1.3 Components and origins of health beliefs
Health beliefs, like other personal beliefs, are learned. Knowledge about health and illness is built up from childhood onwards, from diverse sources including family, social networks, community and religion, and through ‘official’ government health messages. Individual health beliefs, while rarely ‘scientific’ in themselves, none the less are grounded in experience, modified over time in the light of that experience, and rational in the light of people's wider belief systems and world views. There can be a dissonance between people's ‘lay’ beliefs about health, including the appropriate ways of maintaining health, and professional understandings of health and disease. There may be contradictions within the same individual, or health practitioners may ‘dispense’ advice contrary to their own personal health-related behaviour: for example, encouraging people to stop smoking or drinking alcohol excessively.
Individual accounts of health are sometimes dismissed as naïve and irrational, despite their ability to provide meaning for that person's experience of illness. However, beliefs about health give meaning to personal experiences of illness and how they fit in with unique life stories and world views. These beliefs are so strong that people often cling to them, even when faced with rational scientific explanations to the contrary.
So, people use a variety of constructs, both professional and lay, to make sense of their illnesses. These constructs are socially and culturally determined. In a study of the health beliefs and folk models of diabetes in British Bangladeshi people, Greenhalgh et al. (1998) found that informants wanted to understand and explain the onset and experience of illness. However, this tended to lead not to a systematic search for professional or scientific explanations but, rather, to a reflection on personal experience and the experiences of friends and relatives. Lay sources of information were frequently cited as a major influence on behaviour. While all the Bangladeshi respondents held strong religious (Muslim) views, and often gave explanations in terms of ‘God's will’, such views were usually held in parallel with accepting individual responsibility and understanding the potential for change. The authors of the study note that the people they interviewed may simultaneously hold both ‘traditional’ constructs (deeply rooted values and perceptions drawn from their culture of origin) and ‘recent’ ones (drawn from the host culture and less enduring in the long term).
Thus, people live with, and draw on, multiple realities and paradigms for understanding health. This phenomenon is apparent in all cultures, even seemingly homogeneous ones. Helman (2001) states that modern urbanised societies, whether western or non-western, exhibit ‘health care pluralism’. Although different therapeutic modes coexist, they are often based on entirely different premises and may even originate in different cultures, such as western medicine in China or Chinese acupuncture in the modern western world (Helman, 2001).