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 Broad or complex understanding of health. health. Medically biased definitions focusing More holistic definitions of health on the absence of disease or dis- taking a wider range of factors into ability. account such as mental and social dimensions of health. Doesn’t take into account the wider Takes into account wider influences on influences on health (outside the health such as the environment the physical body). impact of inequalities. Influenced by scientific and expert Takes into account lay knowledge and knowledge. understandings. Emphasises personal, individual Emphasises collective, social responsibility for health. 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) 1. 2. 3. 4. 5. 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) 1. Body as machine (links with medical model understandings) 2. Body under siege (external factors influence health i.e. germs) 3. Inequality of access (i.e. to medical services) 4. Cultural critique (linked with ideas about exploitation and oppression) 5. Health promotion (linked with ideas about responsibility for health as being individual and collective) 6. Robust individualism (linked with rights to a satisfying life) 7. 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 socioeconomic status defined health as ‘not being ill’ Lifespan and Health - examples • Children understandings of health are wideranging 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.