Ideologies of health : towards a social psychology of health inequalities
This thesis works towards a social psychology of health inequalities in order to further
understanding of the relations between structure and agency (re )producing these
inequities. It does so by exploring the ideological construction of health and identities
associated with the axes of inequality. Employing a material-discursive
methodological standpoint to link work on inequality with that of 'lay health beliefs',
it is argued that discourse is the semiotic moment of practices (re )producing health
inequalities. Critical discourse analysis thereby provides a means to examine the
ideological construction of health and identities associated with health inequalities.
The interview and focus group methods used to generate text in interaction with a
small, diverse sample of participants living in Bristol are described, paying particular
attention to the reflexive issues embedded within the research process.
F our competing ideologies within which health and illness were constructed as
discursive objects are described: minimalism, associated with health as the absence of
illness and medical ideology; psychological constructions of health as wellness or
happiness relating to psychological ideology; lifestyle constructions of life ethics
pertaining to health promotional ideology; and holism, the interdependency of mind,
body and spirit, tied to alternative health ideology. The four interwoven health
identities arising from these ideologies of health and respecting the key axes of
inequalities in health, namely social class, gender, ethnicity and place, are considered.
Resistance to class as prejudice is explored, alongside an examination the politics of
class identity and a reading of working class and middle class health identities.
Hegemonic gender identities of women as carers and men as uncaring, active agents
are then examined. Ethnicity as health identity emerges as a site of solidarity and
fragmentation closely linked to place via the concept of community. Finally,
constructions of pollution, space and community provide a structural and spacial
grounding to health identities associated with place.
In conclusion, the usefulness of this social psychological analysis is evaluated in
consideration of individualisation in ideologies of health, interpreted as 'internalised
oppression', 'methodological product' and 'an assertion of agency' in the context of
recent debate about identity in late modem society. In sum, the thesis both examines the social structuring of subjects and foregrounds the ethical and political dimensions
of the ideologies of health within which inequalities research must recognise its'