'Lay perceptions of health are rooted in the social experience of people' (Marks et al, 2005, p78). To what extent is this statement supported by the research evidence?
'Lay perceptions of health are rooted in the social experience of people' (Marks et al, 2005, p78). To what extent is this statement supported by the research evidence?
Before I begin introducing the research evidence investigating the claim that 'lay perceptions of health are rooted in the social experience of people' (Marks, 2005) I feel its necessary to first breakdown this statement into smaller sections and discuss the parts briefly so as to get a better understanding of the paragraphs to follow. I will therefore firstly discuss what is meant by the term 'lay' or as Kleinman (1980) calls it 'the popular sector' in his conceptual model of the health belief system. Secondly, for the purpose of the paper, I shall make the brief distinction between a social context and a cultural context so as to appreciate the related significance of the evidence. And then lastly I shall introduce the research evidence supporting the extent to which lay perceptions of health are rooted in the social experience of people by considering evidence in respect to various social contexts. This will then follow with a final section summarising the proposed evidence, finishing with a brief discussion on how lay health beliefs are fundamentally problematic.
Research on lay health beliefs essentially seeks to determine how people think and define health in different cultures and social settings. The concept of 'lay' in health belief's can initially be traced back to Kleinman (1980). It is one sector in his conceptual model of the health care system, used as a means to understand how the lay person thinks about health and illness. Kleinman also identified two other broad sectors of knowledge, namely; the 'professional' and the 'folk' however for the purpose of the paper our interest remains in the popular sector. This sector consists of the lay, non-professional, non-specialist, popular culture arena and their 'social networks' of family and friends. Hughes provided an early definition of lay beliefs as "those beliefs and practices relating to disease which are the products of indigenous cultural development and are not explicitly derived from the conceptual framework of modern medicine" (Hughes, 1968, p.88), although can be best understood as commonsense understandings and personal experiences of health, imbued with professional rationalisations (Blaxter, 2004).
Health care systems are social and cultural constructs and in some respects are forms of social reality that people variably experience depending on their class, education, occupation, socio-economic statues etc (Kleinman, 1980). In health belief research, the social and/or cultural aspects of people's experience are either investigated together or individually, as like health and/or illness are investigated (discussed in more depth later). A quote from Loustaunau and Sobo (1997) provides a brief but adequate description of culture as... "all the shared, learned knowledge that people in a society hold", and a society... "generally consisting of people who share a specific geographical area within which they interact together, guided by their culture' (1997; p10). The point that I am making here is that for the purpose of the paper I shall only consider the social experience of people's lay perceptions while only making reference here to the cultural aspect in order to understand the broad nature of health belief research.
One of the first studies to explore the way people define health and illness was undertaken by Claudia Herzlich (1973). Herzlich carried out a study in France on a sample of 80 middle-aged subjects, drawn mainly from middle-class backgrounds living in Paris and Normandy. Through conducting a series of interviews, Herzlich identified three distinct dimensions; the first is 'health-in-a-vacuum', which implies an absence of illness. This view mirrors the biomedical definition of health, the prevalent professional paradigm lay people participating in these studies encountered (Jones, 1994). Calnan (1987) terms this outlook as a negative definition of health because ...
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One of the first studies to explore the way people define health and illness was undertaken by Claudia Herzlich (1973). Herzlich carried out a study in France on a sample of 80 middle-aged subjects, drawn mainly from middle-class backgrounds living in Paris and Normandy. Through conducting a series of interviews, Herzlich identified three distinct dimensions; the first is 'health-in-a-vacuum', which implies an absence of illness. This view mirrors the biomedical definition of health, the prevalent professional paradigm lay people participating in these studies encountered (Jones, 1994). Calnan (1987) terms this outlook as a negative definition of health because it focuses on avoiding particular outcomes, rather than achieving particular consequences. Williams (1983) found that health in elderly people was seen more than meaning an absence of a disease, but rather the idea that good health was something as a strength to overcome an already present disease. The second dimension Herzlich identified was the 'reserve of health', which refers to an individual's ability to maintain good health, and resist illness, and lastly, health as an equilibrium. The last dimension represents a more positive conception of health. Herzlich (1973) found that informants desired and worked toward achieving a state of equilibrium characterised by happiness, relaxation, feeling strong, and having good relations with others. In a sample of middle aged mothers, Pill and Stott (1982) alternatively found that positive health was attributed with being cheerful, enthusiastic, and effervescent. Overall, Herzlich noted that people where frequently inconsistent in their explanations, often producing many conceptualisations of health thus representing more than just a simple opposition of 'health' and 'illness'. Herzlich's findings have been echoed to varying degrees by other researchers; in particular, the notions of health as a reserve of strength (as capacity to function fully) and the 'absence of disease' recorded by Pill and Scott (1982) and Williams (1983).
