguilhem on which normativity in health is not a capacity to establish new norms under changed conditions”; it waits on a NOTE that reads the book. This reading does not read the book, but it quotes the book’s definition: “the possibility of tolerating infractions of the habitual norm and instituting new norms in new situations” (Canguilhem 1991, pp. 196–197, note 8), and “a regulatory flywheel of the possibilities of reaction” (p. 198). That is the capacity the claim reads, in Canguilhem’s words, at one remove, and nothing in Giroux’s account of him contradicts it. The paper also reports Canguilhem’s reason for refusing health to collectivities (a society “is not an organism endowed with a purpose and a totality … obtained by a specialized system of devices of regulation”), which is the reason behind the claim’s own caveat that “institutions are not organisms”. Giroux’s argument for population health does not extend normativity to institutions; it concerns statistical populations, and she denies them an organism’s unity.
- No instruction for machine-learning practice; nothing for the anthology.
Limitations
- Canguilhem at second hand. Every Canguilhem quotation is Giroux’s choice and translation; note 11 shows she departs from the published translation at least once (“normality” for “morality”).
- No pages in this copy. The PMC text gives article number 111 only, so claims are located by section.
- The epidemiology is reviewed, not tested. The paper cites Rose’s distributions, Wilkinson’s income distribution and the herd-immunity definition, and notes criticism of Keys’s Seven Countries Study (note 25), but runs no analysis.
- The ontology is left open. “Different degrees of the ontological unity of entities could be envisaged”; which degree a population has is not settled.
Open questions
- Can a population’s health be normative in Canguilhem’s sense, a capacity to institute new norms, or only a distribution of individual outcomes? The paper argues for population health without saying whether normativity extends with it.
- What degree of ontological unity is enough for a concept of health to apply?