'Health for me': a sociocultural analysis of healthism in the middle classes

What is healthism?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 stories 1 .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 all 2 ).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 citizen 3 .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 partnerships 2,4,5 .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.