HEALTH CAPABILITY MODEL
Health capability is the ability to be healthy; it integrates health functioning and health agency. Health capability helps us understand the conditions that facilitate and barriers that impede health and the ability to make healthy choices. Health capability has the effect of creating a virtuous circle; developing people’s health capability enables them to create and support the conditions for their own and other’s health capability and so forth. It offers an evaluation of the aim and success of public policies in terms of people’s lived experiences. Health capabilities ought to be the primary dimension in which equity in health policy is sought.
Health capabilities are key strengths resulting from individual and societal commitment of human, financial, and physical resources with the goal of helping people thrive. Differences in health capability explain why, for example, personal skills and determination or health beliefs are not enough to achieve health, why people with even the best external conditions can still have poor health, and why a narrow biomedical model of disease is insufficient. Health capability captures the dynamic, interactive, multidimensionality of health and flourishing.
We developed a health capability model of components that are internal and external to the individual. Health capability is an ability or power to perform with the potential for achieving desired ends, it entails aptitude. Health capability is a cradle-to-grave concept requiring life-long abilities and conditions that enable optimal health.
To model health capability, we must consider both individual and societal factors to discover interactive influences. Where the circles overlap, this figure represents the way individual and social factors interact to affect health capability.
This model differs from causal, reductionist models in health policy and the health sciences, in that it is one of multiple relationships among factors. Its overlapping circles allow for a more nuanced, sequentially interactive, iterative, and multidimensional understanding. This is unlike linear models, which are limited to one-to-one associations between variables even with interactive terms and even when one controls for a number of variables. Similarly, reductionist models examine simple relationships first and then sum the principal subcomponents; the aggregated form of these models, however, can be difficult to interpret. By accounting for both internal and external influences at the individual level, the health capability model is a more flexible analytical approach that reveals greater heterogeneity in the influence of irreducibly social goods and experiences on the individual.
The health capability model is effective for longitudinal, intersectoral, and multisectoral policy and institutional analysis and design over time. It allows for heterogeneous relations among individual-level variables (e.g., income and education) and attempts to address the problem of lack of information on the direct impact of external factors by measuring a different construct, health capability, as opposed to just health. It therefore incorporates external factors into the individual level rather than trying to draw inferences about individual health based on group- or macro-level characteristics (e.g., race or socioeconomic status).