What Is Health?

Health is a term used throughout this research to convey, understand, and represent human physical and mental well-being, capabilities, and capacities. As theoretically framed by the critical review of the literature, this thesis offers a variety of multifaceted conceptualizations of health. The intangible definition of good health can be ascribed to different states of being, which means that health has become ascribed to and is maintained by individual education and prevention, self-regulation, self-surveillance, and self-tracking.¹ Therefore, health is not used interchangeably in opposition to poor physical or mental health. Rather, health is theoretically framed and interpreted by the participants to demonstrate and encompass many aspects of their lifestyles and relationship with their bodies, behaviors, and sense of personal identity.

Ideologically, we no longer simply view good health as an opposite to ill health. Conceptualizations of the digital self are now identifiable by signs of consumption, reflexive participation, and sharing through digital technologies.

Through neoliberal political and socioeconomic discourses, individuals are told how to be healthy through consumption habits. These practices of consumption can be identified not only as what we put in our physical bodies (e.g., food or drink intake), but also the platforms and devices we use in the management of our health, as well as what we share online through self-representational tools on social media. A collapse has therefore occurred between the physical and metaphorical consumer, achieved through embedding consumption practices within a moral discourse. Social media are key platforms and social venues to represent such healthy lifestyles through self and peer surveillance of health-related content. By drawing on participant responses, this research illustrates how health has increasingly become representative of and entwined with constructions of the self and lifestyle practices, analyzing how individual participants identify and understand health.

One of the first interview questions asked was: What does the word health mean to you?

Although the participants were recruited based on sharing health-related content on Facebook and Instagram, most were confused by this question and struggled to identify what the significance of health was for them. This highlighted the many conceptualizations, wide ambiguity, and understandings of what health meant to these individuals, even though their lifestyles centered around attempts to maintain good health. Most participants considered health to be an overly abstract term and concept. As Sophie explained in her final interview:

It’s hard to quantify what healthy means because there’s so many contexts it can apply to. (Sophie, Final Interview, 31, F)

Here, Sophie demonstrates many of the participants’ internal struggles with the term health and what it means to them, and the many contexts in which health or ill health can be applied.

It means everything, it’s my life, … but it has made me realise, before I was a bit like you can just be happy, you don’t have to be sad, just choose to be happy, but what I’ve realised now sometimes that’s not something you can just choose to do. You’ve got to enjoy the journey and learn from it. (Annie, First Interview, 28, F)

Most participants perceived health in a holistic way. This can be aligned with Crawford’s theory of “healthism”;² the representation of good health as a priority in which health promotion expects individuals to adopt health as a priority and to change their lifestyles accordingly.

Most also acknowledged that being both physically and mentally healthy was something that felt automatic when they were young or younger. Considering that the participants’ ages ranged from twenty-six to forty-nine years, none of them would be considered old. Yet, they all acknowledged that good health was something that needed to be achieved, worked on, optimized, or improved as a transformative result of self-knowledge, personal discipline, and hard work. Compared to when they were young(er) and good health was automatically understood as a given, with age (similarly ambiguously interpreted) came an internal locus of control to influence and hold power over and manage individual health outcomes.³ Through these relatively long-term health self-tracking practices, users are drawn into a continual cycle of health analysis, reflection, and action.

Lara for example, identified with being fit, active and healthy when young but recognized with age that this was harder to maintain. She referred to this as “letting herself go,” a very derogatory yet common discourse that sees weight gain as something that comes with age:

I think, I’ve always been quite health conscious, I used to teach Jazzercise [an aerobics class], I was always fit, maybe I’ve just let myself go, because in my head I was still fit because that was part of my identity. Now I don’t feel like I am as fit, and it dawned on me when I couldn’t do certain things [exercises], and when I wasn’t “looking” as I had done [before], then I wanted to cover up parts [of my body] on the beach or whatever. I went for a run then the other day and I was like – it’s hard, it’s the realisation that you’re not part of that identity, that you are getting older or you need to go out and do stuff to maintain that. (Lara, First Interview, 28, F)

Health was also equated to being “fit” and, more importantly, not being “fat.”⁴ Participants perceived health often in terms of polarizing frames, such as success (being healthy) or failure (being unhealthy or having illness), which were attributed to a personal belief in their own success or failure to manage their health. With age, good health was not automatic and was recognized as requiring a lot of effort, which would be perceived by participants as personal success. Furthermore, in opposition, automatically assumed health when young(er) was perceived by the participants as something out of their control: when you are young, you are heathy. If you are unwell this would be down to bad luck, demonstrating an external locus of control.⁵ This reflects the public health discourses of the 1970s and 1980s, which advocated “rights to health,” but in the context of an individual moral obligation to preserve one’s own health as public duty, free from the state or institutional support.⁶ For Roy, health and fitness are about making decisions, and making him a “better person,” who is proactive and productive:

Right now, for me, health and fitness are decisions. The whole “I’m moving” [physically] and this is making me a better person … but it’s not like ok I’m doing this to lower my blood pressure or not die. It’s something I do, and then what I do in that context that matters. (Roy, First Interview, 26, M)

For Roy, exercise was not about tackling the impact of aging on his body. Rather, similar to Lara’s view, health was about decisions he made to optimize himself as a person and subject, reflecting Neff and Nafus’s argument that: “The promise of individuals ‘taking control’ may very well be disguised as empowerment.”⁷ Such feelings of empowerment that the participants put forward to control health through self-management were bound up with internal contentions related to how to maintain balance.

