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- Herausgeber: John Wiley & Sons
- Kategorie: Geisteswissenschaft
- Sprache: Englisch
Contemporary Health Studies provides an accessible introduction to current issues and key debates in understanding and promoting health. Its up-to-date, global focus places a strong emphasis on the social, political and environmental dimensions of health.
Part One sets the scene by looking closely at the definition of ‘health’ and outlining the aims and purpose of health studies. Part Two explores the different disciplines that underpin health studies, such as sociology, psychology, anthropology and health psychology, incorporating new theoretical frameworks to help readers understand health. Part Three applies this knowledge to address the determinants of health, including chapters on individual factors, the role of public health, the latest policy influences on health and the growing importance of the global context. Each chapter contains contemporary statistics and evidence alongside carefully developed learning features designed to highlight the fundamentals of each topic, to apply these to in-depth case studies – from global antibiotic resistance to the challenge and promise of digital data –, and to pose questions for reflection and debate.
Contemporary Health Studies is an essential guide for undergraduate health students written by three authors who have a wealth of teaching experience in this subject area. Their book will inspire readers to consider the human experience of health within contemporary global society as it is mediated by individual, societal and global contexts.Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 822
Veröffentlichungsjahr: 2021
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CONTENTS
Cover
Dedication
Title Page
Copyright
Foreword
Acknowledgements
How to use this book
Introduction
Part I Understanding and Promoting Health
1. What is Health?
Key learning outcomes
Overview
Definitions of health
Theoretical perspectives
Lay perspectives
Why is this important for understanding health?
Summary
Questions
Further reading
2. Contemporary Threats to Health
Key learning outcomes
Overview
Conceptualizing the identifying of threats
Why and how is all this important?
Summary
Questions
Further reading
3. Investigating Health
Key learning outcomes
Overview
What is research?
Philosophical frameworks
Research question/s
Quantitative research
Qualitative research
Differences between quantitative and qualitative research
Ethics of research
Evidence-based practice
Why is understanding research important?
Summary
Questions
Further reading
Part II The Disciplinary Context of Health Studies
4. Sociology
Key learning outcomes
Overview
What is sociology?
Society as a determinant of health
Sociological theories of health and illness
Sociological critique of health promotion
Why is this important for understanding health?
Summary
Questions
Further reading
5. Social Anthropology
Key learning outcomes
Overview
What is social anthropology?
Culture and health
Experiencing illness
Culture and treatment
Cultural representations
Culture and mental illness
Cultural influences upon health
Why is this important to health studies?
Summary
Questions
Further reading
6. Health Psychology
Key learning outcomes
Overview
What is health psychology?
How is health psychology important?
Critical perspectives
Summary
Questions
Further reading
7. Health Promotion
Key learning outcomes
Overview
What is health promotion?
Origins of health promotion
Tools for understanding health promotion
Principles and values
Critiques of health promotion
Contribution of health promotion
Summary
Questions
Further reading
Part III Influences upon Health
8. Individual Characteristics and their Influence upon Health
Key learning outcomes
Overview
What is this all about?
How do individual characteristics influence health?
What does this mean?
A lifespan perspective
How is this relevant?
Summary
Questions
Further reading
9. Social and Community Characteristics and their Influence upon Health
Key learning outcomes
Overview
Social and community networks
Social support
Relationship between social support and health
Social capital
Measuring social capital
Relationship between social capital and health
Settings for social and community networks
Implications for policy and practice
Social and community networks
Summary
Questions
Further reading
10. The Physical Environment and its Influence upon Health
Key learning outcomes
Overview
What is this all about?
Physical environment (living and working conditions)
What does this mean?
How is this relevant?
Summary
Questions
Further reading
11. Policy Influences upon Health
Key learning outcomes
Overview
What is social policy?
Social policy as a determinant of health
Current policy issues
The British Welfare State
Ideological and political values
Health services as a determinant of health
Health in all policies
The broader policy environment
The importance of fiscal policy
Social policy and health studies
Summary
Questions
Further reading
12. The Global Context of Health
Key learning outcomes
Overview
Why is global health important?
How does the global context influence health?
Why is all of this important?
