individualistic medical model of health, and the idea of the body as a machine (Stephens, 2008), which challenges more holistic ideas about health, reflected in more critical psychological perspectives. (See chapter 6, which explores the contribution of psychology in more detail.) Health is also equated with happiness for many people (Cloninger and Zohar, 2011). Warwick-Booth and Cross (2018) note how happiness has gained more attention over the past few years as concerns about health move away from illness and disease and focus more on notions such as well-being. There are a number of studies that clearly demonstrate the links between health and happiness and, specifically, the role that social connections have to play in subjective experiences in this area (for example, Clark et al., 2017).
Social construction
One of the key issues when trying to define health that also impacts on perspectives about health is the idea that ‘health’ is socially constructed. This means that the way we think about health is determined by a range of factors that influence us at any given time, in any given place. As a consequence, the notion of health is seen to be organic and fluid, changing all the time. Social constructionism argues that ‘meaning’ is socially constructed. In terms of health then, we can see that the meaning we give to it, or the way that we understand it is not straightforward or uncomplex. From a social constructionist perspective the meaning of health is created (constructed) through the way that we, as social beings, interact and the language that we use. Through talking about health we draw on different discourses, creating social consensus about what health actually is. We then reproduce and reinforce ideas about health through our talk and use of different discourses. This means that ideas about health are both timebound and culture-bound – they change and vary across time and place. In addition, many different ways of talking about health (discourses) may (and do) exist at any one time.
A moral phenomenon
It is also worth considering briefly a dominant theoretical idea about health that is concerned with its moral nature. Crossley (2003) argues that, increasingly, health has become synonymous with ideas to do with being a good and responsible person. The pursuit of health is therefore seen as something virtuous and highly valued. Lupton and Peterson (1996) refer to this as the ‘imperative of health’. The extent to which this notion is prevalent is indicated by research findings that demonstrate that people prefer to claim that they are healthy (Blaxter, 2010) or at least are trying to be (Cross et al., 2010). This ties in with neo-liberalist notions about individual responsibility. The notion that individuals have a moral responsibility to look after their own health is echoed through many aspects of health promotion and health-service provision. Lawton et al. (2005) highlights the promotion of self-management and self-care in people with type 2 diabetes, for example. The morality of health is strongly linked to ideas of ‘good citizenship’ and the drive to be a fully functioning member of society – one who protects and maintains their own health rather than being a strain on society’s finite resources. In contemporary Western societies this can be seen, for example, in the way that people who are overweight or obese are judged and blamed for their size.
So far we have focused on the way that health is theorized, which has largely drawn on professional discourse about health. The next section of this chapter will explore these ideas in more detail in relation to lay understandings about health.
Lay perspectives
This section of the chapter will consider lay perspectives on health and how these can contribute to understanding what health is. First we need to determine the meaning of the term ‘lay’ in this context. Lay perspectives (or ‘lay knowledge’, Earle, 2007a; or ‘lay expertise’ Martin, 2008) are distinguishable from theoretical or professional perspectives in that they are the perspectives of ‘ordinary’ (or non-professional) people. Essentially lay perspectives are about how non-expert people understand and experience their health and how they perceive it. Bury (2005) refers to lay understandings as ‘folk beliefs’ and argues that research into lay concepts of health has revealed complex and sophisticated understanding and ideas that go beyond the medical model outlined earlier.
Blaxter (2007) points out that it is not necessarily useful to use the term ‘lay’ because lay knowledge and understanding is informed, at least in part, by professional knowledge and understanding. So Blaxter (2007: 26) suggests that ‘lay understandings can better be defined as common-sense understandings and personal experience, imbued with professional rationalizations’. Nonetheless, since the term ‘lay perspectives’ is commonly used and understood and is, as such, reflected in much of the literature and research in this area, it will be used in this chapter. From this point on the term ‘lay perspectives’ will be used as a generic term, which is also seen to encompass the terms ‘lay beliefs’, ‘lay understandings’ and ‘lay concepts’.
Lay perspectives are central to the social model of health as discussed previously. The importance of paying attention to people’s subjective experience of health has been highlighted by many, including Lawton (2003) and Bishop and Yardley (2010). This is based on the fundamental assumption that people themselves often have the greatest insight into their own experiences of health and that it is therefore important to understand what these are (Earle, 2007a). As argued by Green et al. (2019: 11) ‘lay interpretations [of health] are complex and multi-dimensional’. Most often lay accounts or concepts of health are ‘uncovered’ through empirical research, so it is important to bear in mind the limitations that features such as study design and theoretical assumptions will have on findings and the way in which they are interpreted (see chapter 3 on researching health for further explanation of research methods). Health surveys often tend to ask how people would rate their own health (Bopp et al., 2012). When reading research in this area it is also important to make note of whether the research is focused on ‘health’ rather than illness (as is commonly the case due to the difficulties of defining ‘health’). Hughner and Kleine (2008), among others, argue that relatively few studies have actually focused on concepts of health as opposed to illness and Blaxter (2010) argues that different studies use different measures, categories and means of investigation, which is also problematic. There is also a ‘Western’ bias in the research that has been done into concepts of health; most of the studies reported have taken place in Europe and the USA (Downey and Chang, 2013). Nonetheless there is a body of knowledge that continues to evolve and grow around lay perspectives of health.
Lay perspectives are not homogenous nor are they uncomplex – they have been described as ‘reflecting health as a complex, multi-factoral construct’ (Downey and Chang, 2013: 825). They differ across individuals, communities and cultures and evolve over time. They also differ with age, levels of education, social class and gender. It is important to consider lay perspectives on health for many reasons. Not least because they tend to challenge theoretical, reductionist notions about what health is and draw on a much wider range of understandings and experiences, which inevitably adds to the debate. Indeed, much of the contemporary health-care provision agenda in Western societies is driven by public and user-involvement in which lay perspectives are inevitably key (Martin, 2008).
A study by Calnan (1987) carried out in the 1980s is often referred to in the literature on lay perceptions of health (although it actually focuses on lay understandings of health inequalities). Calnan’s summary of the findings revealed that ‘being healthy’ was viewed as such things as being able to get through the day (‘functioning’), not being ill, feeling strong, fit and energetic, getting exercise and not being overweight, being able to cope with the stress of life. Being healthy was also viewed as a state of mind. In contrast, being unhealthy was viewed as things like being unable to work, being ill or having something wrong – a serious, long-term or incurable illness,
