Contemporary Health Studies. Louise Warwick-Booth
of eating (Glanz et al., 1998). Laestadius and Wolfson (2019) outline several health-damaging trends, such as high demand for non-animal-derived products, convenience foods, nonregional foods and large serving sizes. Similarly, levels of activity are influenced by town planning, the configuration of leisure space and the organization of transport systems, which are all analysed within the scope of the social model of health. Mueller et al. (2020) point out that car-dependent city planning causes environmental pollution and encourages sedentary lifestyles, which are damaging to public health.
Examining the causal pathways for health and illness can aid our understanding of the diversity of threats to health. Bhopal (2008) provides a useful model for analysing the complexity of causal pathways called a web of causation, which visualizes the interconnectedness of factors that influences health and illness. Bhopal’s (2008) diagram represents a complex group of health determinants, such as the environment, behaviour and the workplace. It also shows the inter-relatedness of these factors in terms of how they contribute to the occurrence and spread of disease. The web of causation can help us to understand aetiology by linking social determinants as well as biomedical factors (Ventriglio et al., 2016). Now complete learning task 2.2, which demonstrates the complexity of health determinants in relation to a specific illness, hypertension (high-blood pressure).
Hypertension and health
Consider stage 2 hypertension as a threat to health. Outline as many influences as you can think of in relation to what determines the development of hypertension among individuals. Use the internet to help you explore the causes of hypertension. Represent these influences in a diagram, for example a ‘spider web of causation’, following Bhopal (2008), showing the connections between different influences.
Finally, think about how you conceptualize these influences. Do you see the influences that you listed as threats?
The dominant contemporary discourse for health is one of threats and disease. Giddens (1999) argues that the societal focus upon health risks leaves both governments and individuals debating the outcomes of such risks because there are no definitive answers. This is not entirely surprising, as generating positive health appears for many to be a less important priority than preventing and reducing mortality and morbidity. Indeed most ‘health’ targets underpinning practice are framed around reducing illness. For example, PHE (2019) aim to reduce poor health as a mechanism to save health and social care costs. However, a good example of an integrative framework of action in relation to desired health outcomes are the Sustainable Development Goals (see chapter 12 for a description of these), which consider the wider determinants of health.
This book demonstrates throughout part III in particular that there are a large range of determinants of health. Consequently, the threats to health discussed here are conceptualized as broad in scope to encapsulate the broad nature of determinants of health outlined in Dahlgren and Whitehead’s 1991 rainbow model. In this way seemingly non-related health factors such as climate change, war and conflict and poverty can be considered to be threats to health. This has important implications for who is defined as a health workforce and the types of initiatives and programmes that are considered to impact upon the health of populations.
Magnitude and severity
Other factors that can influence what issues are seen as threats to health are the number of people affected and the seriousness of the threat. Large and visible dangers tend to receive more attention and are therefore more likely to be categorized as threats to health. For example, GPs in the UK saw influenza-like symptoms in 19.4 of every 100,000 registered patients in the week leading up to 29 December 2019, but two weeks previously they only saw such symptoms in 13.1 per 100,000 (Merrifield, 2020). The recent global pandemic of coronavirus (COVID-19) was the most serious infectious disease experienced in a hundred years because of its magnitude. Pandemics can be classified as stronger threats because of their scope being across continents and the world. Notions of mortality (death), morbidity (burden of diseases), impact on quality of life and chronic and acute disease can also be brought to bear on how threats are conceptualized. For example head lice incidence rates within the UK are suggested to be increasing following on from government policy changes, in which GPs are no longer able to prescribe treatments (Ferguson, 2018), and they affect children across the world; but very few people would suggest that head lice are a major threat to health, as they do not lead to death. Whereas HIV-related illness does lead to death, has high incidence rates, is associated with stigma and discrimination, results in reductions in quality of life and is therefore a significant contemporary threat to public health, particularly in sub-Saharan Africa and Asia.
However, conceptualizing health threats using this approach can mean that marginalized sub-populations or hidden health issues can be neglected. Issues that are perceived by society as stigmatized or shameful can go under-reported, under-investigated and unrecognized; for example, disability.
Media construction and moral panics
The way that health issues are reported within the media influences how both lay people and policy-makers understand the nature of these threats and interpret their subsequent risk to health. In most countries, there are now many health scares reported in the media. These scares often emphasize both physical and emotional threats that are posed by everyday occurrences such as sunbathing, using a mobile phone and vaccinations like measles, mumps and rubella (the combination of three vaccines into a single injection known as MMR). The media play a key role in this process, headlining stories about health scares despite the lack of science behind many of the claims that are made (Wainwright, 2009a). The availability of information via the media can lead to the social amplification of risk, where risks categorized as minor by scientific experts actually elicit strong public concerns and even reactions, resulting in large-scale impacts. Despite the fact that physical health and general life expectancy have improved massively over the last century, perceptions of threats to our health are increasing. The health scares reported in the media arguably give rise to a heightened sense of public panic, creating more physical and mental vulnerability (Buckingham, 2009). Increasing social media presence may also be contributing to these phenomena.
The media have certainly been influential in enhancing our fear of risk by overreporting health scares and by advising the public to change their behaviour, be vigilant and to take precautions despite the actual risks to us being small. However, the government can also contribute to our fear of illness and disease, when it launches campaigns about looming epidemics. A good example of this was the expected influenza A H1N1 epidemic of 2009. Boseley (2009) argues that the first flu pandemic of the twenty-first century was far less lethal than expected as it only killed 26 out of every 100,000 people who became ill. However, it can be argued that the government had to stock-pile vaccinations (despite the vested interests of the pharmaceutical industry) in case the pandemic did become as lethal as the others have been historically. More recent media reports have similarly focused on other infectious diseases such as ebola and coronavirus.
Box 2.1 Media and moral panics (selected examples)
Mass media and lay network discourses have sought to raise moral panic about several different health threats. Moral panic can be thought of as anxiety and fear generated by moral judgements about people and behaviour that poses risks to social order.
For example, Accoron and Watson (2006) discuss moral panics related to HIV, conceptualized as retribution and a plague on individuals who engage in ‘deviant’ behaviour. For example, in the US the ‘4-H risk groups’ were initially