Health is a broad concept which can embody a huge range of meanings, from the narrowly technical to the all-embracing moral or philosophical. The word ‘health’ is derived from the Old English word for heal (hael) which means ‘whole’, signalling that health concerns the whole person and his or her integrity, soundness or well-being. There are ‘common-sense’ views of health which are passed through generations as part of a common cultural heritage. These are termed ‘lay’ concepts of health, and everyone acquires a knowledge of them through their socialization into society. Different societies or different groups within one society have different views on what constitutes their ‘common sense’ about health.

Health has two common meanings in everyday use, one negative and one positive. The negative definition of health is the absence of disease or illness. This is the meaning of health within the western scientific medical model, which is explored in greater detail later on in this chapter. The positive definition of health is a state of well-being, interpreted by the World Health Organization in its constitution as ‘a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity’ (World Health Organization 1946).

Health is holistic and includes different dimensions, each of which needs to be considered. Holistic health means taking account of the separate influences and interaction of these dimensions. Figure 1.1 shows a diagrammatic representation of the dimensions of health.

Figure 1.1 Dimensions of health.

The inner circle represents individual dimensions of health.

The three outer circles are broader dimensions of health which affect the individual. Societal health refers to the link between health and the way a society is structured. This includes the basic infrastructure necessary for health (for example, shelter, peace, food, income), and the degree of integration or division within society. We shall see in Chapter 2 how the existence of patterned inequalities between groups of people harms health. Environmental health refers to the physical environment in which people live, and the importance of good-quality housing, transport, sanitation and pure water facilities and involves caring for the planet and ensuring its sustainability for the future.

Disease, illness and ill health are often used interchangeably, although they have very different meanings. Disease derives from desaise, meaning uneasiness or discomfort. Nowadays, disease implies an objective state of ill health, which may be verified by accepted canons of proof. In our society, these accepted canons of proof are couched in the language of scientific medicine. For example, microscopic analysis may yield evidence of changes in cell structure, which may in turn lead to a diagnosis of cancer or disease. Disease is the existence of some pathology or abnormality of the body which is capable of detection. Disease can be due to exogenous (outside the body, e.g. viral infection) or endogenous (inside the body, e.g. inadequate thyroid function) factors. Health then is the normal functioning of the body as a biological entity.

Illness is the subjective experience of loss of health. This is couched in terms of symptoms, for example the reporting of aches or pains, or loss of function. One way that illness is given meaning is through the narratives we construct about how we fall sick. The process of making sense of illness is a task most sick people engage in to answer the question ‘why me?’ Illness and disease are not the same, although there is a large degree of coexistence. For example, someone may be diagnosed as having cancer through screening, even when there have been no reported symptoms. That is, a disease may be diagnosed in someone who has not reported any illness. When someone reports symptoms, and further investigations such as blood tests prove a disease process, the two concepts, disease and illness, coincide. In these instances, the term ill health is used. Ill health is therefore an umbrella term used to refer to the experience of disease plus illness. Health then is not being ill, the absence of symptoms.

Social scientists view health and disease as socially constructed entities. Health and disease are not states of objective reality waiting to be uncovered and investigated by scientific medicine. Rather, they are actively produced and negotiated by ordinary people. In Cornwell’s (1984) study of London’s Eastenders, they referred to three categories of health problems:

Illness has often been conceptualized as deviance – as different from the norm and a source of stigma. Goffman (1968) identifies three sources of stigma:

The subjective experience of feeling ill is not always matched by an objective diagnosis of disease. When this happens, doctors and health workers may label such sufferers ‘malingerers’, denying the vali­dity of subjective illness. This can have important consequences, for example a sick certificate may be withheld if a doctor is not convinced that someone’s reported illness is genuine. The acceptance of a behaviour as an illness then becomes an issue of how to manage it. Several conditions, such as chronic fatigue syndrome and repetitive strain injury (RSI), have taken a long time to be recognized as illnesses.

It is also possible to experience no symptoms or signs of disease, but to be labelled sick as a result of examination or screening. Hypertension and precancerous changes to cell structures are two examples where screening may identify a disease even though the person concerned may feel perfectly healthy. Figure 1.2 gives a visual representation of these discrepancies. The central point is that subjective perceptions cannot be overruled, or invalidated, by scientific medicine.

Figure 1.2 The relationship between disease and illness.