When we define prosperity as health, we must not only rethink our current model of health but also the means to create and sustain health - equally, equitably and with positive impact in lived experience. We must acquire a novel lens of health that goes beyond the biomedical, bodily and baseline view of physiological functioning as well as the norms of mental wellbeing.
In my book Interactional Creation of Health, I do just this. I introduce a model of prosperity as health that I call social desire. And I define an end-to-end process and method for its creation. In this article, I outline the concept of social desire and explain how it is variably produced in the lived experiences of people, communities, places, social and ethnic groups and populations.
Introducing social desire contrasting with material desire
Social desire connotes the idea of a positive, normative striving of human existence and experience that acts as a force of individual and collective being and becoming. It defines the universal values, impulse and want of (most) humans to strive to be healthy, to continuously explore, to experiment and create their life, and to connect and interact with one another.
As an intrinsic productive and positive power of human existence, thought and action, social desire differs from the more typical meaning of desire - material desire - as the “lack” of something (or somebody) and the desire to obtain it (or them); a calculated want, passion, pleasure or need for personal utility and material accumulation.
Here I set-out the distinction between material and social desire:
Social desire is a positive, productive force and tendency that generates positive affects of health. Material desire is a negative force and tendency that compensates for lack of social desire and generates negative affects of disease.
Forces of material and social desire in affects of experience
The concept of social desire helps to better distinguish and then trace the forces that differentiate lived experiences with health in individuals, societies, cultures, social groups, communities and places both historically and in the present.
It provides a novel frame to reveal and explain how, where and why negative affects (sensations, impressions, feeling states) of a more material desire forming lived experiences with arise and persist, positive affects are unequally distributed and where surplus affects of potential positive experience may be found and/or created.
Here are some example negative affects produced from material desire, and their expression in dispositions towards and actual disease.
Affects of envy, desire, material gain arising from widening income inequalities and growing poverty levels including child poverty
Affects of anxiety, stress, uncertainty, precarity arising from increases in unstable work and presenteeism
Social-cultural affects of hopelessness, low self-esteem, lack of potential, entrapment in place, family or home arising from reducing social mobility
Perceptual, social and bodily affects of stress, anger, frustration, loss arising from structural racism embedded in institutions (education, immigration, policing, criminal justice) and its reinforcement in politics of identity and difference
Perceptual, social and bodily affects of stress, anger, frustration, loss arising from cultural racism
Perceptual, social and bodily affects of stress, anger, frustration, loss arising from ongoing intentional and non-intentional discrimination, indignities and bias in everyday encounters and key life events (e.g., job interviews, internal promotions)
Bodily, perceptual, social affects of stress, anger, frustration, loss arising from being a victim of and witness (e.g., children) to increases in domestic violence and threat
Material affects of addiction, self-esteem decline, time loss arising from technological substitution for real human interactions and a rise in social isolation-anxiety
Social affects of loneliness and isolation arising from decline in social / community cohesion
Social affects of distrust, misinformation, exclusion, non-participation, subjectification leading to stress arising from diminished role of the truth (and trust/respect for [health and other] experts)
Deploying social desire as a conceptual framework for the interactional creation of health
To deploy social desire as a conceptual tool to understand lived experiences with health, along with their production and differentiation, first we must know the most ideal or positive qualities that constitute this vital original force in the social body.
To do so, I restate as social desires Martha Nussbaum’s ten Central Capabilities[1] that together define the most positive, dignified and flourishing state of human living, being or existence. Briefly, these are as follows:
Desire for a full life duration — the desire for physical survival and to live to the end of a normal human life, not dying prematurely or to have one’s quality of life reduced to the extent that life is not worth living
Desire for bodily vitality — the desire to have and enjoy good health including reproductive health, to be adequately nourished with access to a variety of healthy foods and to have adequate, safe and secure shelter
Desire for bodily integrity — the desire to be able to move freely from place to place, to be secure against physical or sexual violence or abuse, to have opportunities for sexual freedom and satisfaction and to have ethical and moral choice in matters of reproduction
Desire for experiencing, creativity and learning — the desire to imagine, explore, think and reason in a human (not machine-like) way that is informed and cultivated by an adequate education and that allows a desire to experience, create and produce ideas, thoughts, works and events of one’s own choice and interest, and that are guaranteed by political, religious, spiritual and artistic freedom of expression and exercise of mind, and without non-beneficial pain
Desire for emotional attachment — the desire to form and have attachments to things, places, spaces and persons outside ourselves; to love those who love and care for us, to grieve, to experience longing, gratitude and justified anger and to develop emotions free of fear and anxiety in relationships with others
Desire for practical reason — the desire to conceive of the good, to engage in critical reflection of one’s experiences and to plan and conceive of purpose and to change one’s own lived experiences in the future
Desire for social connection and engagement — the desire to live for, with and towards others, to recognise and show concern and empathy for others, to form social connections and interactions and to be treated by others with dignity, respect and without discrimination or prejudice.
