Professional Documents
Culture Documents
477-494
Abstract
Introduction
From infancy and childhood, most individuals are subjected to imperatives, first issued by their parents, as to the quantity and types of food
Blackwell Publishers Ltd/Editoriai Board 1995. Published by Blackwell Publisher, 108 Cowley Road,
Oxford OX4 UF. UK and 238 Main Street, Cambridge, MA 02142, USA.
For some time now, orthodox medical and health promotional advice has
insisted that the reduction of dietary fats and cholesterol is vital to the
maintenance and preservation of cardiovascular health, and that the level
of cholesterol in the bloodstream is an important indicator of an individual's propensity to develop coronary heart disease. The accepted wisdom
was that a high blood cholesterol level was an indicator of an increased
risk of heart disease and that individuals with such readings should take
steps to modify their diet or even take drugs to lower their cholesterol
level. Over the past decade, the interest in the relationship between blood
cholesterol levels and heart health has reached such an intensity that the
majority of adults in most westem countries are now highly aware of
cholesterol as a potentially life-threaten ing substance; 'cholesterol awareness programs have reached every comer of the westem world' (Atrens
1994: 433). However, in recent years, there have been published a growing number of research reports and commentaries in medical journals
that have questioned the validity of the link between blood cholesterol
levels and cardiovascular disease (for example, Becker 1987, Strandberg ei
al. 1991, Oliver 1992, HuUey et ai 1992, Atrens 1994). The findings of
several cohort studies have revealed unexpected relationships between low
biood cholesterol levels and an increased risk of dying from non-cardiovascular diseases, and between undergoing drug therapy for high blood
cholesterol and the propensity to die from non-cardiovascular diseases, as
well as a lack of association between high blood cholesterol and cardiovascular deaths in women (Hulley et al. 1992, Marmot 1994). These
findings have prompted some critics to argue that mass screening and
treatment of blood cholesterol is not advisable, and indeed may even be
ethically suspect, and should be limited to the minority of people deemed
to be at very 'high risk' from coronary heart disease for factors other
than their cholesterol level (HuUey et al. 1992, Oliver 1992, Davey Smith
and Egger 1994, Atrens 1994).
It was some time before the debate around the value of cholesterol
Blackwei! Publishers Ltd/Editorial Board 1995
The focus group discussions began with general questions on the relationship between health and lifestyle. Questions then focused more
specifically on media coverage of health and diet. Each member of the
group was given to read copies of three recent newspaper clippings on
diet, cholesterol and heart disease which gave contradictory advice about
whether diet and cholesterol control was beneficial or negative for heart
health. Participants were asked what they made of such news coverage
and how they knew what was the 'right' thing to do {ie. what sorts of
food one should be eating or not eating in the interests of health). Lastly
they were asked who they thought they could 'trust' to get the 'right'
advice about what to do to keep healthy.
e Blackweil Publishers Ltd/Editorial Board 1995
Have all your vegies and all that kind of thing' (woman, group 4).
It was cmnmonly stated that good health was an achievement, something that had to be worked at, something you 'do' rather than possess
naturally: 'it is hard work. You have to devote yourself to it' (man,
group 3). Keeping healthy may be a matter of luck, but it is also about
constant vigilance. As such, it was difficult to establish and maintain
good health. It is a matter of discipline, for it involves giving up things
like spare time or enjoyed foods. As one man in group 3 noted, health
and fitness activities are 'not natural'; they involve a 'conscious decision
to become healthy'. It is difficult to maintain a routine, given all the
other demands of life {cf Crawford 1984: 67-8, Saltonstall 1993: U). It is
also harder when one gets older: 'I mean, anyone can be fit at 20 but in
your 40s you have to work at it' (man, group 5).
When discussing causes of good and Ul health, a moralistic discourse
was evident in some participants' responses, referring to the notions that
'we are what we eat', that we are each personally responsible for our
state of health. For example, one woman (group 2) recounted the story of
a friend of hers who had cancer of the colon due to her 'really, reaily
bad' dietary habits and who, despite her illness, 'is still doing the wrong
things to her body'. A woman in group 8 commented that some people
are unhealthy because 'they abuse their health, they don't look after
themselves', while another in that group followed up her remark by noting that others 'care more about their bodies and what they're doing to it
and what they put into it'. In illustrating this point, one woman in group
2 used the mechanical metaphor of the body to describe how health
states are produced and maintained:
My father always used to use the example that if you had a car and
you put bad petrol and bad oil into it, it would not go. So it is the
same with our bodies - if we put the wrong food and we drink the
wrong things, then our bodies are going to stop too.
Building on the mechanical metaphor, several participants described
good health as possessing enough energy to get through the day and to
carry out one's everyday functions and responsibilities. Health was thus
represented as a resource for living {cf. Watson 1993). A further interpretive repertoire represented good health as being related to a certain state of
mind, involving maintaining a level of motivation to continue to 'work' at
securing good health and having a 'positive attitude' about life. It was
noted by several participants that feeling depressed and lethargic was
strongly related to feeling physically unwell and to eating the 'wrong' foods,
and vice versa; for example, a woman (group 8) commented, 'basically if
I'm not happy I tend to eat and I'll eat the wrong thing. But if I'm feeling
good I eat the right things'. This repertoire echoes Calnan and Johnson's
(1985: 60) findings in their study of women living in London, in which the
respondents expressed the belief that one must be happy to be healthy.
^3 Blackwell Publishers Ltd/Editoria! Board 1995
Most participants said they had first heard about cholesterol in the
media, typically locating the first such 'appearance' of cholesterol in the
early 1980s. Older people were more likely to have had a cholesterol test
and to know their 'score'. For example, one woman (group 6) could
recount the readings of several tests she had had over the years:
I had one done in 1988 - oh, no it was 1987, or about 1987-1988. It
was about 6.5. Then I had another one done in about 1990 and it had
come down to about 5.8. Then the last one I had done was measured
at 5.6.
Those participants who had decided to have the test said that they did
so because it was a topical issue - 'flavour of the month', as one woman
(group 5) described it - because it was being offered free and they had
just decided to do it (for example, when giving blood), or because their
doctor had suggested it. There was evidence in some participants'
accounts of a desire to fulfil a curiosity about one's 'score' just for the
sake of knowing it, not necessarily because of a concern about one's
health. For example, one woman (group 8) had persoiaded her 77 year
old mother to have a cholesterol test for the first time, simply because she
had decided that 'it was time' her mother *had one done'. Other participants said that they had a family predisposition for heart disease and
high blood cholesterol readings and so were advised to have a cholesterol
test so that they could monitor their levels and engage in preventive
action such as controlling their diet.
Blackweil Publishers Ltd/Editorial Board 1995
Acknowledgments
This study was funded by a National Heart Foundation grant for 1993.
Notes
I The clippings used in the study were provided from the files of the Australian
National Heart Foundation, which employs a commercial clippings service to
collect all national news items relating to heart health.
References
Atrens, D.M. (1994) The questionable wisdom of a low-fat diet and cholesterol
reduction. Social Science and Medicine, 39, 435-47.
Backett, K. (1992) Taboos and excesses: lay health moralities in middle class families. Sociology of Health and Illness, 14, 255-74.
Backett, K., Davison, C. and Mullen, K. (1994) Lay evaluation of health and
healthy lifestyles: evidence from three studies, British Joumal of General
Practice, 44, 277-80.
O BlackweU Pubtishen Ltd/Editorial Board I99S
494