What is health?

Session Aims To explore the complexities of health as a concept To reflect on your own perspective on health To summarise and critique key debates about the concept of health

Definitions of health Dependent on a wide range of perspectives, subjectivities and experiences Socially, historically and culturally located Health is an abstract concept (Earle et al, 2007) Health is a contested concept No universally agreed definition (Pridmore & Stephens, 2000)

Definitions of Health Health as the absence of disease Health as a continuum (positive/negative) Holistic health Health as well being Health as being able to function

Definitions of Health (Johnson, 2007) Dictionary definitions Assumptive definitions Determinist definitions Spiritual definitions

Theoretical Perspectives The Medical Model of Health Based in science Focuses on the individual Health is ‘located’ in the individual body Ill-health is caused by biology or physiology Health is the absence of disease or abnormality Forms the basis of healthcare provision

Theoretical Perspectives The Social Model of Health Health is determined by a range of factors Ill-health is caused by structural factors such as poverty and inequalities Health is socially constructed Health is socially produced Lay perspective is key

Comparing and Contrasting the Medical and Social Models Medical Model Social Model Narrow or simplistic understanding of health. Broad or complex understanding of health. Medically biased definitions focusing on the absence of disease or dis-ability. More holistic definitions of health taking a wider range of factors into account such as mental and social dimensions of health. Doesn’t take into account the wider influences on health (outside the physical body). Takes into account wider influences on health such as the environment the impact of inequalities. Influenced by scientific and expert knowledge. Takes into account lay knowledge and understandings. Emphasises personal, individual responsibility for health. Emphasises collective, social responsibility for health.

Theoretical Perspectives Salutogenesis (Antonosky) The origins of health Challenges the pathogenic nature of the medical model of health Focuses on what makes people healthy not what makes people sick Suggests a health-ease-dis-ease continuum which everyone is located on

Theoretical Perspectives The Holistic Model of Health An integrated approach Takes into account the interactiob of biologicalm psycholgocial and social factors (Earler 2007) Person is viewed as a ‘whole’

Other perspectives Philosophical Psychological Social Constructionist

Lay Perspectives on Health ‘Non-expert’ understandings Not homogenous Complex Differ across individuals, communities, cultures, contexts and time Differ with age, levels of education, social class and gender Valuable in understanding what health is

Lay Perspectives – Blaxter (2004) Health as not-ill Health as physical fitness, vitality Health as social relationships Health as function Health as psychosocial well-being

Lay Perspectives – Stainton-Rogers (1991) Body as machine (links with medical model understandings) Body under siege (external factors influence health i.e. germs) Inequality of access (i.e. to medical services) Cultural critique (linked with ideas about exploitation and oppression) Health promotion (linked with ideas about responsibility for health as being individual and collective) Robust individualism (linked with rights to a satisfying life) Willpower account (linked with ideas about individual control)

Culture and Health - examples Ideas of beauty and slenderness being equated with health in a Western context (Burns & Gavey, 2004) Differences between lay persons and professional understandings of mental health in Zambia (Aidoo & Harpham, 2001) – different definitions of ‘ill-health’ used by both.

Social Class and Health - examples D’Houtard & Field – study of 4000 French people Higher & middle social classes – health was about hedonism, equilibrium, vitality and the body; lower classes – health was about absence of sickness, and linked to hygiene and psychological well-being Blaxter & Paterson (Blaxter, 2004) poor socio-economic status defined health as ‘not being ill’

Lifespan and Health - examples Children understandings of health are wide-ranging and include being happy, thinking positively about yourself and being kind (Burrows & Wright, 2004) Older people define health more in terms of being able to look after yourself and declining health as being an inevitable part of aging (Lawton, 2003)

Gender and Health - examples Women are more likely to focus on caring and reproductive roles; men more on the disadvantages of their ‘provider’ roles (Emslie & Hunt, 2008) Assumptions that women are more interested in health than men.

Key issues The nature of health is contested, varied and changeable A range of different perspectives should be taken into account Lay perspectives on health are important and influential Understanding what health is about is crucial to promoting and researching it

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.