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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:

1 What does the word ‘health’ mean to you?

2 What does it mean to you, to be ‘healthy’?

3 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 potentials’. This perspective also broadens understandings of health beyond the absence of disease or ‘abnormality’ as understood using a medical model (this will be discussed in more detail later in the chapter). Someone may be, for example, encountering disease or be disabled and still lay claim to health, thus challenging assumptions of a ‘normality’ of health. As Blaxter (1990: 35) argued, ‘health is not, in the minds of most people, a unitary concept. It is multi-dimensional, and it is quite possible to have “good” health in one respect, but “bad” in another’.

In what ways can health be considered a purchasable commodity? How does health differ from other products that can be bought, sold and invested in?

Health can also be conceived of in a number of other ways. Health may be regarded as a value (Downie and Macnaughton, 2001) and, while most people would argue that ‘good’ health is of value too, the degree to which people will strive for, or prioritize, health will, of course, vary according to individual circumstances. Health is also viewed both as a right and as a responsibility. The Constitution of the World Health Organization of 1946 first held up health as a human right in the statement ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being’ (cited in WHO, 2008a: 5). Article 25 of the Universal Declaration of Human Rights of 1948 references health in relation to the right to an adequate standard of living and many of the other articles are indirectly related to the ‘right to health’. Many people point to the requirement to meet basic human needs in order to achieve health, such as adequate sanitation and resources for life like shelter and food (Capone et al., 2018). ‘The right to health was again recognized as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights’ (WHO, 2008a: 5). Viewing health as a ‘right’ can create tension, because with this comes a sense of responsibility for health that in turn generates debate as to who has responsibility for health – the individual or the state? These issues are discussed in more detail later in this book.