by The Open University
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Popay et al. (1998) are also concerned that lay knowledge be taken seriously to help us understand the causes of variations in health status found in different social groupings. It has been suggested that we need a ‘lay epidemiology? which would study the experiences of individuals and their biographies within specific social situations. They argue that people express their views on health in narrative form which is, as they say, ‘antithetical to traditional models of cause and effect, such as those given prominence within the inequalities research literature? (Popay et al., 1998, p. 640).
The story-making quality of lay knowledge and the importance of creating narratives which explain health and illness has been a particular feature of much of the work on lay accounts. Stainton-Rogers (1993) suggests that people draw on a rich repertoire of explanations as they weave their stories about health. These explanations are, as she says:
texts, available to us in our culture, out of which we are able to ‘make sense? of health and illness ... different ‘texts? that a person could, at different moments and in different circumstances, pull off the shelf, digest, use where they are helpful to push the story along, thrust back when they seem irrelevant or look nonsensical ? ‘texts? one would cite, use, manipulate, reject, as different needs arise.
(Stainton-Rogers, 1993, pp. 41?2)
In an article called ‘Why study narrative?? Greenhalgh and Hurwitz (1999) suggest that ‘the lost tradition of narrative should be revived in the teaching and practice of medicine? (p. 48). They suggest that this would aid diagnosis, help in the therapeutic process and further education and research. They give the following reasons:
In the diagnostic encounter, narratives:
encourage empathy and promote understanding between clinician and patient
allow for the construction of meaning
may supply useful analytic clues and categories.
In the therapeutic process, narratives:
encourage a holistic approach to management
are intrinsically therapeutic or palliative
may suggest or precipitate additional therapeutic options.
In the education of patients and health professionals, narratives:
are often memorable
are grounded in experience
encourage reflection.
In research, narratives:
help to set a patient-centred agenda
may challenge received wisdom
may generate new hypotheses.
(Adapted from Greenhalgh and Hurwitz, 1999, p. 48)
Lay and expert knowledge should not be seen in oppositional terms. Neither should the pendulum swing too far in undervaluing expert knowledge. People knowledge is not invariably superior but it does provide another and equally valid perspective.
The picture of health built up from the many visions presented here is very broad and ranges from the more medical perspective of health as the absence of disease to the very positive view as wellbeing and feeling good. Indeed the World Health Organisation's definition is, some would say, impossibly broad with health being ‘a state of complete physical, social and mental wellbeing? (WHO, 1984).
The next two sections deal with the opposite ends of the health spectrum: quality of life at the positive end and illness and disease at the negative end.
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