Summary
Questions
Further reading
13. Synthesizing Perspectives: Case Studies for Action
Key learning outcomes
Overview
The determinants of health ‘rainbow’
Key strengths of the rainbow model
How the rainbow model might be improved
Summary
Glossary
References and suggested reading
Index
End User License Agreement
Guide
Cover
Table of Contents
Dedication
Title Page
Copyright
Foreword
Acknowledgments
How to use this book
Introduction
Begin Reading
Glossary
References and suggested reading
Index
End User License Agreement
List of Illustrations
Introduction
Figure i.1
The Dahlgren and Whitehead determinants of health rainbow
Chapter 2
Figure 2.1
Population pyramids – Zambia
Chapter 3
Figure 3.1
Representative sampling
Chapter 6
Figure 6.1
The Health Belief Model
Figure 6.2
The Theory of Planned Behaviour
Figure 6.3
The Health Action Model
Chapter 7
Figure 7.1
Tannahill’s model of health promotion
Figure 7.2
Beattie’s model of health promotion
Figure 7.3
Tones and Tilford’s model of health promotion
Figure 7.4
Caplan and Holland’s model of health promotion
Part III
Figure iii.1
The Dahlgren and Whitehead determinants of health rainbow
Chapter 8
Figure 8.1
The health career
Chapter 9
Figure 9.1
Proposed mechanisms of action for social support
Chapter 13
Figure 13.1
Factors influencing malaria using Dahlgren and Whitehead’s model as a framework …
Figure 13.2
Factors influencing cervical cancer using Dahlgren and Whitehead’s model as a fr…
Figure 13.3
Factors influencing neighbourhood health using Dahlgren and Whitehead’s model as…
Figure 13.4
Factors influencing COVID-19 using Dahlgren and Whitehead’s model as a framework…
Figure 13.5
Barton and Grant’s ‘health map’ – an extension of Dahlgren and Whitehead’s model
Figure 13.6
The Commission on the Social Determinants of Health conceptual framework
List of Tables
Chapter 1
Table 1.1
The medical model of health compared with the social model of health
Table 1.2
The lay perspective on health
Chapter 2
Table 2.1
Changing patterns of disease, illness and health
Table 2.2
Effects of climate change upon health
Table 2.3
The impact of safety and security upon health
Chapter 3
Table 3.1
Assumptions of different philosophical traditions
Table 3.2
Generating research questions
Table 3.3
Example research questions and methodological approaches
Table 3.4
An overview of quantitative data-collection techniques
Table 3.5
An overview of quantitative probability sampling approaches
Table 3.6
Levels of measurement
Table 3.7
An overview of qualitative data-collection techniques
Table 3.8
An overview of qualitative sampling approaches
Table 3.9
Stages of drawing upon evidence
Chapter 4
Table 4.1
Summary and critique of explanations of health inequalities
Chapter 6
Table 6.1
Different types of behaviour
Chapter 7
Table 7.1
Different types of models
Chapter 11
Table 11.1
Policy changes to English organ donation
Table 11.2
Ideological positions and their implications for health
Chapter 12
Table 12.1
Comparison of life expectancy and healthy life expectancy, 2020
Table 12.2
Disparities in global health-care spending
Table 12.3
The key actors in global policy-making
Table 12.4
An overview of the Sustainable Development Goals
Chapter 13
Table 13.1
Determinants of malaria
Table 13.2
Determinants of cervical cancer
Table 13.3
Determinants of unhealthy neighbourhoods
Table 13.4
Determinants of COVID-19
List of Case Studies
Chapter 1
Case Study 1
Concepts of health and open defecation
Chapter 2
Case Study 2
Global antibiotic resistance
Chapter 3
Case Study 3
Digital data
Chapter 4
Case Study 4
The medical management of sleep
Chapter 5
Case Study 5
The Western culture of well-being
Chapter 6
Case Study 6
Perspectives on skin bleaching
Chapter 7
Case Study 7
Using Caplan and Holland’s model to consider different approaches to addressing …
Chapter 8
Case Study 8
Individual characteristics and the experience of HIV/AIDS
Chapter 9
Case Study 9
Asset-based community development in Northumberland
Chapter 10
Case Study 10
Rural Ghana: the impact of the physical environment on health
Chapter 11
Case Study 11
Policy approaches to reducing inequalities
Chapter 12
Case Study 12
Action on the global social determinants of health
Chapter 13
Case Study 13
Malaria
Case Study 14
Cervical cancer
Case Study 15
Neighbourhoods
Case Study 16
COVID-19
List of Learning Tasks
Chapter 1
Learning tasks 1.1
Defining health
Learning tasks 1.2
Comparing definitions
Learning tasks 1.3
Influences upon health
Learning tasks 1.4
Different people, different definitions
Chapter 2
Learning tasks 2.1
The significance of health threats
Learning tasks 2.2
Hypertension and health
Learning tasks 2.3
HPV media coverage
Learning tasks 2.4
Analysing trends in life expectancy
Chapter 3
Learning tasks 3.1
Where do I begin in thinking about my research project?
Learning tasks 3.2
Choosing an appropriate method for your project
Learning tasks 3.3
Sampling for your project
Learning tasks 3.4
Appraising evidence for your project
Chapter 4
Learning tasks 4.1
Developing your sociological thinking about health
Learning tasks 4.2
Thinking about social influences upon health
Learning tasks 4.3
Stigma and health: biographical disruption
Learning tasks 4.4
The social construction of disability
Chapter 5
Learning tasks 5.1
Reflecting upon why culture matters
Learning tasks 5.2
Exploring your own lay beliefs
Learning tasks 5.3
Healthworld, culture and environment
Learning tasks 5.4
Cultural representations of mental illness
Chapter 6
Learning tasks 6.1
Reflection on changing behaviour
Learning tasks 6.2
Reflection on changing behaviour
Learning tasks 6.3
Determinants of health behaviour
Learning tasks 6.4
Limitations of models of behaviour change
Chapter 7
Learning tasks 7.1
What do you think health promotion is?
Learning tasks 7.2
Applying Beattie’s model of health promotion
Learning tasks 7.3
Behaviour-change campaigns
Learning tasks 7.4
Ethics in health promotion
Chapter 8
Learning tasks 8.1
Individual characteristics and health
Learning tasks 8.2
The Avon Longitudinal Study of Parents and Children
Learning tasks 8.3
Personality and motivation
Learning tasks 8.4
The nature/nurture debate and individual differences
Chapter 9
Learning tasks 9.1
Your social network map
Learning tasks 9.2
Measuring social capital
Learning tasks 9.3
Example of a connected community?
Learning tasks 9.4
Communities and social capital
Chapter 10
Learning tasks 10.1
The physical environment and health
Learning tasks 10.2
Food scares and health
Learning tasks 10.3
Community-led total sanitation (CLTS)
Learning tasks 10.4
The influence of the working environment upon health
Chapter 11
Learning tasks 11.1
The UK media and policy influence
Learning tasks 11.2
Making health policy work
Learning tasks 11.3
Ideological beliefs
Learning tasks 11.4
Policy sectors and health implications
Chapter 12
Learning tasks 12.1
Global health challenges
Learning tasks 12.2
Investigating the impact of health professional migration
Learning tasks 12.3
Globalization, the environment and health
Learning tasks 12.4
Were the Millennium Development Goals a success?
