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, 2001). Two final examples relating to culture and understandings of health come from New Zealand and 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.