In seminal work on lay concepts of health, Blaxter (1990 in Blaxter, 2010) provided a framework of five categories (or ways) of describing health. This was based on the findings of a major UK study in which, among other things, people were asked what it was like to be healthy. The five categories of responses were as follows:
1 Health as not-ill
2 Health as physical fitness, vitality
3 Health as social relationships
4 Health as function
5 Health as psychosocial well-being
Blaxter’s findings are referred to in more detail throughout the rest of this chapter in relation to different lay understandings. Stainton-Rogers (1991) also studied lay descriptions of health and illness and offers a framework of seven different lay accounts for health as follows:
1 Body as machine (links with medical model understandings)
2 Body under siege (external factors influence health, i.e. germs)
3 Inequality of access (i.e. to medical services)
4 Cultural critique (linked with ideas about exploitation and oppression)
5 Health promotion (linked with ideas about responsibility for health as being individual and collective)
6 Robust individualism (linked with rights to a satisfying life)
7 Willpower account (linked with ideas about individual control)
Bishop and Yardley (2010: 272) analysed qualitative studies of lay definitions of health and identified three major themes in the findings across the studies. These were (1) health as the absence of illness – ‘health is something that one is’, (2) health as the ability to perform daily activities – ‘health can be something that one has’, and (3) health as experiences of vitality and balance – ‘heath can be something that one does’. In short, health is about ‘having, being and doing’ (Bishop and Yardley, 2010: 273). More recently Svalastog et al. (2017: 434) contended that the lay perspective on health is characterized by three qualities: wholeness, pragmatism, and individualism. See table 1.2 for further details.
Table 1.2 The lay perspective on health
Source: adapted from Svalastog et al. (2017: 434)
| Quality | Explanation |
|---|---|
| Wholeness | This is related to health as ‘holistic’. Health is viewed as intrinsic to all other aspects of life, including work, family and community. Health is also viewed as a resource for living and as the ability to function. In addition, to be able to live according to one’s values is also important. |
| Pragmatism | This reflects health as a relative experience. Health is viewed and experienced according to what people might reasonably expect in the light of their personal circumstances (age, health condition/s and social situation). Other positive values in life can compensate for disability or disease. |
| Individualism | Health is conceptualized as a very personal phemomenon. This depends on who you are as a person; however, feeling close to others and part of a community or society is an important factor. |
In trying to define health lay understandings (and indeed, professional ones) we are constrained by the use of language and for the most part, people tend to draw on mainstream discourse around health in order to articulate their understandings. Changes in knowledge and understanding over time also bring changes in understanding about health. As noted by Bishop and Yardley (2010), a full appreciation of the subjective nature of health has not yet been realized. This is due, in part, to the very changeable nature of health and health experience. Indeed, in a study on Eastern Canadian ‘baby boomer’s’ perspectives on health (and illness), Murray et al. (2003) noted several different narratives about the changing nature of health and illness.
Things such as age, class and gender influence how we think about health. In a sense, these different aspects of an individual co-exist and it is not really possible to separate them out. I, for example, am a Caucasian woman, aged 21 years (plus a bit!) and would be described as being middle class – as defined by my profession. All of these features may influence the way I think about health, in addition to my past experience, my beliefs, my culture and many other things. However, for the purposes of this discussion, lay understandings of health will be considered under some of these different aspects while the problematic nature of using this type of categorization, which is ‘very social in nature’ (Stephens, 2008: 6) is acknowledged.
Understandings according to culture
One of the major things that has been seen to influence understanding about the nature of health is culture. Cultural perspectives on health offer many different ways of looking at health and the way that we think about health is influenced by our culture (see chapter 5 for more detailed discussion of the relationship between culture and health). Likewise, different belief systems, for example, about the origin of life, the existence of a ‘higher’ being, and the meaning of life, all influence understandings about health. An example of the way that culture impacts on ideas about health is the promotion, in contemporary Western cultures, of the slender body as equated with health. This results in the promotion of the thin ideal through the discourse of ‘healthy weight’, which equates being slim with being healthy (Burns and Gavey, 2004). This type of discourse suggests that health is achieved by being within certain weight limits (as medically and socially defined). Critics of this position argue that this is more to do with looking healthy (as defined by Westernized body ideals) than being healthy (see Burns and Gavey, 2004 and Aphramor and Gingras, 2008 for example) and yet this is a very pervasive idea in contemporary culture, which is being seen to have wider influence globally (chapter 12 explores global influences upon health).
The personal fitness industry is booming in the UK and many other countries across the world. Does it reflect and shape how people understand what it means to be ‘healthy’?
With regard to mental health, research in Zambia, Aidoo and Harpham (2001) explored the ways in which urban women in low-income groups explained mental ill-health as compared with local health-care practitioners and found that the women tended to speak of ‘problems of the mind’ while the practitioners used terms such as ‘stress’ and ‘depression’. This illustrates two points about the influence of culture on understanding of health. Firstly, that the practitioners were likely to have been influenced by more Westernized ideas about mental health through their training and secondly that the ‘culture’ of the practitioners contrasted with the culture of the non-practitioners in terms of understanding and experiencing mental ill-health. The practitioners used different definitions of ill-health, viewing depression as an indication that something was wrong, while the non-practitioners – the women – only defined physical symptoms as ill-health (note again that the focus here was on negative (or ill-) health rather than positive health). ‘Problems of the mind’ were not necessarily viewed as ill-health (Aidoo and Harpham,