Chapter 13
Learning tasks 13.1
Using Dahlgren and Whitehead as an analytical tool
Learning tasks 13.2
Strategies for tackling health problems
Learning tasks 13.3
Evaluating Dahlgren and Whitehead’s rainbow model
Learning tasks 13.4
Building on the rainbow model of health
List of Boxes
Chapter 2
Box 2.1
Media and moral panics (selected examples)
Box 2.2
Examples of wide-ranging health inequalities
Chapter 3
Box 3.1
An example of a mixed method evaluation
Box 3.2
Principles of research ethics
Chapter 4
Box 4.1
An example of sociological theory – Parson’s sick role
Box 4.2
An example of sociological theory – Goffman and the concept of stigma
Box 4.3
An example of sociological theory – medicine for profit
Box 4.4
An example of sociological theory – the medicalization of women’s bodies
Box 4.5
Key sociological questions about health promotion
Chapter 5
Box 5.1
An example of cultural norms affecting health behaviour
Box 5.2
An example of cultural interpretations of illness
Box 5.3
Lay beliefs about cancer screening
Box 5.4
HIV/AIDS and stigma
Box 5.5
Medicine and the construction of health problems
Chapter 6
Box 6.1
Application of the HBM to testicular self-examination (might also be applied in…
Box 6.2
Application of the Theory of Planned Behaviour to taking up yoga
Box 6.3
Application of Protection Motivation Theory to condom use
Box 6.4
Application of the Stages of Change Model to changing eating behaviour (reducing…
Box 6.5
General critiques of behaviour change models in health psychology
Chapter 7
Box 7.1
Common features of new public health and health promotion
Box 7.2
Levels of prevention
Box 7.3
Upstream approaches in health promotion
Chapter 8
Box 8.1
The example of Foetal Alcohol Spectrum Disorder (FASD)
Box 8.2
Key life stages
Box 8.3
Social and economic influences upon health
Box 8.4
Addictive personality
Box 8.5
Levels of motivation applied to the issue of safer sex (after the Health Action…
Chapter 9
Box 9.1
Different types of social capital
Box 9.2
The importance of family ties for health
Box 9.3
Examples of social capital and faith-based organizations
Chapter 11
Box 11.1
Challenges for the English NHS
Box 11.2
Rationing health care – the role of NICE in the UK
Box 11.3
Important debates in the provision of welfare
Box 11.4
UK Fiscal Policy – Austerity and health outcomes
Chapter 12
Box 12.1
Defining global health
Box 12.2
Globalization and health
Box 12.3
Overview of health tourism
Box 12.4
Examples of unethical trade practices
Box 12.5
Inequalities in global health
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Dedication
ToAlex, Maia, Milana, Meadow and Race
ToEvie-Joy William – love you to the moon and back
Contemporary Health Studies
An Introduction
2nd edition
Louise Warwick-Booth
Ruth Cross
Diane Lowcock
polity
Copyright © Louise Warwick-Booth, Ruth Cross & Diane Lowcock 2021
The right of Louise Warwick-Booth, Ruth Cross and Diane Lowcock to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
First edition published in 2012 by Polity PressThis second edition first published in 2021 by Polity Press
Polity Press65 Bridge StreetCambridge CB2 1UR, UK
Polity Press101 Station LandingSuite 300Medford, MA 02155, USA
All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
ISBN-13: 978-1-5095-3954-3
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Names: Warwick-Booth, Louise, author. | Cross, Ruth, author. | Lowcock, Diane, author.
Title: Contemporary health studies : an introduction / Louise Warwick-Booth, Ruth Cross, and Diane Lowcock.
Description: 2nd edition. | Cambridge, UK ; Medford, MA : Polity, 2021. | Includes bibliographical references and index. | Summary: “A comprehensive and rigorous introduction to the field”-- Provided by publisher.
Identifiers: LCCN 2020033042 (print) | LCCN 2020033043 (ebook) | ISBN 9781509539529 (hardback) | ISBN 9781509539536 (paperback) | ISBN 9781509539543 (epub)
Subjects: MESH: Social Determinants of Health | Health Status Indicators | Global Health | Health Promotion | Socioeconomic Factors
Classification: LCC RA418 (print) | LCC RA418 (ebook) | NLM WA 30 | DDC 362.1--dc23
LC record available at https://lccn.loc.gov/2020033042
LC ebook record available at https://lccn.loc.gov/2020033043
The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this book are correct and active at the time of going to press. However, the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate.
Every effort has been made to trace all copyright holders, but if any have been overlooked the publisher will be pleased to include any necessary credits in any subsequent reprint or edition.
For further information on Polity, visit our website: politybooks.com
Foreword
I welcome the second edition of this excellent text. The Introduction sets out what the book is designed to provide and it delivers on these promises. One test of a book is that it engages the reader from the outset. The early chapter on Contemporary Threats to Health led me to think about the way some specific threats were perceived at the start of my own professional life in health promotion. At that time, the impact of the physical environment on health was addressed but there was little mention of climate change; some discussion of malnutrition associated with food shortages and nutritional deficits but less with obesity; there was early discussion of what became known as HIV/AIDS but little general consideration of pandemics; and there was a growing recognition that health inequalities in the UK continued to exist, despite the welfare state. Where inequalities were concerned, the nature of these was analysed and explanations for them debated, especially after the 1980 Black Report and the reports that followed, and strategies to ameliorate them were discussed. I recall some optimism that as appropriate strategies were identified there would be the will to implement them and a reduction of inequalities would follow. Over the intervening years there have been policies and actions with the potential to reduce health inequalities, with initiatives to reduce child poverty being one example; but they have not been sustained, and inequalities continue to prevail. Moreover, there is the realization that COVID-19 has led to a further widening of gaps. In comparison with that early naive optimism, the resistance to implementing changes designed to achieve greater health equity is now very clear. This book provides a thorough consideration of health inequalities, which should enable health-studies students to understand their nature and make future contributions to the task of overcoming these and the other key barriers to achieving health for all.
