3 Health as social representation
3.1 Health and low income
Health is a very personal matter, but people's health is very much situated in their life experiences and so their perceptions of health are likely to reflect their social situation.
Bostock (1998), a health researcher, interviewed mothers who were managing on low incomes to find out about their perceptions of their health. She was struck by the difference between her respondents' self-assessed health status compared to that found by the British Household Panel Survey (BHPS) which relates to all mothers with pre-school children. Although her study was a small scale in-depth survey of just 30 mothers compared to the BHPS which interviewed 741, the figures for those who assessed their health as excellent/good or fair/poor were reversed, as Table 1 shows.
Table 1: Self-assessed health of mothers
|Self-assessed health status||Bostock study||BHPS mothers with pre-school children|
The definition of health/illhealth that Bostock's mothers were using turned on an energy/exhaustion dichotomy. Good health was made up of an energy reserve as these mothers who said they thought they were currently in good health explained:
I feel that I am energetic and I enjoy myself and get on and cope with the kids. (29-year-old cohabiting white mother, on income support, caring for six children aged 10, eight and six years, two four-year-olds and a two-year-old.)
Oh gosh, I suppose to be bouncing about, be happy and smiley, have get up and go and full of vitality and, gosh, go round kissing Jake [her son]. (16-year-old black lone mother, on income support, caring for one child five months.)
As many of her sample of mothers assessed their present state of health as only fair, Bostock asked them what it had felt like when they were in good health. This mother's reply was echoed by many others:
I mean, before I was married I was less tired, because it was just yourself and I used to go out to work, come in, have a meal and go to bed. I had more time for me. I was less tired before I got married, but after you get married, everything changes, you know. I had my child straight after I got married, and so I didn't have time to think because I was just on the go. Then when I decided to have my second one, and sometimes I think that I had her too early, but I think that it is nice now because they have the same interests and they are growing up together. But that's the price you pay when you get married and have kids, of course you are going to lose your health because as you get older you are less fit and that's just the price of kids. (Gujarati Muslim mother, on family credit, caring for two children aged seven and four years.)
Many of the mothers she interviewed felt exhausted and described themselves as ‘running on empty’; they couldn't even remember feeling well, as these two mothers explained:
Once you start feeling knackered all the time you can't remember a time when you wasn't. It gets you down. (19-year-old white lone mother, on income support, caring for one child aged two years.)
I can't remember the last time I felt really good. It's been that long. I mean I am tired a lot and then I get irritable with the kids. It's just hard, you know. (28-year-old white lone mother, on income support, caring for two children aged five and three years.)
(Quoted in Bostock, 1998, pp. 189–91)
Living on a low income and trying to care for children clearly took its toll on these mothers who had to cope with the anxiety of mounting debts and the constant strain of ‘doing without’. They also experienced loneliness and depression as they couldn’t afford to go out or treat themselves or their children. Certainly their experience of poverty and social isolation affected their health status and coloured their views on health.