A Critical Hermeneutic Analysis of Medical Rationality: The Tension between the Clinical and the Health

Introduction and Objectives: Contemporary medicine is generally understood as an objective form of knowledge akin to the natural sciences, a discipline that relies on observation, measurement, and technological intervention to diagnose and treat disease. Yet, unlike the silent objects studied in the natural sciences, medicine engages the lived body, meaningful suffering, and human experiences that can only be grasped within a horizon of interpretation. For this reason, medical rationality should not be seen as neutral knowledge but as a historically situated mode of understanding the body, disease, and health, deeply entangled with values, institutions, and relations of power. From this perspective, the medical humanities are not a marginal supplement but a necessary condition for understanding medicine itself. Only through a hermeneutic-critical approach can medical rationality be analyzed as a historical way of interpreting human life.
Within this framework, a central site where this rationality becomes visible is the tension between “the clinical” and “the health.” The clinical is organized around diagnosing and treating disease at the individual level, while the health concerns prevention, health promotion, and the governance of populations. Historical analysis of pandemics shows that clinical logic has typically taken precedence over public health policies, with preventive interventions emerging belatedly under crisis conditions. This recurring pattern is conceptualized here as the “health lag,” referring to the structural and epistemic subordination of public health within treatment-oriented medicine. This study argues that such lag is not simply a managerial failure but a consequence of a dominant medical rationality that renders disease visible and health invisible.
Method: This study adopts an interdisciplinary and theoretical approach, employing conceptual and historical analysis within the framework of critical hermeneutics. The research method is structured around three principal axes.
First, a conceptual analysis of the distinction between the clinical and the health is developed. Drawing on the difference between health and disease, as well as between health as a condition and public health as practice, the study shows how modern medical knowledge has been organized around disease and the individual body, thereby marginalizing preventive and population-based perspectives.
Second, the theoretical insights of Gadamer and Foucault are mobilized. From Gadamer’s standpoint, health possesses an enigmatic and largely invisible character, becoming noticeable primarily in its loss. This invisibility hinders its transformation into a stable object of scientific knowledge. Foucault, in contrast, demonstrates how the clinical gaze and the institutionalization of hospital medicine relocated knowledge and power within the individual body. Together, these perspectives provide an epistemic and institutional account of the structural lag of public health.
Third, a comparative examination of major pandemics is undertaken. By analyzing the Spanish influenza, AIDS, Ebola, SARS, MERS, and COVID-19, the study identifies a recurring pattern in which treatment-centered strategies consistently precede preventive measures. These cases function as historical evidence of the structural character of public health lag.
To extend this framework, the contributions of Byung-Chul Han and Hans-Herbert Kögler inform the paper’s notion of care politics. The approach remains interpretive and critical, aiming to clarify conceptual and historical foundations rather than propose direct policy solutions.
Results: The conceptual and historical analysis demonstrates that the lag of public health is not an accidental or episodic phenomenon but a structural feature of modern health systems. In all the cases examined, initial responses focused on treating patients and mobilizing clinical resources, while preventive measures, public communication, and social interventions emerged belatedly. Moreover, the World Health Organization’s definition of health has not provided a sufficient solution to this structural problem.
During the Spanish influenza, cities that implemented non-pharmaceutical interventions earlier experienced lower mortality rates; nevertheless, in many instances such measures were adopted only after hospitals became overwhelmed. In the AIDS crisis, the initial focus was placed on pharmaceutical treatment, while public education and the fight against social stigma received attention later. In the Ebola outbreak, neglect of cultural contexts and social distrust made disease control more difficult. COVID-19 likewise demonstrated that even with unprecedented advances in vaccine development, lack of public trust, inequality of access, and weak health communication prolonged the crisis.
The findings indicate that health systems tend to value “crisis management” more than the “absence of crisis.” Public health, as a preventive endeavor, is less visible and less media-attractive, whereas clinical successes are rapidly highlighted. This imbalance leads to disproportionate allocation of resources, intensification of health inequalities, and increased pressure on medical professionals.
Furthermore, the medicalization of the health has consequences such as health anxiety, professional burnout, and the depoliticization of public health. In such conditions, the relationship between the state and society is reduced to that between physician and patient, where compliance replaces participation.
Discussion and Conclusions: The findings of this study indicate that the health lag is rooted in the conceptual construction of health within modern medical rationality. As long as health is defined merely as the absence of disease and the individual body remains the privileged object of knowledge, prevention and public health will continue to occupy a secondary position. Overcoming this structural imbalance therefore requires a fundamental rethinking of the concept of health itself.
Health should be understood as a positive, relational, and socially embedded condition, closely connected to the capacity to live meaningfully, to participate in social life, and to pursue health justice. Within this perspective, the concept of care politics is proposed as an alternative normative horizon. Care politics does not reduce health governance to technocratic population management; instead, it frames health as a shared ethical and political responsibility involving governments, institutions, and citizens alike.
Such an orientation demands sustained investment in public health infrastructure, education, transparency, and the cultivation of social trust. It also requires resisting the reduction of health to statistical indicators or to an individualized project of constant self-optimization. Health is fragile and sustained through networks of social relations; without attention to justice and equality, it cannot endure.
Pandemics act as mirrors, exposing the limits of treatment-centered logic. Moving beyond the lag of public health necessitates a paradigm shift that restores health to the center of ethical, social, and political concern in everyday governance and collective life.
The study also critically engages with the WHO definition of health, arguing that its conceptual vagueness, deontic character, and non-operational nature have inadvertently contributed to the very medicalization it sought to overcome. By defining health as “complete physical, mental, and social well-being,” the definition renders health an unattainable ideal, blurs the distinction between individual and public health, and expands the scope of medical intervention without providing a clear theoretical framework or institutional accountability. This critique reinforces the argument that overcoming the health lag requires not only institutional reform but also conceptual clarity and philosophical reflection on the nature of health itself.