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One of the major things that has been seen to influence understanding about the nature of health is culture. Cultural perspectives on health offer many different ways of looking at health and the way that we think about health is influenced by our culture (see chapter 5 for more detailed discussion of the relationship between culture and health). Likewise, different belief systems, for example, about the origin of life, the existence of a ‘higher’ being, and the meaning of life, all influence understandings about health. An example of the way that culture impacts on ideas about health is the promotion, in contemporary Western cultures, of the slender body as equated with health. This results in the promotion of the thin ideal through the discourse of ‘healthy weight’, which equates being slim with being healthy (Burns and Gavey, 2004). This type of discourse suggests that health is achieved by being within certain weight limits (as medically and socially defined). Critics of this position argue that this is more to do with looking healthy (as defined by Westernized body ideals) than being healthy (see Burns and Gavey, 2004 and Aphramor and Gingras, 2008 for example) and yet this is a very pervasive idea in contemporary culture, which is being seen to have wider influence globally (chapter 12 explores global influences upon health).

The personal fitness industry is booming in the UK and many other countries across the world. Does it reflect and shape how people understand what it means to be ‘healthy’?

With regard to mental health, research in Zambia, Aidoo and Harpham (2001) explored the ways in which urban women in low-income groups explained mental ill-health as compared with local health-care practitioners and found that the women tended to speak of ‘problems of the mind’ while the practitioners used terms such as ‘stress’ and ‘depression’. This illustrates two points about the influence of culture on understanding of health. Firstly, that the practitioners were likely to have been influenced by more Westernized ideas about mental health through their training and secondly that the ‘culture’ of the practitioners contrasted with the culture of the non-practitioners in terms of understanding and experiencing mental ill-health. The practitioners used different definitions of ill-health, viewing depression as an indication that something was wrong, while the non-practitioners – the women – only defined physical symptoms as ill-health (note again that the focus here was on negative (or ill-) health rather than positive health). ‘Problems of the mind’ were not necessarily viewed as ill-health (Aidoo and Harpham, 2001). Two final examples relating to culture and understandings of health come from New Zealand and North America. Ma concepts of health comprise four dimensions as follows: Hinengaro (mental health – recognizing the inseparability of mind and body; expressing thoughts and feelings), Wairua (spiritual health – unseen and unspoken energies; faith and spiritual awareness), Whānau (health of the extended family – wider social systems; belonging, sharing and caring), and Tinana (physical health – good physical health) (Rolleston et al., 2016: 61). Bradley et al. (2017) note how concepts of health for Native Americans, Alaska Native and Native Hawaiians, are closely tied to the concepts of community, spirit and the land. The Māori and Native American concepts of health emphasize the importance of social connection, which is proven to be inextricably linked to health experience (Seppala et al., 2013).