Contemporary Health Studies. Louise Warwick-Booth
considering what health is in the first chapter, chapter 2 considers the contemporary threats to health and provides an overview of the main issues and challenges in relation to public health within the twenty-first century across the UK and much further afield. The nature of threats is conceptualized and then changing patterns of health threats are analysed. The chapter outlines the contemporary threats to public health including climate change, population growth and poverty. The chapter examines both communicable and non-communicable diseases and evaluates the threat of these to contemporary societies. The chapter also considers issues such as emerging epidemics and the implications of these for public health. Finally, lifestyle
diseases as a threat to health are discussed critically.
The final chapter in this section, chapter 3, Investigating Health, goes on to discuss how health might be investigated, measured and researched. This chapter gives an overview of the importance of research in relation to health and introduces the research process as a whole. The various methods and processes by which health information is gathered and analysed are presented, illustrating the importance of researching health for health studies. Quantitative and qualitative approaches to researching health are presented and critiqued, highlighting strengths and weaknesses of different data-gathering techniques. The chapter provides a clear outline of the research process for students, who can use this to inform the development of their dissertations at undergraduate level.
1 What is Health?
Key learning outcomes
By the end of this chapter you should be able to:
understand and articulate the complexities of health as a concept
reflect on, define and defend your own perspective on health
summarize and critique key debates about the concept of health within the literature, drawing on theoretical and lay understandings
Overview
This chapter addresses the key question ‘what is health?’ There are no easy, straightforward answers to this. Trying to define health relies on developing understanding about a wide range of perspectives, subjectivities and experiences that are, in turn, socially, historically, culturally and temporally located. Nevertheless, this chapter will try to uncover some of the inherent complexities in attempting to understand what we mean by ‘health’. To do so, an array of different materials will be drawn upon in order to make sense of what it is we are trying to ‘capture’ (or, in the first instance, ‘define’). It is important for several different reasons to consider how health is conceptualized and understood, including understanding how people experience health and how to promote it. We return to the question of why it is important at the end of this chapter. Before you go any further take some time to do learning task 1.1.
Definitions of health
Health has been called ‘an abstract concept’ that people can find difficult to define (Earle, 2007a: 38). You may appreciate this more fully having completed learning task 1.1. Nonetheless different attempts have been made. One of the most frequently referenced definitions of health is the classic one offered by the World Health Organization. Health is defined as ‘a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity’ (WHO, 1948 cited in WHO, 2006). One of the strengths of this definition is its all-encompassing breadth. It moves away from the notion that being healthy is simply about not being ill. In this sense it has a more positive, holistic view about what health is. Notably it also takes into account different dimensions of health including social and mental health which, although difficult to define (Green et al., 2019), are very important dimensions of health. However, the WHO definition has also been criticized on many counts; for example, as being unattainable, idealistic and utopian (Huber, 2011; Lucas and Lloyd, 2005). According to this definition, is it possible for anyone ever actually to be healthy? In addition there are other dimensions of health that are not considered in this definition such as sexual and emotional (Scriven, 2017). Spiritual health is also neglected; however, this dimension of health is increasingly recognized as being an important factor for health experience (Nunes et al., 2018) and there have been calls for the WHO to revise the definition of health to include spiritual well-being (Chirico, 2016). Despite the criticisms levelled at the WHO’s definition of health it has stood the test of time in many respects, largely because subsequent developments in the WHO agenda have broadened understandings about health. For example, in the Ottawa Charter (WHO, 1986) it was acknowledged that ‘health is created in the context of everyday life and environment, where people live, love, work and play’.
Defining health
Statement:
Health is one of those things that most people assume they understand. But if we just stop and consider it for a moment and try to focus on it, it starts to float about in our minds (Johnson, 2007: 45)
Reflect on your own understanding of what ‘health’ is. Think about the following:
1 What does the word ‘health’ mean to you?
2 What does it mean to you, to be ‘healthy’?
3 Can you come up with a definition that captures what you mean by ‘health’? If you can, try not to focus on this in terms of health as being only the absence of disease (or there being something ‘wrong’).
Write your ideas down and you can refer back them as you read this chapter.
Health can be viewed positively or negatively. Green et al. (2019) refer to this as dichotomous differences in approaches to defining health. On the one hand there are positive approaches to defining health (health as well-being or as an asset) and on the other hand there are more negative definitions of health – those that are illness or disease oriented. When health is viewed in a negative way, definitions will tend to focus on health as absence of disease. When health is viewed in a more positive way definitions tend to be broader and take into account concepts such as ‘well-being’. The World Health Organization definition outlined earlier is an example of a more positive definition and marks a shift in understanding away from a more narrow, medical and negative view of health.
‘Well-being’ is another rather slippery concept and is also difficult to define (Chronin de Chavez et al., 2005). There is a lack of consensus as to what well-being is, although generally theoretical understandings converge around the three major aspects of physical, social and psychological well-being. Like the notion of health, this makes it difficult to investigate, as it means different things to different people. However, drawing on the concept of well-being to understand health is important. Laverack (2004) provided a useful way of thinking further about the concept of well-being. He separates well-being into three different types – physical, social and mental. Physical well-being is concerned with healthy functioning, fitness and performance capacity, social well-being is concerned with issues such as involvement in community and inter-personal relationships as well as employability and mental well-being – which involves a range of factors including self-esteem and the ability to cope and adapt. According to Johnson et al. (2016)