Learning task 1.2
Comparing definitions
Activity
Compare and contrast two different definitions of health as discussed.
1 What do the definitions have to offer in terms of furthering our understanding of health?
2 What are the limitations of them? What are their strengths?
3 How would you alter the definitions? What would you add or remove and why?
4 How do the definitions compare or contrast with your own definition of health from learning task 1.1?
The variety and breadth of definitions of health presented here are not exhaustive but they serve to illustrate the many different ways in which health can be conceived and experienced and the problematic nature of trying to produce a definition that suits everyone. Downie and Macnaughton (2001: 11) argue that ‘health does not have a clear identity of its own’ and therefore we are faced with a real challenge when trying to define what it is. However, what we do know is that health is influenced by a wide range of factors. This will be discussed in more detail throughout this book.
Essentially the concept of health is not static or stable over time or within different contexts. It is influenced by a plethora of things and means different things to everyone. The meaning of health is also contested and, as has been demonstrated, ‘there is no universally agreed definition’ (Pridmore and Stephens, 2000: 30). Indeed, the concept of health remains elusive (Johnson, 2007). In his book Creating Health for Everyone: Principles, Practice and Philosophy, Colin Johnson (2007) offers a definition of health that extends to nearly four pages, which illustrates the nebulous nature of it and the somewhat impossible task of trying to produce a universally acceptable definition! However, he does state that ‘the concept of health is a cluster of sub-concepts, which together constitute a dynamic whole’ (p. 91) acknowledging the range of influences on understanding. Johnson (2007) offers a framework of definitions of health that has four categories of definition – dictionary definitions, assumptive definitions, determinist definitions and spiritual definitions. While the framework Johnson uses provides a valuable contribution to our knowledge about definitions of health we are really not that much further forward in terms of concrete understanding (and, indeed, we may never be). The extent to which this actually matters is debatable.
Given the difficulties of trying to produce a satisfactory definition of health, the next section of this chapter will examine different theoretical perspectives on the nature of health and consider what these might have to offer to our understanding of ‘what health is’.
Theoretical perspectives
This section of the chapter will consider a range of different perspectives on health, including theoretical perspectives, alternative models of health and also lay perspectives versus professional perspectives. Theoretical perspectives on health are distinguishable from lay perspectives on health (we return to these later) as those that are derived from academia. Theoretical perspectives on health inform professional perspectives, which are also distinguishable from lay perspectives.
To begin with, it is useful to consider two fundamental theoretical constructs of health – the medical model of health and the social model of health.
The medical model
The medical model of health is located within a scientific paradigm of understanding. It is sometimes also referred to as the ‘biomedical’ model (Blaxter, 2010), the medical model, the ‘biological’ model or even the ‘Western scientific medical model’. The medical model draws on scientific, mechanical, individualistic and reductionist understandings of what health is and views health in terms of pathology, disease, diagnosis and treatment. The physical body is viewed as being separate from social or psychological processes, sometimes referred to as ‘mind–body dualism’ (Green et al., 2019: 31). Health is seen as being ‘located’ in the individual body and the causes of ill-health are viewed as being biological or physiological in origin, requiring expert intervention. Health, according to a medical view, is conceived of as the absence of disease or ‘abnormality’. If medically defined illness and disorder are absent then health is assumed to be present. The medical model is, and has been, very influential in terms of understandings of what health is. The dominance of ideas of health as ‘the absence of illness’ in mainstream discourse about health is testimony to this. The medical model does, however, have some distinct advantages and through technological advances in scientific knowledge it has been extremely influential in Western societies within the last two centuries. As a result the medical model of health forms the basis of much health-care provision within these contexts.
However, the medical model of health has faced heavy criticism. One of the main criticisms is that the wider context is given little attention and therefore the numerous social, psychological and environmental factors that influence, or determine, health are not considered. It is difficult to account for the complexity of health if we consider it solely in biological terms, using the medical model. Another criticism of the medical model is that its view of health as the absence of disease or abnormality can be seen as being rather negative (Earle, 2007a). Surely health is about more than just this? Are we necessarily healthy simply because we are not ill? However, this is problematic because, as Duncan (2007: 8) argues, one of the main difficulties with arguing that health is about more than simply the absence of disease or abnormality is that this can lead to ‘muddle and confusion’, which may render meaningful description ‘impossible’. In addition, the widespread use of the medical model of health has increased perceptions that the responsibility for health, and indeed the control of it, lies with the individual (Jackson, 2007). This is a position that is reflected in more contemporary neo-liberalist stances in the Western world that emphasize personal responsibility for health (Friesen, 2017). This position is challenged by other concepts of health such as the social model, which will now be discussed in more detail. Before we move on to the next section take some time to carry out learning task 1.3.
Influences upon health
1 Take a few minutes to reflect on all of the things that you think impact on, and influence your health. Write them down.
2 Can you spot any patterns or group the different influences in any way?
When you have completed this task, see part III of this book and particularly chapter 13 for Dahlgren and Whitehead’s (1991) rainbow model of health determinants. Are there influences that you had not thought of?
The social model
In contrast to the medical model of health the social model of health views health as being influenced by a range of different factors, including those that are political, economic, social, psychological, cultural and environmental (as well as biological) (Earle, 2007a). The causes of ill-health are attributed to factors outside the physical
