Contemporary Health Studies. Louise Warwick-Booth
means different things to different people. Notions of health may differ between groups and between different contexts. Perceptions of health will vary across the lifespan and are influenced by a range of factors, including individual experiences and socialization. Personal experience and subjectivities mould our understandings of what health is and the meanings that we attach to it. These are, in turn, influenced by a range of things such as our social and physical environment and culture.
Why is this important for understanding health?
There are several reasons why it is important to look at different perspectives about health – both theoretical perspectives and lay perspectives. Firstly, appreciating different understandings of health may help towards understanding why people behave in certain ways when it comes to their health (Bishop and Yardley, 2010; Downey and Chang, 2013). This, in turn, can influence the way in which interventions intended to improve health are designed, communicated and implemented. As Earle (2007a) argues, anyone concerned with trying to change or influence health needs to understand what people mean when they talk about health. Secondly, in terms of health promotion we need to be clear about what it is we are actually trying to promote (health promotion is explained and analysed in chapter 7).
Thirdly, it is important because, as Entwistle et al. (1998) argue, lay perspectives can complement ‘expert’ perspectives and add to knowledge and understandings. As such they should be incorporated into, for example, health-care provision and also research into health. Understanding what health is about is crucial to researching it (Earle, 2007a). If we don’t know what we mean by the term ‘health’ how can we investigate its existence and meaning? Parallels between lay and expert understandings do exist with regard to some things; for example, in terms of how stress is conceived and understood (Clark, 2003) but this is not always the case. Differences in understandings have been found in relation to a range of health-related phenomena such as, for example, the body (Nettleton and Watson 1998). Finally, Schoenberg et al. (2005) point out the need to take people’s views into account in terms of influencing policy and programmes (in health) that are appropriately designed and sustainable.
As Duncan (2007: 93) argues, ‘we can assume nothing about the nature of health’ – it is contested, varied and changing. In addition, in order to understand health we need to take into consideration a variety of different perspectives to avoid having a narrow, constrained idea about what health is. Drawing on different disciplines and giving due consideration to lay perspectives can aid and enhance our understandings about health. In addition, Green et al. (2019) argue that trying to come up with a working definition of health can provide a basis for practice in promoting health – after all, as pointed out earlier, we need to have at least an idea of what it is we are trying to promote! Definitions of health therefore have implications for a range of things including theory, practice, policy and promoting public health (Marks et al. 2015). In a special issue of the Journal of Health Psychology, published in 2003 on the topic of health concepts, the editor at the time, Flick, argued that there were still a lot of ‘open questions and unresolved problems’ when it came to addressing the main issues (Flick, 2003: 484). Flick summarized these as the variety of health concepts that are encountered in everyday life and through professional practice. Now, several years later, it seems that the same challenges remain. Lawton (2003: 32) argued that more work needs to be done, the reason being 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