Second edition
Copyright © Mildred Blaxter 2010
The right of Mildred Blaxter to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
First edition published in 2004
Second published in 2010 by Polity Press
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ISBN-13: 978-0-7456-4845-3
ISBN-13: 978-0-7456-4846-0(pb)
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This book was originally derived from a series of lectures presented to students in their first year of the Medical School in the University of East Anglia. Thanks are due to Professor Sam Leinster, Inaugural Dean of the Medical School, for his enterprising and generous belief that a sociological view of the concept of ‘health’ was one of the first things that prospective doctors should be introduced to.
I don’t think I know when I am healthy, I only know if I am ill. (Office worker aged twenty-eight, UK, Blaxter 1990)
Health is both your inner and your outer state – the state of your soul – being more optimistic, not giving in to any kind of difficulties, trying to find some kind of compromise … and also, probably, being needed by society too, however old you are. (Nurse aged fifty-two, Moscow, Manning and Tikhonova 2009)
I think that if one day I wake up and I’m seventy, and I’ve lived like that, then I will say that’s good health … in short, it will have been life without incident. (Woman, France, Herzlich 1973)
Health is a state of mind, about knowing what to do and how to do it, how to cope. (Male clerical worker aged fifty-four, UK, Blaxter 2004)
My health is a reflection of my lifestyle – I need to be spiritually, mentally, emotionally and physically whole to be truly healthy. I believe complete wholeness is only attainable through reconciliation with God. (Herbalist, UK, Stainton Rogers 1991)
What is health? That’s a silly question! (Driver aged thirty-nine, UK, Blaxter 1990)
What is health? Many studies have asked ordinary people this question, and their replies, as these brief examples from research in different countries show, range from the thoughtful to the dismissive. Few people think about their health all of the time, but for most it is, at least intermittently, an important topic. How are you? The common greeting may not actually expect an answer in medical terms, but health is one of the most ubiquitous topics of conversation in everyday life. At the same time, health and medicine are major sections of the social organization of any society, and a great deal of resources and manpower go into systems for the promotion of health and the management of disease.
It may seem obvious that we must know what ‘health’ is. However, it is not only something on which individuals can have very different views, but also a concept which has inspired endless theorizing and dispute throughout the centuries.
This volume attempts to summarize where we are now, in the early twenty-first century, in thinking about health. The emphasis is on contemporary ideas and their development during the last century or so. A historical approach is the starting point, and consideration of the latest developments and speculation about how the concept of health is changing is a major focus. The emphasis is upon what is known as ‘Western scientific medicine’, because this is the system to which most developed societies subscribe and which tends to be adopted by most developing societies. This is not, though, to denigrate other, non-Western, systems of belief, or to ignore the way in which ‘alternative’ ideas are incorporated into modern ideas of health.
The central discipline here is medical sociology. But others make contributions – psychology, biological science, clinical medicine, social epidemiology, philosophy, anthropology, history of medicine, policy and politics. This, again, shows how deeply embedded ideas about health are, and how many perspectives may be brought to bear.
The volume is not presented as a textbook of the whole of medical sociology, or a review of all the facts and figures of what is usually called social medicine. Rather than a textbook, it is an introduction to ideas about health, which may provide students of any of these disciplines, and especially those in medicine, nursing, and other health professions, with provocative ways of thinking about its social aspects. It attempts to demonstrate the particular contribution of modern social science to medicine, and, while keeping references to research studies to a minimum, it introduces some of the best writing and all the most important scholars on the subject. Since concepts are not easily reduced to statistics, most of the material is qualitative rather than quantitative. The topic is, as far as possible, health rather than illness, and health rather than health-care systems.
This revised edition not only brings the text up to date, but introduces new material which relates especially to current developments in science and technology which are fundamentally altering our perceptions of the body and redefining health.
Besides its intellectual interest, the book has practical relevance for health systems and those who study or work in the health-care professions. As will become evident, ways of defining health have always influenced the practice of healers and the organization of care, and continue to play a part in determining the social policies of nations. The meaning of health is neither simple nor unchanging.