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What is Health?

Chapter aims

• To consider health as complex and contested
• To examine different definitions of health, including the World Health Organization's classic definition
• To explore health as socially constructed
• To highlight the importance of lay perspectives and lived experiences of health

Introduction

This chapter considers the question 'what is health?' as a broad introduction the rest of the book. It provides the foundation for the subsequent discussions in the following chapters and sets the context for discovering the nature of health. The chapter starts by outlining why it is necessary to think about health in detail and to consider what health is, acknowledging from the outset that ideas about it are complex and contested. Different definitions and concepts of health from the wider literature are introduced and discussed, including the 'classic' definition offered by the World Health Organization. The chapter introduces different philosophies of health and ideas of what it means to be 'healthy', drawing attention to the complicated and debated nature of health and differing lived experiences. More critical debates about health are also introduced, such as health conceived as a social construct and as a moral phenomenon. Finally, the importance of lay perspectives on health will be considered, as a basis for this being a key theme throughout the book.

The importance of health

Why is health important? Perhaps you could take a few minutes to think about this. Is health important to you? If so, why? Most people, when asked what is important to them or what they value most, will mention health at some point. For some people health is the most important thing, viewed as an integral or essential part of life. After all, being healthy generally means experiencing life in a more meaningful, enjoyable way as well as enabling us to do what we desire. Health, however, is a nebulous concept, and what it means to one person is likely to be different to what it means to another (Tapper, 2021).

Health: complex and contested

The notion of health, then, is highly complex, and there are many ways in which it can be defined, understood and experienced (Cross, 2020). Although the word 'health' is frequently used, its meaning is often taken for granted or there is assumed to be a shared understanding about what it is. However, if you ask any number of people what health means to them you are likely to get different answers, although there may be some common themes in the responses. What we understand health to be is influenced by many factors, including where we live, our age, our gender, our health experience and status, the era in which we were born and so on.

One of the simplest ways of thinking about health is a dichotomous one - health can be viewed either positively or negatively (Green et al., 2019). Positive ideas about health tend to emphasize aspects such as well-being, happiness and holism. Such ideas encompass very broad perspectives on health and what it means to be healthy, taking into account the many dimensions of health (see the further discussion of this in Chapter 2). On the other hand, negative definitions of health tend to focus on not being ill, and the absence of disease or disability. Negative definitions therefore tend to be narrower, more focused on our physiology (the physical body), and rooted in the (bio)medical model of health that promotes scientific understandings about what health is. However, these definitions tend to overlook subjective perspectives on health: people's everyday experiences, understandings and realities of health (Cross et al., 2017). So, health can also be viewed as socially constructed. We will consider this in more detail later in this chapter.

Health may also be seen as a value, as a right or as a responsibility. Mahatma Gandhi highlighted health as a value when he said in 1948: 'It is health that is real wealth and not pieces of gold and silver' (cited in Oleribe et al., 2018: npn), emphasizing the importance of health compared to being rich. Many people will put a high value on health when asked about the things that are important to them; however, health may not always be a priority, depending on the circumstances of a person's life. The pursuit of health for its own sake will often come second to other more pressing concerns.

There is ongoing debate about health as a right and health as a responsibility. Many would argue that everyone has a right to health and, indeed, this is enshrined in the Universal Declaration of Human Rights (1948), which states in Article 25 that 'everyone has a right to a standard of living adequate for the health and well-being of [themselves and their family], including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond [their] control'. Already we can see how this right to health encompasses many aspects of life. The right to health was recognized again in the 1966 International Covenant on Economic, Social and Cultural Rights (WHO, 2008), and health has more recently been highlighted in Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages.

Nampewo et al. (2022) contend that the right to health is one of the cornerstones for enhancing and improving overall well-being and human development, and that there are many different stakeholders who have a significant role to play in this, including individuals, states, corporations and institutions, as well as the international community. Nampewo et al. argue that everyone has a duty to play their part and that this implies a responsibility too. Health as a right is reflected in the Constitution of the World Health Organization, which states that 'the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being' (cited in WHO, 2008: 5), 'without distinction of race, religion, political belief, economic or social condition' (WHO, 2023: npn). As we have just seen, the right to health is also reinforced in Article 25 of the Universal Declaration of Human Rights in relation to the right to an adequate standard of living. Many of the other articles in that declaration are also directly or indirectly related to the right to health. Most people acknowledge that, for anyone to achieve health, basic human needs have to be met first, such as shelter, food and basic sanitation (Capone et al., 2018).

Health can also be understood in terms of consumption and as something that can be bought through either goods or services (Aggleton, 1990). The framing of health as a market or consumer need that requires services and products (pharmacological, technical, financial, etc.) is compelled by the (bio)medical model (see Chapter 3 for more detail). More recently, ideas about health have been influenced by social media, where there is a daily proliferation of posts about healthy eating and physical activity that emphasize the idea of health as a project, as something to be improved or acquired (Baker and Rojek, 2019). Such ideas also promote notions of health as consumption.

What 'being healthy' looks like might vary from person to person, too. Humanist perspectives on health emphasize our ability to adapt, cope and achieve our maximum potential whatever that might be, recognizing that not everyone can achieve the same end results (Morilla and del Palacio, 2016). Such perspectives link health directly to ideas about self-actualization, self-realization and self-fulfilment (Svalastog et al., 2017), another area where social media can play a key role.

Professional and lay understandings of health may differ or have similarities; however, there is good evidence to suggest that lay understandings of health are often complex and sophisticated (Cross, 2020). This is despite the fact that, as Green et al. (2019) argue, lay perspectives are often undervalued and seen to be illogical, unsound and inconsequential compared to so-called expert opinion. The complexities and sophistication of lay perspectives on health will become apparent when we return to them later in this chapter and throughout the book.

Definitions of health

As Angela Scriven (2017) argues, it is very hard to define health. In fact, finding a universally agreed definition would be impossible. Nevertheless, there are several different ways of defining health that can aid our understanding of what it is, and of how people experience and make sense of it. Definitions of health vary considerably dependent on a range of factors. Some definitions construe health as being an objective reality that can be assessed and measured (usually by establishing the absence of disease, illness, distress or injury). Such understandings are grounded in positivist ways of viewing the world which imply that there is an absolute truth that is discoverable. Definitions of health that centre on the absence of disease or illness reflect this type of worldview.

In contrast, other definitions consider the fact that health is a subjective experience and that understandings about what health is are not just rooted in our physical being but extend far beyond this. In this sense health is understood as being socially constructed, as socially, historically, culturally and temporally located (Warwick-Booth et al., 2021). We...