Gendered assumptions about health tend to portray that women are interested in health and men are not. However, Smith et al. (2008), in their research on Australian men, found that the men self-monitored their health status to determine whether to seek professional help and they argue that this shows a higher degree of interest in health than has previously been assumed of men as compared with women generally. Male prisoners’ concepts of health included strength and fitness, and being able to function but also acknowledged the importance of positive mental health (Woodall, 2010). Robertson (2006) carried out a study exploring men’s concepts of health, including sub-samples of gay and disabled men. He found that many of the men’s narratives about health involved notions of control and release that were associated with issues of risk and responsibility. While these themes are echoed in research focusing solely on women, ideas about the nature of risk and responsibility in health do differ with gender.
Perspectives and theoretical (professional) understandings about health can be very different from one another. While lay accounts undoubtedly draw on expert and professional understandings, to some extent they can, and do, offer alternative and increased understandings about the nature of health. A substantial amount of research has been done in this area and, as Robertson (2006) argues, this has shown the extent to which lay perspectives understand health as something that is integrated with daily life rather than being a separate entity. The importance of lay perspectives to how health is defined and theorized is therefore apparent.
Nevertheless, some criticisms have been levelled at taking lay perspectives into account in terms of the legitimacy of them and the value that they bring to general understandings of health. Entwistle et al. (1998: 465) argue that lay perspectives may be biased, unrepresentative and, it can be argued, they are ‘rarely typical’. In addition there are assumptions of mutual understandings, which may be problematic. Are ‘expert’ interpretations of ‘lay’ opinion accurate and reliable? Are we using the same language to mean different things or different language to mean the same things? With regard to ‘beliefs’, Shaw, in his 2002 paper ‘How lay are lay beliefs?’, problematizes the concept and examines the inherent difficulties with using this term. He argues that it is virtually impossible to study lay beliefs because they are intertwined with a number of things, including medical rationality. Even ‘common-sense’ views, he argues, are ‘based upon understandings within expert paradigms’ (Shaw, 2002: 287). Given the problematic nature of lay concepts of health Shaw contends that what we should be focusing on are lay ‘accounts’ – specifically lay accounts of illness. Kangas (2002) contests this position, however, and warns against juxtaposing lay and expert perspectives on health, arguing that this can ‘blur the analysis of their complex relationship’ (Kangas 2002: 302). So, this is something that is worth bearing in mind – despite the distinctions made by the majority of the literature between ‘lay’ and ‘expert’ (or professional) perspectives, in reality the boundaries between the two are often less clear cut. With respect to terminology Prior (2003) notes a change over the last twenty or so years in the academic literature, from a focus on lay health beliefs and understandings to a focus on lay knowledge and expertise, which is worth noting, since it may affect the way we attempt to ‘understand’, account for and incorporate non-professional definitions (and concepts) of health. Prior (2003: 45) criticizes those who use the term ‘lay expert’ as failing to be specific about ‘how exactly lay people might be expert’ but later in her paper argues that lay people do have information and knowledge to share.
Learning task 1.4
Different people, different definitions
Consider what health might mean to a range of different types of people in different contexts.
For example:
1 What do the definitions have to offer in terms of furthering our understanding about health?
2 What are the limitations of them? What are their strengths?
3 How would you alter the definitions for the people are you thinking about? 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?
In summary, health means different things to different people. Notions of health may differ between groups and between different contexts. Perceptions of health will vary across the lifespan and are influenced by a range of factors, including individual experiences and socialization. Personal experience and subjectivities mould our understandings of what health is and the meanings that we attach to it. These are, in turn, influenced by a range of things such as our social and physical environment and culture.
Why is this important for understanding health?
There are several reasons why it is important to look at different perspectives about health – both theoretical perspectives and lay perspectives. Firstly, appreciating different understandings of health may help towards understanding why people behave in certain ways when it comes to their health (Bishop and Yardley, 2010; Downey and Chang, 2013). This, in turn, can influence the way in which interventions intended to improve health are designed, communicated and implemented. As Earle (2007a) argues, anyone concerned with trying to change or influence health needs to understand what people mean when they talk about health. Secondly, in terms of health promotion we need to be clear about what it is we are actually trying to promote (health promotion is explained and analysed in chapter 7).
Thirdly, it is important because, as Entwistle et al. (1998) argue, lay perspectives can complement ‘expert’ perspectives and add to knowledge and understandings. As such they should be incorporated into, for example, health-care provision and also research into health. Understanding what health is about is crucial to researching it (Earle, 2007a). If we don’t know what we mean by the term ‘health’ how can we investigate its existence and meaning? Parallels between lay and expert understandings do exist with regard to some things; for example, in terms of how stress is conceived and understood (Clark, 2003) but this is not always the case. Differences in understandings have been found in relation to a range of health-related phenomena such as, for example, the body (Nettleton and Watson 1998). Finally, Schoenberg et al. (2005) point out the need to take people’s views into account in terms of influencing policy and programmes (in health) that are appropriately designed and sustainable.
As Duncan (2007: 93) argues, ‘we can assume nothing about the nature of health’ – it is contested, varied and changing. In addition, in order to understand health we need to take into consideration a variety of different perspectives to avoid having a narrow, constrained idea about what health is. Drawing on different disciplines and giving due consideration to lay perspectives can aid and enhance our understandings about health. In addition, Green et al. (2019) argue that trying to come up with a working definition of health can provide a basis for practice in promoting health – after all, as pointed out earlier, we need to have at least an idea of what it is we are trying to promote! Definitions of health therefore have implications for a range of things including theory, practice, policy and promoting public health (Marks et al. 2015). In a special issue of the Journal of Health Psychology, published in 2003 on the topic of health concepts, the editor at the time, Flick, argued that there were still a lot of ‘open questions and unresolved problems’ when it came to addressing the main issues (Flick, 2003: 484). Flick summarized these as the variety of health concepts that are encountered in everyday life and through professional practice. Now, several years later, it seems that the same challenges remain. Lawton (2003: 32) argued that
