1.2.2 Reviewing the research: how people understand ‘health’
Being a contested concept, ‘health’ is constantly being redefined and re-evaluated. Lay people do not necessarily accept biomedical definitions of health and illness uncritically. Instead they have a complex web of beliefs, constructs and understandings about health and illness. These inform people's health behaviour, including decisions about whether to self-manage, seek help within local or lay networks, or consult a health professional.
Some lay people regard health as the absence of disease. Indeed, in a large study in the UK, Cox et al. (1987) investigated lay views of health and ill health. This health and lifestyle study found that 30 per cent of respondents defined health as ‘not ill’ or ‘disease-free’, which could imply different meanings of ill health or disease. One rather crude explanation could be that only certain diseases, which individual lay people cannot manage without professional help, are classified as ‘illnesses’. Most people treat their own ill health, whether it is with lay remedies or over-the-counter (OTC) medicines, with or without the advice of a pharmacist, friend or relative.
So how do people build up their knowledge about health and the nature of healing? Stacey (1988) explains that, for much of the 20th century, the main concern when investigating lay concepts was to ascertain how much lay people understood and took heed of ‘what biomedicine taught about appropriate health behaviour’ (p. 142). Stacey and other medical sociologists have noted that lay concepts are important because they provide information on what:
people think about and explain to themselves in their own way – ways which they may share with others – the misfortunes which happen to them, the ailments which afflict their bodies and the disorders which enter their lives. Their ideas are taken as logical and valid in their own right, although they may not be consonant with biomedical science or any other organized healing system. Ordinary people, in other words, develop explanatory theories to account for their material, social and bodily circumstances. These they apply to themselves as individuals, but in developing them they draw on all sorts of knowledge and wisdom, some of it derived from their own experience, some of it handed on by word of mouth, other parts of it derived from highly trained practitioners. These lay explanations go beyond common sense in that explanations beyond the immediately obvious are included …
(Stacey, 1988, p. 142)
People's explanations of health are diverse and can be contradictory, as demonstrated by examples taken from four studies of different populations. Firstly, Herzlich's research (1973) on lay beliefs in middle-class French people identified three distinct ways of conceptualising health:
health as something to be had – a reserve of strength, a potential to resist illness, which is determined by temperament or constitution
health as a state of doing – the full realisation of a person's reserve of strength, characterised by equilibrium, wellbeing, happiness, feeling strong, getting on well with other people
health as a state of being – the absence of illness.
Secondly, Williams’ study (1983) of the health histories of older men and women in Aberdeen identified four similar categories of beliefs about health:
health as the absence of illness and disease
health as stamina – the ability to keep going
health as inner strength – a reserve of fitness
health as the capacity to cope with illness or endure chronic pain.
Thirdly, Blaxter's survey of health and lifestyles (1983) revealed a multiplicity of meanings of health and distinct differences according to age, gender and class. Her research identified six main definitions of health:
health as not being ill
health as a functional capacity
health as physical fitness
health as leading a healthy lifestyle
health as a psychological concept
health as a reserve.
Lastly, Calnan's research (1987) identified broadly similar categories to the others, but also indicated the need to look systematically at differences between the social classes. He proposed four different concepts of health:
health as never being ill
health as being able to get through the day – to carry out routines
health as being fit – being active, taking exercise
health as being able to cope with stresses and crises in life.
In Calnan's study, working-class women were more likely to quote the first two concepts, while the latter two concepts were referred to more frequently by middle-class women. This was true only when the women were asked to talk in general terms about health; the class difference was less apparent when the respondents talked about their own health. To summarise, these four studies show that people work with multiple meanings of health, rather than a single, unitary concept.
Further research shows that people commonly relate ill health to life events such as the death of a close relative, marriage, divorce or job change and do not simply accept or interpret their ill health as being due to objectively verifiable pathogens or disease processes. In a historical study, Herzlich and Pierret (1986) demonstrate that lay people always take a variety of causal factors into account when conceptualising health and ill health, including air, climate and seasons, and poor working conditions. People may switch between professional and lay belief systems to make sense of their personal experience of illness.