2 Session Aims To explore the complexities of health as a concept To reflect on your own perspective on healthTo summarise and critique key debates about the concept of health
3 Definitions of healthDependent on a wide range of perspectives, subjectivities and experiencesSocially, historically and culturally locatedHealth is an abstract concept (Earle et al, 2007)Health is a contested conceptNo universally agreed definition (Pridmore & Stephens, 2000)
4 Definitions of Health Health as the absence of disease Health as a continuum (positive/negative)Holistic healthHealth as well beingHealth as being able to function
5 Definitions of Health (Johnson, 2007) Dictionary definitionsAssumptive definitionsDeterminist definitionsSpiritual definitions
6 Theoretical Perspectives The Medical Model of HealthBased in scienceFocuses on the individualHealth is ‘located’ in the individual bodyIll-health is caused by biology or physiologyHealth is the absence of disease or abnormalityForms the basis of healthcare provision
7 Theoretical Perspectives The Social Model of HealthHealth is determined by a range of factorsIll-health is caused by structural factors such as poverty and inequalitiesHealth is socially constructedHealth is socially producedLay perspective is key
8 Comparing and Contrasting the Medical and Social Models Medical ModelSocial ModelNarrow or simplistic understanding of health.Broad or complex understanding of health.Medically biased definitions focusing on the absence of disease or dis-ability.More holistic definitions of health taking a wider range of factors into account such as mental and social dimensions of health.Doesn’t take into account the wider influences on health (outside the physical body).Takes into account wider influences on health such as the environment the impact of inequalities.Influenced by scientific and expert knowledge.Takes into account lay knowledge and understandings.Emphasises personal, individual responsibility for health.Emphasises collective, social responsibility for health.
9 Theoretical Perspectives Salutogenesis (Antonosky)The origins of healthChallenges the pathogenic nature of the medical model of healthFocuses on what makes people healthy not what makes people sickSuggests a health-ease-dis-ease continuum which everyone is located on
10 Theoretical Perspectives The Holistic Model of HealthAn integrated approachTakes into account the interactiob of biologicalm psycholgocial and social factors (Earler 2007)Person is viewed as a ‘whole’
11 Other perspectivesPhilosophicalPsychologicalSocial Constructionist
12 Lay Perspectives on Health ‘Non-expert’ understandingsNot homogenousComplexDiffer across individuals, communities, cultures, contexts and timeDiffer with age, levels of education, social class and genderValuable in understanding what health is
13 Lay Perspectives – Blaxter (2004) Health as not-illHealth as physical fitness, vitalityHealth as social relationshipsHealth as functionHealth as psychosocial well-being
14 Lay Perspectives – Stainton-Rogers (1991) Body as machine (links with medical model understandings)Body under siege (external factors influence health i.e. germs)Inequality of access (i.e. to medical services)Cultural critique (linked with ideas about exploitation and oppression)Health promotion (linked with ideas about responsibility for health as being individual and collective)Robust individualism (linked with rights to a satisfying life)Willpower account (linked with ideas about individual control)
15 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.
16 Social Class and Health - examples D’Houtard & Field – study of 4000 French peopleHigher & 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-beingBlaxter & Paterson (Blaxter, 2004) poor socio-economic status defined health as ‘not being ill’
17 Lifespan and Health - examples Children understandings of health are wide-ranging 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)
18 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.
19 Key issues The nature of health is contested, varied and changeable A range of different perspectives should be taken into accountLay perspectives on health are important and influentialUnderstanding what health is about is crucial to promoting and researching it
20 SummaryHealth 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.