By Thomas Schramme (external contributor)

The fact that health is a form of wealth has perhaps never been as obvious as it is today. Increasingly, human health is being perceived from an economic point of view. Relevant policies additionally bolster and encourage such a perspective. More specifically, the Covid-19 pandemic has led to a new form of perception of other people: as competitors and potential threats to our individual health capital.

Any person carrying an infectious virus poses a threat to the health of others. This is not a new insight. Human history has seen plenty of similar scenarios. Public health measures have included liberty-restricting measures, such as bans on certain conduct, or quarantines. In this respect, Covid-19-related policies simply differ in scale. Still, a new quality has been reached, which involves a perspective on health in terms of a competitive asset. I explain this development with a focus on two aspects: the increased value of health and the spotlight on health as an individually and socially enabling factor.

The value of health

From an individual point of view, health is not simply the absence of disease. It is a condition that has value over and above medical norms. The value of health is often hidden from view, but we become fully aware of it when we are sick. When many people around us become ill or even die, we realise how cherished a possession health really is and how vulnerable we actually are.

During the Covid-19 pandemic, the value of health was furthermore emphasised by numerous public health measures. The value of health was politically raised to a point that it could easily be perceived as more important than individual freedom – though we need to appreciate differences between the values of individual health and population health. Still, a pandemic surely increases the perceived value of health for many.

These days, we additionally appreciate the instrumental value of health: its value as a means to pursue all kinds of activities. For instance, many self-employed workers cannot earn money when put in quarantine; care homes cannot maintain their business without a sufficient number of healthy staff. From an individual point of view, one's health status is the kind of asset that can be invested and converted into activities, such as pursuing a career, making pleasurable experiences, or supporting one's loved ones.

Health status can be manifested beyond the medical norm of health as absence of disease. Even when a person is not acutely ill, threats such as high infection rates in the community can reduce the relative instrumental value of individual health. A poor health disposition or lack of fitness goes along with a lower health status. The perception of people with low health status is often accompanied by social value judgements, for instance ascriptions of guilt and vice, which might further impact on health.

Whether a relatively bad health status should be deemed unfair depends on numerous considerations. Social justice theorists will likely condemn disadvantages that are due to circumstances, as opposed to voluntary choice. This common distinction, however, seems hopelessly simple in relation to the complex determinants of individual health status.

Others as threats

A new dimension has become more vivid recently, which adds to the established qualities of health. During a pandemic, we realise how other people can impact on our own health status. Seeing other people as threats and consequently as competitors comes with a Gestalt switch that can be analysed in economic terms.

For most of the time in human history, individual health status has been seen as depending on a combination of luck, circumstances, and one's own behaviour. During a global pandemic, we easily realise that our fellow human beings can actually pose a threat to our health, both directly and indirectly. They are direct threats when they are carriers of a pathogenic virus, such as Covid-19. They represent indirect threats – perhaps better called risks - when they are themselves more likely to become infected, for instance because they are not vaccinated or do not follow lockdown rules. The perception of others as threats commonly goes along with stereotypes and discriminatory attitudes towards some groups of people. During the Covid-19 pandemic, people of East Asian heritage were especially targeted.

Health-related threats and risks posed by others are of course more easily visible during a pandemic. Yet they are constantly present, if in other forms. I have already alluded to the fact that any pathogenic virus can reduce one's health and thereby undermine the real value of one's health status relative to other people. For example, a self-employed worker can also be held back from earning wages by a common flu; a patient's surgery might be postponed due to an emergency case that has been caused by the reckless or illegal behaviour of fellow citizens. In other words, the diagnosed scenario of competition for a scarce resource, individual health status, is ubiquitous.

Health capital

The perhaps unusual notion of health capital allows us to combine the different strands of developments into one unifying category. Health capital is hence a potentially valuable analytical concept. It has the additional benefit of allowing for a non-moralised assessment of social developments and perceptions in terms of self-interest, without excluding normative perspectives on the just allocation of health capital.

Individual health capital comprises, firstly, a specific malleable health condition, which we can call health stock. This aspect is most clearly related to traditional medical perspectives on health. A certain genetic disposition, for instance, but also one's investment – say, visiting a fitness studio or living a healthy lifestyle – constitute and maintain one's health stock.

Secondly, enabling social conditions, which comprise far more than the provision of traditional health care, are also part of one's health capital. Social epidemiologists have rightly emphasised the significance of social determinants of health, such as being able to do meaningful work or being integrated in social circles. These are the means of health production.

The level of health capital is partly due to relational aspects that have been mentioned above. Other people can threaten to reduce one's health capital, or they can work to promote it. Their status is also positionally relevant in competitive scenarios. For instance, chronically ill patients are less able than others to compete for scarce places in higher education.

Health capital justice

The Covid-19 pandemic has highlighted many of the abovementioned dimensions of health capital and thrown up numerous concerns of justice in relation to them. Disadvantaged groups have suffered from the impact of the pandemic more than others. Although from a naive, purely biological point of view, the susceptibility to infectious disease would appear to be arbitrarily allocated in society, an analysis in terms of health capital allows us to explain the actual disparities. Different levels of health capital lead to variable levels of power to maintain health.

Putting the pandemic into the broader perspective of health capital allows us to avoid moralising attitudes, for instance towards citizens who refuse vaccination. Instead of blaming ignorance and belief on conspiracy theories, we better analyse the social situation as based on rational self-interest. The nature of the health maintenance dilemma we are facing in our societies is indeed similar to the established model of the prisoner's dilemma. After all, not getting vaccinated in a situation where all others opt for the jab is the most beneficial outcome from an individual, rational point of view. By using this model, we will quickly understand that we will not solve our health-related social problems by sanctions alone. Rather, we need a just allocation of health capital.