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.