Health studies is a distinct discipline, which integrates concepts and theories from contributory ones. There will be debates about what these disciplines should be and the relative weight to be given to each. In this book, the authors focus on four key ones and give readers the tools to draw on each of these in analysing health matters. The later chapter on social policy provides a further important disciplinary perspective. The guidance on how to use the book makes readers aware from the outset that they will be on a journey in which they will reflect on and critique the meanings of health and the influences on it, as well as examining conceptual models of health and its determinants. Although a social model informs the book, readers are enabled to think critically about all models and, specifically, to compare and contrast the social and medical ones. The encouragement to readers to think about health in salutogenic terms and not simply as absence of disease – and to consider lay as well as professional perspectives – is important. The use of the Dahlgren and Whitehead model in the third section, and modifications to include a stronger global emphasis, is a particular strength of the book. In analysing health issues this model facilitates the consideration of multi-level influences and their interactions.
Given the scope of health studies, ensuring that depth is not sacrificed to breadth is a challenge. The authors have successfully met this challenge. Their own extensive teaching experience in health studies and health promotion is evident in the clarity of their explanations of complex ideas, while encouraging readers to reflect on these ideas and read further. Relevant theory is drawn upon throughout the book and critiques offered. The inclusion of learning tasks and case studies, particularly the integrative ones in the last chapter, all serve to keep the reader actively engaged. These updated case studies provide excellent models for analysing existing and newly emergent health issues, such as COVID-19. Although each of the chapters contributes to an integrated whole, many can stand alone. The Investigating Health chapter, for example, offers a succinct but critical introduction to the research process and could usefully be read by students on courses other than health-related ones. I especially welcome the global focus of the book and this is informed by the professional experience of the authors. Overall, the book offers an excellent amalgam of content, theory, critique and practical examples. While offering an essential text for health-studies courses, it can be strongly recommended to related ones.
Sylvia TilfordEmeritus Professor of Health Promotion, Leeds Beckett University
Acknowledgements
The authors would like to thank the following people:
Polity for commissioning us to work on this second edition and supporting us in developing the updated materials.
The reviewers for providing constructive feedback on the development of the book proposal, and the draft manuscript.
The members of the Centre for Health Promotion Research team, and the wider Health Promotion subject group, for their regular support, commitment to research and teaching, and ongoing engagement in critical, reflective discussions about the discipline and teaching.
The diverse range of students that we continue to teach, who challenge us to keep learning, to develop our practice and to refine our approach on a continuous basis. We look forward to continuing to work with you and hope to keep learning alongside you.
Picture credits
p. 10 Dollar Gill, Unsplash; 20 bruce mars, Unsplash; 30 Hello I’m Nik, Unsplash; 41 Philippe Leone, Unsplash; 63 © zoran mircetic/iStock; 64 © kate_sept2004/ iStock; 87 code6d/iStock; 96 Wikimedia Commons; 106 © sturti/iStock; 113 © Hans Hillewaert, Wikimedia Commons; 132 Wikimedia Commons; 140 © Adam Jones, Flickr; 147 © Kent Rosengaard/iStock; 170 © baona/iStock; 177 vikram sundaramoorthy, Unsplash; 193 © tttuna/iStock; 198 © FangXiaNuo/iStock; 207 Wikimedia Commons; 209 Wikimedia Commons; 227 Wikimedia Commons; 233 © Karen Town/ iStock; 246 © Fiona Henderson, Flickr; 249 © Gumpanat, iStock; 261 © Kwangmoozaa, iStock; 275 United Nations, Unsplash.
How to use this book
This section is designed to help you get the most out of this book. The book aims to provide an in-depth multi-disciplinary overview of the field of ‘health studies’. Contemporary Health Studies focuses on what health studies is about as a discipline, examining how health is conceptualized in various ways and how it might be understood from a variety of different disciplinary perspectives. Health is known to be strongly influenced by social factors as well as individual ones and this book aims to explore this idea in some depth.
The book does not promote a particular theoretical viewpoint because health studies as a discipline draws upon a range of theoretical stances to allow for different perspectives to be applied to health-related issues. Indeed, the discipline encourages students to engage critically in the numerous discourses surrounding health. The book therefore examines, throughout the text, human experience of health as it is mediated by individual, societal and global contexts, putting particular emphasis on the social, political and environmental dimensions of health. An understanding of these issues is absolutely essential for contemporary health practitioners. Thus, the book contains a strong, up-to-date, social-scientific focus all the way through. The book is primarily geared towards undergraduate students undertaking a public-health-related course. However, it will also be very useful for undergraduate students studying a wide range of generic health-related courses, including clinical programmes such as dietetics, environmental health and nursing. Students studying health promotion will also find this book invaluable. Students at all levels of undergraduate study will be able to engage with the content and it should prove to be a useful companion to undergraduate programmes other than health studies. Whatever the specific ‘health’ focus of their course this book should enable students to engage actively with their learning and contemporary debates about health by providing active and meaningful opportunities to learn and reflect.
This book is designed to be used in several different ways. It can be read as a whole – from start to finish – since the chapters are organized in a logical sequence. Alternatively, readers might wish to select certain chapters for attention, depending on their interest or concerns and what might be relevant to them. Sections of each chapter that relate to other parts of the book have been highlighted in the text through cross-referencing, so that the reader can follow ideas and topic areas without having to read the whole book from cover to cover. The book is an introductory level text and so offers a comprehensive and contemporary framework of key topic areas within the discipline of health studies. It contains useful references to further reading, resources and additional material available on the companion website, allowing scope for those who wish to explore in more depth.
