North America. Ma concepts of health comprise four dimensions as follows: Hinengaro (mental health – recognizing the inseparability of mind and body; expressing thoughts and feelings), Wairua (spiritual health – unseen and unspoken energies; faith and spiritual awareness), Whānau (health of the extended family – wider social systems; belonging, sharing and caring), and Tinana (physical health – good physical health) (Rolleston et al., 2016: 61). Bradley et al. (2017) note how concepts of health for Native Americans, Alaska Native and Native Hawaiians, are closely tied to the concepts of community, spirit and the land. The Māori and Native American concepts of health emphasize the importance of social connection, which is proven to be inextricably linked to health experience (Seppala et al., 2013).
Understandings vary according to social class and level of formal education
Several authors (see Bury, 2005; Blaxter, 2010; Duncan, 2007 and Marks et al., 2015 for example) reference a substantial, seminal piece of published work examining beliefs about health by Herzlich in 1973. Herzlich carried out one of the earliest studies that looked at lay concepts of health in middle-class French people and she found that ideas about health were closely linked to the ‘way of life’ in urban living. The way of life was seen to mitigate against good health (by causing stress and fatigue) and to generate illness. In contrast, positive health was viewed as being something inherent within the individual – health as existing in a vacuum (acknowledged only by its absence or being ill), as a ‘reserve of strength’ and as ‘equilibrium’ (Duncan, 2007: 19). Ill-health resulted from the impact of environmental factors when there were not enough ‘reserves’. Blaxter (2010: 49) states that these three representations are also sometimes discussed as health being to do with ‘having, doing and being’.
Blaxter is an influential writer and researcher in the area of concepts of heath (see Blaxter, 1990, 2010). Her research has focused on exploring lay beliefs about health within the UK. An early study by Blaxter and Paterson (1982, cited in Blaxter, 2010) found that middle-aged women, and their daughters, in poor socio-economic situations defined health as ‘not being ill’ first and foremost. Blaxter’s (1990) Health and Lifestyles study found that the better educated and those with higher incomes used the ‘health as not-ill’ definition more frequently as well as the ‘health as psychosocial well-being’. This draws on a medical perspective viewing health as absence of illness.
Understandings across the lifespan
Our health experience changes over the course of our lifetimes as we are exposed to different circumstances and due to the physiological changes that take place in our bodies as we grow and age. Inevitably, how we experience health will also impact on our perceptions of what health is and what health means to us. Here we consider two points in life when ideas about health might differ considerably – when we are younger, and when we reach older age.
Children and young people’s perceptions of health
Many studies have explored how children and young people talk about health. When asking children about their health, Brannen and Storey found that relatively few felt that their health was good (34% good, 48% fairly good, 9% not good and 9% unsure: Brannen and Storey, 1996: 25). The children in the study frequently linked their health status with eating habits. In a different study Brynin and Scott (1996) asked children if they thought that health was a ‘matter of luck’. They found that while younger children are more likely to accept this, older children are more likely to believe that health is under their own control and less a matter of luck.
Ideas about health appear to change with age during childhood and adolescence. Chapman et al. (2000) examined how children and young people define health. The younger children (aged 5–11 years) defined health in terms of diet, exercise and rest, hygiene and dental hygiene. They described health in more negative terms such as illness, smoking and the environment. The younger children also referred to emotions and mental health. The older children (over the age of 12 years) included things like smoking and drinking behaviours, having a healthy mind, feeling happy and confident and self-acceptance. Interestingly the older children also linked looking good, being happy and feeling confident with being healthy.
A more recent study, carried out in New Zealand, also explored children’s understandings of health and found that these were wide-ranging (Burrows and Wright, 2004). Being healthy was seen to be about being happy, thinking positively about yourself and being kind. In addition the children linked health with physical bodies, morality and character and also took into account mental, social, spiritual and environmental factors. A study by Downey and Chang (2013), which explored US college student’s perspectives on health, resulted in a four-component model by way of explanation. The four components were Social-Emotional Health, Positive Health Practices, Absence of Stress and Anxiety, and Adequate Rest. Interestingly, the absence of illness did not feature for these young people. The authors make the valid point that this result would be unlikely to occur with older people, who are more likely to have experienced ill-health. In a study on Korean mothers living in the USA Cha (2013) found that the women conceptualized health in relation to their role as a mother; to them being healthy was first and foremost about being able to care for their children. This also illustrates how concepts of health change across the lifespan as our personal and social circumstances change.
Older people’s perceptions of health
In terms of age, research shows that understandings about health become more complex and develop ‘multi-layers’ of understanding over a person’s lifespan (Hardey, 1998). Blaxter’s (1990) Health and Lifestyles study found that older people tended to define health more in terms of being able to function and do things or care for themselves. Much of the research claiming to focus on lay perspectives in older age actually examines illness experience rather than concepts of health or well-being (in common with other research into ‘health’ across the lifespan). What it tends to reveal is that the onset of chronic diseases is viewed as being inevitable in older age and part of normal transition through this specific life-stage, as such challenges to ‘health’ in older age are more or less anticipated (see Lawton, 2003 for an overview). In addition being ‘independent’ is strongly linked to ideas about being healthy (Lloyd, 2000).
Understandings of health vary according to gender
Among others, Emslie and Hunt (2008) contend that gender has a major part to play in lay perceptions of health. Again, we can draw on Blaxter’s work here to illustrate the fact that ideas about health may vary according to gender. Blaxter (2010) claimed to find clear gender differences, particularly in the way that men and women responded to questions about health. Women seemed to be more interested in talking about health and generally gave more detailed answers. Specifically, she found that young women’s ideas about health included the importance of social relationships and being able to look after the family (drawing on functionalist notions of health). Emslie and Hunt (2008) likewise found that, with regard to perspectives on differences in life expectancy between males and females (on average women live longer), women’s accounts were more likely to focus on reproductive and caring roles – as referred to earlier in the study by Cha (2013) – and men’s accounts more on the disadvantages of their ‘provider’ roles. In a study exploring rural Nepalese women’s concepts of health the women talked about the absence of disease, no tension, peace in the family and being able to work (Yang et al., 2018). In addition, they noted the necessity for good food, money, education and employment for good health for their children and of a healthy community. Interestingly, the most striking finding was ‘money is everything’ (Yang et al., 2018: 15). This is an indication of the relative disadvantage that the women in the study experience in terms of limited opportunities for education, lack of