Desire for connection and engagement with nature — the desire to live and act with concern for nature and to form a mutually beneficial connection with non-human species and the natural environment
Desire for play and fun– the desire to laugh, have fun and enjoy recreational, sports and leisure activities
Desire for equal recognized participation and free rights (freedom)— the desire to have freedom over one’s environment, including political freedom and freedom of expression of political ideas and self, to hold property and rights to material goods on an equal basis, and to access and have work on an equal basis and recognition with other workers without exploitation, discrimination, bias or injustice.
Affective capacity for social desire
When framing prosperity as health, we can see how capacities for acquiring social desire vary. We can determine how the human potential to strive towards, realise and preserve one, many or ideally all of the ten elements of social desire differs across individuals, families, communities, social groups, places and populations. I call these Affective Capacities. They define a more than human model of agency and force of affect that goes beyond the individual person.
Affective capacity moderates affects — sensations, impressions and feeling states that transition lived experience — as well as tendencies and forces in interactional flows. Below is a video of my conceptual model — a moving assemblage model — of the dynamic interactional creation of social desire in lived experience (from interactions of flows, forces and affects).
Through the lens of affective capacity, we can better see how and also why individual people, families, social groups, communities and places or geographies (or affectees in my terminology) have different potential to realise social desire in the interactional flows of affects forming their experience; some affectees have more potential affective capacity and therefore greater powers of interactional creation of positive qualities of social desire, whereas others have little.
A lack of or suppressed affective capacity can lead to the development and recurrence of disease and illness amongst affectees due to their diminished powers of acting on illness- and disease-generating or -bearing entities in interactional flows.
For any focal lived experience with health context, disease or illness, we can identify extremes of positive and negative qualities and affective capacities of social desire for that context. I define these extremes as poles, as follows:
An ill-health experience pole that defines the worst affect quality and affective capacity. Here, there is a stuck flow and low capacity to act arising from disagreement in relations and interactions with other entities and bodies in interactional flows, an experience of dis-ease and “stuckness” that diminishes the power or capacity of acting and creating in lived experience.
A desired (valued) experience pole that contains the most desired affects and affective capacity. Here there is an intensity of affect creation arising from agreement and fluidity in relations and interactions with other persons, entities (“other bodies”), an intensity of lived experience that generates and augments a power or capacity of acting, interacting and creating.
A new definition of health as social desire in lived experience
Combining the concepts of social desire and affective capacity, I can now redefine health as prosperity as framed by Tim Jackson.
In doing so, I go beyond the dominant biomedical, reductionist and individual behavioural agency / person-centric view of health as normal baseline functioning, end-state absence of disease, risk mitigation and a resource for living.
Rather I define health as:
A whole affective capacity or power for creating desired valued and meaningful lived experiences that (using the ten dimensions of social desire) are expressed as a full expected life, bodily vitality and integrity, creativity, belonging and attachment, social purpose, human connection, connection with nature, play and freedom.
In this perspectival relocation, health is no longer a separate object existing outside of our self-perception but rather is now brought fully into or inside our whole actual lived experience.
In this perspectival expansion, health is no longer seen as an objectified and quantified functional end in itself to be normalized or repaired but rather is viewed as a capacity to create and realize the desired, valued experiences we seek; a whole potential capacity for positive, normative striving in lived journeys of experience and a creational force for individual and collective being and becoming.
With this view of health as inside and whole to our experience, the freedoms, creations, belongings and connections that we seek, together with their absence and the forces enabling or preventing them in our experience ecosystem become the objects of study, design, intervention and action.
Health has therefore moved firmly into the centre of a critical social science. Health is lived experience and is the foundation of all our prosperities.
For more on these concepts, visit www.umio.io
[1] Martha Nussbaum (2000) Creating Capabilities: The Human Capability Development Approach. Belknap Harvard University Press