The book is also divided into three coherent parts and each part can be read independently of the whole. The first part sets the context for the book, exploring what health is, contemporary threats to health and how we investigate it; the second part focuses on disciplinary perspectives such as sociology, anthropology, health psychology and health promotion; the third part looks at influences upon health, ending with a set of contemporary case studies that brings everything together.
Part I
Chapter 1 – What is Health?
Chapter 1 will be useful to students on any health-related and health-professional courses, as it explores the fundamental question ‘What is health?’, providing an overview of how health is conceptualized and understood. Understanding different perspectives and theories on health is foundational to learning about health and training, in any profession, to promote health. This chapter is also a necessary read in order to contextualize the debate within subsequent chapters.
Chapter 2 – Contemporary Threats to Health
This chapter identifies and explores contemporary threats to health. It is a useful and interesting read for all those working in the public-health field because it helps to identify public-health objectives within the UK and globally. The chapter also provides insight into the nature of these threats and the factors that influence specific issues that are identified as such threats. Hence, it encourages thought about the processes associated with defining contemporary threats to health and also identifies threats that are less obvious, such as terrorism. Ultimately, this chapter is a unique summary of the contemporary threats to health.
Chapter 3 – Investigating Health
In every profession, including health, there is the need to evaluate new information, particularly as evidence-based practice has become so important in recent years. However, there is often not enough evidence or there may even be competing research findings, so the need to evaluate and research constantly remains ever present. This chapter is therefore an essential read for all those studying health, as it will enable them to understand the key components of the research process and therefore to interpret research findings. Furthermore, a key stage of completing an undergraduate degree is the completion of an honours project or dissertation; this chapter has been written with this specifically in mind and so is an ideal guide to help students on their journey in completing such undergraduate projects. Indeed, many undergraduate Quality Assurance Agency benchmark statements make clear reference to the importance of research within their programmes, so this chapter is a fundamental read for all health students.
Part II
Chapter 4 – Sociology
Chapter 4 will be useful for all health students because it outlines the focus of the discipline of sociology specifically in relation to health and illness. Readers will gain an insight into the social world from the point of view of sociologists and therefore begin to be able to develop new perspectives, understand various theoretical viewpoints and think critically about social situations in terms of both structure and agency. The focus in this chapter upon health as social and the importance of health inequalities is a central theme for those completing health-studies degrees. In addition, this chapter is a useful introductory resource for broader health professionals such as nurses, allied health professionals and those studying health promotion, who are often required to complete sociology modules as part of their degree programmes.
Chapter 5 – Social Anthropology
This chapter gives an insight into the relationship between health and culture, demonstrating the importance of lay beliefs in relation to understanding health and treatment. It is important for those completing undergraduate health programmes because it further enhances their knowledge about the importance of the social in relation to health. The chapter also facilitates the ability of the reader to make comparisons between a range of health contexts. The chapter is again relevant to any health professional because it creates an awareness of different cultural settings and draws attention to the importance of the everyday understandings (lay perspectives) that co-exist alongside medical and professional viewpoints.
Chapter 6 – Health Psychology
This chapter focuses on a discipline that makes a major contribution to public health. Health psychology is fundamental in many ways and for many reasons, as it is about exploring the ways in which people behave in relation to their health. Underpinning behaviour is a range of complex influences, which this chapter explores, drawing on theory and recent research in the discipline. This chapter will be of interest to students on a range of health-related courses as well as those on health-professional courses, such as nursing, and other allied health professions that encourage and facilitate behaviour change at an individual level through one-to-one encounters. Of course, students of psychology, especially health psychology, will find this useful reading for their studies.
Chapter 7 – Health Promotion
This chapter provides the reader with an introduction to health promotion and gives an overview of the frameworks used to underpin health-promotion practice. It also outlines the principles and values that underpin health promotion, so the chapter is an excellent introduction to all of those interested in learning about health promotion. The chapter is essential for students who are beginning to study health promotion across a range of subject areas, such as health studies, health promotion and public health. It is also a useful resource for inter-professional health care students and nurses who are often required to undertake health-promotion modules and is internationally relevant because health promotion is practised across the world in a variety of contexts.
Part III
Part III of the book takes the reader on a journey, looking at influences upon health, starting at the individual level and moving on to consider wider structural factors, such as the importance of global society. It draws explicitly on Dahlgren and Whitehead’s determinants of health model, using it as a framework for developing understanding about the determinants of health; the chapters are therefore structured to reflect this.
Chapter 8 – Individual Characteristics and their Influence upon Health
This chapter explores critically a range of individual characteristics that influence health. Some of the topics covered include foetal programming, the influence of age, the influence of biological sex and gender and the influence of personality. The range of subject matter means that it will be of general interest to students on a variety of different health-related courses. This chapter can be read alongside Chapter 6, which focuses on behaviour at an individual level. It may be of particular interest to students studying for a range of health professions that consider individual differences and development across the lifespan.
Chapter 9 – Social and Community Characteristics and their Influence upon Health
This chapter explores how social and community networks act as determinants of health. Two major concepts, social support and social capital, are defined and debated and evidence presented of their relationship to health status. The proposed mechanisms of how social support and social capital influence health are explained. In the final section the implications for policy-makers and practitioners of social and community network influences upon health are considered. This chapter is useful for all those studying public health, health promotion and health studies, as social capital is increasingly cited as an important health determinant and is used within contemporary policy. The chapter will also be of interest to those working with communities in any context, such as community development workers and community nurses.