The balance between maintaining and improving personal health whilst not being overwhelmed by self-policing and regulating practices, particularly in regard to consumption (such as food and drink intake), became a continual and contentious process for participants within individual conceptions and interpretations of health.

You know what I think healthy is? Having a healthy relationship with food, that’s a good way to look at it … everything in balance, everything in moderation. Don’t give yourself a hard time, try and eat good most of the time, if you fancy a treat have a treat … Not getting obsessive. (Sophie, Final Interview, 31, F)

Overwhelming self-policing practices, which affected mental health, for Sophie and others, were understood as obsessive behaviors. Sophie discussed how she determined when her behavior became obsessive:

Obsessive for me is when there is a constant thought about something I should be doing or shouldn’t be doing, I’ve got quite an obsessive personality, and that’s been with a lot of things in life. (Sophie, First Interview, 31, F)

These behaviors were described by participants as often the motivating factor for self-improvement and continual self-optimization, but which frequently fed into and spilt over into many aspects of their lives and lifestyles, not just health and fitness behaviors. This identification and regulation of obsession is a result of internal self-surveillance and preoccupation with the body “being presented [within postfeminist media culture as] simultaneously as a women’s source of power and as always already unruly and requiring constant monitoring.”⁸ Though Gill refers to women here, many of the participants both male and female acknowledged and referred to “transformations of the body” as being part of a health “journey” to discipline the disorderly body through health and lifestyle transformations.⁹ Whether this was because they were going through bouts of ill health or serious disease, or simply engaging and reflecting on their often-changing health practices over time, this process was always considered a personal discovery, described in a narrative format.

This was particularly pertinent for those working towards specific goals like marathon training or weight loss, and those dealing with illness and disease. Amy, for example was diagnosed with cancer two months before beginning the reflexive diary. She was publicly diarizing what she called her health “journey” through Facebook status updates, and reflecting on this process during the research period:

In the past week, though I still very much believe I need to maintain a healthy diet whilst I have cancer, I have learnt not to compromise my mental state to do this, and still enjoy food I love when I feel like it, just mindfully. This gave new confidence in my family and friends, seeing I wasn’t only choosing certain lifestyle choices out of fear, but listening to my body and giving some leeway. I felt much more settled with this approach and felt everyone was on my side and not wanting something different from me. I would never have changed my lifestyle habits because of what they were all saying – I am independent in this journey and have taken full responsibility for researching all there is to know and making my own choices – but it did help to be on the same page as my loved ones when I started to relax my regime. (Amy, Diary Entry, 27, F)

Amy recognized that her interpretation of what health meant was constantly evolving in line with her own decision-making and internal contentions of what she was (not) allowed to do and eat. This demonstrates Ziebland and Wyke’s assertion that “the social construction of an illness is contoured as well as challenged by people with the illness.”¹⁰ This diary entry was contextualized in her final interview, where she stated that when she was diagnosed with cancer she felt a strong drive to eat only healthy nutritious foods and avoid certain treats, through strict self-discipline. To maintain and improve her physical health through food intake, she additionally felt that by eating well, and avoiding treat foods, she could potentially mitigate any negative health effects and prevent further deterioration of her physical health, which could lead to “making the cancer worse.” Surveying and monitoring then, were used as methods to prevent future ill health or disease from materializing. As Swan asserts: “The individual has become the central focal point in health, which is now seen as a systemic complexity of wellness and prevention, as opposed to an isolated condition or pathology.”¹¹ Managing susceptibility, or managing disease in Amy’s case, refers to a biological marker, as well as enabling considerations of future ill health or the continuation of a disease. Therefore, enacting healthy decisions in the present brings the potentially pathological future into the current day, by taking action to reduce the likelihood of ill health in the future.¹²

For Amy, eating well contributed to her mental health. She felt she was prioritizing nutrition over enjoyment of other pleasurable “cheat” foods to enact self-responsibilizing practices of self-care, which she embodied as healthy and productive. Amy felt that this self-surveillance and self-regulation enabled her best attempt to manage food and nutritional intake and to fight the cancer, thus giving her the best chance of recovery.

Disease, and especially cancer, was often interpreted by the participants, through a discourse of a battle to be won and overcome.¹³ Over time though, as expressed in the diary entry above, the pressured self-policing of food helped to maintain and enable good health during chemotherapy treatment, Amy identified with a perspective of fear, which she perceived as negatively contributing to her mental health. She said that her loved ones supported this view to relax her regime of overregulation and disciplinary practices with regard to her consumption practices, as they were causing her stress and anxiety. In turn, this was viewed as having a negative effect on her mental and physical health. In this entry, she stressed personal independence, taking responsibility to accrue knowledge of how she can maintain and improve her health whilst undergoing chemotherapy treatment, and simultaneously resisting any urges to let her lifestyle be dictated by the disease, treatment, personal health management, and self-care.