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 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).