Chapter 10 – The Physical Environment and its Influence upon Health
This chapter considers a range of factors within our physical environments that impact on health. These include all of the factors that appear in Dahlgren and Whitehead’s framework, namely agriculture and food production, education, working environments, water and sanitation, and housing. Each factor is considered in critical depth, drawing on recent research findings and debate. This chapter may be of particular interest to students of environmental health; however, it will also have relevance to a wide variety of health-related courses.
Chapter 11 – Policy Influences upon Health
Social policy permeates all areas of society and is the subject of everyday discussion and daily experiences. It is also controversial and often debated; hence this chapter is essential reading for anyone who is studying health because social policy is fundamentally about who is entitled to support from the state in terms of both health and welfare and the kinds of support that can and should be provided. The chapter explores what social policy is, how it is made, the ideological basis of policy and offers an insight into how many policy sectors have an impact upon health. The chapter draws specifically upon UK health policy and so is a useful resource for practitioners, nurses and students of health studies as a general introduction to the area.
Chapter 12 – The Global Context of Health
Dahlgren and Whitehead’s framework does not make reference to the importance of the global context of health but, given the way in which the world is more closely connected through the processes associated with globalization, it is essential to understand how the global context influences and determines health outcomes. Globalization is a key determinant of health. This chapter uses the concept of globalization specifically to explore health within the global context, examining global health patterns, inequalities, health care and governance, including the Sustainable Development Goals. Given that health is global in so many respects, as this chapter demonstrates, this is an essential read for everyone studying health or working in a health profession.
Chapter 13 – Synthesizing Perspectives: Case Studies for Action
Chapter 13 brings everything that has been discussed in previous chapters together. It provides three detailed case studies, which consider much of the content of the book in relation to specific and contemporary public-health challenges. The individual case studies are about malaria, cervical cancer, neighbourhoods and strategies to tackle COVID-19. Each case study introduces the issue in depth and then considers ways in which health might be promoted in relation to it. The chapter then considers Dahlgren and Whitehead’s determinants of health rainbow framework critically and in some depth, examining its strengths and how it might be improved upon. This chapter will be useful to those working in the public-health field because it demonstrates the application of different schools of knowledge to specific health problems. Consequently, readers gain practice-related insights here, as well as the ability to build upon the theoretical understandings provided across the earlier chapters.
Introduction
The overall aim of this volume is to enable the reader to examine how health is conceptualized in various ways and how it is understood from a variety of disciplinary perspectives (terms in bold appear in the Glossary at the end of the book). Health studies is a distinct discipline in its own right, which attempts to explore all of the factors that can and do influence health, while examining the very meaning of health itself, which is the starting point for this book in chapter 1. As the scope of health studies is extremely large, this book will enable the reader to focus upon the central tenets of health studies by exploring the human experience of health across several contexts; for example, community in chapter 9, the environment in chapter 10, the policy context in chapter 11 and the global context in chapter 12. The book also discusses critically and analyses the many factors that are influential in relation to health, such as the contemporary threats to health that are considered in chapter 2 and the individual characteristics considered in chapter 8. Indeed, as there are many diverse discourses that surround health, these are illustrated in detailed case studies throughout the chapters. Health studies is also interdisciplinary in its nature and so draws upon many different disciplines, including sociology (chapter 4), anthropology, (chapter 5), psychology (chapter 6) and health promotion (chapter 7). Through the examination of different disciplines and influences, health is shown to be overwhelmingly socially influenced, and is situated within a multi-disciplinary critical framework. The key strength of health studies as a discipline is its ability to synergise understandings and influences from a variety of fields, as chapter 13 clearly demonstrates. Indeed, another key aspect of the discipline of health studies is the scope of analysis that can be achieved across a variety of fields, aided by the examination of evidence and research findings, which are discussed in detail in chapter 3. Through easy to navigate interactive chapters this book also enables the reader to develop and enhance subject specific skills, such as the ability to compare health contexts and to understand the range of influences upon health (part III), the ability to draw upon research methodologies and to analyse research findings (chapter 3) and the ability to enhance theoretical understandings (part II).
Detailed outline of the book
This book is divided into three parts, which take readers on a journey through several specific areas related to health studies. The first part of the book, Understanding and Promoting Health, begins with three chapters that introduce the reader to key issues within the field of health studies. From the outset, these chapters encourage students to begin to think both critically and reflectively about health. Chapter 1 tackles the very complex question of What is Health? Readers are encouraged to consider the concept of health critically and in depth and to think deeply about a concept that is often taken for granted, by considering definitions and conceptions of health. Widespread understandings of health as the absence of disease are challenged through discussions drawing upon both lay and theoretical perspectives. The second chapter in this first part of the book gives a critical overview of the main contemporary threats, issues and challenges in relation to public health within the twenty-first century, considering a range of both communicable and non-communicable diseases, and broader threats such as climate change. This chapter also explores the ways in which these problems can be tackled through both prevention and treatment. The third and final chapter in this first part tackles the importance of research in relation to health and health studies. This chapter introduces students to the entire research process, discussing the methods and processes by which information about health is gathered, analysed and used. The chapter demonstrates that health can be investigated in a number of different ways, exploring both quantitative and qualitative approaches to researching health. The strengths and weaknesses of these different techniques for gathering data are also considered. Readers are also shown how to formulate questions about health and how to decide upon the most appropriate research approaches, with the chapter offering practical examples to support those working on dissertations.
