'Health for me': a sociocultural analysis of healthism in the middle classes
'Health for me': a sociocultural analysis of healthism in the middle classes
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DOI：
10.1093/bmb/ldh013
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发表时间：
2004-01-01
影响因子：
6.7
通讯作者：
Wessely, S
中科院分区：
文献类型：
--
作者：
Greenhalgh, T;Wessely, S
在本文中，我们解决了许多卫生专业人士认为的一个常见的、日益难以控制且个人压力很大的问题：善于表达、具有健康意识和信息丰富的中产阶级的信念、行为和期望。我们描述了一些虚构的案例场景，这些场景反映了我们作为全科医生（Greenhalgh）和精神科医生（Wessely）在临床情况中遇到的现实问题。这些场景是使用一种称为“批判小说”的技术构建的，其中真实案例的主题被系统地提取并虚构成新的故事1。它们故意带有一定的刻板印象，我们承认任何个人的看法和选择不会仅仅（甚至主要）由本章探讨的各种社会文化现象决定。然而，这些案例足以说明我们对“健康为我”现象的起源和本质的分析。健康主义与消费主义有关，但不应等同于消费主义，这是一个更广泛的术语，根据具体情况有许多不同的含义（并且可以说根本不适合医疗保健2）。加布里埃尔和朗讨论了消费者的不同面孔——作为选择者、作为沟通者、作为探索者、作为身份寻求者、作为享乐主义者或艺术家、作为受害者、作为反叛者、作为活动家和作为公民3。他们讨论了“消费主义”一词的五个广泛含义：权力和幸福的工具；炫耀性消费的意识形态；全球发展的经济意识形态；政治意识形态；以及保护消费者权利的社会运动。最后一个含义最接近消费主义在医疗保健中的积极内涵，例如以患者为中心的医疗、共同决策和伙伴关系2,4,5。但“炫耀性消费”的更负面概念可能是最符合健康主义作为个人行为模式和潜在公共卫生问题的含义。
In this paper, we address what many health professionals see as a common, increasingly uncontainable and personally stressful problem: the beliefs, behaviour and expectations of the articulate, health-aware and information-rich middle-classes. We describe some fictitious case scenarios, which reflect real-life problems that we have encountered in clinical situations as a general practitioner (Greenhalgh) and psychiatrist (Wessely). The scenarios were constructed using a technique called ‘critical fiction’, in which themes from real cases are systematically extracted and fictionalized into new stories1. They are deliberately somewhat stereotypical, and we acknowledge that the perceptions and choices of any individual will not be determined solely (or even predominantly) by the various socio-cultural phenomena explored in this chapter. Nevertheless, these cases serve to illustrate our analysis of the origins and nature of the ‘health for me’phenomenon. Healthism is related to, but should not be equated with, consumerism, which is a broader term with a host of different meanings, depending on context (and, arguably, not appropriate to health care at all2). Gabriel and Lang discuss the different faces of the consumer—as chooser, as communicator, as explorer, as identity-seeker, as hedonist or artist, as victim, as rebel, as activist and as citizen3. They discuss five broad meanings of the term ‘consumerism’: a vehicle for power and happiness; the ideology of conspicuous consumption; an economic ideology for global development; a political ideology; and a social movementg to protect the rights of consumers. This last meaning comes closest to the positive connotations of consumerism as applied in health care, for example, to patient-centred medicine, shared decisionmaking and partnerships2, 4, 5. But the more negative notion of ‘conspicuous consumption’is probably the meaning that aligns best with healthism as an individual behaviour pattern and a potential public health problem.