Turning away now from health concepts derived from particular social groups, we focus our attention on D'Houtard and Field's (1984) study who examined the relationship between health concepts and social class on a sample of 4000 respondents from Lorraine in north-eastern France in order to determine how a population defines the meaning of health. Using open-ended questions, respondents were asked what health meant to them. Of the 6,172 replies obtained, 41 main themes emerged further regrouping into 10 headings. D'Houtard and Field (1984) found that those situated at the lower end of the social class scale tended to define health more negatively than those at the upper socio-economic class who were more likely to view health positively (Calnan, 1987; d'Houtaud and Field, 1986; Herzlich, 1973; Pill and Stott, 1982). For middle and upper-class people health was considered to be the norm and a value to them, something to achieve and maintain; for the working-class people health was more of a means to do things, to be able to function properly, in particular, to be able to work. They argued that this social class difference reflects the complementary position of social class mediated through the occupational structure.
Other studies have attempted to explore the assertion that social and economic circumstances might structure the way people think about health. In a qualitative study, Calnan and Johnson (1985) carried out interviews with a sample of 60 women from social class I, II, IV and V living in outer London. Their analysis revealed that health was usually defined in physical terms, such as a state of physical well-being or physical capability although the women in social class I and II often included an emphasis on mental health too. Expressing health as 'being fit', 'active' and 'energetic' were all elements referred to frequently by women in social class I & II, representing a more positive view towards health. Women from social class IV and V tended to talk about health in a relatively negative way, expressing the importance of 'never being ill' and the functional requirement of 'getting through the day'. In general, women in social class I & II had a more multi-dimensional view of health incorporating ideas of physical, mental and maintenance in addition to including several more definitions.
Health care systems range in their availability to offer facilities and services to the public which can potentially be related to a countries economic positioning. In light of this, Flick (2000) examined the differences and/or similarities in health beliefs by comparing the perceptions of German and Portuguese women in a series of interviews. For each country a phenomenon was found. In general, the Portuguese women tended to express a 'lack of awareness' which affected their ability to take care of themselves. Flick described how the countries slow economic growth has affected health care facilities and services thus not creating the motivation required to view health as important. Portugal's history saw long years of suppression until 1974 when the 'revolution of the carnations' brought democracy to the people. Limited education, poverty and poor living conditions made it difficult for people to take an interest in their own health. In contrast to this, the German women expressed feelings of being 'forced to health'. Being ill was represented very negatively by the German society projected mainly through the media however this forcefulness was seen as a somewhat positive influence. The importance of sport, and physical fitness was emphasised repeatedly by the German women, regarding information offered by the media very useful. Being ill was viewed as one's own fault for not looking after oneself. This victim blaming was seen as potentially problematic because influences that tended to be beyond the individual capabilities were ignored. In general, begin forced to healthiness represented an obligation, therefore fearing illness resulting in enduring anxiety over staying healthy.