The second part of the book is called Disciplinary Context and introduces the reader to four specific disciplinary areas that all have relevance and influence within the health-studies arena. Hence, this section introduces the reader to the disciplinary context in which health studies itself is located. By understanding this complexity of disciplines underpinning health studies at different levels, readers will be able to conceptualize the importance of a range of factors and influences upon health. Chapter 4 introduces students to the discipline of sociology, demonstrating what sociology as a discipline tells us about health being ultimately socially influenced. Social influences upon health are discussed through consideration of different theoretical perspectives and the social model of health. Chapter 5 focuses upon anthropological perspectives and concentrates upon the importance of culture as an influence upon health. The chapter discusses interesting examples of different cultural practices that affect health from across the world, considering how culture can be both positive and detrimental for health. The next chapter in this section, chapter 6, turns the reader’s focus to the discipline of health psychology and specifically, health behaviour. The chapter concentrates upon what health psychology has to offer in terms of understanding how people behave, the choices that they make and the risks they take with regard to their health. The reader is also given a critical discussion of why behaviour change is so complex. The final chapter in this section is chapter 7, which defines and illuminates the scope of the field of health promotion. The key values and principles of health promotion are illustrated and models of health promotion are both discussed and evaluated to provide a foundation for the final chapter of the book, which considers how to address public-health issues in detail.
The third part of this book considers a range of influences upon health, examining a number of determinants outlined in Dahlgren and Whitehead’s (1991) rainbow model, shown in the figure. This model is thirty years old but is still being referred to here because it is a seminal diagram, widely used to illustrate the importance of the relationship between individuals, the social conditions in which they live and their health outcomes. The model has informed research about health inequalities, determinants of health and their interrelationship since it was developed.
Chapter 8 begins with an exploration of individual characteristics in relation to health, drawing upon Dahlgren and Whitehead’s framework. Individual characteristics considered are developmental factors such as foetal experiences and age, constitutional factors such as genetic inheritance and social constructs such as gender (how concepts of femininity and masculinity influence health). Chapter 9 then examines the importance of social and community networks as determinants of health. Concepts such as social support, social capital and social dominance are evaluated in relation to and how they mediate health status. The features of healthy communities are also explored. Chapter 10 explores the physical environment to show how living and working environments influence and impact upon health. Chapter 11 provides the reader with an overview of social policy and then more specifically demonstrates that many facets of policy combine to influence and determine health in a number of ways. The chapter also discusses and evaluates health policy in depth. Chapter 12 examines health determinants within a global context because the global environment is important in determining some aspects of health. Hence, this chapter examines how being part of a global society affects health in both positive and negative ways, particularly in relation to globalization. The final chapter, chapter 13, synthesizes the perspectives that have been discussed throughout the book. Three detailed case studies are used to explain how understanding determinants of health can aid the development of public-health strategy and action. Critique of the Dahlgren and Whitehead determinants model is also provided to conclude the volume, alongside discussion of more recent models. Despite its seminal nature and widespread use, there have been criticisms of the rainbow model related to what it omits; for example, the importance of the global is not reflected within the imagery. This led to the development of an alternative by Barton and Grant (2006) incorporating the importance of the global ecosystem for human health within the imagery. Solar and Irwin (2010) then provided a diagrammatic framework for action on the social determinants of health, so this is also discussed in the final chapter.
Figure i.1 The Dahlgren and Whitehead determinants of health rainbow
Source: Dahlgren and Whitehead (1991)
Part IUnderstanding and Promoting Health
The first part of this book critically examines a range of issues that address the overall question ‘what is health?’ It is divided into three chapters and, together, these chapters set the scene for the whole book and the general context of the discussion within it. The question ‘what is health?’ is key to any text about health studies and this is why a substantial part of this book is devoted to addressing it.
Chapter 1 specifically explores the question ‘what is health?’ This chapter offers an overview and a critical in-depth discussion about the nature of health, how we define it and how we experience it. This chapter facilitates deeper reflection on a term that is used a lot and often taken for granted. It considers how health is defined and the different things that might influence definitions, as well as how we understand and experience health. The chapter challenges the singular, but widely held assumption that health is the absence of disease and offers a variety of different understandings and explanations as alternatives. It draws on both lay and theoretical perspectives illustrating contrasting and competing ideas and constructing a debate about health that moves beyond received wisdom.
After considering what health is in the first chapter, chapter 2 considers the contemporary threats to health and provides an overview of the main issues and challenges in relation to public health within the twenty-first century across the UK and much further afield. The nature of threats is conceptualized and then changing patterns of health threats are analysed. The chapter outlines the contemporary threats to public health including climate change, population growth and poverty. The chapter examines both communicable and non-communicable diseases and evaluates the threat of these to contemporary societies. The chapter also considers issues such as emerging epidemics and the implications of these for public health. Finally, lifestyle
diseases as a threat to health are discussed critically.
The final chapter in this section, chapter 3, Investigating Health, goes on to discuss how health might be investigated, measured and researched. This chapter gives an overview of the importance of research in relation to health and introduces the research process as a whole. The various methods and processes by which health information is gathered and analysed are presented, illustrating the importance of researching health for health studies. Quantitative and qualitative approaches to researching health are presented and critiqued, highlighting strengths and weaknesses of different data-gathering techniques. The chapter provides a clear outline of the research process for students, who can use this to inform the development of their dissertations at undergraduate level.
1What is Health?
Key learning outcomes
By the end of this chapter you should be able to:
understand and articulate the complexities of health as a concept
reflect on, define and defend your own perspective on health
summarize and critique key debates about the concept of health within the
literature
, drawing on theoretical and lay understandings
Overview
This chapter addresses the key question ‘what is health?’ There are no easy, straightforward answers to this. Trying to define health relies on developing understanding about a wide range of perspectives, subjectivities and experiences that are, in turn, socially, historically, culturally and temporally located. Nevertheless, this chapter will try to uncover some of the inherent complexities in attempting to understand what we mean by ‘health’. To do so, an array of different materials will be drawn upon in order to make sense of what it is we are trying to ‘capture’ (or, in the first instance, ‘define’). It is important for several different reasons to consider how health is conceptualized and understood, including understanding how people experience health and how to promote it. We return to the question of why it is important at the end of this chapter. Before you go any further take some time to do learning task 1.1.
