that the ‘contexts within which health (is) defined and experienced are constantly shifting and changing’. This argument still stands today.
Case study 1
Concepts of health and open defecation
Open defecation, in short, is the practice of defecating in open spaces or bodies of water (Saleem et al., 2019; Ayalew et al., 2018) and is directly linked to lack of adequate hygiene and sanitation facilities, lack of awareness or education, and poverty. Globally, 2.3 billion people in low and middle-income countries have no access to a latrine and nearly 892 thousand people still practise open defecation (Saleem et al., 2019). Although the problem largely exists in low and middle-income countries, wealthy countries are not completely exempt where it is a particular problem for people who are homeless, as Capone et al.’s (2018) study in Atlanta, Georgia, USA illustrates.
Open defecation is associated with ill-health and lack of privacy and dignity as well as psychosocial distress for women (Saleem et al., 2019). Public-health experts are clear about the negative effects of open defecation which include exposure to pathogens and microbial risks leading to a number of diseases (Capone et al., 2018) including diarrheal disease and associated morbidity and mortality in young children (Ayalew et al., 2018), and bacterial infections (Kumar et al., 2017). In addition to the detrimental physical impact that open defecation has, for women especially, the practice can also increases the likelihood of sexual exploitation (Saleem et al., 2019).
Despite the negative consequences of open defecation some studies show that the practice can continue in some communities even after the construction of functional latrines. For example, in a study in Northern Ethiopia, Ayalew et al. (2018) found that nearly 13% of the respondents still engaged in open defecation. The question is why? A number of factors have been found to be significant in the persistence of open defecation such as social and community norms which normalize the practice (Jenkins and Scott, 2007), negative attitudes towards authority (Water Aid, 2008) and personal preference or choice (Jenkins and Scott, 2007). A study by Connell (2014) found that open defecation was described by some of the participants as ‘the most natural thing’ and others have noted the role of habit where this practice endures in the presence of adequate latrines (Patwa and Pandit, 2018). A participant in a Ghanaian study by Osumanu et al. (2019: 6) explained the continuance of open defecation like this: ‘our forefathers were defecating openly without any toilet facility but lived over 100 years. How can you convince me that open defecation is not good?’ Beliefs are also important. Children are allowed to defecate freely anywhere because their faeces are generally not regarded as ‘harmful’ (Osumanu et al., 2019: 7). This case study illustrates the power and importance of concepts of health and the links between such socio-cultural factors and health outcomes.
See also the website accompanying this book at www.politybooks.com/chs
Summary
Health is a complex concept and is difficult to define. Many different definitions and understandings exist.
Understandings of health differ according to experience and expertise. Factors such as age, social class and gender impact on these. Theoretical perspectives about health can aid our understandings of subjective health experience.
Lay and expert understandings of health may differ but both are central to developing understandings about what health is, how it may be explored and how it may be maintained.
Questions
1 Health means different things to different people. Consider what health might mean to other people in different contexts for example – a person who uses a wheelchair, a person in a country experiencing conflict, a person who is experiencing a mental-health problem or some other person of your choice. How might their understanding of health differ from yours and why?
2 Drawing on the material in this chapter, compare and contrast theoretical (or professional) understandings/concepts of health with lay understandings/concepts. Take time to reflect on why it is important to take both types of perspectives into consideration.
3 What factors do you think impact on, and influence, your understandings about health and what health means to you? Which of these are most significant and why?
Further reading
Blaxter, M. (2010) Health. 2nd edn. Cambridge, Polity. This second edition of a classic book is one of the most useful, readable texts around on lay perspectives and health. Readers should note that it focuses mainly on understandings of health within a ‘global North’ (or ‘Western’) context. However, it explores the meaning of health in some depth, drawing on a range of literature and research, so it is a very good introduction to the key issues.
Green, J., Cross, R., Woodall, J. and Tones, K. (2019) Health Promotion: Planning and Strategies. 4th edn. London, Sage. Chapter 1: Health and Health Promotion. This book chapter provides a more in-depth, critical overview of the nature of health, drawing on a number of different perspectives and highlighting the importance of understanding health in order to inform health-promotion programmes.
Duncan, P. (2007) Critical Perspectives on Health. Basingstoke, Palgrave Macmillan. This book addresses the question ‘what is health?’ and critically examines a range of diverse perspectives. It is a useful follow-up to this chapter and explores a number of issues in greater analytical depth than can be achieved here. See part III, Critical Perspectives on Health, for a more in-depth critical discussion about the nature of health.
2 Contemporary Threats to Health
Key learning outcomes
By the end of this chapter you should be able to:
understand how health threats can be conceptualized
analyse how changing patterns of health relate to key societal events
identify contemporary public-health issues within society
Overview
This chapter aims to give an overview of the main issues and challenges in relation to public health in the twenty-first century and to explore the key health ‘issues’ focused upon in the current public-health agenda across the UK and beyond. The importance of these issues is fully discussed at the end of this chapter, but to really understand health within contemporary society, it is essential to be able to identify what the key health issues and challenges are. Therefore, this chapter starts with an exploration of the nature of threats and factors that influence societal decisions about their magnitude. Secondly, changing patterns of health threats are outlined and epidemiological transitions are discussed. Thirdly, current key threats to public health, including both communicable and non-communicable diseases, are examined. Finally, the chapter discusses critically current threats to health such as lifestyle diseases that are inherently socially influenced. For example, illnesses associated with the over-consumption of food and alcohol, the problems of inactivity and sedentary lifestyles and risky behaviours such as unprotected sexual encounters. These
