Introduction

Increasing attention to ‘positive’ health within public health can be seen in the way the term ‘health’ in policy documentation and discourse has more frequently become ‘health and well-being’ (Lazenbatt et al, 2000; DH, 2001, 2003; HDA, 2002, 2004). This emphasis on positive health (rather than a focus solely on negative, ill health) seems to chime with other changes and shifts, in particular the opening up of the traditional territory of public health to now be the proper concern and responsibility of all agencies and individuals (see, for example, DH, 2002), and widespread acceptance that health generally is now set free from an outdated dominant medical model (Acheson, 1998).

At first sight, this appears to be both a welcome development (there seems to be a ring of progress about it) and quite straightforward. After all, being healthy is something that is more readily agreed about and more widely understood than ill health. And the changes should lead to ‘better’ measurement of community health generally. Also this may be a timely shift given the search for measures that now focus on ‘upstream’ influences and indicators on health, rather than downstream ‘medical’ ones, and current priorities that include the reduction of health inequalities (see, for example, DH, 2001, 2003; HDA, 2001; Wanless, 2004).

We suggest, however, that while this new emphasis on positive health might indeed be welcome, much of the ground on which this and accompanying ideas are founded, is rather more crumbly and precarious than is typically assumed. Underlying definitions around positive health are typically unclear, unaddressed or value-laden. Associated assumptions that these changes lead to ‘better’ indicators of health may prove less robust under closer scrutiny.

This chapter offers some contributions to these issues. First, we reflect briefly on some current thinking and challenges around concepts of health (positive and negative) within sociology and social research. Second, we consider the notion of ‘well-being’ within public health discourse and its link with positive health. Through reviewing ‘well-being’ in wider social discourse, we offer a critical view of its current application in public health. Third, we draw on findings from our recent research (HealthCounts), a two-year project, funded by the Department of Health under its health inequalities programme, which set out to find common ground between community groups and professionals about better ways to measure health.