Rethinking flourishing: Critical insights and qualitative perspectives from the U.S. Midwest

Representing disabling experiences: Rethinking quality of life when evaluating public health interventions

“…In practical terms, this includes an interest in capturing the extent that interventions facilitate inclusion, emancipation, and empowerment by promoting definitions of human development consistent with the original and positive intent associated with “capability” and “flourishing” (Robeyns, 2005). This offers an opportunity to reimagine current approaches by presenting a vocabulary in which individuals can articulate their priorities (Willen et al, 2022), while epistemically challenging the contributory injustice (Dotson, 2012) and the associated hermeneutical ignorance that denies alternative explanations (Pohlhaus, 2012). Generating epistemic resources and repertoires empowers a socially aware concept of “flourishing.” Reconciling individual aspiration with the potentially detrimental impact of structural inequalities that transform impairment into disability offers the possibility of measures able to assess an intervention's value when: developing positive relationships free from disadvantage and discrimination; facilitating social inclusion and engagement in which an individual is accepted and valued; and sustaining autonomy without reference to deficit, burden, or loss.…”

“…This, however, reflects a more fundamental theoretical tension. The detrimental impact of structural inequalities of health is continual and requires an evaluation of interventions able to connect with “the broader structures and dynamics—historical, political, socio‐cultural and ideological—that shape and constrain individual and collective chances of flourishing” (Willen et al, 2022, p. 2). This is a matter for social justice.…”

“…An individual's capacity to flourish depends on the circumstances in which they live: “for individuals to flourish, they must be situated in societies that promote their flourishing” (Roberts, 2019, p. 201). This necessitates questioning the “hostile environments” (Garland‐Thomson, 2019, p. 24) that create disability by denying agency and restricting an individual's potential (Willen et al, 2022).…”

“…Identifying factors that facilitate an individual's values within the context of their family and social networks, while accessing how inequalities impact on the social detriments of health, offers a different exploration of QoL. This includes developing outcome measures able to identify intersectional, institutional, interpersonal, and internalized discrimination, including how educational and employment opportunities, poverty, poor housing, and access to care mediate disability (Willen et al, 2022). When considered alongside the extent interventions (and policies) can generate equity through creating more inclusive environments on the basis of equality (rather than despite of), alternative ways of understanding in which active agency can be understood relative to the social context in which it is realized are established.…”

“…Rather than asking how a functional impairment prevents individuals from realizing normative expectations, QoL measures could more appropriately explore how cultural, economic, and social resources (and processes), facilitate participation. This includes encouraging individuals to reflect on how relationships mediate their experiences (Thomas, 2007) and, in particular, how negotiating an acceptable QoL requires interdependency and reciprocity (Willen et al, 2022). Understanding social inclusion, for example, while exploring the conditions that facilitate social opportunity, offers alternate explorations consistent with these ideas of interdependence (Krahn et al, 2009).…”