Definitions of health
Health has been called ‘an abstract concept’ that people can find difficult to define (Earle, 2007a: 38). You may appreciate this more fully having completed learning task 1.1. Nonetheless different attempts have been made. One of the most frequently referenced definitions of health is the classic one offered by the World Health Organization. Health is defined as ‘a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity’ (WHO, 1948 cited in WHO, 2006). One of the strengths of this definition is its all-encompassing breadth. It moves away from the notion that being healthy is simply about not being ill. In this sense it has a more positive, holistic view about what health is. Notably it also takes into account different dimensions of health including social and mental health which, although difficult to define (Green et al., 2019), are very important dimensions of health. However, the WHO definition has also been criticized on many counts; for example, as being unattainable, idealistic and utopian (Huber, 2011; Lucas and Lloyd, 2005). According to this definition, is it possible for anyone ever actually to be healthy? In addition there are other dimensions of health that are not considered in this definition such as sexual and emotional (Scriven, 2017). Spiritual health is also neglected; however, this dimension of health is increasingly recognized as being an important factor for health experience (Nunes et al., 2018) and there have been calls for the WHO to revise the definition of health to include spiritual well-being (Chirico, 2016). Despite the criticisms levelled at the WHO’s definition of health it has stood the test of time in many respects, largely because subsequent developments in the WHO agenda have broadened understandings about health. For example, in the Ottawa Charter (WHO, 1986) it was acknowledged that ‘health is created in the context of everyday life and environment, where people live, love, work and play’.
Learning task 1.1
Defining health
Statement:
Health is one of those things that most people assume they understand. But if we just stop and consider it for a moment and try to focus on it, it starts to float about in our minds (Johnson, 2007: 45)
Reflect on your own understanding of what ‘health’ is. Think about the following:
What does the word ‘health’ mean to you?
What does it mean to you, to be ‘healthy’?
Can you come up with a definition that captures what you mean by ‘health’? If you can, try not to focus on this in terms of health as being only the absence of disease (or there being something ‘wrong’).
Write your ideas down and you can refer back them as you read this chapter.
Health can be viewed positively or negatively. Green et al. (2019) refer to this as dichotomous differences in approaches to defining health. On the one hand there are positive approaches to defining health (health as well-being or as an asset) and on the other hand there are more negative definitions of health – those that are illness or disease oriented. When health is viewed in a negative way, definitions will tend to focus on health as absence of disease. When health is viewed in a more positive way definitions tend to be broader and take into account concepts such as ‘well-being’. The World Health Organization definition outlined earlier is an example of a more positive definition and marks a shift in understanding away from a more narrow, medical and negative view of health.
‘Well-being’ is another rather slippery concept and is also difficult to define (Chronin de Chavez et al., 2005). There is a lack of consensus as to what well-being is, although generally theoretical understandings converge around the three major aspects of physical, social and psychological well-being. Like the notion of health, this makes it difficult to investigate, as it means different things to different people. However, drawing on the concept of well-being to understand health is important. Laverack (2004) provided a useful way of thinking further about the concept of well-being. He separates well-being into three different types – physical, social and mental. Physical well-being is concerned with healthy functioning, fitness and performance capacity, social well-being is concerned with issues such as involvement in community and inter-personal relationships as well as employability and mental well-being – which involves a range of factors including self-esteem and the ability to cope and adapt. According to Johnson et al. (2016) well-being also includes having one’s basic psychological needs met, experiencing positive emotions, engaging with others, having meaningful relationships, and achieving things. The concept of well-being varies between disciplinary perspectives; however, it is receiving increasing attention. This is rightly so, since well-being and health are intricately connected and perhaps not easily distinguishable from each other. Well-being is often viewed as being closely associated with mental health (Gu et al., 2015). Health and well-being are both influenced by many different factors and may also mean different things to different people. Surveys about subjective well-being often ask about satisfaction with life, how happy or anxious someone feels and whether or not someone feels their life is worthwhile (World Economic Forum, 2015) whereas surveys about health might focus more on the biological and physical. A further concept that is arguably related to how health may be perceived is quality of life. For example, functional perspectives may assume that increased health automatically results in increased quality of life (Lee and McCormick, 2004).
Definitions of health can also focus on different aspects of health. Some are idealistic, as in the WHO definition offered earlier. Some definitions have a more functional view of health, where it is seen as the ability to be able to ‘do’ things and get on with life. Other definitions centre on the idea of health as a commodity. For example Aggleton (1990) argues that health is something that can be bought (by investment in private health care) or sold (through health food shops), given (by medical intervention) or lost (through disease or injury). The parallels with contemporary consumerism are evident in this type of definition and Bambra et al. (2005) note how, under capitalist systems, health has become increasingly commodified.
Other types of definitions draw on the idea that health is about being able to cope and adapt to different circumstances and achieve personal potential and may be more aligned with ideas from humanism. Drawing on humanist ideas, health might also be considered as self-actualization and many modern concepts of health acknowledge aspects of self-realization and self-fulfilment for the individual as important for subjective health (Svalastog et al., 2017). Such notions link with the idea of empowerment, a concept discussed in more detail later in this book. Health might enable the process of self-actualization or the attainment of health might constitute self-actualization. Either way, research appears to show that this is an important idea that has implications for health and, specifically, health-promoting behaviours (Acton and Malathum, 2008). Seedhouse (2001) described health as the ‘foundations for achievement’. In keeping with the position of this chapter Seedhouse starts from the point of acknowledging that health is a complex and contested concept. Seedhouse views health as the means by which we achieve our potential, both as individuals and as groups. Seedhouse (2001) therefore describes a person’s optimum state of health as being ‘equivalent to the set of conditions that enable a person to work to fulfil her realistic chosen and biological
