Contemporary Health Studies. Louise Warwick-Booth
A more recent study, carried out in New Zealand, also explored children’s understandings of health and found that these were wide-ranging (Burrows and Wright, 2004). Being healthy was seen to be about being happy, thinking positively about yourself and being kind. In addition the children linked health with physical bodies, morality and character and also took into account mental, social, spiritual and environmental factors. A study by Downey and Chang (2013), which explored US college student’s perspectives on health, resulted in a four-component model by way of explanation. The four components were Social-Emotional Health, Positive Health Practices, Absence of Stress and Anxiety, and Adequate Rest. Interestingly, the absence of illness did not feature for these young people. The authors make the valid point that this result would be unlikely to occur with older people, who are more likely to have experienced ill-health. In a study on Korean mothers living in the USA Cha (2013) found that the women conceptualized health in relation to their role as a mother; to them being healthy was first and foremost about being able to care for their children. This also illustrates how concepts of health change across the lifespan as our personal and social circumstances change.
Older people’s perceptions of health
In terms of age, research shows that understandings about health become more complex and develop ‘multi-layers’ of understanding over a person’s lifespan (Hardey, 1998). Blaxter’s (1990) Health and Lifestyles study found that older people tended to define health more in terms of being able to function and do things or care for themselves. Much of the research claiming to focus on lay perspectives in older age actually examines illness experience rather than concepts of health or well-being (in common with other research into ‘health’ across the lifespan). What it tends to reveal is that the onset of chronic diseases is viewed as being inevitable in older age and part of normal transition through this specific life-stage, as such challenges to ‘health’ in older age are more or less anticipated (see Lawton, 2003 for an overview). In addition being ‘independent’ is strongly linked to ideas about being healthy (Lloyd, 2000).
Understandings of health vary according to gender
Among others, Emslie and Hunt (2008) contend that gender has a major part to play in lay perceptions of health. Again, we can draw on Blaxter’s work here to illustrate the fact that ideas about health may vary according to gender. Blaxter (2010) claimed to find clear gender differences, particularly in the way that men and women responded to questions about health. Women seemed to be more interested in talking about health and generally gave more detailed answers. Specifically, she found that young women’s ideas about health included the importance of social relationships and being able to look after the family (drawing on functionalist notions of health). Emslie and Hunt (2008) likewise found that, with regard to perspectives on differences in life expectancy between males and females (on average women live longer), women’s accounts were more likely to focus on reproductive and caring roles – as referred to earlier in the study by Cha (2013) – and men’s accounts more on the disadvantages of their ‘provider’ roles. In a study exploring rural Nepalese women’s concepts of health the women talked about the absence of disease, no tension, peace in the family and being able to work (Yang et al., 2018). In addition, they noted the necessity for good food, money, education and employment for good health for their children and of a healthy community. Interestingly, the most striking finding was ‘money is everything’ (Yang et al., 2018: 15). This is an indication of the relative disadvantage that the women in the study experience in terms of limited opportunities for education, lack of access to health-care services and the subordination of women in the rural Nepalese context.
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?