a global society affects health in both positive and negative ways, particularly in relation to globalization. The final chapter, chapter 13, synthesizes the perspectives that have been discussed throughout the book. Three detailed case studies are used to explain how understanding determinants of health can aid the development of public-health strategy and action. Critique of the Dahlgren and Whitehead determinants model is also provided to conclude the volume, alongside discussion of more recent models. Despite its seminal nature and widespread use, there have been criticisms of the rainbow model related to what it omits; for example, the importance of the global is not reflected within the imagery. This led to the development of an alternative by Barton and Grant (2006) incorporating the importance of the global ecosystem for human health within the imagery. Solar and Irwin (2010) then provided a diagrammatic framework for action on the social determinants of health, so this is also discussed in the final chapter.
Figure i.1 The Dahlgren and Whitehead determinants of health rainbow
Source: Dahlgren and Whitehead (1991)
Part I Understanding and Promoting Health
The first part of this book critically examines a range of issues that address the overall question ‘what is health?’ It is divided into three chapters and, together, these chapters set the scene for the whole book and the general context of the discussion within it. The question ‘what is health?’ is key to any text about health studies and this is why a substantial part of this book is devoted to addressing it.
Chapter 1 specifically explores the question ‘what is health?’ This chapter offers an overview and a critical in-depth discussion about the nature of health, how we define it and how we experience it. This chapter facilitates deeper reflection on a term that is used a lot and often taken for granted. It considers how health is defined and the different things that might influence definitions, as well as how we understand and experience health. The chapter challenges the singular, but widely held assumption that health is the absence of disease and offers a variety of different understandings and explanations as alternatives. It draws on both lay and theoretical perspectives illustrating contrasting and competing ideas and constructing a debate about health that moves beyond received wisdom.
After considering what health is in the first chapter, chapter 2 considers the contemporary threats to health and provides an overview of the main issues and challenges in relation to public health within the twenty-first century across the UK and much further afield. The nature of threats is conceptualized and then changing patterns of health threats are analysed. The chapter outlines the contemporary threats to public health including climate change, population growth and poverty. The chapter examines both communicable and non-communicable diseases and evaluates the threat of these to contemporary societies. The chapter also considers issues such as emerging epidemics and the implications of these for public health. Finally, lifestyle
diseases as a threat to health are discussed critically.
The final chapter in this section, chapter 3, Investigating Health, goes on to discuss how health might be investigated, measured and researched. This chapter gives an overview of the importance of research in relation to health and introduces the research process as a whole. The various methods and processes by which health information is gathered and analysed are presented, illustrating the importance of researching health for health studies. Quantitative and qualitative approaches to researching health are presented and critiqued, highlighting strengths and weaknesses of different data-gathering techniques. The chapter provides a clear outline of the research process for students, who can use this to inform the development of their dissertations at undergraduate level.
1 What is Health?
Key learning outcomes
By the end of this chapter you should be able to:
understand and articulate the complexities of health as a concept
reflect on, define and defend your own perspective on health
summarize and critique key debates about the concept of health within the literature, drawing on theoretical and lay understandings
Overview
This chapter addresses the key question ‘what is health?’ There are no easy, straightforward answers to this. Trying to define health relies on developing understanding about a wide range of perspectives, subjectivities and experiences that are, in turn, socially, historically, culturally and temporally located. Nevertheless, this chapter will try to uncover some of the inherent complexities in attempting to understand what we mean by ‘health’. To do so, an array of different materials will be drawn upon in order to make sense of what it is we are trying to ‘capture’ (or, in the first instance, ‘define’). It is important for several different reasons to consider how health is conceptualized and understood, including understanding how people experience health and how to promote it. We return to the question of why it is important at the end of this chapter. Before you go any further take some time to do learning task 1.1.
Definitions of health
Health has been called ‘an abstract concept’ that people can find difficult to define (Earle, 2007a: 38). You may appreciate this more fully having completed learning task 1.1. Nonetheless different attempts have been made. One of the most frequently referenced definitions of health is the classic one offered by the World Health Organization. Health is defined as ‘a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity’ (WHO, 1948 cited in WHO, 2006). One of the strengths of this definition is its all-encompassing breadth. It moves away from the notion that being healthy is simply about not being ill. In this sense it has a more positive, holistic view about what health is. Notably it also takes into account different dimensions of health including social and mental health which, although difficult to define (Green et al., 2019), are very important dimensions of health. However, the WHO definition has also been criticized on many counts; for example, as being unattainable, idealistic and utopian (Huber, 2011; Lucas and Lloyd, 2005). According to this definition, is it possible for anyone ever actually to be healthy? In addition there are other dimensions of health that are not considered in this definition such as sexual and emotional (Scriven, 2017). Spiritual health is also neglected; however, this dimension of health is increasingly recognized as being an important factor for health experience (Nunes et al., 2018) and there have been calls for the WHO to revise the definition of health to include spiritual well-being (Chirico, 2016). Despite the criticisms levelled at the WHO’s definition of health it has stood the test of time in many respects, largely because subsequent developments in the WHO agenda have broadened understandings about health. For example, in the Ottawa Charter (WHO, 1986) it was acknowledged that ‘health is created in the context of everyday life and environment, where people live, love, work and play’.