To summarise, the aim of the present paper was to investigate the extent to which 'lay perceptions of health are rooted in the social experience of people' (Marks, 2005) by utilising research evidence. Evidence came from a number of authors who interviewed numerous lay people in various social groupings and situations enquiring as to their health beliefs. After collating the evidence it seems that one should be careful of its initial face value, however, collectively, the findings can be related. For example, Herlizch (1973), Pill and Stott (1982), and Williams (1983) all found similar health beliefs, for example, health being an absence of illness or disease, however the samples from Pill and Scott (1982) and Williams (1983) subscribed different meanings to the belief. Middle-aged mothers emphasised health in functional terms, specifically, to be able to 'cope' whereas elderly people denoted health as the ability to overcome an already present disease. The subjects in D'Houtard and Field (1984), Calnan and Johnson (1985) and Calnan's (1987) all expressed the importance of having the ability to work as a function of being healthy which were subsequently linked to socio-economic statues. Calnan and Johnson (1985) noticed that upper-class people viewed health in a more positive manner as did D'Houtard and Field (1984), in addition, both studies finding that upper-class people tended to express the importance of being active, viewing healthy as the norm. The findings from Flick (2000) demonstrated how perception's of health can potentially be influenced by a countries economy, exhibited in the way German women reported to obtain their information about health from family members such as, parents or grandparents, whereas the Portuguese women tended to obtain their knowledge on their own or from books, journals, television and doctors.
In light of the evidence, the concept of lay health beliefs is still however problematic.
Consider the way research investigates lay health and/or illness perceptions. If a study takes into account both perceptions of health and illness, participants may over-shadow one over the other, meaning one will become its opposite. A problem identified by D'Houtard and Field (1984). Calnan questions the assertion that it is the experience of material deprivation and adverse social conditions which leads to people subscribing to functional definitions of health (Calnan, 1987). He suggested a possible alternative explanation in which social class differences in concepts of health are products of the social context of the research interview. The more elaborate responses to questions about health gathered from middle-class respondents were due to nature of the interaction between the interviewer and interviewee. Middle-class interviewers may be more successful in developing rapport with interviewees from similar social backgrounds (Calnan 1987: 35). Secondly, most research was conducted in the 70's and 80's. Environments change rapidly, including health care knowledge and with the rapid, widespread growth of the internet one must acknowledge that professional knowledge be can so freely passed and draw upon. This brings me onto my final point. In an article titled 'How lay are lay belief's?', Ian Shaw (2002) argues that when people search for meanings, they adopt a professional explanation and interpretation about their health and illness consequently accepting this rationality. He points that in general the public is bombarded by professional messages and concepts of health, for example, on TV or in newspapers including medical columns, so as a result, the discourse surrounding this particular problem is dominated by a professional rationality. Creating a distinction between the lay and the professional belief system is fundamentally the original rationale for making a distinction between lay and professional health beliefs.
Word Count: 1647
Benjamin Iannotta
References:
Blaxter, A. (2004) Health (Key Concepts). Cambridge: Polity Press.
Calnan, M. & Johnson, B. (1985) Health, health risks and inequalities: An exploratory study of women's perceptions. Sociology of Health and Illness, 7, 55-75.
Calnan, M. (1987). Health and illness: The lay perspective. New York: Tavistock Publications.
Chamberlain, K. (1997). Socio-economic health differentials: from structure to experience. Journal of Health Psychology, 2, (3), 399-411.
D'Houtaud, A. and Field M. G. (1984). The image of health: Variations in perception by social class in a French population. Sociology of Health and Illness, 6, 30-60.
Flick, U. (2000) Qualitative inquiries into social representations of health. Journal of Health Psychology 5, (3), 315-324.
Herzlich, C. (1973). Health and illness: A social psychological analysis. London:
Academic Press.
Hughes E. C., (1968) `Ethnomedicine' in International Encyclopaedia of the Social Sciences, Vol.10, pp. 87-93, New York, Macmillan
Kleinman A. (1980) Patients and Healers in the Context of Culture, London, University of California Press
Loustaunau, M.O. & Sobo, E.J. (1997). The Cultural Context of Health, Illness and Medicine, pp. 21-48, 145-162. Bergin and Gervey: Westport, Connecticut.
Marks, D et al. (2005). Health psychology (2nd Ed). Culture and health. London: Sage.
Pill, R. & Stott, N. (1982). Concepts of illness causation and responsibility: Some preliminary data from a sample of working class mothers. Social Science and Medicine, 16, 43-52.
Shaw, I. (2002) How lay are lay belief's? Health, 6, (3), 287-299.
Williams, R. (1983). Concepts of health: An analysis of lay logic. Sociology, 17, 185-204.
Benjamin Iannotta 20139208
